Department of Food and Nutrition, School of Home Science, Babasaheb Bhimrao Ambedkar University, Lucknow, (UP), 226025, India
This study's goal was to examine the existing research in this field and present a high-level synthesis of it. In the context of today's fast-paced lifestyle, Emphasizing the significance of eating habits is crucial for improving mental and general wellness. Once thought to be uncommon, eating disorders (EDs) are now widespread worldwide. Eating disorders are prevalent but underdiagnosed illnesses that affect both physical, Mental and psychosocial functioning. They are serious psychiatric disorders that frequently have a chronic course and high mortality rates. It substantially lowers quality of life and has a high comorbidity rate with many mental health conditions. Eating disorder sufferers are more likely to have mental health issues such as depression, anxiety, attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD), substance-related and addictive disorders (SRADs), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). The presence of multiple eating disorders is associated with higher incidence of mental illness. To understand how potential comorbidities of Eating disorders work and how they affect health, more research is required. The prevalence and correlates of binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN) are examined in this study, along with their relationships to other mental health problems, role-function impairment, and individual help-seeking behaviors.
Among the eating disorders (ED) associated with increased rates of physical and psychological morbidity, impairments, and death are binge eating disorders, bulimia nervosa, and anorexia nervosa. The lifetime prevalence of eating disorders is rising; it ranges from 0.8 to 6.5% for men and from 3.3 to 18.6% for women [1]. Among young people, obesity and ED ranking the third most prevalent chronic illnesses. Eating disordered behavior, which does not match all diagnostic criteria, is far more prevalent. Approximately 15% of boys and one-third of girls in our previous study (the BELLA study, Germany) reported disordered eating practices and attitudes. About 20% of the girls were dieting at the time of the examination, while roughly half of the girls and one-third of the boys in the German "Health Behavior in School-aged Children" (HBSC) study sampled ages 11 to 15 complained of being too overweight [2]. All ED diagnoses at all times were associated with depressive symptoms and a poor mental health quality of life. Important traits that have been found to predict persistent disordered eating include body dissatisfaction, weight anxieties, weight importance, unhealthy weight management practices including dieting, and depressed symptoms. Probands that are extremely underweight (below the third percentile) most likely reflect individuals who exhibit symptoms similar to anorexia nervosa. Retrospective investigations have shown that people with anorexia nervosa frequently experience childhood depression. Eating disorders (EDs) are becoming more common, and more and more afflicted individuals are turning to professionals for assistance. Recurrent bouts of binge eating, which are typified by consuming an excessive quantity of food in a specific time frame and an inability to control overeating during this episode, are what constitute BED. Eating far more quickly than usual, eating till uncomfortable full, eating even
when not hungry, eating by oneself out of embarrassment, and feeling disgusted or guilty about oneself are all examples of these experiences [3].
Understanding Eating Disorders:
Any disorder that involves irregular or disordered eating patterns is referred to as an eating disorder (ED). They are distinguished by either an excessive or insufficient consumption of food. Adolescents typically become aware of it when they are exposed to exaggerated representations of fitness bodies on television or other mass media platforms. These are followed by over exercising, self-induced vomiting, hunger, laxative misuse, and other issues that eventually lead to a full-blown eating disorder [4]. The particular symptoms of an eating disorder vary depending on the kind and include compensatory behaviors like self-induced vomiting, disordered behaviors like restricting or bingeing, and emotional and cognitive abnormalities related to eating, weight, and body shape. Other eating disorder classifications, such as binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN), are listed in the Diagnostic and Statistical Manual of Mental Disorders 5 and are not covered in this study [3]. The lifetime prevalence of eating disorders (EDs), which include binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN), is 2% for males and over 8% for women. Among ED patients, 70% are recorded [7]. Epidemiological data indicates that women with substance use disorders are around eleven times more likely than the general population to have eating disorders or eating disorder behaviors [5].
Mental Health Overview:
A vital and crucial aspect of health is mental well-being. Our social, psychological, and emotional well-being are all included in our mental health. It affects our feelings, ideas, and actions as we go through life. It also influences our decision-making, interpersonal relationships, and stress management. From childhood and youth to adulthood and aging, mental health is crucial at every stage of life [6]. The lack of psychopathological symptoms or mental disorder is only one aspect of mental wellness. Well-being is another aspect of mental health [3]. Compared to the general population, ED patients report lower levels of wellbeing in addition to significant levels of comorbidity [7]. Neuropsychiatric disorders have been associated with around 14% of the global burden of disease, mostly because of the persistently incapacitating character of psychoses, alcohol and substance use disorders, depression, and other common mental illnesses. These projections have highlighted the significance of mental illnesses for general health. However, they may have solidified the exclusion of mental health from mainstream initiatives to promote health since they emphasize the distinct roles that physical and mental illnesses play in impairment and mortality. Due to a lack of understanding of the connections between mental disease and other medical conditions, the burden of mental disorders has probably been underestimated. One major contributor to long-term incapacity and dependency is mental illness. According to a WHO report from 2005, neuropsychiatric disorders were responsible for 31?7% of all years lived with disability. The five main contributors to this total were dementia (1?6%), schizophrenia (2?8%), bipolar depression (2?4%), alcohol-use disorder (3?3%), and unipolar depression (11?8%) [8].
Figure 1; Understanding of Mental Health Overview
Interplay Between Eating Disorders and Mental Health:
Numerous studies have shed light on the reciprocal relationship between eating disorders and mental health, which has been the subject of much research. Eating habits can change in people with mental health conditions such depression, anxiety, or stress. These changes might range from binge eating or limited dieting to overindulging [9]. Depression and social anxiety have been found to be the most common mental comorbidities among ED patients. For instance, comorbidity rates in AN are roughly 40% for depression, 20–30% for generalized anxiety disorder, and >50% for social anxiety disorder, according to recent studies. Over 50% of those with BN or BED also have a comorbid anxiety disorder, and approximately 45% of those with these illnesses also have a concurrent unipolar depression [3]. Research on ED patients using psychometric networks is rapidly growing and shedding light on the connections between symptoms. These researches have examined the relationships between co-morbid conditions including trauma, social anxiety, or general psychopathology (i.e., symptoms of mood, anxiety, and general discomfort) and ED symptoms (both within and between ED kinds) or a combination of ED symptoms. Overall, studies found common fundamental signs of eating disorders, such as excessive weight and form evaluation [10]. Significant co-morbid symptoms, including feelings of overload, anxiety, difficulty concentrating, low self-esteem, sadness, anxiety, interpersonal sensitivity, and ineffectiveness, were also identified in ED patients across studies [11]. According to the research currently available, individuals with EDs like BED are more likely to experience mental health issues and trouble regulating their emotions. However, additional study is needed in this area because eating disorder sufferers who struggle with emotion management may be at risk for serious mental health issues (such assuicidality). Comorbid mental health issues are common in people with BED. For example, a systematic review revealed a substantial correlation between BED and depression, while another study demonstrated that anxiety plays a significant role in the initiation and maintenance of binge eating. Furthermore, a recent study conducted in the US discovered a link between BED and anxiety and mood disorders throughout one's life. The urge to binge eat is associated with psychological stress in addition to mood and anxiety issues in individuals with BED. For example, people with BED may feel more of a need to binge eat when under psychological stress than people without BED. Finally, poor mental health-related quality of life also be linked to BED [1].
Figure 2; The Interplay of Eating Disorders and Mental Health
Treatment Approaches and Challenges:
Most eating problem sufferers remain undiagnosed. The majority don't seek therapy, and when they do, they typically do so to get help with co-occurring mental or physical illnesses or dieting and weight loss. Because eating disorders are concealed, screening for them is necessary, and mental health clinicians serve as important gatekeepers. Early detection and an improved prognosis are made possible by eating disorder screening. Early detection reduces the burden on individuals, families, and health care systems while preventing the psychological and physical effects of illness progression. Along with two Norwegian studies and a program that treats co-occurring substance misuse and PTSD, there is little data on screening and point prevalence of eating disorders in outpatient mental health populations. Instead of using professional diagnostic interviews or proven screening tools to make a diagnosis, many investigations relied on staff or self-report [12]. Research on how eating disorders are handled as part of standard alcohol and other drug treatment is crucial. Women receiving therapy with and without weight-related concerns had different eating pathologies, the authors suggested that treatment facilities recognize and address weight-related and eating disorder concerns in women undergoing substance use treatment [5]. Shame has drawn attention as a potential contributing element to clinical outcomes in the effort to improve ED treatments. Shame is associated with unfavorable self-perceptions of one's weight, shape, and body image, which can worsen clinical impairment and prolong symptoms of eating disorders. A meta-analysis found a medium to large association between eating disorders (such binge eating and restriction) and shame (Nechita, Bud, and David 2021). Despite the well-established correlation between shame and the intensity of ED symptoms, no studies have looked at the relationship between shame and treatment dropout, changes in ED symptoms, or clinical impairment [13]. Prejudice based on weight is a common issue that has drawn more attention due to the detrimental health effects it is linked to. Several of these reported adverse health impacts are linked to self-directed weight stigma, also known as weight prejudice internalization, in addition to the stigma that people with obesity endure from others and society [14].
Clinical Therapies:
Depending on the therapist's presumptions or preferences, the patient's preferences, and pragmatic factors like the number of available sessions, therapists in practice employ a range of therapy approaches. A common tactic is for the doctor to employ several interventions at once by combining various methods that appear appealing and pertinent. For instance, it could be tempting to use a single video-feedback session borrowed from social anxiety treatment when the patient expresses that they are unable to eat in front of others because they feel embarrassed and judged. This is a common manner that therapists stray, and despite its obvious attraction and prevalence, there is no written evidence to support this kind of "mixing and matching" of interventions [15]. Care paths are complicated because clinical presentations vary widely. Inpatient medical or psychiatric care, residential or rehabilitative treatments, psychological counseling, self-help, general practitioner (GP) care, or high-intensity care—such as intensive day care or outpatient care—can all be included in this category. Patients with AN who are severely compromised should be the only ones receiving inpatient treatment. Medical consultation, pharmaceutical management, supervised meals, and sometimes restrictive measures like nasogastric (NG) tube feeding, one-on-one monitoring, and the Mental Health Act are all part of it. Although dietary guidance and psychological therapy are generally recommended as part of the treatment for eating disorders, medication may also be necessary. Multidisciplinary specialized services must contact or give treatment for eating disorders, and family members or carers should be involved whenever feasible [3].
Psychological Therapies:
According to psychometric network theory, this is a key characteristic of mental illnesses, which are characterized by intricate networks of symptoms. Advances in psychometric network analysis have opened up new avenues for investigating and comprehending the dynamics and structure of mental illnesses. Symptoms are described in these studies as nodes that can be connected to one another in a network. It is possible to estimate the centrality of nodes in a psychometric network, or the relative importance of nodes in relation to one another, as well as the edge-weights, or strength of the relationship between nodes. According to numerous studies, the most prevalent symptoms are obsessive scrutiny of one's weight and shape and weight-related concerns [7]. Since they have the biggest effects on symptom reduction and other outcomes, some psychological therapies, such as the trans-diagnostic Cognitive Behaviour Therapy Enhanced (CBT-E), are the first-line treatment for all eating disorders. CBT-E is typically administered in 40 sessions for anorexia nervosa and 20 weekly sessions for bulimia nervosa and BED [16].
Pharmacological Therapies:
Pharmacological treatment has advanced further than psychological care; there are currently a few small trials of second-generation antipsychotics, such as olanzapine for anorexia nervosa, with mixed results. Other psychotropic drugs, including antidepressants, may be used in cases when there is co-occurring significant depression, even though there is little evidence to support their efficacy in treating anorexia nervosa. Numerous trials support the use of agents to treat BED and bulimia nervosa. Since the early trials with higher dose-selective serotonin reuptake inhibitors, topiramate and (for BED) lisdexamfetamine have only been used in a small number of trials [16]. The pharmacodynamic, pharmacokinetic, psychological, psychiatric, and pathophysiological aspects of the drug used to treat eating disorders, the mental health issues linked to eating disorders, and the physical health effects of malnutrition gives a summary of several illnesses that can require medication treatment. There is mounting evidence that olanzapine, aripiprazole, and other atypical antipsychotics, as well as the cannabinoid receptor agonist dronabinol, may be beneficial in treating AN. See for an up-to-date review of pharmaceutical approaches to treating AN. In five randomized controlled trials (RCTs), the atypical antipsychotic medication olanzapine demonstrated superiority in terms of weight gain. An NMDA receptor agonist called D-cycloserine appears to increase the advantages of exposure treatment for AN. Dronabinol (THC) increased weight gain in an RCT in AN when compared to a placebo. Physicians who treat EDs should be aware of the potential pharmacokinetic issues with medications like fluoxetine and lisdexamfetamine, which are licensed for the treatment of EDs [3].
CONCLUSION:
According to the review's findings, eating problems and mental health conditions are significantly correlated. Mental health conditions like anxiety, depression, and suicidal thoughts are more common in those with eating disorders. Furthermore, eating disorders are influenced by impulsive behavior, poor emotion regulation, a history of physical and emotional abuse as a child, pain tolerance, and interpersonal worries like feeling burdened. Compared to the general population, ED patients had lower levels of wellbeing. For patients with insufficient well-being, a well-being-focused approach to treatment should be taken into consideration. Given the generally weak to moderate strength of the connections, a treatment approach that solely focuses on reducing ED psychopathology may not sufficiently enhance well-being. Given that certain correlates have been linked to both ED psychopathology and well-being in some ED subtypes, such as BN and BED, this may be even more crucial to take into account.This study is the investigation into the connections between eating disorders and mental health. Interestingly, ED symptoms were reported by those with higher levels of stress, anxiety, and depressive symptoms. These relationships were found to be worsened by the existence of disordered eating practices, with worse outcomes for mental health being associated with larger degrees of disordered eating. These results provide credence to the idea that eating disorders and mental health are correlated in both directions, with problems in one area exacerbating problems in the other. This study's analysis of the releation between eating habits and mental health is one of its strong points.
ACKNOWLEDGMENTS:
Author expresses deep gratitude to Dr. Neetu Singh, Professor, and Anu Ram Kailash Mishra, Assistant Professor, Prashant Sagar, Research Scholar for their support and guidance. Special thanks to Babasaheb Bhimrao Ambedkar University, Lucknow, and the Department of Food and Nutrition for providing an enriching academic environment.
REFERENCES
Rachit Shakya*, Neetu Singh, Anu Ram Kailash Mishra, Prashant Sagar, Exploring the Link Between Eating Disorders and Mental Health: A Synthesis of Existing Research, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 4, 2614-2621. https://doi.org/10.5281/zenodo.15260129
10.5281/zenodo.15260129
