The Overlap between Eating Disorders and Gastrointestinal Conditions

Prevalence, Pathology & Symptoms

EDs affect all ages and genders and are associated with preoccupations and anxiety around food, weight and/or body shape. Disordered eating behaviors include restrictive eating, binge eating, purging, compulsive exercise, and disturbed eating practices, such as cutting up or mashing foods into tiny pieces, microbiting, hiding food, and eating habitually. Despite the high prevalence of GI symptoms in patients with EDs, the underlying link between EDs and GI symptoms are numerous and not completely understood [2]. In some cases the ED precedes the GI disorder, while in others the GI disorder occurs prior to the ED [3].

GI complications often develop following chronic dietary restriction, which can impair GI tract function, and most GI symptoms in ED patients are a result of this impairment. Postprandial fullness, early satiety, epigastric pressure and nausea are common gastric symptoms, while abdominal pain, chronic constipation, diarrhea and feelings of anal blockage are common intestinal complications. With normal digestion, gastric distension following a meal stimulates release of hormones that promote digestion and regulate feelings of hunger, fullness and satiety. Dysregulation of this physiological response to eating, common with EDs, impacts eating behavior and can provoke GI symptoms, leading to nausea, bloating and early satiety. Restricted intake, vomiting and straining can also lead to smooth muscle atrophy or pelvic floor dysfunction, which impair intestinal motility and prolong gut transit times, both of which  contribute to constipation [4]. Overall, this GI dysfunction resulting from disordered eating can exacerbate ED behaviors and impair recovery.

A more updated understanding of the relationship between EDs and GI conditions also considers the increasing prevalence of hyper-awareness around food, which is especially heightened in patients with GI conditions [5].  Strict dietary guidelines and elimination diets that begin in an effort to control GI symptoms contribute to food-related anxiety and increase the risk for ED development. GI conditions that require strict diets and lead to heightened attention to food preparation and intake include celiac disease (CD), inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) [6]. ED symptoms that may result from GI disorders or impaired motility include loss of appetite, self-induced vomiting, constipation and bloating. Plus, chronic dietary restriction puts patients at risk for nutrient and energy deficiencies and further impairs quality of life.

Screening

Screening of patients with GI conditions who exhibit disordered eating behaviors is vital to ensure they receive appropriate care. While CD is the only GI disease with a validated screening tool, the Celiac Disease Food Attitudes and Behaviors (CD-FAB), a number of tools validated in the general population may guide assessment [7]. Find additional information and intake-related topics to probe during counseling sessions here. Open-ended questions can elicit “flags” for disordered eating that can be further assessed or may indicate a patient should be referred to a specialist provider.

Nutrition Care

Dietary interventions and nutrition counseling for patients with GI conditions and EDs is highly complex and patient-specific. Care plans should be guided by an interdisciplinary team that includes a therapist, primary care physician and Registered Dietitian (RD) with experience in ED treatment.

Patients with EDs and GI conditions commonly exhibit heightened food fears and strong associations between foods and symptoms. They often also display health-related beliefs rooted in misinformation, moral associations with food and distrust of the medical system. Goals of treatment will be patient-specific, but generally should aim to help patients achieve a safe and stable weight, restore micro and macronutrient adequacy, control GI symptoms and normalize a patient’s relationship with food.

Join Us to Learn More

We will cover the connection between EDs and GI disorders in our upcoming webinar, “Helping Them ‘Go’ Without Harm: Managing Common GI Diagnoses In Clients With Eating Disorders,” led by Beth Rosen, MS, RD, CDN. Beth is an expert dietitian with over 20 years of experience helping patients with digestive conditions and EDs or disordered eating mend their relationship with food and their body.

Join us for this free session on August 4 at 3:00pm EST where Beth will provide information on how to recognize and treat, from a nutrition standpoint, the most common GI conditions that impact those with EDs. We’ll provide an introduction to the most common EDs and cover dietary interventions, non-diet tools, supplements, and behavior modifications to address disordered eating. You’ll gain the knowledge and skills to support patients to improve their GI symptoms and quality of life without triggering disordered eating behaviors.

Reserve your spot here! Eligible for 1 CEU for RDs and DTRs.