Food Allergy Linked to Disordered Eating & Body Image

Happy Food Allergy Awareness Month!

Did you know May is also Mental Health Awareness Month? That is no coincidence in my book.

In celebration of this annual intersection, All Things Allergies is extending beyond our usual trauma-related content into another chapter of the Diagnostic and Statistical Manual of Mental Disorders – Feeding and Eating Disorders.

Research suggests that nearly 9% of the world’s population are affected by eating disorders – A category of illnesses that include anorexia nervosa, binge eating disorder, bulimia, and more. The DSM-V characterizes eating disorders as a, “Persistent disturbance of eating or eating-related behaviors that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.” Eating disorders are among the deadliest of mental health disorders – Second only to drug overdoses. With such high risks of heritability, suicidality, and mortality, mental health professionals and eating disorder specialists around the globe work tirelessly to understand, prevent, and treat these disorders.

Yet, largely absent from disordered eating research is its intersectionality with food allergic diseases, despite the fact that dietary restrictions are strongly associated with increased incidence of eating disorders (Keski-Rahkonen & Mutselin, 2016).

Although not completely understood, Jafri (2021) hypothesizes that the required diet modifications, constant vigilance, and increased attention paid to daily food choices may contribute to the development of disturbed eating behaviors across the food allergy community. The authors stated, “A significant diagnostic feature of these eating disorders is the existence of restricted patterns of eating – Given that the cornerstone of food allergy management is this very type of diet modification, it is difficult to ignore the potential for an increased risk for dietary pathology.”

And ironically enough, it seems that the very thing that keeps us safe from the life-threatening consequences of anaphylaxis is what puts us most at risk for the development of disordered eating patterns. Sigh.

“The maladaptive or disordered dietary behaviors adopted in food allergic cohorts have evolved as a mechanism of avoiding undesirable consequences.”

Jafri, Frykasa, Bingemann, Phipatanakul, Bartnikas, & Protudjer (2021)

Another hallmark feature of eating disorders is body image, or the collection of positive and/or negative thoughts, feelings, and behaviors that you have about your body. Body image is separate from our actual bodily physiology, but can be influenced by personality traits, cultural factors, beauty standards, social media, and medical conditions.

This can include food allergies – A study out of Sweden highlighted how a focus group of adolescents felt something was inherently wrong with their food-allergic bodies, describing themselves as “inadequate, insufficient, and deformed” (Marklund, 2007). Later research gathered similar sentiments from food-allergic adults, who expressed feeling “isolated, embarrassed, and defective” because of their chronic illness (Peniamina, 2014). Aside from the heartbreaking adjectives, researchers discovered a key commonality among the respondents – Rather than viewing their food allergies as an external illness that they had, food allergies were seen as something that they intrinsically were. Their chronic illnesses were internalized, integrated into a stable part of their self identity.

This was the missing link for Jafri (2021) and his team. The authors hypothesized that in combination with the strict dietary modifications required by a food allergy diagnosis, food allergies may be associated – in part – with eating disorder vulnerability as a consequence of disturbed body image and poor self concept. Their predictions are illustrated in the figure below.

Proposed Mechanism for Development of Eating Disorders Mediated by Body Image Disturbance.
(Jafri et al, 2021)

Continued research will be integral for a deeper understanding of the link between food allergies, body image, and eating disorder vulnerability – And we aren’t the only ones advocating for it! Here’s what one research team out of Canada had to say.

“Due to the prevalence of this chronic illness and the evidence that food allergy has a significantly larger impact on quality of life than other chronic illnesses, it is interesting that there does not exist sufficient consideration for the ways the healthcare system or government programs can raise awareness for and address this concern to prevent damaging psychopathologies.

Policy makers must advocate for development of mental health services geared towards individuals with food allergies and consider the possibility that individuals with food allergies who develop patterns of disordered eating are followed in clinics that may escape the scope of practice of eating disorder specialists.”

Jafria, Frykasa, Bingemann, Phipatanakul, Bartnikas, & Protudjer (2021)

I simply could not have said it better myself.

Up next in this All Things Allergies eating disorder series is an investigation into disordered eating patterns as an Invisible Consequence of Anaphylaxis. I’ll share my personal experiences with disordered eating after an allergic reaction, and discuss how the recent acknowledgement of Avoidant Restrictive Food Intake Disorder (AFRID) by the American Psychiatric Association may pertain the food allergy community.

Disclaimer: This post is intended for educational purposes only, and should not be substituted for medical or professional advice. Please contact a licensed medical or mental health professional with further inquires.

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