What is an Eating Disorder?
Eating disorders include extreme emotions, attitudes, and behaviors surrounding weight, shape, and food. Eating disorders are serious and can have life-threatening consequences.
Anorexia Nervosa is characterized by excessive food restriction and weight loss. Symptoms include:
- Restriction of energy intake leading to a significantly low body weight in the context of age, sex, development, and physical health
- Intense fear of gaining weight or of becoming fat
- Distorted body image, such as feeling “fat” despite dramatic weight loss.
Bulimia Nervosa is characterized by a cycle of binge eating followed by purging. Binge eating is defined as eating large amounts of food in short periods of time, then “getting rid” of the food through methods such as vomiting, laxative abuse, or over-exercising. Symptoms include:
- Recurrent episodes of binge eating and purging
- Feeling out of control during a binge and eating past the point of comfortable fullness
- Self evaluation excessively influenced by body shape and weight
Binge Eating is characterized by periods of uncontrolled, impulsive, or continuous eating beyond the point of comfortable fullness. While there is no subsequent purging, there may be repetitive diets along with feelings of guilt, shame, or self-hatred following a binge.
Other Eating Disorders will include some combination of symptoms of anorexia, bulimia, and/or binge eating. While the behaviors may not clinically be considered a specific eating disorder, they can still be physically and emotionally dangerous. It is highly recommended that all eating disorders be professionally treated.
Symptoms
There are many symptoms of eating disorders, and each one is different. Anorexia nervosa notably causes the patient to refuse to eat, sometimes by denying hunger. They have a real fear of weight gain and excessively exercise, and due to their lack of food and nutrition, are thin and irritable. Bulimia nervosa is associated with binging and purging, so any signs of either, such as excessive eating or vomiting, are often signs of bulimia. Additionally, rotting teeth from the stomach acid and diarrhea from possible laxative use are other common signs. Binge eating occurs when the patient eats to the extreme point of discomfort. It is often emotional and the patient eats far more than they would at a normal meal or snack.
Causes
Most eating disorder counselors agree that emotional health is a very large factor, while biology may be much less of one. Self esteem problems and traumatic events, as well as societal influences, can often influence emotional and other types of eating disorders as well.
Treatment
Medication cannot treat an eating disorder. Psychotherapy by a trained therapist is the favored treatment option, as it can get to the root of the problem rather than focusing on the symptoms alone. However, sometimes the symptoms must be addressed in therapies in which patients learn about nutrition and restore their body to a healthy weight.
Prevention
Nutritional education and good self-esteem are both critical to preventing eating disorders. Treating them early, before your weight hits an unhealthy level in either direction, is also incredibly important. This is why it’s crucial to go to an eating disorder counseling center as soon as possible if any symptoms start to develop.
Risk Factors for Eating Disorders
| Gender | Both women and men are affected; ratio is estimated at 2:1 or 3:1 |
| Age | Cases have been noted in patients from 7-77, but most likely in the teens and early 20s. Research indicates peaks at ages 13-14 and 17-18. |
| Location | Highest prevalence found in Western culture that value slimness, also upper socioeconomic classes in developing countries. More common in urban areas. |
| Personality | Anorexia Nervosa: typically sensitive, perfectionist, obedient/rule following, persevering, self-critical, high achievingBulimia Nervosa: typically impulsive, emotionally intense, volatile, dramaticBinge Eating Disorder: typically high novelty seeking, high harm avoidance, low self-directedness General: tend to repress emotions, low self-esteem, negative/pessimistic/ruminators, sensitive, lack of sense of identity |
| Family History | Increased in patients with family history of obesity, depression, anxiety, and eating disorders |
| Heritability | Estimated 50-70% genetic: developmental, body type, co-morbidity, etc. |
| Cultural Factors | Cultural pressures that glorify thinness and place value on appearance rather than inner qualities. Narrow definitions of beauty that include only persons of specific body weights and shapes. |
| Interest Groups Events | Dancers, body builders, models, wrestlers, sports with high performance and appearance demands, visual media professionals, actorsCritical Sensitizing Teasing, criticism for overweight (especially by mothers, coaches, peers, and significant others), involuntary weight loss for medical/surgical reasons, demands for improved athletic performance, need for meeting military weight standards, obesity at the onset of menstruation, childhood abuse |
| Sexual Orientation | Increased prevalence in homosexual males and heterosexual females (note that prevalence is connected to higher demand for perfectionist body image ideals rather than to sexuality) |
| Age of Onset of Dieting Behavior | Girls begin to worry about weight at age 9-10 and 60-70% are trying to reduce weight by age 14 |
| Racial and Ethnic | Independent, however increased with adoption of Westernized body ideals within groups |
| Medical Diseases Predisposing | Type I diabetes mellitus, cystic fibrosis |
| Psychiatric Disorders Predisposing | Depressive disorders, anxiety disorders, ADHD, PTSD, OCD |
| Influence of Media | Decreased self-esteem, more self-critical body image after viewing unrealistic body size/shape ideals in the media |
| Interpersonal Factors | Troubled family/personal relationships, difficulty expressing emotion/feelings, history of being teased or ridiculed based on size or weight, history of physical or sexual abuse |
General:
tend to repress emotions, low self-esteem, negative/pessimistic/ruminators, sensitive, lack of sense of identityFamily HistoryIncreased in patients with family history of obesity, depression, anxiety, and eating disordersHeritabilityEstimated 50-70% genetic: developmental, body type, co-morbidity, etc.Cultural FactorsCultural pressures that glorify thinness and place value on appearance rather than inner qualities. Narrow definitions of beauty that include only persons of specific body weights and shapes.Interest Groups EventsDancers, body builders, models, wrestlers, sports with high performance and appearance demands, visual media professionals, actorsCritical Sensitizing Teasing, criticism for overweight (especially by mothers, coaches, peers, and significant others), involuntary weight loss for medical/surgical reasons, demands for improved athletic performance, need for meeting military weight standards,
obesity at the onset of menstruation, childhood abuseSexual OrientationIncreased prevalence in homosexual males and heterosexual females (note that prevalence is connected to higher demand for perfectionist body image ideals rather than to sexuality)Age of Onset of Dieting BehaviorGirls begin to worry about weight at age 9-10 and 60-70% are trying to reduce weight by age 14Racial and EthnicIndependent, however increased with adoption of Westernized body ideals within groupsMedical Diseases PredisposingType I diabetes mellitus, cystic fibrosisPsychiatric Disorders PredisposingDepressive disorders, anxiety disorders, ADHD, PTSD, OCDInfluence of MediaDecreased self-esteem, more self-critical body image after viewing unrealistic body size/shape ideals in the mediaInterpersonal FactorsTroubled family/personal relationships, difficulty expressing emotion/feelings, history of being teased or ridiculed based on size or weight, history of physical or sexual abuse
*Adapted from Eating Disorders: A Guide to Medical Care and Complications by Philip S. Mehler, M.D. & Arnold E. Andersen, M.D.
Effects of Poor Nutrition
Attitudes and Behaviors toward Food
- Food preoccupation
- Collecting recipes, cookbooks, menus
- Cooking food for others or feeding others without eating
- Unusual eating habits and rituals
- Increased consumption of spices and condiments
- Binge eating
Cognitive Changes
- Decreased concentration
- Poor judgment and difficulty making decisions
- Apathy
Emotional and Social Changes
- Increase in anxiety and/or depression
- Irritability and/or anger
- Personality changes
- Social withdrawal and/or isolation
Physical Changes
- Sleep disturbances and insomnia
- Weakness, muscle cramps
- Constipation and/or diarrhea
- Sensitivity to noise and light
- Edema (fluid retention)
- Hypothermia or low body temperature (anorexia)
- Decreased metabolic rate (anorexia)
- Decreased sexual interest
- Hypotension: low blood pressure (anorexia)
- Bradycardia: decreased heart rate (anorexia)
- Dry skin, brittle and thinning hair
- Lanugo: fine body hair (anorexia)
- Slowed growth in adolescents
- Decrease in sex hormones
- Amenorrhea: absence of menstruation (can lead to infertility)
- Low potassium level (bulimia)
- Low chloride levels (bulimia)
- Dehydration
- Kidney problems
- Seizures
- Cardiac dysfunctions
- Brain atrophy and changes in brain activity
- Death
The Treatment Team
The eating disorder treatment team is just that: a team. It typically includes a therapist, a dietician, and a physician all working closely with the client and each other. In some circumstances, a psychiatrist may be added to manage medication helping with symptoms such as anxiety through the journey. Below is a description of each team member’s role.
Therapist
- Educate patient and family about the basic facts about eating disorders
- Help patient to identify underlying causes of eating disorder behavior
- Help patient to identify cognitive distortions and other triggers to eating disorder behaviors
- Provide patient with tools to reduce and eliminate self-destructive patterns
- Teach the patient coping skills including emotion regulation, distraction, distress tolerance, cognitive shifts, and “Moderation” mindset
- Help patient with body image and body awareness
- Develop self-understanding with the patient
- Promote hope, patience, and commitment on the road to recovery
- Assist patient with expanding support network to ensure ongoing recovery
- Help families communicate effectively and have healthy relationships
- Consult with other members of the Treatment Team for the patient’s well being
- Help with relapse prevention
Nutritionist
- Provide nutrition assessment and nutrition education
- Develop individualized meal plan and goals
- Monitor weight and intake if needed
- Assist in gradual behavior and eating changes with the patient
- Consult with other Treatment Team members
Physician
- Monitor medical status
- Assist in keeping patient stable while treatment proceeds
- Advocate for care from a medical perspective
- Educate patients about the importance of adequate nutrition and healthy habits
Family
The family is The Primary Support System for the patient. The family role, ideally, is as follows:
- Educate themselves about eating disorders to better help the patient
- Instill a sense of ownership
- Be available for family therapy sessions as requested by therapist/nutritionist
- Be willing to get support for their own issues during the recovery process
The Four Stages of Recovery
Denial
- We still believe that we can control our eating and that everything will be okay.
- We continue our eating disorder behaviors
- We deny the emotional component to our problem
- We tend to keep our feelings and problems to ourselves
- Emphasis on outer solutions
Transition
- Realize our problems go deeper than the size of our bodies
- Become aware of triggers
- Continue struggling with food, weight, or body image
- Begin to accept the need to look toward inner solutions
- Begin to recognize our insufficient ways of dealing with life
- Begin to let go of self-destructive behaviors
- Begin to experience emotions we were previously avoiding
- Often enter a crisis period
- Emergence of feelings can be a difficult and frightening experience
- Requires enormous amount of emotional support
- Reaching out can be difficult
- Without adequate support, emotions can be overwhelming and cause many to return to the Denial Stage
Early Recovery
- Things start to calm down
- Begin to depend on ourselves more
- Easier to reach out
- Increased tolerance for handling emotions/better at coping with them
- Experimentation with eating
- Begin to have faith in the recovery process
Ongoing Recovery
- About knowing and trusting ourselves/treating ourselves with love and respect
- More and more comfortable with food and our bodies
- Know how to handle feelings
- Better able to identify our needs and speak our truth
- Use support system
Recovery from an eating disorder takes 1-7 years. Recovery depends on factors such as the duration of the disorder, client’s level of commitment to the treatment process, and available support.
What to Expect
In The Beginning Stages of Treatment
Be aware that these are all possible symptoms that are usually temporary and subside as your recovery progresses with improved nutrition and coping skills. These are all normal. Though unpleasant, they are actually positive signs that your body and mind are adjusting to healthier ways of living.
Physical (typically last 2-3 weeks)
- Fullness, bloating, gas
- Night sweats (from increased thyroid hormone)
- Edema (swelling from fluid retention)
- Hypermetabolism with refeeding (anorexia)
Emotional
- Increase in anxiety and depressive symptom
- Emotional outbursts
- Increase in other destructive or impulsive behaviors
- Increase in family stress
Playing a Supporting Role:
Ways You Can Be a Part of Your Loved One’s Recovery
Come to an agreement on the recovery approach that you and your treatment team have developed:
- Accept different levels of understanding. Be kind and sensitive to each other.
- Disagreements about how to help can be a big obstacle and one of the biggest challenges for families. Work together as a team to present a united front.
- Parents can inspire hope for each other.
- Remember that in early recovery you will hear more from the Eating Disorder than you will from your loved one.
- Keep in mind that motivation is often not high (especially with adolescents)
Learn all that you can
- Seek additional resources and information
- Speak to a knowledgeable physician (don’t be afraid to ask him/her about their experience treating eating disorders)
- Educate yourself about how people with eating disorders think and behave, what motivates them to do the things they do.
Share your observations of your child’s current behaviors and symptoms
- Any contributing problems or conflicts?
- Any strengths and abilities?
Keep in contact with the treatment team
- Ask questions, get feedback
In the beginning, discuss what to expect
- Review what to expect during early recovery
- Discuss different stages: improvements, symptoms
- Agree on how and when to be updated
Have a backup plan
- If progress is stalled, discuss next steps
- Understand your options: i.e. psychological treatment, family treatment, individual therapy, nutritional counseling, medications, and intensive treatments.
Keep your child in treatment
- Your loved one’s motivation is very low. Encourage, support, or insist (especially minors) that they attend treatment sessions.
- You may have to work with your child’s school to excuse from classes to attend treatment.
- Make it a priority to attend requested sessions, loved one’s education/support meetings.
Take the Eating Disorder seriously
- Understand that this is a serious medical and psychiatric illness.
- This is not an instance of taking dieting “too far” – this is truly an illness.
- Understand that it is not a matter of being good or bad, strong or weak. Blaming, guilting, and pleading, or reasoning will not work; just as you can’t blame, guilt, plead or reason someone out of having cancer.
It’s not your fault!
- Accept that this is stressful
- Give yourself time to absorb the problem and process your feelings.
- Discard the notion that you caused the problem. This idea is unproven and will cripple you in your efforts to help.
- Try to alleviate any anxiety or guilt that is keeping you from contributing to your child’s return to health – if you feel guilty and responsible for causing the eating disorder, you will likely also feel hopeless and inadequate when facing the task to help your child change her eating behaviors.
Holding the family up
Save yourself from your child’s problem overwhelming you – take care of yourself too! Build coping strategies to lessen the impact that the illness has.
- Don’t waste time on the “why?” Focus on the solution, not the problem.
- Do not focus on the details of the eating disorder behaviors – instead, focus on their day, how the person is feeling. Talk about feelings. Getting the feelings out is a huge step in recovery.
- Have fun together as a family in a setting that does not revolve around food (movies, bowling, games, art events, etc.)
Other “dos and don’ts” for families
- Consult your dietician about any food or exercise related issues. Do not attempt to resolve these issues on your own.
- Let your loved one know that you understand their dilemma, that the illness doesn’t allow them to be rational about food and weight right now, that you understand that for the time being they see you as the enemy, but that none of this can deter you from doing what you know will save their life.
- Get rid of scales. This doesn’t mean just hide them. Throw them away. To someone with an eating disorder the number on the scale can become a way to determine how much to eat or how to feel (“good” or “bad” about themselves). Weighing can become an unhealthy obsession. The number on the scale is another way for individuals with eating disorders to look outside themselves for answers.
- Don’t comment on appearances. This is true even when you think it’s a compliment. Something like “you look healthy,” or even “you’re so thin,” can be twisted around and distorted in the mind of someone with an eating disorder. Try to avoid these comments at all times.
- Keep a wide variety of food around the house. Being an intuitive eater means figuring out what is being craved during the times of hunger. The more variety is available, the better chance the craving can be identified and satisfied. It is important to consider taste preferences and meal options while shopping at the grocery store.
- Don’t buy diet foods. These are very triggering and tempting to individuals with eating disorders. They feed into eating disordered thoughts and behaviors. Plus, they are generally unsatisfying.
- Challenge traditional beliefs about food: Avoid labeling food as “good” or “bad.” Food is food. It has no moral value. ALL foods have nutritional value because every food is made up of carbohydrates, protein, and/or at that our bodies need in order to function properly.
Resources/Recommended Reading
Anorexia Nervosa
- The Anorexia Workbook: How to Accept Yourself, Heal Your Suffering, and Reclaim Your Life, by Heffner & Eiffert
- Life Without Ed, by Shaefer
- Goodbye Ed, Hello Me, by Shaefer
- Eating in the Light of the Moon, by Johnston
- Rules of Normal Eating: A Commonsense Approach for Dieters, Overeaters, Undereaters, Emotional Eaters, and Everyone In Between
- Love Your Body: Change the Way You Feel About the Body You Have, by Brannon-Quan & Licavoli
Bulimia Nervosa
- Dialectical Behavior Therapy Skills Workbook for Bulimia, by Astrachan-Fletcher & Maslar
- Overcoming Bulimia Workbook, by McCabe, McFarlane, & Olmstead
- Life Without Ed, by Shaefer
- Goodbye Ed, Hello Me, by Shaefer
- Eating in the Light of the Moon, by Johnston
- Rules of Normal Eating: A Commonsense Approach for Dieters, Overeaters, Undereaters, Emotional Eaters, and Everyone In Between
- Love Your Body: Change the Way You Feel About the Body You Have, by Brannon-Quan & Licavoli
Binge Eating / Overeating
- Life is Hard, Food is Easy, by Spangle
- Overcoming Binge Eating, by Fairburn
- Crave: Why You Binge Eat and How To Stop, by Bulik
- Eating in the Light of the Moon, by Johnston
- Rules of Normal Eating: A Commonsense Approach for Dieters, Overeaters, Undereaters, Emotional Eaters, and Everyone In Between
- Love Your Body: Change the Way You Feel About the Body You Have, by Brannon-Quan & Licavoli
- Food: the Good Girl’s Drug, by Gold
- The Don’t Diet, Live It! Workbook, by Wachter & Marcus
For Parents
- Skills-based Learning for Caring for a Loved One with an Eating Disorder, by Treasure, Smith, & Crane
- Help Your Teenager Beat an Eating Disorder, by Lock & LeGrange
- Brave Girl Eating, by Brown
- The Parent’s Guide to Eating Disorders, by Herrin & Matsumoto
Online Resources
- National Association of Anorexia Nervosa & Associated Disorders (ANAD) – www.anad.org
- National Eating Disorder Association (NEDA) – www.nationaleatingdisorders.org
- Maudsley Parents – www.maudsleyparents.org
- Binge Eating Disorder Association (BEDA) – www.bedaonline.com
The Elisa Project – www.theelisaproject.org
Families Empowered & Supporting Treatment of Eating Disorders (FEAST) – www.feast-ed.org
The Body Positive – www.thebodypositive.org
Health at Every Size – www.haescommunity.org
National Association of Males with Eating Disorders (NAMED) – www.namedinc.org