Eating Disorders

What are eating disorders?

Eating disorders are complex mental health conditions that encompass disordered thinking about food, body weight, and body image, as well as abnormal eating and disordered eating patterns. It affects both males and females, both children and adults and does not discriminate between race or age. If left untreated, they can cause lifelong complications, or even death.

There are several different types of eating disorders and symptoms will vary in levels of severity between individuals. Eating disorders can cause significant levels of stress and impairment socially, occupationally, and academically. It is important to seek help if you or your loved one is struggling with an eating disorder. The most common treatment for eating disorders is cognitive behavioral therapy, which is often paired with medication to help reduce symptoms of depression and anxiety. In more severe cases, patients will need to seek longer-term help at a residential treatment facility or may need to be admitted to the hospital.

  The four main types of eating disorders include:
  • Avoidant/Restrictive Food Intake Disorder. This disorder demonstrates an eating or feeding disturbance due to a lack of interest in food, or an avoidance because of certain sensory characteristics of the food. There is also a fear of adverse consequences of eating. These symptoms typically result in a person not maintaining a healthy weight or failure to meet appropriate nutritional or energy requirements. 
  • Anorexia Nervosa. This disorder demonstrates a restriction of energy intake relative to necessary requirements. The restriction leads to a significantly low body weight within the context of age, sex, developmental trajectory, and physical health. People with anorexia nervosa have an extreme fear of gaining weight, becoming fat, and will engage in behaviors to interfere with weight gain, regardless of being at a significantly low weight. Distress regarding body weight or shape is experienced, along with negative self-evaluation, and lack of recognition of how dangerous their current low body weight is. Anorexia nervosa has two subtypes, which are restricting type, and binge-eating/purging type.
  • Bulimia Nervosa. This disorder demonstrates recurrent episodes of binge eating. These episodes are characterized by eating in a discreet period, an amount of food that is significantly larger than most individuals would eat under the same circumstances and time frame. People with bulimia nervosa typically feel a lack of control while eating during an episode. There will also be recurrent inappropriate or unhealthy behaviors to compensate for the overeating to prevent weight gain, such as vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. People with bulimia struggle with negative self-evaluation regarding body shape and body weight. 
  • Binge-eating disorder. This disorder is demonstrated by recurrent episodes of binge eating. Binge eating is characterized as eating in a discreet period, an amount of food that is significantly larger than most individuals would eat under the same circumstances and time frame. During the episodes, people will feel a lack of control regarding eating. The binge-eating episodes are characterized by eating more quickly than normal, eating until uncomfortably full, eating large amounts of food when not feeling hungry, eating alone due to embarrassment by how much one is eating, and feeling disgusted with oneself, depressed, or guilty after the episode. Compensatory behaviors are not present with binge-eating disorder.

Signs and Symptoms

Signs and symptoms of eating disorders depend on the type of eating disorder. One of the most difficult issues with identifying an eating disorder is that sometimes symptoms are not visible. You may not always notice physical differences. An eating disorder can occur at any size or weight. Additionally, a person may choose to keep their disordered eating thoughts and behaviors hidden, which increases risk of complications. Depending on the type of eating disorder, some symptoms may be apparent. Symptoms include:

  • Fatigue
  • Fainting, dizziness, lightheadedness
  • Mood swings
  • Thinning hair or hair loss
  • Dental issues
  • Frequent bathroom breaks after eating
  • Drastic or unexplained weight loss
  • Unusual hot flashes or sweating
  • Choosing to eat alone or not out in public
  • Withdrawing from friends or social activities
  • Fixation on food or calories (calorie counting)
  • Fixation on exercise or weight loss
  • Hiding or throwing away food
  • Food rituals (chewing longer than normal, eating in secret, etc.)

If you or your loved one is struggling with an eating disorder, please consult with your healthcare provider and they can walk you through your options and help get you on your way to healing and recovery.

Risk Factors

Several risk factors can contribute to developing an eating disorder. Eating disorders can affect any sex, age, race, or ethnicity. There are certain risk factors that may make you more prone to developing an eating disorder. Risk factors include:

  • A family history of eating disorders, addictions, or other mental health issues
  • A trauma history
  • History of depression, anxiety, or obsessive-compulsive disorder (OCD)
  • History of rigid, strict, or restrictive dieting
  • Diabetes (1/4 of women with Type 1 diabetes struggle with an eating disorder)
  • Perfectionism
  • Major life changes or transitions (divorce, moving, job loss or starting a new job, etc.)
  • Having a profession or being involved in activities that focus on physical appearance, (gymnastics, wrestling, dance, swimming, diving, running, modeling, etc.)
  • Having a low body weight

Complications

Eating disorders, if left untreated, can cause life-threatening complications. Restrictive dieting, intentional starvation, excessive exercising, and compensatory behaviors have potential to cause serious short-term and long-term health problems, including death. The level of severity and duration of symptoms increase the potential for complications. Complications include:

  • Significant health problems (arrythmia, heart failure, acid reflux, gastrointestinal issues, low blood pressure, organ damage, organ failure, osteoporosis, tooth damage, severe dehydration, constipation, stopped menstrual cycle, infertility, or stroke)
  • Anxiety and depression
  • Problems with growth and development
  • Self-harm (self-mutilation) 
  • Suicidal thinking
  • Substance use issues or disorders
  • Occupational and academic issues
  • Death

Causes

There is no singular cause for developing an eating disorder. Generally, eating disorders develop because of a culmination of issues related to genetics, environmental, social, and psychological factors. Because there are so many variables that may contribute to developing an eating disorder, it is important to seek help early on, as the first signs start to develop. Being proactive about your mental health, identifying any perfectionistic tendencies, obsessive thoughts about food and body image, negative self-talk, or any experience of anxiety or depression connected to your relationship with food is critical to treatment outcomes. Please reach out to your healthcare provider if you are experiencing any symptoms of an eating disorder.   

Diagnosis

Eating disorders are usually diagnosed through assessments and evaluations conducted by a medical provider and mental health provider. A healthcare provider will take a medical history, perform a physical exam, and most likely, order blood tests. If an eating disorder is suspected, a referral will be made to a mental health provider. A mental health provider will do a thorough intake and gather information through evaluations and assessments. A mental health provider will look at biological, psychological, social, and environmental factors that may be contributing to symptoms, and determine if it meets criteria for an eating disorder.

Treatment

Treatment of eating disorders vary depending on the individual and the type of eating disorder. Depending on the level of severity, some patients may need medical attention, while others may only need to seek treatment through a mental health provider. Typically, treatment involves a team approach. A team may include a medical provider, mental health expert, dietician and nutritionist, and a caregiver. Treatment methods fall under the categories of nutrition education, psychotherapy, and medication. If symptoms are severe enough, some people may require immediate hospitalization. 

  • Nutrition education. Your team will provide resources and education regarding nutrition, healthy eating habits, and the dangers of malnutrition.
  • Psychotherapy. Your mental health provider will help you identify any disordered thinking and behaviors regarding food and will try to help you replace unhealthy or negative thoughts, behaviors, emotions, and beliefs to healthier and more positive ones. The most common and effective therapies used to treat eating disorders are cognitive behavioral therapy (CBT) and family-based therapy (FBT).
  • Medication. There is no specific medication that cures an eating disorder; however, medications can help control the urges to binge or purge. Medications can also help reduce symptoms of anxiety and depression. 
  • Hospitalization. Some people who have more severe symptoms may require hospitalization to treat physical problems. Additionally, people who have struggled with an eating disorder over a longer duration of time and have more severe symptoms may be recommended to try residential programs or inpatient care that work specifically with treating eating disorders.