Eating Disorders

Eating disorders are serious illnesses that cause disturbances in people’s eating patterns and are marked by excessive thoughts with body weight, shape or size. There are three main types of eating disorders -- anorexia, bulimia and binge-eating.

According to the National Eating Disorder Association, nearly 20 million women and men suffer from a clinically significant eating disorder in their lifetime. Eating disorders are 10 times more common in young women, but eating disorders are being reported at an increasingly higher rate in men and older women.

Eating disorders, which typically develop during teenage year or early adulthood, are treatable, but can result in serious medical and health problems without intervention. In fact, approximately 10 percent of people with anorexia die as a result of the disorder, the highest mortality rate of any mental illness.

Types of Eating Disorders

There are three main types of eating disorders -- anorexia, bulimia and binge eating.

Anorexia Nervosa

Anorexia Nervosa, or simply known anorexia, is an eating disorder marked by abnormally low body weight characterized by a fear of gaining weight because of a distorted body image. Those diagnosed with anorexia weigh, on average, 85 percent less of what is average for their age and height; although this 85 percent marker is not a criterion factor for diagnosing anorexia.
Those with anorexia go to extreme measures to restrict calories, sometimes limiting their eating, using diet aids, laxatives or enemas, as well as vomiting.

Those with anorexia may obsess with exercising to reduce weight. Additionally, binging - overeating or eating obsessively -- and purging - using unhealthy ways to get rid of calories (vomiting, excessive exercising) -- also are associated with anorexia, which is similar to bulimia, but those with anorexia maintain a significantly low body weight.

Anorexia has less to do about actual weight and more to do with self-worth associated with body image. Those with anorexia struggle with shame, guilt and depression, and may have trouble with social connection. Additionally, a co-occurring diagnoses of Obsessive Compulsive Disorder can develop because of an obsession with food patterns and rituals.

Bulimia Nervosa

Bulimia Nervosa, or simply known as bulimia, is associated with bingeing and purging behaviors -- overeating and then trying to get rid of calories through vomiting, excessive exercising or other restrictive diets, but do not meet the criteria for anorexia in that those diagnosed with bulimia may not maintain an extremely low body weight comparable to anorexia.

As with anorexia, bulimia is an emotional illness that is connected to low self-esteem and poor self image. Studies have shown that purging behavior provides a sense of self-control and reduction in anxiety, making it hard to treat. Additionally, research has suggested that purging is often learned through friends and that dieting is a precursor to the development of bulimia.

Binge Eating Disorder

Binge Eating Disorder is characterized by overeating or consuming large amounts of food to the point of loss of control. Binge eating may contribute to weight gain and obesity and can cause feelings of shame, guilt and disgust when eating urges can’t be control. Those who suffer from binge eating disorder turn to food to cope with feelings of low self worth and can trigger depression and anxiety, causing a vicious cycle that indirectly contributes to the disorder.

Differences in the Three Main Eating Disorders

Anorexia
  • Low body weight - typically 85 percent difference from average weight for height and age.
  • Use of extreme measures to control weight - restriction of calories -- excessive exercising, laxatives, diet aid, limiting food consumption, vomiting
  • May co-occur with diagnosis of Obsessive Compulsive Disorder connected to compulsive behaviors tied to food patterns, thoughts or rituals.
  • Connected to feelings of low self-worth and distorted body image
Bulimia
  • Use of extreme measures to control weight - restriction of calories -- excessive exercising, laxatives, diet aid, limiting food consumption, vomiting
  • Is not necessarily connected to low body weight
  • Connected to feelings of low self-worth and distorted body image
Binge Eating Disorder
  • Overeating or consuming large amounts of food in one setting.
  • Feeling a loss of control to stop urges
  • Connected to feelings of guilt and shame regarding food consumption and can trigger depression and anxiety
  • Use of food to cope with depression and anxiety which contributes to cycle of overeating.
  • Causes of Eating Disorders and Risk Factors

What Causes an Eating Disorder

While they are no definitive causes of eating disorders, there are several factors that can contribute to the development of the illness, including:

Genetics - Studies have found that eating disorders are common in people whose first-degree relatives – parents, siblings – also have the illness. Additionally, children may learn behaviors connected to eating disorders from moms who struggle eating issues, unwittingly teaching negative behaviors to their children, such as using food as a reward, modeling unusual eating patterns or expressing concern about their own weight or their child’s weight.

Environmental - those who have experienced family dysfunction or witness alcohol or substance abuse in the family may turn to food to cope. Additionally, those whose caregivers or family members were overly critical of their weight or body were more at risk for an eating disorder.

Trauma - those who have experienced sexual abuse or physical or emotional neglect are at a higher risk of eating disorders

Society Pressures - Society and cultural pressures to be thin and feelings of low self worth or inadequacy connected to societal preferences can contribute to eating disorders.

Substance abuse - those who are currently substance abusers or are withdrawing from drugs or alcohol are more prone to anxiety disorders. Additionally, those who experience anxiety may be more prone to turn to drugs or alcohol to lessen their symptoms.

Co-occurring conditions - those dealing depression and anxiety, as well as obsessive compulsive behaviors can be contributing factors to an eating disorder.

Signs and Symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a reference manual used by healthcare professionals as the authoritative guide to the diagnosis of mental disorders – the symptoms of the three main eating disorders are highlighted below.

Anorexia Nervosa

The signs and symptoms of anorexia includes the following and are identified as behaviors that are recurrent and consistent over at least a 3-month period:

  • Restriction of calorie intake that leads to significantly low body weight in comparison to the average of those with the same age, height, sex.
  • Fear of gaining weight or becoming overweight and using extreme measures to restrict calorie use.
  • Distorted view of body image and persistent lack of awareness of the current low body weight.
Bulimia Nervosa

The signs and symptoms of bulimia includes the following and are identified as behaviors that are recurrent, at least once a week, and consistent over at least a three-month period:

  • Recurrent episodes of binge eating, which is characterized by the following:
    • Eating an amount of food, in a short period of time (within any two-hour period) that is disproportionately larger than the average person would eat in the same setting under similar circumstances.
    • A feeling of loss of control during the eating episode.
  • Recurrent behaviors to prevent weight gain, including vomiting, misuse of laxatives, diuretics or enemas, excessive exercising or dieting.
  • Distorted views on weight and body shape.

 

While the behaviors and thought patterns are similar to anorexia, those who struggle with bulimia are not characterized by extremely low body weight.

Binge Eating Disorder

The signs and symptoms of binge eating includes the following and are identified as behaviors that are recurrent, at least once a week, and consistent over at least a three-month period.

Binge eating episodes are associated with three or more of the following:

  • Eating faster than normal
  • Eating until uncomfortably full
  • Eating large amounts of food when not actually hungry
  • Eating alone because of shame
  • Feeling guilt, shame or disgust after episodes of overeating

 

While an eating disorder requires a clinical diagnosis, below are some signs that may be helpful in determining whether to seek an assessment for yourself or family member:

  • Changes in food habits or patterns, including skipping meals, drastically reducing portion sizes or not eating in front of people.
  • Consistently selects low-fat or low-calorie food items to limit calorie intake such as lettuce, tomatoes, cucumbers or other foods with limited calories, fats or sugars.
  • Immediately excuses themselves to go to the bathroom after a meal to purge themselves of the recent caloric intake. Turns on faucet to cover sounds of vomiting or uses mouthwash frequently to cover smell of vomit.
  • Large amounts of empty food containers or empty cupboards to restrict food intake.
  • Wears baggy clothing or oversize clothing disproportionate to their size to hide body.

There are Two Subtypes of Anorexia

Restricting type - Behaviors in which the weight loss is accomplished through restrictive measures -- dieting, fasting or excessive exercise.

Binge-eating/purging type - Behaviors in which the weight loss is accomplished through excessive eating in a short time frame followed by a purging behavior to get rid of the calorie intake, such as vomiting, misuse of laxatives, diuretics or enemas.

Do I Have an Eating Disorder?

While many people will diet or restrict calories at some point in their lives, it may be hard to identify definitive symptoms of an eating disorder.

A diagnosis of an eating disorder requires an evaluation and diagnosis by a licensed clinician such as a psychiatrist or psychologist who specializes in eating disorders. At Clarity Clinic, we specialize in eating disorder assessments and treatment for children, teens, and adults aimed at understanding the severity, length and frequency of the symptoms, including ruling out a differential diagnosis, to determine the best treatment options.

Treatment for Eating Disorders

To date, there are no medications approved specifically for the treatment of eating disorders, although medication has been found to be helpful in treating co occurring disorders that are connected to eating disorders including depression and anxiety. Some medications, including antidepressants, have found to be helpful in treating serotonin levels that may be a contributing factor to eating disorder symptoms.

Unfortunately only ⅓ of those struggling with an eating disorder seek treatment. Studies have shown that the therapeutic alliance -- the connection between an individual and his/her therapist -- has the greatest effect in regard to client success.

Because those who struggle with an eating disorder may be more sensitive to disapproval, judgement or criticism, it is important that individuals feel empathy and nurturing in their relationship with their therapist.

Studies have found that cognitive behavior therapy has been effective in treating eating disorders. Cognitive-behavior therapy or CBT is a goal oriented therapy that focuses on changing behaviors and thought patterns for those suffering from eating disorders. At Clarity Clinic, our therapists are trained in CBT interventions and strategies to help patients acknowledge and redirect distorted thought patterns about their weight and body image, as well as strengthen their view about themselves, to improve self-worth and self esteem.

Our therapists take an multi-disciplinary approach, working in conjunction with the psychiatrist treating co-occurring disorders, as well as the client’s nutritionist and family to devise an individual treatment plan tailored to each client's symptoms.

Family therapy is also recommended in the treatment of individuals struggling with an eating disorders, particularly adolescents, considering family dynamics often contribute to the development and continuity of the disorder.

Living with Someone with An Eating Disorder

An eating disorder can obviously take a huge emotional and physical toll on the individual struggling, but it can also cause depression and anxiety in family members who feel helpless in improving their loved one’s symptoms. Some suggestions to help your loved one may include:

  • Encourage them to seek professional help
  • Focus on strengths
  • Take the focus off food and weight
  • Reduce conflict at mealtime but discussing concerns separate from food settings
  • Seek family therapy or participate in a support group
  • Highlight characteristics of self outside of appearance (i.e. compliment on their kindness, sense-of humor, thoughtfulness, etc.)

Initial Evaluation

At Clarity Clinic, we have highly trained staff who specialize in diagnosing and treating eating disorders. To schedule an appointment, click on one of the specialists below to schedule an initial evaluation to and discuss assessment, diagnosis and treatment options.

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