Eating Disorders: Diagnosis, Treatment, and Resources

Feeding and nourishing ourselves is necessary for physical and emotional survival. Our relationship with food is complicated. Food is love, history, tradition, and connection. It is powerful, we use it to comfort, soothe, and reward ourselves. Our time and energy is spent cooking, buying, eating, hating, loving, counting, and judging food. When our relationship with food becomes distressing, exhausting, and a means by which we measure our worth, we may in fact be struggling with an eating disorder. An eating disorder is not oppositional behavior, it is not a weakness or character flaw or a way to get even. It is complex illness where genetics, temperament, and environment play a role. You are not to blame for your eating disorder and in many ways it provides you comfort and control, so it can be scary to think about addressing or stopping these behaviors. Eating disorders are relentless, and will never be satisfied, they take you out of the world and lead to isolation, fear and sometimes death. You did not choose to have an eating disorder but you can choose to accept treatment.


Definition, Symptoms, and Diagnosis

What is an eating disorder?

Eating disorders are severe disturbance in eating patterns that involve restricting, avoiding, and/or binge eating. Distress caused by eating disorders may impair an individual’s daily functioning as well as mental and physical wellbeing. It can also cause problems with growth, development, and fertility. Eating disorders can occur at any age with typical onset in adolescence. Eating disorders often co-occur with other disorders such as depressive and anxiety disorders.

How common are eating disorders?

Eating disorders affect 30 million people of all ages, genders, races, and ethnic group each year; in the United States, 20 million women and 10 million men suffer from an eating disorder at some point in their lives. Eating disorders have the highest mortality rate of any mental illness; at least one person dies every 62 minutes as a direct result of an eating disorder.

At what age do eating disorders occur?

Eating disorders can affect individuals of any age, but typically appear during teenage years or young adulthood. The median age of onset is 21 years-old for binge eating disorder and 18 years-old for both bulimia nervosa and anorexia nervosa, according to a study by the NIMH. In a large national study of college students, 3.5% sexual minority women and 2.1% of sexual minority men reported having an eating disorder. 16% of transgender college students reported having an eating disorder. Another study showed that 13% of women over 50 engage in eating disorder behaviors.

What causes eating disorders?

What causes eating disorders? There is no one cause of eating disorders; rather, genetic, biological, environmental, and psychological factors contribute to increased risk for developing an eating disorder.

Psychological factors may include negative body image, low self esteem, as well as anxiety and stress. Environmental factors can include family issues (parental divorce and other family related stressors), professions that encourage weight loss and thin bodies (examples: ballet and modeling), aesthetically oriented sports (examples: rowing, diving, gymnastics), childhood trauma, sexual abuse, cultural and/or peer pressure, stressful life transitions.

What types of eating disorders are there?

There are many types of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, selective eating disorder, purging disorder, and other specified feeding or eating disorders (OSFED) (previously called eating disorder not otherwise specified (EDNOS)). Anorexia nervosa is the restriction of food intake leading to reduction of body weight to below what is deemed acceptable and normal for the individual’s age and height. Bulimia nervosa includes episodes of eating large quantities of food (binging) and then purging through compensatory behaviors like self-induced vomiting, inappropriate use of laxatives, fasting, and/or over-exercising. It often involves the individual feeling a lack of control over their eating. Binge eating also includes episodes of eating large quantities of food (binging) to the point of discomfort, most of the time very quickly, without any self-induced vomiting or other compensatory behaviors found in bulimia. It’s important to seek help if experiencing symptoms of an eating disorder in order to improve one’s physical and mental wellbeing.

Read more about anorexia nervosa >>
Read more about bulimia nervosa >>
Read more about binge eating disorder >>

What is the difference between anorexia, bulimia, and binge eating disorder?

The difference between anorexia and bulimia is binging and purging. A person with bulimia purges their food through: self-induced vomiting, misusing laxatives, and/or over-exercising to “get rid of” the calories. A person with anorexia restricts food intake or doesn’t eat for days at a time and when they do, eats very little. In severe cases of anorexia, a patient will simply not eat at all and these cases, hospitalization will be necessary so that they can receive nutrients and calories through IV or feeding tube.

What are medical complications of eating disorders?

Overall, the long term effects of eating disorders can range from dental and GI problems due to purging and/or laxative use to death from starvation. Hair loss or thinning, loss of menses, anemia, and infertility are other possible effects. The longer term psychological effects can be depression and anxiety as well as co-occurring disorders like substance use or non-suicidal self-harm (cutting).

Learn about the medical complications of anorexia nervosa >>
Learn about the medical complications of bulimia nervosa >>


Treatment for eating disorders

What is the best treatment for an eating disorder?

Most eating disorder treatment includes team approach, typically with a therapist, nutritionist, physician, and psychiatrist. There are different levels of care depending on the severity of the eating disorder. The best approach to treatment is holistic and encompasses all of the different aspects and complexities of an eating disorder. physical and mental as well as social and interpersonal function.

What should you expect from outpatient treatment for eating disorder?

Outpatient treatment involves meeting with a therapist and potentially a treatment team in a setting other than an overnight stay at a hospital. Outpatient treatment is ideal for patients who are medically stable and able to function across all areas of daily life, including social, educational, and vocational. Patients attend treatment at a therapist’s private practice, a treatment center, or a hospital and attend therapy (individual, group, family), meet with medical providers such as psychiatrists and nutritionists, and participate in activities like yoga classes or art therapy workshops. In appointments with nutritionists, patients have meals and snacks during the day where some of the skills they are learning can be practiced. Patients go home each day and are encouraged to practice the skills they have learned while in therapy. Meal plans and relapse prevention plans are a key component to treatment so that the patient can exit treatment with ongoing care and support.

What should you expect from inpatient treatment for eating disorders?

Patients are admitted to an inpatient program, which involves overnight hospitalization, when they are psychiatrically and/or medically unstable. For example, if someone has lost so much weight that they have developed a heart problem or have suicidal intentions and are at risk of physically harming themselves, an inpatient program would be appropriate. Inpatient programs offer twenty-four hour care and patients live at the center for however long treatment is deemed necessary. This can be for 2 weeks to sometimes a whole year. Similar to outpatient treatment, the daily schedule involves therapy (individual, family, group) and classes (yoga, meditation), as well as nutrition counseling and meeting with various providers, such as psychiatrists, dietitians, and therapists.

How can you help someone with an eating disorder?

The best way to help someone with an eating disorder is to be a source of support, comfort, and empathy. Get educated about eating disorders and learn about signs, symptoms, and treatments available (learn more about anorexia nervosa, bulimia nervosa, binge eating disorder). At the same time, while it is helpful to learn more, avoid using this information as a way to advise your loved one. Eating disorders can cause patients to feel a tremendous amount of shame because much of the behavior is secretive and hidden from their family and friends; advising and instructing may have the opposite effect of making them feel resentful and angry. Instead, try to be compassionate and empathetic. Validate their feelings, and notice if what you are sharing may come across as judgmental or critical.

Learn more on how to help a friend >>
Learn how to help a friend struggling with anorexia nervosa >>
Learn how to help a friend struggling with bulimia nervosa >>
Learn how to help a friend struggling with binge eating disorder >>



Additional resources

What are some national advocacy organizations for eating disorders?

National Eating Disorders Association: The National Eating Disorders Association (NEDA) is a nonprofit organization dedicated to supporting individuals and families affected by eating disorders. NEDA offers our programs and services to raise awareness, build communities of support and recovery, and fund research.

National Association of Anorexia Nervosa and Associated Disorders (ANAD): The National Association of Anorexia Nervosa and Associated Disorders (ANAD) is a non-profit organization headquartered in Illinois, providing support, awareness, advocacy, referral, education, and prevention work for people struggling with eating disorders.

Project HEAL: Project HEAL is a non-profit organization that advocates for everyone who is seeking treatment for eating disorders, regardless of their race, income, insurance plan, age, education level, sex, or sexual orientation. They provide financial assistance in accessing treatment for highly motivated applicants who want to recover from an eating disorder but cannot afford to pay for treatment. They also have a peer mentorship program called Communities for HEALing, in which they offer one-on-one support and local weekly support groups. Communities for HEALing is undergoing a research study that will demonstrate whether different kinds of mentorship can help people recover from an eating disorder, whether that is through peer mentorship or social support mentorship.

International Association of Eating Disorders Professionals (IAEDP): The International Association of Eating Disorders Professionals (IAEDP) provides ethical and professional standards for therapists, nutritionists, and other medical and mental health professionals  that treat eating disorders. They provide educational classes, and trainings in order to promote a standard of excellence in the field of eating disorders. They also certify that professionals have met prescribed requirements, help raise public and professional awareness for eating disorders, and assist in prevention efforts.




About the contributors

Dr. Marianna Kessimian, MD

Dr. Marianna Kessimian is a child, adolescent, and adult psychiatrist in Providence, RI. She received her MD from Boston University where she was also selected for the Gold Humanism in Medicine society as well as the Ruth J Hunter Johnson Prize for excellence in psychiatry. Dr. Kessimian completed her adult psychiatry training and child psychiatry fellowship at Brown University, where she served as chief resident. Previously, she was a staff psychiatrist at the Young Adult Behavioral Health clinic, and in this role was afforded the opportunity to work on campus at the Rhode Island School of Design providing psychiatric care to their students.

 

Hannah Goodman, LMHC

Hannah Goodman is a Licensed Mental Health Counselor in Barrington, RI. She specializes in anxiety, including panic disorder, Obsessive Compulsive Disorder and worry. She also has expertise in depression, adolescent issues, life transitions, couples counseling, and family counseling. Outside of her counseling practice, Hannah works as a writing coach and college counselor, drawing on her years of experience in the school system to help individuals of all ages with writing projects and prospective college and graduate students with their applications.

 

 

Sources

  • At least 30 million people of all ages and genders suffer from an eating disorder in the U.S.
    • Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.
    • Le Grange, D., Swanson, S. A., Crow, S. J., & Merikangas, K. R. (2012). Eating disorder not otherwise specified presentation in the US population. International Journal of Eating Disorders, 45(5), 711-718.
  • Every 62 minutes at least one person dies as a direct result from an eating disorder.
    • Eating Disorders Coalition. (2016). Facts About Eating Disorders: What The Research Shows.
  • Eating disorders have the highest mortality rate of any mental illness.
    • Smink, F. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports,14(4), 406-414.
  • 13% of women over 50 engage in eating disorder behaviors.
    • Gagne, D. A., Von Holle, A., Brownley, K. A., Runfola, C. D., Hofmeier, S., Branch, K. E., & Bulik, C. M. (2012). Eating disorder symptoms and weight and shape concerns in a large web‐based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. International Journal of Eating Disorders45(7), 832-844.