Understanding Eating Disorders and Treatment Interventions

Eating disorders are severe and complex conditions that affect both physical and mental health. These conditions go beyond just habits around food and body weight to impact a person’s overall well-being. Understanding eating disorders is critical for behavioral health and other healthcare professionals, since these disorders can affect anyone.

Conditions like anorexia, bulimia, and binge-eating can have a significant impact not only on the person suffering but also on their family and friends. They can even be fatal. Understanding eating disorders helps foster better treatment outcomes for those struggling with these complex conditions.

Recommended course: Understanding Obesity and Eating Disorders

Types of eating disorders

Eating disorders are officially recognized psychiatric disorders characterized by abnormal or disturbed eating habits and related thoughts and emotions. Understanding eating disorders starts with knowing the various types, including:

Anorexia Nervosa

This disorder is characterized by a distorted body image and an irrational fear of gaining weight, leading to severe food restriction and dangerous weight loss. Individuals with anorexia often see themselves as overweight, even when they are underweight.

There are two subtypes of anorexia: restrictive subtype and binge-purge subtype.

Restrictive subtype: Those who exhibit this type of anorexia nervosa severely limit the amount of food they consume.
Binge-purge subtype: In this subtype, people severely restrict the amount of food they consume, but they also exhibit episodes of binge-eating and purging.

Symptoms of anorexia nervosa might include:

Dramatic weight loss
Extreme restrictive eating
Dressing in loose clothing or layers to hide weight loss or stay warm
Intense fear of gaining weight
Low blood pressure
Thinning of hair and nails
Anemia
Muscle weakness
Maintains excessive and rigid exercise routines
Preoccupation with food, weight, calories, and dieting
Constipation and dehydration

Bulimia Nervosa

Bulimia is a condition where individuals experience frequent and recurrent episodes of eating large amounts of food and feeling a lack of control over these episodes. The binge-eating episodes are followed by behaviors to prevent weight gain, such as self-induced vomiting (purging), excessive exercise, or the use of laxatives.

The main difference between bulimia and anorexia binge-eating type is that people with bulimia may maintain an average or above average weight, making the disorder less noticeable to others. Those with anorexia binge-eating subtype engage in long-term weight suppression.

Symptoms of bulimia include:

Preoccupation with body shape and weight
Consuming a substantial amount of food in a short period of time
Exhibiting purging behaviors, such as vomiting or using laxatives after meals
A chronically sore or inflamed throat
Sensitive or decaying teeth
Acid reflux or gastrointestinal issues
Severe dehydration
Electrolyte imbalance

Binge-Eating Disorder (BED)

Binge-eating disorder is like bulimia, with episodes of eating large quantities of food in a short period of time but without the regular use of purging behaviors. This can lead to weight gain and is often associated with feelings of shame or guilt.

Symptoms of BED can include:

Eating large amounts of food in a short period of time
Fear of eating in public or around others
Feeling a lack of control or inability to stop eating
Stealing or hoarding food

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/restrictive food intake disorder is a new diagnosis in the DSM-5 and was previously known as “Selective Eating Disorder.” Unlike anorexia, where the avoidance of food is related to weight and body image concerns, ARFID involves a lack of interest in eating or an aversion to certain foods based on sensory characteristics or a past negative experience with food. It can lead to significant nutritional deficiencies and weight loss.

Pica

Pica involves eating things that are not considered food, such as dirt, clay, or hair, for at least one month at an age where this behavior is developmentally inappropriate. Typically, those with pica are not averse to eating food and do not experience the same body image issues as other eating disorders.

Rumination Disorder

This disorder is characterized by regurgitating food. The regurgitated food is often repeatedly chewed and re-swallowed or spit out. To be diagnosed with rumination disorder, frequent regurgitation must be present for at least one month. Those with this disorder appear without the apparent nausea or disgust that accompanies purging in bulimia.

Other Specified Feeding or Eating Disorder (OSFED)

This category includes eating disorders that do not meet the full criteria for the above disorders but still cause significant distress or impairment in social, occupational, or other important areas of functioning.

Eating disorders have serious health consequences and are often fatal. Understanding eating disorders and the importance of treatment is beneficial to those who suffer from these conditions.

How common are eating disorders?

Experts estimate that around 9% of Americans have or have had an eating disorder at some point in their life. These disorders often affect women more than men, with women having a higher prevalence for all eating disorders. The lifetime prevalence of anorexia nervosa for females ranges from 0.3%-1.5%. For males, it ranges from 0.1%-0.5%.

The overall prevalence of bulimia nervosa is around 0.3%. Broken down by gender, bulimia develops in 1.5% of women and 0.5% of men. Binge-eating disorder is the most common eating disorder, with a lifetime prevalence for females ranging from 2.5%-4.5% and for men ranging from 1%-3%. Conditions such as ARFID, pica, and rumination disorder have varying prevalence rates and are less studied than anorexia, bulimia, and binge-eating disorder.

Understanding eating disorders and their risk factors

Eating disorders are complex and complicated. These conditions can affect all kinds of people, and the development of an eating disorder often involves a combination of biological, psychological, and environmental factors.

Internal factors effecting eating disorders: Genetic, biological, psychological

Significant evidence suggests that eating disorders run in families, pointing to a genetic predisposition. Relatives of individuals with eating disorders are at a higher risk of developing these conditions themselves. Hormonal imbalances, differences in brain structure and function, and certain nutritional deficiencies can contribute to the development of eating disorders.

Psychological characteristics, such as perfectionism, body dissatisfaction, low self-esteem, and an excessive focus on body image are commonly associated with eating disorders. Traumatic events such as abuse, chronic stress or illness, can also trigger these behaviors. Bullying, especially regarding size or weight, and critical or judgmental comments about weight can increase the risk of developing an eating disorder.

Eating disorders also often coexist with other mental health disorders such as anxiety, depression, and obsessive-compulsive disorder (OCD), suggesting a link between these conditions.

External factors impacting eating disorders: Sociocultural influences

The portrayal of ideal body images in media and cultural pressures to attain a specific body shape can significantly impact an individual’s body image and can contribute to eating disorder behaviors. Peer pressure and societal norms around weight and dieting also play a role.

Significant life changes or stressors, such as starting a new school, going to college, or experiencing a breakup, can trigger the onset of an eating disorder, especially in individuals who may already be susceptible.

Understanding the interplay of these factors is critical to preventing and treating eating disorders. It is a complex issue without a single cause, and everyone’s experience with an eating disorder is unique.

The connection between eating disorders and obesity

Obesity is characterized as excessive or abnormal body fat, which can significantly impact physical well-being and increase the risk of various chronic diseases. A body mass index (BMI) of over 30 is considered obese. Globally, obesity has reached epidemic proportions. The World Health Organization reported that between 1975 and 2016, obesity rates among children and adolescents (5 -19) had increased nearly fourfold.

The consequences of obesity are far-reaching, impacting nearly every system in the body. It is a significant risk factor for chronic conditions such as:

Type 2 diabetes
Cardiovascular diseases
Certain types of cancer
Musculoskeletal disorders like osteoarthritis

Beyond the physical health risks, obesity can also lead to psychological issues, including depression and low self-esteem. Fad diets, often promoted for quick weight loss, can be dangerous because they are often lacking in essential nutrients and unsustainable in the long term. These diets can lead to a cycle of yo-yo dieting that can further harm metabolism and make long-term weight management more difficult.

Healthcare interventions for obesity focus on a sustained and multidisciplinary approach that includes:

Dietary changes
Increased physical activity
Behavior modifications
When necessary, pharmacotherapy or bariatric surgery

These interventions aim to reduce body weight and improve health and maintain these health gains over the long term. Preventive strategies are also essential, addressing the root causes of obesity and promoting healthier lifestyles.

Treatment for eating disorders

Treatment for eating disorders typically involves a multidisciplinary approach tailored to the individual’s needs, considering the type and severity of the disorder, as well as the individual’s physical and mental health. Some of the common interventions for eating disorders include:

Medical stabilization: If an eating disorder has led to severe health issues, the priority is to address and stabilize these conditions. This may involve hospitalization, especially if there is severe malnutrition, electrolyte imbalance, or psychiatric emergencies.
Nutritional counseling: A registered dietitian can help develop a meal plan to achieve and maintain a healthy weight. These plans often include re-establishing regular eating patterns and addressing issues like dieting, body image, and food myths.
Psychotherapy: This is a crucial component of treatment.
Cognitive-Behavioral Therapy (CBT): CBT can help to change unhealthy eating patterns and distorted thoughts about body shape and weight.
Family-Based Therapy (FBT): Also known as the Maudsley Approach, FBT is beneficial for adolescents with eating disorders, involving the family in the recovery process.
Interpersonal Psychotherapy (IPT): IPT addresses issues in relationships that may contribute to the eating disorder.
Medications: While no medication can cure eating disorders, some can help control urges to binge or purge or handle symptoms of depression or anxiety that often accompany these disorders. For example, selective serotonin reuptake inhibitors (SSRIs) are often used for bulimia and binge-eating disorders.
Physical therapy: Some individuals with eating disorders may benefit from physical therapy and work on rebuilding muscle mass and strength.
Alternative therapies: Alternative therapies like art, music, and body awareness can complement traditional approaches. These help individuals bring awareness to and process their thoughts and feelings around food, their body, and their self-image.

Recovery: Developing a healthy relationship with food

Recovery from an eating disorder is often a long-term process. Relapses can occur, and treatment needs to be flexible and adaptable to the individual’s evolving needs. The goals of eating disorder treatment are restoring adequate nutrition, bringing weight to a healthy level, reducing excessive exercise, and stopping binge-purge behaviors while helping individuals form healthy relationships with food and their bodies.