Eating Disorders and Treatment: An Overview
Do you remember the messages your parents implicitly taught you about food when you were growing up? Or weight? How about cultural norms for weight and appearance? Weight stigma is real and even if you grew up learning healthy messages about food and appearance from your parents, the non-stop cultural messaging of “thin is beautiful” can still negatively impact how we view our bodies and our relationship with food. For some of us, this problematic relationship with food and body image and transform into an eating disorder, one of the more frequently diagnosed mental illnesses – and one of the deadliest – in Western society.
A long-term study from the University of Minnesota Project EAT followed over 2,000 middle and high school students reflects how prevalent the drive to be thin can be. The study touched base with the same group of kids at 5 years 10 and 15 years into young adulthood to determine risk factors and patterns of eating behaviors and outcomes in adulthood. Among their results, they found:
- 38% of adolescent boys and 50% of girls tried to reduce their weight by smoking more, taking diet pills and skipping meals.
- 4% of boys and 7% of girls took more extreme measures such as taking laxatives, vomiting after meals, taking diuretics or fasting.
High Risk Communities
In the early days of eating disorder research and treatment, it was believed that eating disorders mainly afflicted white, upper middle class teenage girls. But eating disorders are present in all ethnic and racial groups, genders, ages, income and education levels.
Project EAT found that in Minnesota, Native American teens had the highest incidence of eating disorders out of any other adolescent group. In addition, eating disorders are often common in athletes in sports where there is an emphasis on thinness or weight, among the queer and trans communities, the military, and immigrant groups who are trying to assimilate—an attempt to strive toward the adopted culture’s preferred body type. And, the incidence of eating disorders is rising in older women. Life transitions such as post-pregnancy, menopause and divorce can instigate extreme eating disordered behaviors. Body distress and dieting are two strong predictors for development of eating disorders.
Risk Factors
There is some question whether eating disorders have a genetic component, since eating disorders tend to run in families. Certainly, parents with eating disordered behaviors and beliefs about food are likely to influence their children’s behaviors and beliefs around food and eating. However, there is also a growing body of evidence suggesting a strong genetic component as well. As with many mental health conditions, the most likely answer is that there is some combination of environment and genetics that explain the tendency for eating disorders to be passed down from one generation to the next.
In addition to having a family history of eating disorders, other environmental risk factors include bullying, trauma of all types, criticism of body size and shape (especially from family members), and food insecurity. There are also person-specific risk factors: things like temperament and personality traits and conditions (believed to be at least partly genetic), including perfectionism, anxiety, Obsessive Compulsive Disorder (OCD) and depression. There also appears to be a link between substance abuse and eating disorders, as up to 50% of people with eating disorders abuse drugs and alcohol, which is a rate five times higher than the general population.
It’s important to keep in mind, though, that risk factors are not guarantees. Someone could have immediate family members with an eating disorder, or a highly perfectionistic personality, or OCD, or a history of trauma (or some combination therein), and that does not mean they will absolutely develop an eating disorder. It just means they are at greater risk of developing an eating disorder than someone who has none of these.
Disordered Eating Versus Eating Disorders
It is important to distinguish eating disorders from disordered eating. While everyone with a diagnosed eating disorder engages in disorder eating, not everyone who engages in disordered eating has an eating disorder. Many individuals will participate in yo-yo dieting, go through times with they feel preoccupied with food and/or their weight, or periodically have a hard time controlling their food intake. Given the societal pressures on women and girls to be thin, it is understandable that they may experience unhappiness with their weight and attempt diets or other measures to lose weight. And while these behaviors may be problematic, and can contribute to mental health problems, they are not necessarily symptoms of an eating disorder.
Types and Nature of Eating Disorders
As with substance use disorders, eating disorders often start out as something “sub-clinical,” such as disordered eating. Oftentimes, people don’t even realize their disordered eating has developed into an eating disorder. Most people with eating disorders are unable to recognize that they have an eating disorder and – again, much like with substance abuse – they will vehemently deny that there is a problem.
As with addictions, eating disorders can serve as a coping mechanism to help people deal with emotional pain, and individuals may be reluctant to seek treatment for this reason. Eating disordered individuals who also have a substance use disorder may find that remission in one area leads to flare-up or relapse in the other.
Eating disorders can change an individual both psychologically as well as physically. The biological, physical and psychological aspects of these disorders make them uniquely complex and difficult to treat. However, they ARE treatable and individuals who are able to follow through with treatment often have positive outcomes.
Categories of Eating Disorders
- Anorexia Nervosa is characterized by severe restriction of calories coupled with a distorted body image; additionally there may be persistent behaviors that promote weight loss or interfere with weight gain such as laxative and diuretic abuse and purging behavior, as well as excessive exercise. Anorexia has one of the highest mortality rates of any mental illness, with death resulting from direct complications of the disease or by suicide.
- Bulimia Nervosa involves a vicious cycle of binging behavior or eating an amount larger than is typical in a short period of time. After binging , the individual tries to compensate to get rid of the food such as vomiting, excessive exercise, or using laxatives or diuretics. In order to diagnose Bulimia, these behaviors need to be going on for at least 3 months and one or more times a week.
- Binge Eating Disorder includes recurrent episodes of eating large quantities of food in a short period of time without using compensatory behaviors. People with Binge Eating Disorder often feel a lack of control over their food intake and may binge even when they are not hungry. They tend to feel disgusted or depressed after an episode.
- Avoidant Restrictive Food Intake Disorder (ARFID) occurs in individuals who severely restrict food intake because of the sensory nature of food, rarely feel hunger or a desire to eat, and fail to meet their own nutritional needs. While ARFID may look like Anorexia Nervosa, it is important to note that people with ARFID are not preoccupied with a fear of weight gain, nor do they have a distorted perception of their body shape or size.
Treatment
Treatment for eating disorders depends on the person and the severity of the disorder. Individuals may need to be hospitalized if they are unstable medically or psychiatrically. Additionally, the levels of care can include: residential treatment, partial hospitalization, intensive outpatient and outpatient treatment.
Addressing eating disorders requires a team of professionals, which typically includes a therapist, dietitian, physician, and medication prescriber. There are many different therapeutic approaches to working with eating disorders. The most important component is giving eating disorder sufferers a feeling of safety and security within the therapeutic relationship, especially for those who have experienced trauma.
Relationships with loved ones who have eating disorders can be very painful and even adversarial; consequently, family therapy and couples therapy are often important adjuncts to individual therapy.
For younger clients suffering from anorexia nervosa or ARFID, family therapy is often the primary intervention. Parents are trained to take over the re-feeding of their child completely. The focus is on necessary weight restoration and interrupting any compensatory behaviors before returning the control of eating back to the young person, then helping the client and family work on co-occurring mental health issues.
Treatment Focus
- Works toward behavioral and medical stabilization.
- Explores distorted thoughts about food, weight and body image.
- Clarifies values, and develops a sense of self outside of the eating disorder.
- Increases tolerance of different types of food and feelings of fullness.
- Uncovers and works through the underlying psychological reasons for the development and maintenance of these disorders.
Nutritional Help for Eating Disorders at LynLake Centers for Wellbeing
Nutrition Therapy and Counseling Services at Lyn Lake Centers for Wellbeing includes Registered Dietitians with extensive experience working with clients who have eating disorders. They work with clients purely on an outpatient basis, in partnership with the client’s therapist. Should a higher level of care become necessary, our nutritionists will refer the client to a formal eating disorders treatment program.
The Registered Dietitians at LynLake will first conduct a thorough assessment, gathering information about the individual’s current and past eating behaviors, weight history, symptoms, medical issues and treatment history. They also ask about developmental history regarding feeding and eating, family and sociocultural factors influencing eating issues, and whether the individual has a history of trauma, including food trauma.
Following the initial assessment, our Registered Dietitians work with their clients to set treatment goals and create an eating plan. The ultimate goal is to help clients learn how to normalize food, and to decrease the power food has over their daily lives. They also work with clients to learn how to trust their own body’s hunger cues and satiety signals, rather than external cues like weight, measurements, calories, etc.
Eating disorders are a relatively common, but extremely destructive, mental health condition with many contributing factors. While recovery is rarely an easy or simple process, eating disorders are treatable. For those who are able to recover from an eating disorder, they often experience a transformation in nearly every aspect of their daily life. If you or a loved one is suffering from an eating disorder, please contact us today to connect with one of our Registered Dietitians to begin your path to recovery.
By: Sharon Burris-Brown, LICSW, NBC-HWC
Resources/Articles
- http://www.sphresearch.umn.edu/epi/project-eat/
- https://www.nationaleatingdisorders.org/busting-myths-about-eating-disorders
- https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders
- https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/
- https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia
- https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid
- https://www.nationaleatingdisorders.org/types-treatment
- https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf
- Help Your Teenager Beat an Eating Disorder, Lock, James MD, PhD, Le Grange, Daniel PhD. Guildford Press 2015.