Eating Disorders
By: Sharon Burris-Brown, LICSW, NBC-HWC
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, cultural messages can take over, because it is impossible to get away from the onslaught that to be thin is beautiful.
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.
Results
- 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. However, it is known that they run in families. The question is: are these individuals at risk genetically or do eating habits, beliefs around food and weight get passed down? Even when two people have the exact same symptoms, their background and treatment needs will differ. Environment and biology intertwine to increase risk.
Some of the environmental risks are bullying, trauma of all types, familial criticism of body size and shape, and food insecurity; temperament/psychological traits and states, believed to be partially predisposed genetically, include perfectionism, anxiety, Obsessive Compulsive Disorder and depression. Substance abuse and eating disorders often go hand in hand. In fact, up to 50% of people with eating disorders abuse drugs and alcohol which is a rate five times higher than the general population.
Disordered Eating Versus Eating Disorders
It is important to distinguish eating disorders from disordered eating, says Kay Guidarelli, a Registered, Licensed Dietitian at Lyn Lake Psychotherapy and Wellness. Many individuals will participate in yoyo dieting, struggle with preoccupation with food, have a hard time controlling their intake at times.
And those who struggle with depression, anxiety and other mental illnesses may be prone to disordered eating which may or may not rise to the level of an eating disorder.
Types and Nature of Eating Disorders
As with substance use disorders, clients can fall over the edge into the disorder without realizing or desiring it. Both hijack the brain and those who fall victim to eating disorders may not perceive the degree of their illness and/or deny that there is a problem.
As with addictions, eating disorders for some people become a coping mechanism to help them deal with emotional pain and individuals may be reluctant to let go of the behaviors for this reason. Eating disordered individuals who also have a substance use disorder may find remission in one area leads to flare-up or relapse in the other, the “whack-a-mole” effect.
Eating disorders can change an individual both psychologically as well as physically. The biological, physical and psychological aspects to these disorders cause them to be uniquely complex, and, at times, tough to treat. However, they ARE treatable and individuals who can do the courageous work of sticking with their 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, 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. Those who binge often feel a lack of control over their intake and may binge even when not hungry. They tend to feel disgusted or depressed after an episode.
- Avoidant Restrictive Food Intake Disorder occurs because of the sensory nature of food, fear about negative consequences of eating and where an individual is not meeting their appropriate nutritional needs.
Treatment
Treatment depends on the person and the severity of the disordered eating. Individuals may need to be hospitalized if they are unstable medically or psychiatrically. Additionally, the levels of care include: residential, partial hospitalization, intensive outpatient and outpatient.
Addressing eating disorders requires a team, typically including, at minimum, a therapist, dietitian, physician, and medication prescriber. There are many different therapeutic approaches to working with eating disorders. The most important component is a feeling of safety and security within the therapeutic relationship, especially for individuals who have experienced trauma.
Relationships with loved ones may be very painful and conflictual and family therapy and couples therapy are often important adjuncts to individual therapy.
Family Based Treatment is most successful with younger clients with anorexia nervosa. 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.
- Uncovers and working through the underlying psychological reasons for the development and maintenance of these disorders.
Nutritional Help for Eating Disorders
The nutritionists at Lyn Lake Psychotherapy and Wellness all specialize in working with clients who have eating disorders and have many years of experience both with eating disorders and with substance abuse disorders. They work with clients purely on an outpatient basis in partnership with the client’s therapist.
“First I do a thorough assessment” says Elizabeth Jackson a Registered Dietitian Nutritionist at Lyn Lake Psychotherapy and Wellness, who also specializes in parent-child feeding issues. “I gather information about not only an individual’s current and past eating patterns, weight history, symptom use, medical issues and treatment history, but also their developmental history regarding feeding and eating, and family and sociocultural contributions to eating issues.” Many of my clients have had some sort of trauma, and, in particular, food trauma, Jackson explains.
Kay Guidarelli states that a large part of her early work with clients is to help them set goals. She works with them on creating an eating plan. The ultimate goal is for clients to learn how to normalize food, to realize that food is only one part of their life, Guidarelli explains, not the whole of their focus and to trust that they can respond to their body’s hunger and satiety signals to maintain.
Jackson states that promoting healthy eating starts from the beginning of life. In her work with parents with infants and children, she promotes “Responsive Feeding”. The basis of responsive feeding is for a parent to respond to their child’s cues and create an environment in which developmentally appropriate food is offered consistently and lovingly. This includes demand feeding for babies and family meals with kids 1 year old and up. Feeding a child is not just for nutritional needs, but it is a time of connection. So, it is imperative for the feeding parent to be present during this time with their baby and as their child grows. This allows the child to connect to his own body signals and to trust that these signals will be respected. Responsive Feeding nurtures secure attachment as well as intuitive eating throughout the life-span.
Nutritionists at Lyn Lake Psychotherapy and Wellness
- Elizabeth Jackson-Registered Dietitian Nutritionist, Licensed Dietitian Nutritionist, elizabeth@therapy-mn.com
- Kay Guidarelli-Nutritionist, Registered Dietitian and Licensed Dietitian, kgnutrition@msn.com
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.