Eating Disorders Explained

Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight.

Eating disorders are not due to a failure of will or behavior, rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own.

The main types of eating disorders are anorexia nervosa and bulimia nervosa, and binge eating disorder.

ANOREXIA NERVOSA — Signs and Symptoms

  • Resistance to maintaining body weight at or above a minimally normal weight for age and height.
  • Intense fear of gaining weight, or becoming fat, even though underweight.
  • Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  • Infrequent or absent menstrual periods (in females who have reached puberty).

People with this disorder see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession. Unusual eating habits develop, such as avoiding food and meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxative, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.

The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode, some have a fluctuating pattern of weight gain and relapse, and others experience a chronically deteriorating course of illness over many years. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.

(Above information is reproduced courtesy of NIMH)

BULIMIA NERVOSA — Signs and Symptoms

  • Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode.
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, or misuse of laxatives, diuretics, enemas, or other medications (purging), fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur at least twice a week for 3 months.

Because purging or other compensatory behavior follows the binge eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.

BINGE EATING DISORDER — Signs and Symptoms

  • Recurrent episodes of binge eating, which are associated with at least 3 of the following:
    • eating much more rapidly than normal;
    • eating until feeling uncomfortably full;
    • eating alone because of being embarrassed by how much one is eating;
    • feeling disgusted with oneself, depressed, or guilty after overeating.
  • Marked distress about the binge-eating behavior.
  • The binge eating occurs, on average, at least 2 days a week for 6 months.
  • The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g. purging, fasting, excessive exercise).

People with binge-eating disorder experience frequent episodes of out-of-control eating, with the same binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating disorders do not purge their bodies of excess calories. Many individuals with this disorder are overweight for their age and height.

TREATMENT STRATEGIES

According to NEDA (National Eating Disorders Association), the most effective treatment for an eating disorder is some form of psychotherapy coupled with careful attention to medical and nutritional needs. Ideally, this treatment needs to be tailored to the individual and will vary according to both the severity of the disorder and the client’s individual problems, needs, and strengths.

In the Intensive Outpatient program provided by New Directions Eating Disorders Center, we provide small group sessions by a licensed clinician specializing in eating disorders, and we also provide the services of a nutritionist and will refer to an M.D. psychiatrist when appropriate. Counseling addresses both the eating disordered symptoms and the psychological, interpersonal, and cultural forces that contribute to the eating disorder. We offer family sessions which include significant others as well as family members, and encourage their participation in the recovery process. We also coordinate care with the family physician to ensure that the client is medically stable and can benefit from an intensive outpatient program.