An Introduction to Eating Disorders
What Are Eating Disorders?
Eating Disorders are defined as any “severe, prolonged disturbance in eating behaviours” (Brandsma, 2007) which include anorexia nervosa, bulimia nervosa and “eating disorders not otherwise specified” (American Psychiatric Association, 2000). All involve a distorted perception of body shape and weight with an intense fear of becoming fat.
Eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships. They are not a fad, phase or lifestyle choice. They are often misunderstood as their outward symptoms relate to food and preoccupation with weight, shape and size while their underlying causes involve deeper issues such as low self-esteem, distorted body image, perfectionism or other “stressors” that are very unique to the person struggling with an eating disorder. Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health. Like any mental illness, they bring with them misunderstanding, guilt, shame, fear, anxiety and depression making the disease hard to treat and isolating both those with the eating disorder and their families.
People struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery.
Types of eating disorders as per the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder (BED)
- Avoidant/ Restrictive Food Intake Disorder (ARFID)
- Rumination Disorder
- Other Specified Feeding or Eating Disorder (OSFED)
- Unspecified Feeding or Eating Disorder
Psychological counseling for an eating disorder
Psychological counseling (psychotherapy) is generally the most important eating disorder treatment. It involves seeing a psychologist, psychiatrist and other trained professionals (dietitians, physicians, recreational therapists) on a regular basis. It is important to tailor the treatment to each unique individual as evidence shows us rigid clinical programs are not as effective as individualized, multidisciplinary approaches that involve a trained therapist and/or psychiatrist, dietician and physician.
Counseling may last from a few months to years. Most programs today acknowledge that a combination of individual, family and group therapy works best for speedy recovery. Family and group therapy are highly recommended not only to increase support but to break the silence and secrecy that is an integral part of maintaining an eating disorder.
Families and the individual are often surprised by the diagnosis and need considerable support to mend the loss of trust and find their way back into a healthy way of being. Recovery from an eating disorder rarely follows a straight line and families need help to navigate the rocky path with their loved one. Intensive, consistent therapy with a trained therapist is ideal.
Group therapy allows the individual to realize that they are not alone, to lift the shame of the illness, to navigate the disappointments and to celebrate the victories of recovery. Individuals value the opinion and honest feedback of somebody who has struggled the same as they have. Groups also allow individuals to hold each other accountable to recovery and work on interpersonal skills.
Models effective in group therapy include CBT, DBT (dialectical behaviour therapy) , EFT (emotion focused therapy) and mindfulness.
Dietitians and other professionals involved in your treatment can help you better understand your eating disorder and help you develop a plan to maintain healthy eating habits. Goals of nutrition education generally include:
- Education about how nutrition affects your body
- Meal planning
- Establishing regular eating patterns — generally, three meals a day with regular snacks
- Taking steps to avoid dieting
Nutrition education may involve cognitive behavioural therapy techniques to help you recognize and manage faulty beliefs and thought patterns that affect your food intake and to better understand how your eating disorder causes nutrition issues and physical problems.
Getting Help for a Loved One or Friend
Eating disorders are physically and emotionally corrosive to relationships. People with eating disorders need to seek professional help immediately. Keep in mind: early diagnosis and intervention significantly enhance recovery. If not identified or treated in their early stages, eating disorders can become chronic, debilitating, and life-threatening.
Seeing someone engage in destructive eating patterns is frightening, frustrating and hard to understand. It is common to experience anger, fear, confusion and guilt. Regardless of how much you want to help, it is important to keep in mind that if the person is an adult, they must make the decision to seek professional help.
People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Ongoing emotional support is necessary for the individual, as recovery can be a long process and relapse is common.
Remember: eating disorders are not due to failure of will or behaviour; rather, they are real, treatable mental illnesses in which certain maladaptive patterns of eating take on a life of their own.
Before you do anything take some time to think about your best course of action, get educated and seek support!
The following is an important list of Dos and Don’ts:
- Learn about eating disorders so you are able to recognize the signs
- Remember eating disorders are potentially fatal diseases and should be treated accordingly
- Listen to your friend or loved one with understanding, respect and sensitivity
- Tell the person you are concerned and that you care and would like to help
- Encourage the person to seek professional help from a physician and/or therapist
- Be available
- Discuss feelings rather than food, weight or exercise
- Empower the individual to make their own decisions and be accountable for their decisions
- Don’t take any action alone- Get help!
- Don’t try to solve the problem for them- they need a qualified professional
- Don’t blame them for doing something wrong or tell them they are acting silly
- Don’t focus on weight or any particular eating habits
- Don’t comment positively or negatively on appearance or weight
- Don’t force the person to eat or tell them to “just eat”
- Don’t reject or ignore them, they need you
- Don’t give up! It takes time and they need your support!
Incidence and Mortality
Eating disorders have the highest mortality of ANY mental illness. The National Association of Anorexia Nervosa and Associated Disorders in the US reported that 5-10% of anorexics die within 10 years after developing the disease; 18-20% die after 20 years and only 30-40% ever fully recover. Eating disorders are generally believed to be a young women’s disease, however, this is not true. It affects girls as young as 5 years old, older women aged 60+ who have been living with the disease for 30 or more years and boys and men. An estimated 10-15% of people suffering with an eating disorder are male. It has recently been stated that there are 800,000 Canadian men currently suffering with eating disorders.
Incidence is likely higher than what reports and studies show us since only 1 in 10 women with eating disorders receive treatment and only 35% of people that receive treatment get treatment at a specialized treatment facility. In 1993, Statistics Canada estimated that up to 2% of women, aged 15 to 25, had anorexia and up to 5% of that same age group had bulimia. Between 3-5% of women aged 18-45 will experience a serious eating disorder in their lifetime. The Academy for Eating Disorders estimates that approximately one in 20 young women have an eating disorder in the U.S. while a 2011 study reported 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or another type of eating disorder (Wade, Keski-Rahkonen, & Hudson, 2011).
About one in five Albertans will experience a mental illness during their lifetime, and in a given year, approximately 1.3% of Albertans (2.2% of females) are at risk of an eating disorder, which affects approximately 31, 531 Albertans (26, 693 females).
Health Consequences, Including Mortality
Although eating disorders have the highest mortality rate of any mental disorder, the mortality rates reported on those who suffer from eating disorders can vary considerably between studies and sources. Part of the reason why there is large variation in the reported number of deaths caused by eating disorders is because those who suffer from an eating disorder may ultimately die of heart failure, organ failure, malnutrition or suicide. Often, the medical complications of death are reported instead of the eating disorder that compromised a person’s health.
Various studies indicate that about 20% of those with anorexia will die within 20 years of the onset – from both suicide and physical illness — and 76% will achieve full recovery (APA, 2000). Almost every part of the body is impaired but the immediate risks may include the following (Stuart & Laraia, 1998):
- Electrolyte imbalance: Hypokalemia and hypochloremic metabolic acidosis (due to purging). Dehydration, edema, hypomagnesemia, and hyperamylasemia.
- Cardiovascular problems: arrhythmias, hypotension, and bradycardia due to starvation.
- Gastrointestinal complications: esophagitis and parotitis due to vomiting. Delayed gastric emptying due to starvation.
- Other: Anemia due to starvation. Diabetes mellitus due to obesity.
Eating disorder treatment: Know your options
Treatments for eating disorders include counseling and education and sometimes medication. Find out what works.
Eating disorder treatment depends on your particular disorder and your symptoms. According to the Cochrane Collaboration, Cognitive Behavioural Therapy (CBT) is considered first line treatment. Evidence is limited as studies are few and involve small numbers (Bacaltchuk et al 2008). CBT combined with psychodynamic and interpersonal therapy also show good results (APA, 2006). In adolescents, family involvement, support and treatment are considered essential. In older patients, individual circumstances should be considered (APA, 2006).
Antidepressant medication is found to be helpful in some cases, but there are safety concerns in those who are severely malnourished, as the risk of seizures is increased (APA, 2006). SSRI treatment has been shown to be effective for bulimia, especially in those with comorbid depression and anxiety (APA, 2006).
Eating disorder treatment also involves addressing other health problems caused by an eating disorder, which can be serious or even life-threatening if they go untreated for long enough.
If an eating disorder doesn’t improve with standard treatment or causes health problems, hospitalization or an inpatient program may be necessary.
Having an organized approach to eating disorder treatment can help you manage symptoms, regain a healthy weight, and maintain your physical and mental health.
Eating disorders are a life threatening, mental illness with physical complications.Although the media sometimes give the impression that eating disorders are new fad, they have a long, tragic, and often hidden history. It has only been in the last decade that research and clinical experience have led to effective treatment and understanding. For most people, recovery is a lengthy process involving specialized intervention by a multidisciplinary team.
Our attitudes and knowledge can help those suffering from them and help them to seek and receive the treatment they need. Remember, that people are much more than their diagnosis and “stand up against the illness and not the person”.