What are eating disorders?
Eating disorders are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight.
People with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies. They usually “feel fat” and see themselves as overweight, sometimes even despite life-threatening semi-starvation (or malnutrition). An intense fear of gaining weight and of being fat may become all-pervasive. In early stages of these disorders, patients often deny that they have a problem.
Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35. There are three main types of eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder.
1.Anorexia Nervosa
Anorexia nervosa is diagnosed when patients weigh at least 15 percent less than the normal healthy weight expected for their height. Hallmarks of anorexia include:
- Limited food intake
- Fear of being “fat”
- Problems with body image or denial of low body weight
People with anorexia nervosa don't maintain a normal weight because they refuse to eat enough, often exercise obsessively, and sometimes force themselves to vomit or use laxatives to lose weight. Over time, the following symptoms may develop as the body goes into starvation:
- Menstrual periods cease
- Osteopenia or osteoporosis (thinning of the bones) through loss of calcium
- Hair/nails become brittle
- Skin dries and can take on a yellowish cast
- Mild anemia; and muscles, including the heart muscle, waste away
- Severe constipation
- Drop in blood pressure, slowed breathing and pulse rates
- Internal body temperature falls, causing person to feel cold all the time
- Depression and lethargy
Bulimia nervosa is another well-known eating disorder.
Like anorexia, bulimia tends to develop during adolescence and early adulthood and appears to be less common among men than women .
People with bulimia frequently eat unusually large amounts of food in a specific period of time.
Each binge eating episode usually continues until the person becomes painfully full. During a binge, the person usually feels that they cannot stop eating or control how much they are eating.
Binges can happen with any type of food but most commonly occur with foods the individual would normally avoid.
Individuals with bulimia then attempt to purge to compensate for the calories consumed and relieve gut discomfort.
Common purging behaviors include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.
Symptoms may appear very similar to those of the binge eating or purging subtypes of anorexia nervosa. However, individuals with bulimia usually maintain a relatively normal weight, rather than becoming underweight.
Common symptoms of bulimia nervosa include :
- recurrent episodes of binge eating with a feeling of lack of control
- recurrent episodes of inappropriate purging behaviors to prevent weight gain
- a self-esteem overly influenced by body shape and weight
- a fear of gaining weight, despite having a normal weight
Side effects of bulimia may include an inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut, severe dehydration, and hormonal disturbances .
In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium, and calcium. This can cause a stroke or heart attack.
Summary People with bulimia nervosa eat large amounts of food in short periods of time, then purge. They fear gaining weight despite being at a normal weight.
Binge eating disorder is believed to be one of the most common eating disorders, especially in the United States .
It typically begins during adolescence and early adulthood, although it can develop later on.
Individuals with this disorder have symptoms similar to those of bulimia or the binge eating subtype of anorexia.
For instance, they typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges.
People with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges.
Common symptoms of binge eating disorder include :
- eating large amounts of foods rapidly, in secret and until uncomfortably full, despite not feeling hungry
- feeling a lack of control during episodes of binge eating
- feelings of distress, such as shame, disgust, or guilt, when thinking about the binge eating behavior
- no use of purging behaviors, such as calorie restriction, vomiting, excessive exercise, or laxative or diuretic use, to compensate for the binging
People with binge eating disorder often have overweight or obesity. This may increase their risk of medical complications linked to excess weight, such as heart disease, stroke, and type 2 diabetes .
Summary People with binge eating disorder regularly and uncontrollably consume large amounts of food in short periods of time. Unlike people with other eating disorders, they do not purge.
Pica is another eating disorder that involves eating things that are not considered food.
Individuals with pica crave non-food substances, such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch .
Pica can occur in adults, as well as children and adolescents. That said, this disorder is most frequently observed in children, pregnant women, and individuals with mental disabilities .
Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.
However, to be considered pica, the eating of non-food substances must not be a normal part of someone's culture or religion. In addition, it must not be considered a socially acceptable practice by a person's peers.
Summary Individuals with pica tend to crave and eat non-food substances. This disorder may particularly affect children, pregnant women, and individuals with mental disabilities.
Rumination disorder is another newly recognized eating disorder.
It describes a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out
This rumination typically occurs within the first 30 minutes after a meal. Unlike medical conditions like reflux, it’s voluntary .
This disorder can develop during infancy, childhood, or adulthood. In infants, it tends to develop between 3–12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it.
If not resolved in infants, rumination disorder can result in weight loss and severe malnutrition that can be fatal.
Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight .
Summary Rumination disorder can affect people at all stages of life. People with the condition generally regurgitate the food they've recently swallowed. Then, they chew it again and either swallow it or spit it out.
Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.
The term replaces what was known as a "feeding disorder of infancy and early childhood," a diagnosis previously reserved for children under 7 years old.
Although ARFID generally develops during infancy or early childhood, it can persist into adulthood. What's more, it’s equally common among men and women.
Individuals with this disorder experience disturbed eating either due to a lack of interest in eating or distaste for certain smells, tastes, colors, textures, or temperatures.
Common symptoms of ARFID include :
- avoidance or restriction of food intake that prevents the person from eating sufficient calories or nutrients
- eating habits that interfere with normal social functions, such as eating with others
- weight loss or poor development for age and height
- nutrient deficiencies or dependence on supplements or tube feeding
It's important to note that ARFID goes beyond normal behaviors, such as picky eating in toddlers or lower food intake in older adults.
Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.
Summary ARFID is an eating disorder that causes people to undereat. This is either due to a lack of interest in food or an intense distaste for how certain foods look, smell, or taste.
In addition to the six eating disorders above, less-known or less common eating disorders also exist. These generally fall under one of three categories :
- Purging disorder. Individuals with purging disorder often use purging behaviors, such as vomiting, laxatives, diuretics, or excessive exercising, to control their weight or shape. However, they do not binge.
- Night eating syndrome. Individuals with this syndrome frequently eat excessively, often after awakening from sleep.
- Other specified feeding or eating disorder (OSFED). While not found in the DSM-5, this includes any other conditions that have symptoms similar to those of an eating disorder but don’t fit into any of the categories above.
One disorder that may currently fall under OSFED is orthorexia. Although increasingly mentioned in the media and scientific studies, orthorexia has yet to be recognized as a separate eating disorder by the current DSM.
Individuals with orthorexia tend to have an obsessive focus on healthy eating, to an extent that disrupts their daily lives.
For instance, the affected person may eliminate entire food groups, fearing they’re unhealthy. This can lead to malnutrition, severe weight loss, difficulty eating outside the home, and emotional distress.
Individuals with orthorexia rarely focus on losing weight. Instead, their self-worth, identity, or satisfaction is dependent upon how well they comply with their self-imposed diet rules .
Summary Purging disorder and night eating syndrome are two additional eating disorders that are currently not well described. The OSFED category includes all eating disorders, such as orthorexia, that don’t fit into another category.
The inner voices of anorexia and bulimia whisper that you’ll never be happy until you lose weight, that your worth is measured by how you look. But the truth is that happiness and self-esteem come from loving yourself for who you truly are—and that’s only possible with recovery.
The road to recovery from an eating disorder starts with admitting you have a problem. This admission can be tough, especially if you’re still clinging to the belief—even in the back of your mind—that weight loss is the key to your happiness, confidence, and success. Even when you finally understand this isn’t true, old habits are still hard to break.
The good news is that the behaviors you’ve learned can also be unlearned. Just as anyone can develop an eating disorder, so too, anyone can get better. However, overcoming an eating disorder is about more than giving up unhealthy eating behaviors. It’s also about learning new ways to cope with emotional pain and rediscovering who you are beyond your eating habits, weight, and body image.
True recovery from an eating disorder involves learning to:
- Listen to your feelings.
- Listen to your body.
- Accept yourself.
- Love yourself.
This may seem like a lot to tackle, but just remember that you’re not alone. Help is out there and recovery is within your reach. With the right support and guidance, you can break free from your eating disorder’s destructive pattern, regain your health, and find the joy in life again.
Levels and Types of Eating Disorder Treatment
The severity of the eating disorder and any co-occurring disorders will determine the initial treatment level you or your loved one should pursue, though it is typical, to begin with, the outpatient level.
Health professionals seen in the outpatient level of care can determine if a higher level of care is needed and refer as necessary. The following are the common levels and types of eating disorder treatment:
Outpatient Eating Disorders Treatment
This type of treatment is the least restrictive level of care. Men and women participating in outpatient programs may see a nutritionist, therapist and other recovery professionals approximately 2-3 times per week.
This level of care can be helpful to those who need to continue to work or attend school. Outpatient treatment is also desirable for those who do not have the insurance to cover higher levels of care but are looking for assistance to stay in recovery.
Intensive Outpatient (IOP) Eating Disorders Treatment
This level of treatment is designed for men and women who do need more support than outpatient treatment but still have some flexibility to remain in school or work.
Programs at this level usually meet at individualized times for the participant, ranging from 2-5 days a week. Treatment options typically include individualized therapy, personalized nutrition consultation, topic-focused groups, and/or family support groups.
Residential Eating Disorders Treatment
At this level of care, individuals are provided with 24-hour care at a live-in facility. Constant medical supervision is placed over every participant, which makes it effective in monitoring health conditions.
These treatment programs are usually very structured, offering a type of setting that allows a man or woman to focus solely on physical and psychological healing. Everything needed is provided in one central location.
Inpatient / Hospital Treatment Eating Disorder Treatment
This level of treatment offers a continuum of care 24 hours a day in a hospital setting. The primary focus of this level of care if medical stabilization and interruption of weight loss, with typical stays less than 3 weeks.
Once the individual is considered to be medically stable, they are usually discharged to a residential treatment center for ongoing care. Find the right eating disorder treatments center in our directory.
Continuing Care
After discharge from residential and/or inpatient programs, men or women have the option of continuing care. This would allow them to continue having periodic sessions with their primary therapist and nutritionist for ongoing support in recovery. The frequency of sessions are typically determined or recommended by the overall treatment team at the higher level of care and prior to discharge.
Additional Treatment Resources
Further treatment resources that are available to men or women with eating disorders include eating disorder support groups or self-help options. Support groups that meet on a weekly or bi-monthly basis are great ways to stay connected to other individuals who are able to empathize and help with accountability. Self-help tools include journal-keeping, meal plan templates, or online recovery support.
Major Types of Therapies for Eating Disorders
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that focuses on negative patterns of thinking as well as beliefs that contribute to these thought patterns. CBT teaches participants skills that allow them to identify problematic beliefs as well as healthy ways to cope with emotions.
CBT has been shown to effectively help those who may be struggling with eating disorders or mood disorders and decrease destructive behaviors. In relation to eating disorders, CBT may include educational components and the development of a meal plan, as well as addressing various facets, such as familial, psychological, and societal factors. Learn more about using CBT to treat eating disorders.
Medical Nutrition Therapy
Medical Nutrition Therapy (MNT) is a holistic method for treatment ofvarious medical conditions and their associated symptoms. This is achieved by the use of customized meal plans that are usually formulated by a Registered Dietitian.
Components of MNT include assessment, dietary modification, and patient education. MNT is used in the recovery of those who suffer from eating disorders to help establish normal eating behaviors and improve one’s relationship with food and body. Learn more about using nutrition therapy to treat eating disorders.
Dialectical Behavioral Therapy (DBT)
Dialectical Behavioral Therapy (DBT) is a form of psychotherapy that connects cognitive and behavioral methods as an approach to coping with painful emotions. The focus of this therapy is usually on individuals who react to emotional circumstances with extreme behaviors.
Components of DBT include the practice of mindfulness as well as emotional regulation. Although DBT was originally designed for those that suffer from Borderline Personality Disorder, it has become an effective treatment therapy for men and women who deal with emotional instability.
DBT techniques can be beneficial for eating disorder treatment in that they allow individuals to better deal with conflict and stress while gaining increased control over negative thoughts and emotions. Learn more about using DBT to treat eating disorders.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy is used to help men and women concentrate on ways to become aware of and accept their emotions and experiences. This therapy is beneficial in eating disorder recovery as it helps individuals develop a healthier relationship with their emotions and intellect.
ACT can also help sufferers with eating disorders to recognize thoughts and urges that are tied to the illness, assisting them in understanding these impulses. ACT is also effective in treating co-occurring disorders such as depression or anxiety. Learn more about using ACT to treat eating disorders.
Art Therapy
This is a form of psychotherapy that uses art media as its main form of communication and therapeutic healing. Men or women who utilize art therapy in treatment are often guided by a professional in illustrating personal stories, thoughts, and/or feelings. Types of art therapy that might be included are painting, clay making, sculpting, and drawing.
Art therapy can be an important part of treatment for those that suffer from eating disorders as it allows a creative outlet for expression and healing. Art therapy can also be useful for treating co-occurring disorders, such as substance abuse or mood disorders. Learn more about using art therapy to treat eating disorders.
Dance Movement Therapy
Dance therapy is a therapeutic form of healing that allows participants to become involved in an alternate way of coping and expressing emotion. Dance therapy also can play a part in achieving a healthy balance as well as an approach to self-expression. Movement is the main way in which dance therapists will observe, evaluate, and apply various interventions.
Dance therapy has been proven an effective form of psychotherapy for various disorders, including learning disabilities and mood disorders. In regards to eating disorders, dance therapy can be influential in healing through guided movements and expressions. Learn more about using dance movement therapy to treat eating disorders.
Equine Therapy
Equine therapy is a form of psychotherapy that uses horses as a tool for emotional growth. Equine therapy is based on the premise that the bond that can grow between humans and animals will allow for emotional healing to occur. Activities that might be involved are care for and grooming of the animal and basic exercises guided by a horse specialist. Men or women who use equine therapy during treatment might have increased self-esteem and body image, particularly as the care for an animal has been shown to be an empowering experience. Learn more about using equine therapy to treat eating disorders.
Exposure and Response Prevention Therapy (ERP)
Exposure and Response Prevention Therapy (ERP) is essential is helping individuals overcome fears and anxiety. This is accomplished by gradually exposing a man or woman to the feared object or circumstance with the goal desensitizing fears.
Additionally, ERP also focuses on assisting participants in resisting the use of compulsive behaviors that might typically be used to cope with feelings of fear or anxiety. The primary goal is for individuals to remain connected to the trigger without the use of their ritualistic behaviors.
ERP can be effective in the treatment of eating disorders as it helps participants overcome fears of forbidden foods and decrease urges to binge/purge. Learn more about using ERP to treat eating disorders.
Family Therapy
Family therapy is an important part of treatment in that is involves and works with families and couples. The goal of family therapy is to promote nurturing change and maturation, and sessions are overseen by a family therapist. Family therapy should be considered when a malfunction is observed within a family, contributing to problems that concern the overall ability of the family to function. This form of therapy is crucial to those suffering from eating disorders in that in promotes healing for the entire family and can be helpful in eliminating life-threatening situations. Learn more about using family therapy to treat eating disorders.
Interpersonal Psychotherapy (IPT)
Interpersonal Psychotherapy (IPT) is a form of therapy that focuses on managing interpersonal problem areas, such as unresolved grief, role disputes, role transitions, and interpersonal deficits. Men or women who participate in this form of psychotherapy address underlying personal issues and learn how to better cope with anxiety under the guidance of a therapist.
IN the treatment for eating disorders, IPT has been shown to be beneficial in that is increases self-esteem and body image. IPT is also useful in addressing other disorders, such as substance abuse and bipolar disorder. Learn more about using IPT to treat eating disorders.
The Maudsley Method
This family based treatment focuses on incorporating parents as an active role in their child’s recovery process from eating disorders. This would include guiding parents in helping their child eat balanced, healthy meals and prevent use of eating disorder behaviors, such as purging or over-exercising. The Maudsley Method typically involves three stages and can be a crucial part of long-term recovery for adolescents with eating disorders. Learn more about using the Maudsley Method to treat eating disorders.
Articles for Eating Disorders
- Somatic Experiencing, Trauma and Treating Eating Disorders – Physical or psychological traumas are often contributing factors to the development of an eating disorder. Appropriately healing from these traumas is an important aspect of the recovery process from an eating disorder. Learn more about how somatic experiencing can be a therapeutic tool for healing from unresolved trauma.
- Benefits of Yoga for Eating Disorder Recovery – Yoga is a therapeutic practice that can complement the recovery process from an eating disorder. Practicing yoga can reap many benefits for the eating disorder sufferer, including physical healing, improved body image, and greater awareness of one’s feelings and emotions. Learn more about how Yoga can be beneficial for someone recovering from an eating disorder.
- Utilizing Brain Stimulation in the Treatment of Eating Disorders – A non-invasive magnetic brain stimulation called “Repetitive Transcranial Magnetic Stimulation (RTMS)” has shown some successful results in a study of 20 participants. The magnetic stimulation is performed on the frontal lobes of the brain.
- Navigating the rough waters when looking for eating disorder inpatient and residential programs – Because of the many stigmas associated with eating disorders, it can be difficult for sufferers to seek the treatment they need. Finding the right level of care and treatment center can involve many challenges and obstacles. Learn more about the Clinical Practice Recommendations for Residential and Inpatient eating disorder programs.
- Neurobiology and Eating Disorders – The brain has millions of neurons with trillions of connections, and a substantial portion of the brain is committed to the emotions and reasoning required to acquire food, what to eat, when to eat, and how much to eat. Is it any wonder, given the complexities of the brain, that some of us develop some sort of disordered eating? The neurobiology of disordered eating could help in developing individualized treatment for those who suffer from eating disorders.
- The Value of PHPs and IOPs – Many eating disorder treatment programs either require round the clock medical supervision in a hospital or a more relaxed outpatient approach where symptoms are less intense. However, there are those that need a treatment option somewhere in between. This is where Partial Hospital Programs (PHP’s) or Intensive Outpatient Programs (IOP’s) provide a real service and value. These solutions afford the patient and their loved ones an intense approach to recovery without having to leave home and the expenses that come with it.
- Experiencing Inpatient Treatment – Eating disorder prevalence rates continue to increase among men and women. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), the mortality rate for individuals suffering from Anorexia Nervosa is 12 times higher than the death rate of all causes of death for females between the ages of 15 and 24 years old. Learn more about Inpatient Treatment.
- Eye Movement Desensitization and Reprocessing (EMDR) in Eating Disorder Treatment – EMDR sessions are not scary. At fi
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