Eating Disorders
What are Eating Disorders?
Disorders characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption of food and that significantly impairs physical health and/or social functioning.
It is NOT the food.
There is something deeper going on…
DSM-5 Diagnosable Disorders:
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
Other Specified Feeding or Eating Disorder (OSFED)
An individual’s symptoms do not quite fit in a category (not enough symptoms are present) but treatment is needed.
Unspecified Feeding or Eating Disorder (UFED)
It is unclear what is going on (symptoms don’t align clearly with a disorder) but treatment is needed.
2021 ICD-10-CM Diagnosis Codes: F50- Learn more
Anorexia Nervosa:
Definition:
Lower body weight, can go back-and-forth between types
Persistent restriction of energy intake, such as food, leading to significantly low body weight
Intense fear of gaining weight or becoming fat OR persistent behavior that interferes with weight gain despite significantly low weight
Distorted body image OR lack of recognition of the seriousness of current low body weight
2021 ICD-10-CM Diagnosis Code: F50.0 — Learn more
Types:
Restriction type: During the last 3 months, no recurrent episodes of binge eating or purging.
Binge-eating/Purging type: During the last 3 months, recurrent episodes of binge eating or purging.
Distinguished from bulimia nervosa in that those with this type of anorexia are of significantly low body weight; whereas those with bulimia nervosa are of average or above average weight.
Severity:
A Body Mass Index of bodyweight 18.5 to 24.9 = Normal Weight
Mild: BMI 17 to 18.5
Moderate: BMI 16 to 16.99
Severe: BMI 15 to 15.99
Extreme: BMI < 15
Note: Units in kg per meters squared
Having struggled with an eating disorder myself, a quote I found helpful in recovering was the quote:
‘There is no magic cure, no making it all go away forever. There are only small steps upward; an easier day, an unexpected laugh, a mirror that doesn’t matter anymore.’
— George Washington University Student
Body Dysmorphic Disorder and Anorexia Nervosa:
Both struggle to accept their body image
Both have obsessional worries, intrusive thoughts, and repetitive behaviors
Both strive to improve their appearance via detrimental and time-consuming behaviors (such as inspecting body parts, excessive grooming, cosmetic surgery)
Both harbor a misconception that a change in outward appearance will improve self-esteem and social standing
Body Dysmorphic Disorder:
Convinced he/she is misshapen or deformed even though it is unrealistic and/or others cannot perceive it.
Individuals with BDD report greater dissatisfaction with their skin, nose, hair, breasts, stomach, and face.
BDD is evenly split across gender, 50% male and 50% female.
People with BDD experience more negative self-evaluation and more avoidance activities due to appearance reasons.
Anorexia Nervosa:
Anorexia is a noticeable appearance deficiency—significantly low body weight ( <= 85%)
Those with Anorexia report greater dissatisfaction with weight and body shape.
90% are female
The demographic of those with Anorexia has a higher incidence of death and longer-term health issues.
Bulimia Nervosa:
*Found with individuals with normal weight if not higher.
Recurrent episodes of binge eating with both:
Eating a large amount of food in short periods of time
A sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behavior (such as purging, laxatives, diuretics, medications, excessive exercise) in order to prevent weight gain
Both of the above at least once per week for three months
Self-evaluation greatly influenced by body shape and weight
2021 ICD-10-CM Diagnosis Code: F50.2 — Learn more
Binge Eating Disorder:
*Defined as recurrent episodes of binge eating with both (1) eating a large amount of food in short periods of time and (2) a sense of lack of control over eating during the episode.
For a diagnosis, binge eating episodes must be associated with 3 or more of the following:
eating much more rapidly than normal
eating until uncomfortably full
eating large amounts of food when not physically hungry
eating alone due to being embarrassed about the quantity one is eating
feeling disgusted, depressed, or very guilty afterward (unique to binge eating disorder)
Individuals with BED experience marked distress regarding binge eating.
Episodes are experienced at least once a week for three months.
There are NO inappropriate compensatory behaviors.
2021 ICD-10-CM Diagnosis Code: F50.81 — Learn more
Eating Disorders Have the Highest Mortality Rate.
Bulimia Nervosa and Binge Eating Disorder Levels of Severity:
Bulimia Nervosa:
Episodes of inappropriate compensatory behaviorsBinge Eating Disorder:
Episodes of binge-eatingMild
1-3 episodes per week
Moderate
4-7 episodes per week
Severe
8-13 episodes per week
Extreme
14 or more episodes per week
Risk and Causal Factors in Eating Disorders:
Biological Factors:
Set-point theory: there is a biological control method in humans that actively regulates weight towards a predetermined set weight for each individual. This may occur through regulation of energy intake or energy expenditure.
Family Influences:
Can heavily influence eating disorders and schizophrenia
Observational behaviors
Blunt/unknowing comments
Helicopter/authoritarian parents
Individual Risk Factors:
Gender (Anorexia and Bulimia are more common with females. Binge Eating Disorder is more common for males)
Age (Anorexia is most common for females ages 15-24 years old and Binge Eating Disorder is most common post-adolescence)
Sexual orientation (homosexual men are more vulnerable)
Internalization of thin ideal (from the media)
Perfectionism
Negative body image
Dieting
Negative emotionality
Childhood sexual abuse
Addiction
Addiction is not just limited to drugs and alcohol. Individuals can become addicted to food or the control of it; this addiction may look very similar to that of a drug addict. It is important to know the types of addictions, how they manifest themselves, how they can be treated, and most importantly, how they can be avoided.
Treatment Information:
Treatment is Challenging:
Difficult to get individuals with eating disorders to recognize there is a problem (better prognosis with Bulimia and Binge Eating Disorder)
Largely Ego-Syntonic (having an eating disorder often causes no distress to an individual, they’re ok with it)
Giving up eating disorder behavior can cause high amounts of anxiety, fear, and frustration
Can be too overwhelmed with emotion to tolerate and then they leave treatment
Treatment Options for Anorexia:
Hospitalization
Anorexia nervosa requiring admission in adolescents — Read now
Restore weight
Weight Restoration in Atypical Anorexia Nervosa: a Clinical Conundrum — Read now
Medications
Treating anorexia nervosa — Read now
Family therapy — Most important for Anorexia
Family-based treatment of eating disorders in adolescents: current insights — Read now
Treatments for Bulimia:
Medications
What Sorts of Medications Are Available for Bulimia Treatment? — Read now
Therapy:
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy for Eating Disorders — Read now
CBT-Enhanced (CBT-E)
Enhanced cognitive behavioral therapy for patients with eating disorders: a systematic review — Read now
Interpersonal Therapy (IPT)
Interpersonal Psychotherapy for Eating Disorders — Read now
Treatments for Binge Eating Disorder:
Medications
Pharmacological Treatment of Binge Eating Disorder: Update Review and Synthesis — Read now
Interpersonal psychotherapy
Interpersonal psychotherapy for eating disorders: current perspectives — Read now
Cognitive Behavioral Therapy (CBT) — Most important for BED
Brief Strategic Therapy and Cognitive Behavioral Therapy for Women with Binge Eating Disorder and Comorbid Obesity — Read now
Resources:
The National Eating Disorders Association (NEDA):
Helpline: 1-800-931-2237 (they also offer click-to-chat messaging)
Website: nationaleatingdisorders.org
Kelty Mental Health Resource Centre:
Resources are available on this website for youth and teens about substance use, including in-depth information on various substances and concurrent disorders, as well as steps to seek help.
National Institute of Alcohol Abuse and Alcoholism:
NIAAA supports and conducts research on the impact of alcohol use on human health and wellbeing. They provide resources directed toward young people to evaluate your drinking and tools to stay in control.
Useful Literature:
DSM-5: Diagnostic Statistical Manual of Mental Disorders (5th edition)
by The American Psychological Association (APA)The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the product of more than 10 years of effort by hundreds of international experts in all aspects of mental health. Their dedication and hard work have yielded an authoritative volume defines and classifies mental disorders in order to improve diagnoses, treatment, and research. DSM–5 is the standard classification of mental disorders used by mental health professionals in the United States…
Hunger: A Memoir of (My) Body
by Roxane GayAs a woman who describes her own body as “wildly undisciplined,” Roxane understands the tension between desire and denial, between self-comfort and self-care. In Hunger, she explores her past—including the devastating act of violence that acted as a turning point in her young life—and brings readers along on her journey to understand and ultimately save herself. Roxane explores what it means to learn to take care of yourself: how to feed your hungers for delicious and satisfying food, a smaller and safer body, and a…
Ghost: Why Perfect Women Shrink
by Iona Holloway“I am going to show you why your pain is invisible to everyone else, and why, in the struggle to be seen, your body became your battlefield.” Haunting, vulnerable, blunt, and stunning, Ghost is a story that reveals why strong women go to war with their bodies. In her debut memoir, Iona Holloway explores lost childhood, identity webs, hot shame, emotional freeze, love, and lineage to tell the story of how to change not just behaviors, but beliefs. How to ask for help. How to let go of perfect.This book won't heal you, but it will help you find the heart to…
Obesity (NOT IN DSM-5):
*While considered for Eating Disorders and Substance Abuse Disorders, obesity is NOT A DISORDER.*
General Information:
Obesity is defined as an excess of body fat.
There are similarities in behaviors associated with obesity and both eating disorders and substance abuse disorders.
There is evidence of different brain responses to food-related cues in lean and obese individuals.
There is growing evidence of a relation between obesity and numerous psychiatric disorders.
There is concern about the association of psychotropic drugs with weight gain and increases in cardio-metabolic risk.
Adult Obesity in the United States: Learn more
How Obesity is Measured:
The Body Mass Index is the current measure for obesity:BMI < 18.5 = underweightBMI 18.5-24.9 = normal weightBMI 25-29.9 = overweightBMI >= 30 = obeseCauses of Obesity:
Behavior - such as overeating and physical inactivity
Environment - such as no sidewalks and portion sizes
Medication - such as steroids and some antidepressants
Disease - such as diabetes and hypothyroidism
Stress and Emotions - people tend to eat more if stressed, bored, angry, etc.
Sleep - less sleep and an irregular sleep schedule lead to being more likely to be overweight
Genetics - being studied
Obesity Impact on Physical Health:
High blood pressure
Cholesterol issues
Type 2 diabetes
Heart disease
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnea and breathing problems
Some cancers
Low quality of life
Mental illness
Body pain and difficulty with physical functioning
It is estimated that 8% to 17% of college students experience symptoms of an eating disorder.
Eating Disorder Symptoms Among College Students: Prevalence, Persistence, Correlates, and Treatment-Seeking — Read now
Relation to College Students:
In today’s modern world, which includes being bombarded by social media, there are a lot of ways society tells us how we should look and what we should wear. The pressure to do what’s “cool” and be “in” seems to never let up. This is particularly true for college-aged individuals, who are endlessly exposed to what “the ideal”. These are just a few of many reasons why college students can be so concerned with body image. Concern about body image also explains why many college students put so much effort into their physical appearance. Whether someone thinks they are too thin, not thin enough, etc., it is quite common for college students to not be satisfied with their physical appearance. Not surprisingly, this can lead to eating issues. For example, if someone thinks they need to lose weight and become fixated on it, they may begin to eat less and less. Eating less, depending on the individual, may not be inherently bad. However, often times it is taken too far and the individual and the behavior become unhealthy. This is just one of many ways that someone’s body image may lead to disordered eating or an eating disorder. For some, however, disordered eating may have very little to do with their body image; rather, they may actually have a predisposition to a particular eating disorder – i.e. their genetics are playing a role. In this case, food can be thought of as a drug and the individual is addicted to it, making it very difficult to stop eating. Eating disorders are particularly challenging since you need food and water to survive. It can be extremely difficult to modulate a person’s eating and determine what is healthy and what is not. And, since eating disorders often are connected to body image and self-esteem, things can get even more complicated. The take away is to be understanding, sensitive, supportive and realize that eating disorder are very complex. Regardless of the fact that eating disorders are a difficult struggle, they can be overcome with help and support.