Eating Disorders
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Eating disorders are among the deadliest mental illnesses, second only to opioid overdose. Left untreated, they can take over a person’s life and lead to serious, potentially fatal medical complications.
Most often affecting women between the ages of 12 and 35, eating disorders can affect people of any age or gender. They can be very serious conditions affecting physical, psychological, and social functions. Behaviors associated with eating disorders include restrictive eating or avoidance of certain foods, binge eating, purging by vomiting or laxative misuse, or compulsive exercise.
Causes
Factors that may be involved in developing an eating disorder include:
Genetics. People with siblings or parents with an eating disorder are more at risk of developing an eating disorder. Evidence that the brain chemical, serotonin, is involved also points to contributing genetic and biological factors.
Environment. Cultural pressures that idealize particular body types place undue pressure on people to achieve unrealistic standards. Popular culture and media images often tie thinness (for women) or muscularity (for men) to popularity, success, beauty, and happiness.
Peer Pressure. This can be a very powerful force, especially with young people. Pressure can appear in the form of teasing, bullying, or ridicule because of size or weight.
Emotional Health. Perfectionism, impulsive behavior, and difficult relationships can all contribute to lowering a person’s self-esteem and make them vulnerable to developing eating disorders. A history of physical or sexual abuse can also contribute to some people developing an eating disorder.
Symptoms
Eating disorders are a group of related conditions that cause serious emotional and physical problems. Each condition involves extreme food and weight issues; however, each has unique symptoms that separate it from the others.
Anorexia Nervosa.
This common eating disorder has the highest death rate of any psychiatric diagnosis. People with anorexia will deny themselves food to the point of self-starvation, driven by an intense fear of gaining weight or becoming fat. Some people with anorexia might also use binge eating and purging behaviors— forced vomiting, abusing laxatives, or excessive exercise—while others only restrict eating.
Anorexia takes a heavy physical toll. Very low food intake and inadequate nutrition cause a person to become very thin. The body is forced to slow down to conserve energy, causing irregular or no menstrual periods, constipation, and abdominal pain. Medical complications can be life-threatening and include irregular heart rhythms, low blood pressure, kidney problems, and seizures.
The emotional symptoms of anorexia include irritability, social withdrawal, lack of mood or emotion, unable to understand the seriousness of the situation, fear of eating in public, and obsessions with food and exercise. Often, food rituals are developed, or whole categories of food are eliminated from the person’s diet, out of fear of being “fat".
Bulimia Nervosa. People living with bulimia alternate extreme dieting with binge eating. They feel out of control when binging on very large amounts of food during short periods of time and will desperately try to rid themselves of the extra calories using forced vomiting, abusing laxatives, or excessive exercise.
The emotional symptoms of bulimia include low self-esteem overly linked to body image, feelings of being out of control, feeling guilty or shameful about eating, and withdrawal from friends and family.
Binges occur at least weekly and become a repeating cycle that controls many aspects of the person’s life and has a very negative effect both emotionally and physically.
Like anorexia, bulimia causes physical damage to the body. Binging and purging can severely harm the parts of the body involved in eating and digesting food. Teeth are damaged by frequent vomiting, and acid reflux is common. Excessive purging can cause dehydration that effects the body’s electrolytes and leads to cardiac arrhythmias, heart failure, and even death.
Family members or friends may not know that a person has bulimia because they do not necessarily appear underweight and because their behaviors are hidden and may go unnoticed by those close to them.
Possible signs that someone may have bulimia nervosa include:
Frequent trips to the bathroom right after meals
Large amounts of food disappearing or unexplained empty wrappers and food containers
Chronic sore throat
Swelling of the salivary glands in the cheeks
Dental decay resulting from erosion of tooth enamel by stomach acid
Heartburn and gastroesophageal reflux
Laxative or diet pill misuse
Recurrent unexplained diarrhea
Misuse of diuretics (water pills)
Feeling dizzy or fainting from excessive purging behaviors resulting in dehydration
Binge Eating Disorder
People with Binge Eating Disorder lose control over their eating and consume a large amount of food in a short period of time. They may also eat large amounts of food even when not hungry or after becoming uncomfortably full.
As with bulimia nervosa, people with binge eating disorder experience a loss of control over their eating and are distressed by their binge behavior. Unlike people with bulimia nervosa however, they do not regularly purge to get rid of the food.
Binge eating disorder can lead to serious health complications, including obesity, diabetes, hypertension, and cardiovascular diseases.
Treatment
When doctors suspect an eating disorder, they will usually perform a physical examination, conduct an interview, and order lab tests. This will help form the diagnosis and check for related medical issues and complications.
In addition, a mental health professional will conduct a psychological evaluation. They may ask questions about eating habits, behaviors, and beliefs. There may be questions about a patient's history of dieting, exercise, binging, and purging.
Often a person with an eating disorder will have symptoms of another mental health condition that requires treatment. Whenever possible, it is best to identify and address all conditions at the same time. This gives a person comprehensive treatment support that helps ensure a lasting recovery.
Each person’s treatment will depend on the type of eating disorder, but generally, it will include psychotherapy along with medical monitoring and nutritional counseling. Treatments will vary depending on the type of disorder but will generally include the following.
Psychotherapy
Because of the complexity, therapy needs to address both the symptoms and a person’s psychological, interpersonal, and cultural influences which contributed to the disorder.
Cognitive behavioral therapy (CBT) is often successfully used in the treatment of eating disorders because it helps people understand the relationship between their thoughts, feelings, binge-purge behaviors, and eating attitudes.
Medication
Many people living with an eating disorder have a co-occurring illness like depression or anxiety, and while there is no medication available to treat eating disorders themselves, many patients find that medicines can help with underlying issues.
Wellness and Nutrition Counseling
Dietitians and other healthcare providers can help change old habits and beliefs about food, dieting, and exercise, with healthy nutrition information and planning. Sometimes planning and monitoring responsibilities are shared with mental health professionals or family members.
Many people receive treatment for an eating disorder without needing an intensive treatment setting. However, for some people, an inpatient or residential eating disorder treatment center or partial hospital setting is best when they begin treatment. Others may need hospitalization to treat serious problems caused by poor nutrition, or for care if they are very underweight.
Self Help
It is helpful to understand when behaviors are destructive, but it may be difficult to control them. Treatment can offer ways to cope. Here are some things to be aware of:
Lifestyle. It’s important to begin making changes to remove the reminders and stop negative behaviors associated with the disorder. Resist the impulse to check the mirror or weight several times a day. Fight the urge to diet or skip meals.
Identify the triggers Certain places, challenging situations, and some friends may spark unhealthy behaviors. Understanding what these are can help in preparing a plan to deal with them.
Work with healthcare providers Give healthcare providers the information they need to help support recovery. Don’t skip therapy sessions and be consistent with meal plans.
Learn more. Read self-help books that offer practical, credible advice. Research helpful topics online.
Connect with others on online message boards or peer-support groups. Share thoughts, fears and questions with other people who have dealt with an eating disorder.
Supporting family members or friends
If a friend or family member is suffering from an eating disorder, learn about the different disorders, symptoms and warning signs. Suggesting they see a doctor, counselor or other health professional may be tricky, as they may not want to admit or even realize there is a problem.
Conflicts and battles are hurtful. If a person is not ready to acknowledge a problem, be a supportive friend. Avoid placing blame, guilt or shame on them about behaviors or attitudes related to the eating disorder.
Having a child with an eating disorder places significant responsibility on parents, making them active partners in treatment planning and implementation. Parents need to feel comfortable and confident in the professional’s approach and abilities, and in discussing the disorder. Finding a mental health professional with experience treating young people or children with eating disorders and their families is important.