Eating Disorders

Anorexia nervosa is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an obsessive desire to be thin. Adding to the list above, specific warning signs include dressing in layers to hide weight loss and/or stay warm; making comments about feeling “fat”; and following an excessive and strict exercise schedule. Anorexia has one of the highest overall death rates and the highest suicide rate of all psychiatric disorders.

Bulimia nervosa is an eating disorder characterized by binge eating and purging as well as excessive concern with body shape and weight. Binge eating occurs when an individual consumes a large number of calories in a relatively short time with the inability to control their behavior. Compensatory behaviors may include self-induced vomiting, abuse of laxatives or diuretics, fasting, or excessive exercise. 

To be identified as bulimia, the individual must engage in the binge-and-purge cycle at least once a week for three months. Possible warning signs include evidence of binge eating, such as the disappearance of large amounts of food in short periods of time; evidence of purging, like frequent trips to the bathroom after meals; excessive use of mouthwash, gum, and mints; and calluses on the back of hands from self-induced vomiting. 

Binge eating disorder (BED) is associated with three or more of the following markers: eating much more rapidly than normal; eating until uncomfortably full; eating large amounts of food when not physically hungry; eating alone because of embarrassment; and feeling disgusted, depressed, or guilty after overeating. It must occur at least once a week for three months and is not followed by compensatory behavior. 

Avoidant restrictive food intake disorder (ARFID) was previously referred to as selective eating disorder. Like anorexia, individuals limit the amount and/or type of food consumed; however, there is no distress or fears about body shape or size. Although many children go through periods of picky eating, a person with ARFID does not consume enough calories to grow, develop, and/or maintain basic body function. 

It’s important to note that no two eating disorders are alike. Every eating disorder is unique to the suffering individual — and so is the treatment plan and recovery process. If you are concerned about yourself or a loved one, pay close attention to the symptoms mentioned above and reach out for help. 

As the highest level of care, inpatient treatment or hospitalization includes around-the-clock supervision. Patients are both psychiatrically and medically unstable; they are constantly monitored for vital signs, lab work, potential complications, and other mental health issues, including depression and mood disorders. Here, the goal is for the individual to become well enough to step down to a lower level of care.

In a residential treatment program, an individual does not require 24/7 care but still needs a high level of support and monitoring. Clients engage in individual therapy, group therapy, and nutrition therapy as well as scheduled free time and visits from family and friends. They sleep at the treatment center, which ensures constant access to medical help.

If a patient is medically stable but still struggling with disordered eating thoughts or unable to function in normal circumstances, a partial hospital plan (PHP) may be developed. These programs usually run for normal business hours, five to seven days per week. For this treatment method, the individual has more independence than an inpatient or residential treatment program but still participates in individual therapy, group therapy, nutrition therapy, and medical monitoring if necessary.

If a patient is considered medically stable and does not require daily monitoring, an intensive outpatient program (IOP) is often effective. Symptoms are under control, and the individual can handle daily situations on their own. These clients engage in sessions three days per week for a few hours each day. IOP generally includes individual therapy, group therapy, and a supported meal. Evening meetings are often available to allow patients to return to work or school. 

This treatment method offers the lowest level of support and the highest level of flexibility and freedom. Patients work towards recovery with an outpatient team, which includes a therapist who specializes in eating disorders, a dietician, and a primary care provider. 

Acceptance and commitment therapy (ACT) encourages patients to identify their values and then create goals to help them fulfill those values. The idea is to change your actions or behaviors rather than your thoughts and feelings.

This relatively short-term and structured therapy focuses on beliefs, values, and cognitive processes. Cognitive behavioral therapy (CBT) allows the individual to become aware of negative thinking so they can respond to challenging situations more effectively. 

Evidence shows that dialectical behavioral therapy (DBT) is successful for the treatment of anorexia, bulimia, and BED. It focuses on developing skills related to mindfulness, interpersonal relationships, and emotion regulation.

Family therapy is an integral part of eating disorder treatment, especially for adolescents. However, individuals of all ages may find family involvement in their treatment to be beneficial. Some of the goals of family therapy can be to increase education regarding eating disorders, to improve communication and boundaries among family members, and to learn how parents and caregivers can provide support to their loved ones.