Eating Disorders 101
What to Know About Eating Disorders and Eating Disorder Recovery
February 14, 2022
When it comes to misunderstood mental illnesses, eating disorders take the cake.
Many people assume an eating disorder is a lifestyle choice, and the solution simply follows, “Just eat”.
“Someone who’s suffering from an eating disorder would love to go out to dinner with friends without obsessively scanning the menu for the least caloric dish, or planning their next workout,” said Caryn Alberini, LCSW, LADC-1 with HBH Therapy.
Caryn has specialized in eating disorder therapy for patients of all ages in the greater Boston area for over a decade. The statements that she so often hears from her patients struggling with disordered eating seldom change.
To better understand these complex mental illnesses, and what treatment from eating disorders looks like, we asked Caryn a series of questions:
Q. What is an Eating Disorder?
A. An eating disorder is a mental illness that involves extreme disturbances in behaviors, thoughts, and attitudes surrounding food, body weight, and body shape.
While eating disorders can develop through an unhealthy consumption of restrictive diets and excessive workout plans, they involve much more than weight loss plans and fad diets.
When an individual suffers from an eating disorder, their extreme feelings of guilt with eating, fear of gaining weight, and desire to obtain an unrealistic body image creates detrimental emotional, mental, and physical consequences for the individual, and their close relationships.
Q. What are the Types of Eating Disorders?
A. Given the complexity of the disorder, the DSM-5 breaks down eating disorders into the following 5 criteria:
- Anorexia Nervosa: A condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. Repeated weighing of oneself. Distorted body image despite being severely underweight.
- Bulimia Nervosa: A condition where people have recurrent episodes of eating abnormal quantities of food and lack control over their eating- followed by behaviors to rid themselves of the food: forced vomiting, excessive use of laxatives, fasting, excessive exercise, or a combination of these behaviors.
- Binge Eating Disorder: A condition where people lose control of their eating and repeatedly eat abnormally large quantities of food. Episodes of binge-eating are not followed by purging, excessive exercise, or fasting.
- Avoidant/Restrictive Food Intake Disorder (ARFID): A condition where people limit the amount or type of food consumed. Person with ARFID does not have a distorted body image or extreme fear of weight gain. A child with ARFID does not consume enough calories to develop properly; an adult with ARFID does not consume enough calories to maintain basic body function.
Other Specified Feeding or Eating Disorder (OSFED): A condition that causes significant distress or disturbance but does not meet the criteria for AN, ARFID, BED, or BN.
Q. What Causes an Eating Disorder?
A. While no one knows for certain what causes an eating disorder, a growing consensus suggests that a range of biological, psychological, and sociocultural factors contribute to the onset of an eating disorder.
The shared biological, psychological, and social factors can include:
- Having a close relative with an eating disorder
- Having a close relative with a mental health condition
- History of dieting
- History of physical or sexual abuse
- Type 1 Diabetes
- Striving for perfection
- Low self-esteem, depression, anxiety, or impulsivity
- Poor body image
- Unhealthy peer norms and social pressure
- Bullying or teasing
- Difficulty coping with stress
- Difficulty in familial relationships/friendships
Q. What Are Some Warning Signs and Symptoms?
A. Eating disorders look different for everyone since they manifest as emotional, psychological, and behavioral disorders, and can affect people of all ages, races, sexualities, and other demographic statuses.
Keep in mind that eating disorders thrive in secrecy, and can be difficult to identify in the early stages. Given their private nature, people suffering from undiagnosed eating disorders are less likely to discuss their unhealthy relationship with food and their appearance with others.
Research shows that the longer a person lives an undiagnosed eating disorder, the more challenging and time consuming recovery can be, so it’s important to know the common warning signs:
- Extreme weight gain or loss
- Frequently talking about food, weight, or body image
- Excessive exercising or use of compensatory measures to “offset” food intake
- Purging, restricting, or compulsive eating
- Abuse of diet pills, diuretics, or laxatives
- Denial of disordered eating despite concerns of those around them
- Isolating during meal times, eating in private, or hiding food
- Medical complications such as amenorrhea, fainting, hair loss, osteoporosis, dental problems, heart problems, or other serious symptoms due to nutritional deprivation
Q. How to Address Eating Disorder Concerns?
A. Eating disorders can be insidious and sometimes less obvious than other mental illnesses, making it difficult to know if you or someone you know is struggling. If you are worried that you or someone you know is struggling with food and physical appearance, you might ask yourself these questions:
- Does it seem like the individual has lost control over their eating behaviors?
- Do they make negative and unrealistic remarks about their body, when others around them do not?
- Do thoughts about food and body seem to dominate their life?
- Do they ever make themself sick or disappear directly after eating?
- Has it become uncomfortable to eat with them due to their behaviors and comments toward food?
If you answered yes to any of the following questions, it is likely that the person is struggling with an eating disorder and needs professional mental health treatment immediately.
Before making any assumptions or decisions about treatment, talk to the individual struggling. Create a safe and intimate space to discuss your concerns, and why they might feel like they don’t have an unhealthy relationship with food or their body.
Q. What Does Eating Disorder Treatment Involve?
A. When you or your family member admits they struggle with disordered eating, thank them for being honest and encourage them that recovery is possible! Following an initial assessment with a primary care physician, one of our trained therapists at HBH will work with the individual suffering from an eating disorder to determine the best treatment approach. To name a few:
Cognitive-Behavioral Therapy (CBT) teaches people to recognize how certain thoughts and emotions contribute to negative behaviors. CBT will help patients evaluate their thoughts, emotions, and behaviors about their weight, shape, and self-image. They will learn how to replace negative feelings and harmful behaviors, such as strict dieting or binging, with positive improvements in life.
Enhanced CBT involves a more in-depth examination of negative thinking about eating, body weight and shape, and self-worth. Therapists might apply Enhanced CBT during treatment to eliminate binge-eating or purging through normalizing eating and re-introducing “fear foods” to reduce fears around eating.
Dialectical-Behavioral Therapy (DBT), a type of therapy that focuses on managing difficult emotions, can help an individual change their behaviors associated with their eating disorder. One of our therapists at HBH might work with you to build; interpersonal skills, emotional expression, openness and flexibility, or mindfulness.
Family-Based Therapy (FBT), one of the most successful treatments for eating disorders in children and teens, integrates the entire family within the treatment process without blaming the family on the child or teens eating disorder. With the active participation of family members, such as taking charge of the child’s eating and exercise behaviors, the child’s recovery is anchored with love and support.
Of course, no one specialist treatment is superior. One of our many trained therapists at HBH will create an individualized treatment plan that is best for you, or a loved one who is struggling with an eating disorder.