There has been a lot of media attention given to eating disorders both on the news and on television talk-shows like Oprah and Dr. Phil. There is also increasing controversy about the ways in which media images of men and women may increase susceptibility to eating disorders or body image concerns of other kinds. But almost none of these media sources clearly educate the public about what eating disorders are and how they are treated. In this article I will attempt to do just that. I will outline three main eating disorders and the classic symptoms and struggles associated with each. I will then talk about treatment options and provide resources for people seeking more information and/or treatment.
In terms of psychiatric diagnoses and treatment, there are three distinct eating disorders that are recognized and described by both the Diagnostic and Statistical Manual, Edition IV, and by the National Institute of Mental Health. They are: anorexia nervosa, bulimia nervosa, and binge eating disorder.
Anorexia Nervosa: The primary characteristics of anorexia include emaciation, a relentless pursuit of thinness, unwillingness to maintain normal body weight, distorted body image (perceiving oneself as fat despite emaciation), intense fear of gaining weight, and for females, a cessation of menstruation. People with anorexia lose weight by restricting their food intake and/or exercising excessively. They may also induce vomiting, abuse laxatives, or use diuretics or enemas to increase their weight loss. People with anorexia tend to become obsessed with thoughts about food and weight, and spend the majority of their days thinking about issues related to food. They may weigh themselves repeatedly and are very controlled in their food rations.
Both men and women get anorexia, and the illness is found across age groups, cultures, and socioeconomic statuses.
There is a very high mortality rate among people with anorexia. The most common complications that lead to death are cardiac arrest and electrolyte imbalances. There is also a higher than average rate of suicide among people with anorexia. In addition to the high mortality rate, people with anorexia also frequently have coexisting psychiatric and physical illnesses including: depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, delayed physical and sexual development (depending on the age of onset), osteoporosis, brittle hair and nails, yellowish skin, growth of fine hair over the body and face, anemia, severe constipation, low blood pressure and pulse, lethargy, and drop in internal body temperature (leading to feeling cold all the time).
Treatment options for this and other eating disorders will be outlined below.
Bulimia Nervosa: People with bulimia engage in recurrent episodes of eating unusually large quantities of food (binge-ing) while feeling out of control of their eating. This binge-eating is followed by purging to get rid of the food. Purging can take several forms including self-induced vomiting, and/or excessive use of laxatives or diuretics. People with bulimia may also go through periods of restricting their food intake and/or exercising compulsively to lose weight and/or compensate for binge-eating.
Like people with anorexia, those with bulimia frequently fear gaining weight, want to lose weight, and are desperately unhappy with their body shape or size. Because purging behavior is typically done privately, there is often a sense of shame that people with bulimia feel in conjunction with their behaviors. Like those with anorexia, those with bulimia also frequently have co-existing illnesses such as depression, anxiety, and/or substance abuse issues.
The process of binge-ing and purging can result in multiple serious health problems including: electrolyte imbalance, gastrointestinal problems, oral and tooth-related problems (from the stomach acid released by vomiting), chronically inflamed and/or sore throat, swollen glands in neck and jaw, tooth decay, acid reflux disorder, and severe dehydration.
Treatment options for people with bulimia and other eating disorders will be outlined below.
Binge Eating Disorder: Similar to bulimia, binge eating disorder is characterized by recurrent binge-eating episodes in which the individual eats an abnormally large quantity of food and feels out of control of his/her eating. Unlike people with bulimia, people with binge eating disorder do not engage in purging activities or excessive exercise or laxative use after their binges. People with binge eating disorder are frequently overweight or obese as a result of their binge-ing. They often experience intense shame and/or guilt about their binge-eating, which frequently serves to perpetuate future binge-eating cycles.
Those with binge eating disorder often experience depression, anxiety, and personality disorders. When obesity results from this disorder, they also show a higher rate of cardiovascular disease and hypertension.
Treatment options for people with binge eating disorder are discussed below.
Treatment for Eating Disorders: The primary goals of any treatment for each of the three eating disorders described above include: restoring the person to a healthy weight, treating any underlying psychological issues, and preventing relapse by reducing or eliminating thoughts/behaviors that lead to disordered eating.
First and foremost, safety is addressed. This means that if someone with an eating disorder presents for treatment and they are at a weight that is so unhealthy that their basic safety is jeopardized, this will be addressed first. This is usually dealt with during a stay at a medical hospital, and may be followed by an inpatient psychiatric hospitalization or stay at a residential treatment facility where 24 hour care and monitoring can be provided.
Once safety is restored, psychological issues can be addressed. This usually involves either inpatient or outpatient psychotherapy, and may also include family therapy, group therapy, or a 12-step support group (such as Overeaters Anonymous). It might also involve the use of psychotropic medications to address any issues of depression, anxiety, or obsessive thoughts. There are many studies that show that the combination of medication and some form of individual or family therapy results in greater treatment outcomes than either of these interventions alone. There are also studies suggesting that for people with anorexia, family therapy may provide more long-term remediation of symptoms and sustained healthy weight.
Frequently treatment of eating disorders also includes nutritional counseling and planning to reduce eating disordered behaviors and provide education about healthy eating. Regular meetings with a nutritionist who specializes in working with people with eating disorders can be helpful in this regard. Groups like Overeaters Anonymous provide sponsors to help people maintain these kinds of healthy eating patterns and also to offer emotional support during this process.
There are many resources for treatment and support in managing eating disorders. The National Eating Disorders Association can be contacted at 888.931.2237 or by visiting their website at www.nationaleatingdisorders.org and they can provide you with a list of local treatment providers. There are also online resources and support groups at www.mentalhelp.net. There is also a local chapter of Overeaters Anonymous that meets in New Bedford. To learn about times and locations of these meetings, visit www.oa.org.