What is an Eating Disorder?

WHAT IS AN EATING DISORDER?

According to the Diagnostic and Statistical Manual, Fifth Edition, the following are a list of symptoms that warrant a clinical diagnosis of an eating disorder.

Anorexia Nervosa:

• Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
• Intense fear of gaining weight or becoming fat, even though underweight.
• Intense fear of gaining weight or becoming fat, even though underweight.

Bulimia Nervosa:

• Recurrent episodes of binge eating characterized by BOTH of the following:
  • Eating in a discrete amount of time (within a 2 hour period) large amounts of food.
  • Sense of lack of control over eating during an episode.
• Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).
• The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa.

Binge Eating Disorder:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.
  • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating).
• The binge-eating episodes are associated with three (or more) of the following:
  • eating much more rapidly than normal.
  • eating until feeling uncomfortably full.
  • eating large amounts of food when not feeling physically hungry.
  • eating alone because of feeling embarrassed by how much one is eating.
  • feeling disgusted with oneself, depressed, or very guilty afterwards.
• Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least once a week for three months.
• The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

Feeding or Eating Disorders Not Elsewhere Classified:

Feeding or Eating Disorders Not Elsewhere Classified (FED-NEC) is characterized as disturbances in eating behavior that do not necessarily fall into the specific category of anorexia, bulimia, or binge eating disorder. It is the most common eating disorder diagnosis. Warning signs and related medical/psychological conditions of FED-NEC are similar to, and just as severe as, those for the other eating disorders.

• Atypical anorexia – all criteria for AN are met with the exception of significant weight loss
• Bulimia nervosa of low frequency/limited duration – all criteria for BN are met with the exception that binge/purge episodes occur less than once a week and/or for less than 3 months
• Binge-eating disorder of low frequency/limited duration – all criteria for BN are met with the exception that binge eating episodes occur less than once a week and/or for less than 3 months
• Purging disorder – recurrent purging behavior intended to influence weight/shape (e.g. vomiting, misuse of laxatives or diuretics) in absence of binge eating
• Night eating syndrome – recurrent episodes of night eating (excessive food consumption after evening meal or by eating after awakening from sleep) that causes significant distress and/or impaired functioning; individuals are aware and can recall eating; night eating not explained by sleep-wake cycle, local social norms; not attributable to behavioral issues, medication effect, or another mental or medical disorder

WHO DO EATING DISORDERS AFFECT?

Eating Disorders do not discriminate.  They can impact children, young adults, the elderly, and any gender.  And contrary to common perception, you cannot tell if someone has an eating disorder just by looking at them.

WHAT CAUSES AN EATING DISORDER?

There is no one cause for an eating disorder.  There are many biological, psychological and social factors involved.  Some factors that may be involved in the development of an eating disorder include but are not limited to:

• Family genetics
• Psychological or emotional health (e.g., anxiety; low self-esteem)
• A trauma experience
• Internalized standards and expectations of attractiveness
• Social pressures or bullying/teasing based on appearance

HOW DO YOU TREAT AN EATING DISORDER?

There are varying levels of treatment for an Eating Disorder.  It is important to intervene as soon as possible when an eating disorder has been identified.  Research has confirmed that Anorexia Nervosa has the highest mortality rate of any psychiatric disorder (Arcelus, Mitchell, Wales, & Nielsen, 2011).

OUTPATIENT THERAPY:

This is the least intensive form of treatment for an eating disorder.  This involves meeting with a licensed clinician in an office at a pre-determined frequency. Typically this is once per week.  Some individuals may visit twice per week depending on the evaluation of the individuals needs by the clinician.  Clinicians may also recommend family therapy to help create a support system for the person with the eating disorder.

HOSPITALIZATION:

There are three different levels of treatment in a hospital:

• Inpatient – The individual will stay overnight at the hospital and attend treatment until they are safe and stable. Typically, someone will then transition down to one of the following below.
• Partial Hospitalization (PHP) – This is typically a program that runs 5 days per week and lasts around 6 hours. The individual will go home in the evenings and on the weekends.
• Intensive Outpatient (IOP) – This is a program that usually runs for 4-5 days per week and lasts around 3 hours.

* It is important to note that these details can vary depending on the program that you choose.

MEDICATION:

Often times, individuals will benefit from also seeking treatment from a psychiatrist who has a working understanding of eating disorders.

Most importantly, always remember that recovery from an eating disorder IS possible.  It is never to late to reach out for help. 

It is important to note, that many people who do not meet criteria for an eating disorder still struggle with body image, making wise food choices, and engaging in a healthy amount of activity.  If you find that you are feeling uncomfortable with your body on a regular basis or struggling to find the right balance with food and exercise, you may still benefit from meeting with a therapist and/or dietitian.  With the busy lives that we lead, it is often easy to put yourself on the back burner and struggle to find balance.  Never hesitate to reach out for help.

Written By: Michelle Bidwell, Psy.D.

Edited By: Lindsey Traudt, LCPC