The National Eating Disorders Association is a non-profit organization in the United States advocating on behalf of and supporting individuals and families affected by eating disorders. According to their webpage, they reach millions every year, campaign for prevention, improve access to quality treatment and increase research funding to better understand and treat eating disorders. They, with partners and volunteers, develop programs and tools to help everyone who seeks assistance. This week, along with NEDA, the LodeStone Center Celebrates National Eating Disorder Awareness Week (February 26 – March 4th, 2017.)

Identifying and treating eating disorders is an important focus for our clinicians here at the LodeStone Center. In addition to counselors and psychologists, we include a registered dietitian in our treatment of clients struggling with eating disorders or disordered eating.

But what is an eating disorder, specifically? Read on to learn more, or fill out the form on the right to talk with one of our clinicians.

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 significant low body weight in the context of age, sex, development trajectory and physical health
• Intense fear of gaining weight or becoming fat, even though underweight
• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

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.

How FED-NEC may display:

• Atypical anorexia – all criteria for Anorexia Nervosa are met with the exception of significant weight loss
• Bulimia nervosa of low frequency/limited duration – all criteria for Bulemia Nervosa 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 Bulemia Nervosa 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 popular belief, you cannot tell if a person has an eating disorder, simply by looking at him or her.

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 and 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. Its 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 of 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 individual’s 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 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, a person will 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 4 – 5 days per week and lasts around hours.

*Its important to note that these details vary depending on the program

Medication:

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

It is important to note, that many people who do not meet the 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 and 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 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.

**This article was written by Dr. Michelle Bidwell as part of The LodeStone Center, one of the companies that now makes up the LodeStone Center. The article first appeared on LodeStone Center’s website on June 8th, 2016, with the forward written by Dr. Michelle Bidwell on 02/25/2017.