Eating Disorders

By Dr. Cheryl Lane, PhD

Eating disorders have become increasingly prevalent in the past few decades. Many experts attribute this to society’s obsession with thinness and a media-driven standard of beauty that is unattainable for the vast majority of people. Up until recent years, eating disorders were almost exclusively associated with females. We now know that they impact a significant number of males as well, particularly those who are competitive athletes, gay, or bisexual.

The primary characteristic of all eating disorders is a highly disturbed pattern of eating behaviors. Individuals with eating disorders almost always have a conflicted relationship with food and a poor or severely distorted body-image. Issues with control are also very common, particularly for those with anorexia nervosa.

Types of Eating Disorders

The DSM (Diagnostic and Statistical Manual of Mental Disorders) currently lists three types of eating disorders:

• Anorexia Nervosa
• Bulimia Nervosa
• Eating Disorder Not Otherwise Specified

The third category listed above includes variations of anorexia nervosa and bulimia nervosa that don’t meet the full criteria for either disorder, as well as other eating-disordered behaviors. It also includes binge-eating disorder, which will be discussed below.

Anorexia Nervosa

Anorexia nervosa is the most serious eating disorder, as it can cause serious health issues and ultimately lead to death. In fact, a significant number of anorexics die from complications of the disorder at some point. Karen Carpenter, a well-known singer in the 1970s and early 1980s, suffered from anorexia nervosa. She died in 1983 due to heart failure associated with the illness. Her death propelled this treacherous disorder into the public spotlight.

The symptoms of anorexia nervosa include:

• A refusal to keep one’s weight at or above a normal weight (based on height and age)
• An extreme fear of getting fat or gaining weight, even if the person is underweight
• One or more of the following:
  • A distorted perception of one’s weight or body shape
  • A self-image that is significantly dependent on weight or body shape (i.e. greatly overshadowing other personal characteristics)
  • Denial regarding the serious effects of being significantly underweight
• A significant disturbance in the menstrual cycle (in females who have reached puberty) – i.e., no periods for at least 3 consecutive months

People with anorexia go to excessive lengths to lose weight. They do this by severely restricting calories, exercising excessively, and / or purging the food once it’s eaten. Purging may be done by self-induced vomiting or the overuse of laxatives, enemas, or diuretics. Some anorexics go on eating binges and then quickly purge the food.

Complications associated with anorexia nervosa can be very serious. They may include:

• Anemia
• Serious heart problems, including heart failure
• Dangerous electrolyte imbalances
• Kidney damage
• Bone loss
• Low testosterone levels in males
• Digestive problems
• Infertility
• Muscle strain and other injuries (due to excessive exercise)
• Other mental health issues, such as depression, anxiety, and substance abuse
• Death

Bulimia Nervosa

Individuals with bulimia nervosa engage in binge-eating behavior. To prevent weight gain due to their binging, they compensate for the excessive calories in a variety of unhealthy ways. For a diagnosis, this pattern must be going on for 3 or more months and happen at least twice a week on average.

Binge-eating is characterized by two things:

1. eating an abnormal amount of food in a short period of time;
2. the feeling that you can’t control it or stop it (while it’s happening)

The complications associated with bulimia may include:

• Damage to the throat and esophagus
• Erosion of tooth enamel and subsequent tooth decay
• Gum disease
• Dehydration (which can lead to kidney failure and other serious health issues)
• Disruptions in the menstrual cycle
• Digestive problems
• Heart problems (which may include heart failure in severe cases)
• Other mental health issues including depression, anxiety, and substance abuse
• Muscle strain and other injuries (due to excessive exercise)

Binge-eating Disorder

Binge-eating disorder has gained increasing recognition in recent years. Also called “compulsive overeating”, this disorder is believed to be much more common than anorexia or bulimia.

Individuals with binge-eating disorder eat large quantities of food in one sitting. To them, the urge to eat feels completely uncontrollable. Unlike individuals with bulimia or anorexia, once the food is consumed they don’t try to undo the potential damage by purging, using laxatives, fasting, or exercising excessively.

With this particular eating disorder, people will binge when they’re not truly hungry, eat until they’re physically uncomfortable, and eat unusually fast. They typically eat alone because they don’t want anyone to know just how much food they’re consuming. Their behavior causes a lot of emotional distress. After a binge they feel guilty, disgusted with themselves, and / or depressed.

In order to meet the criteria for binge eating disorder, the binges must take place (on average) for a minimum of 2 days each week for 6 months or longer. Also, the behavior must be separate from a bout of anorexia or bulimia.

Binge-eating disorder can lead to many other health issues including:

• Significant weight gain or obesity
• Type 2 diabetes
• High blood pressure
• High cholesterol
• Sleep problems
• Depression
• Low self-esteem
• Heart disease
• Muscle and joint pain

Treatment for Eating Disorders

The sooner an eating disorder is treated, the better. Early treatment can prevent or at least significantly reduce the effects of the many complications that can occur as time goes on. With anorexia nervosa, in particular, denial and resistance are often obstacles to treatment. They can also prevent progress from occurring once in treatment.

Psychotherapy is the primary treatment for most eating disorders. Hospitalization may be required in some cases, especially for patients with anorexia who are severely underweight or have other serious health complications. Many individuals with eating disorders benefit from residential treatment programs that require them to live at the treatment facility for several weeks to several months. Residential programs provide comprehensive treatment, addressing emotional issues as well as health issues, using a variety of therapies and treatment modalities.

Psychotherapy

While most types of psychotherapy have some benefit in the treatment of eating disorders, one of the most effective types of therapy is Cognitive Behavioral Therapy. This particular therapy focuses on identifying and changing the maladaptive and irrational beliefs and thought patterns that play a major role in all eating disorders.

Dialectical Behavior Therapy

Dialectical behavior therapy, which has many similarities to CBT and was initially developed to treat borderline personality disorder, has been adapted to treat eating disorders. Since relationship conflicts often play a role in eating disorders, Interpersonal Therapy (another type of psychotherapy) can also be very beneficial.

Family therapy, group therapy, and nutritional counseling

These types of therapy can also play in important role in the treatment of eating disorders. They are typically included in residential treatment programs that focus on eating disorders.

Medication

Medication is generally not effective as the sole treatment for any eating disorder. However, medication may be prescribed for symptoms of depression, anxiety, social phobia, or OCD that are often associated with eating disorders. The SSRI fluoxetine (generic for Prozac) is approved by the FDA for the treatment of bulimia, although it is generally more effective when used in conjunction with psychotherapy.