WHAT ARE EATING DISORDERS? - TYPES, SYMPTOMS AND TREATMENTS - Written by Dean Gustar, Relapse Prevention Specialist
Eating disordersare behavioural conditions often indicated by the observation of acute and continuing disordered behaviours around food and eating. There is often a link between the behaviours to difficult emotions and thoughts. Eating disorders can be very serious, deep-rooted conditions that affect a person's physical and psychological well-being, and impact on all areas of their life. Eating disorders can be extremely upsetting for family members to witness and live alongside.
Most eating disorders are often associated with an obsession with food, weight or shape or with intense anxiety about eating certain foods. Often the obsession is acted out through dysfunctional behaviours, such as restricting food, avoiding certain foods and food types, purging behaviours, and obsession around weight gain and losing weight.
Purging behaviours include such things as, making oneself vomit after eating, overuse of laxative medication, or exercising compulsively. These behaviours become so entrenched that there becomes a strong addictive nature to them, and as a result, treating eating disorders is often a challenging process. Early treatment interventions can improve the long-term outcomes.
How common are eating disorders
Recent studies have estimated that in the United States alone eating disorders affect 9% of adults during their lifetime. A feeding or eating disorder can affect anyone regardless of gender or age; however, women are approximately two times more likely to have an eating disorder compared to men. These are high figures, and one of the many concerns about the common nature of eating disorders is that there are not enough services that are experienced in working with eating disorder to support those suffering. Waiting lists are common across the world, and there is a shortage of expertise.
Types of eating disorders
There are several common eating disorders, each with their own set of indications and eating behaviours. The main and most common eating disorders covered in this article are:
There are also other eating disorders, such as Avoidant Restrictive Food Intake Disorder, Atypical Anorexia Nervosa, Pica and Rumination Disorder.
Anorexia nervosa
Anorexia nervosa is an eating disorder in which a person shows an intense fear of gaining weight or becoming overweight. Often there is a determination to avoid certain foods, eat very small amounts, and become fixated on body shape. They may have a distorted perception of their own appearance — body dysmorphia — often seeing themselves as overweight or fat despite being radically underweight. Often they have a huge bank of behavioural strategies to prevent any increase in weight, achieve weight loss or maintain a particular weight, and strategies to normalise or hide their behaviours. These would include:
Over-exercising, including secret exercising
Obsessive calorie counting
Seeking medication that supports weight loss
Use of laxatives
Going to the bathroom immediately after eating (to engage in purging behaviours)
Wearing baggy, loose fitting clothing
Not wanting to eat in front of other people
These are just the tip of the iceberg in terms of such strategies and are fairly obvious and straightforward. People with anorexia are often experts in not gaining weight and weight loss. Something banal like wanting air conditioning turned up in a room can be a strategy to burn more calories.
Anorexia nervosa can affect anyone regardless of age or gender. Research shows that it mostly begins in adolescence and young adulthood. However, now we are seeing increasing numbers of older adults and children developing eating disorders, including anorexia nervosa. The potential health complications and risk factors are very serious and the mortality rates are extremely high. Anorexia nervosa is one of the most serious mental disorders in terms of mortality.
Symptoms and warning signs
The Diagnostic and statistical manual (DSM V) used across the medical and psychiatric world highlights three main criteria for a diagnosis of 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.
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 denial of the seriousness of the current low body weight.
There may be other warning signs and symptoms that indicate the presence of anorexia nervosa:
Erratic eating patterns, including skipping meals
Significant weight loss
Excessive exercise
Picky eating
Avoiding entire food groups such, as carbohydrates
Distorted body image
Develops food rituals and eating behaviours (for example, excessive chewing, moving food around the plate, eating food in a certain order)
Complains of severe constipation and abdominal pain
Cuts and marks on the fingers due to self-induced vomiting
Dental problems, such as enamel erosion, as a result of vomiting
Dry skin and brittle nails
Fine hair on body and thinning, dry and brittle hair on the head
Impaired immune functioning
Attempts to hide weight loss
Absolute fixation on the need to lose weight
Serious medical complications and health consequences
Treatment
Even though anorexia nervosa is a complex issue to treat, many people do recover successfully with the right support. As with all mental health disorders, assessment and diagnosis are key. The severity of the condition will impact on the treatment. In particular, if the weight loss has become critical then it is very important to start with a full medical assessment so that any serious health consequences can begin to be addressed. The Body Mass Index (BMI) is often used as a measure of severity of anorexia nervosa.
The components of a treatment programme for anorexia nervosa may include:
Full medical assessment
Ongoing Medical treatment and supervision to stabilise physical health
Psychiatric assessment and diagnosis
Psychodynamic therapy
Identification of any other mental health conditions
Psychotherapy - including a strong Cognitive Behavioural Component
Involvement of family through a planned family programme
Nutritional planning, counselling and support
Psychoeducation and counselling
It is important that treatment duration is considered. Like most mental disorders, anorexia nervosa is not going to be cured in a couple of weeks. Also, a return to a so-called normal weight does not mean the battle is over. Relapse can often happen in periods of high stress or exposure to other triggers. The involvement of the family is of particular importance to help improve long-term outcomes.
Bulimia nervosa
Bulimia nervosa is an eating disorder that is indicated by episodes of food binges, followed by purging behaviours after the food has been consumed. Often, large amounts of food are eaten over a short time period. In order to not gain weight as a result of the eating habits, the person will engage in purging behaviours after food intake — before the food has a chance to be digested. Purging behaviours would include induced vomiting. This is the most common strategy. Other purging behaviours are excessive exercise, using laxatives or restriction of food, sometimes specific foods — for some time after a binge.
The binges and the purging of food eaten are usually carried out in secret. Sufferers are usually very hard on themselves and suffer from low self esteem and periods of depression. As with other types of eating disorders, people with bulimia nervosa have a range of strategies to protect the eating disorder. Often, people present with an average weight but the nature of the condition can mean they have nutritional deficiencies that would be identified in medical tests and blood analysis.
Symptoms and warning signs
The Diagnostic and statistical manual (DSM V) used across the medical and psychiatric world highlights the following main criteria for a diagnosis of bulimia nervosa:
Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
Eating, in a discrete period of time (e.g., within a two-hour period), an amount of food that is definitely larger than what most people would eat during a similar period of time and under similar circumstances.
Lack of control over eating during the episode (e.g., a feeling that you cannot stop eating, or control what or how much you are eating).
Recurrent inappropriate compensatory behaviour to prevent weight gain, such as self-induced vomiting, misuse of laxatives — diuretics or other medications, fasting, or excessive exercise.
The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
Bingeing or purging does not occur exclusively during episodes of behaviour that would be common in those with anorexia nervosa.
Other warning signs that may indicate a person has bulimia nervosa include:
Periods of depression or other mental disorders
Distorted body image and low self esteem
Evidence of food binges — e.g., large amounts of food missing
Excessive use of mouthwash or chewing gum (to freshen breath after purging)
Marks or abrasions on the back of the hands
Fluid retention and bloating
Visits to the bathroom directly after eating
Frequent gastrointestinal complaints
Discolouration of teeth
Dental problems such as cavities and sensitive teeth
Preoccupation with food, weight loss and dieting
Cutting out entire food groups
Mood swings
Treatment
Many recover successfully from bulimia nervosa with the right support. It is important to break the binge/purge cycle and establish helpful eating habits. People with bulimia nervosa often present with a normal weight so Body Mass Index is less useful in terms of measuring the severity of the disorder.
Psychotherapy and counselling will look at the impact of early childhood and family history and how they may have affected the eating behaviour. There would be a strong educational component to the treatment, including nutritional support and counselling.
The components of a treatment programme for bulimia nervosa may include:
Full medical assessment
Treatment to resolve any medical complications
Psychiatric assessment and diagnosis
Psychodynamic therapy
Identification of any other mental illnesses
Psychotherapy, including a strong Cognitive Behavioural Component
Involvement of family through a planned family programme
Nutritional planning, counselling and support to establish healthy eating
Psychoeducation and counselling
Binge eating disorder
Binge Eating Disorder involves eating a large amount of food over a very short period of time. The food intake continues despite the person feeling uncomfortably full. The binges are generally carried out alone and in secret. After consumption, there are feelings of shame and guilt. People with this eating disorder do not seek to compensate for their eating through purging.
The National Eating Disorders Association states that binge eating disorder is one of the most recently recognised eating disorders, having been given formal diagnostic symptoms in 2013. The severity of the condition is indicated by the frequency of the binges and the volumes of food consumed.
Symptoms and warning signs
The Diagnostic and statistical manual (DSM V) used across the medical and psychiatric world highlights these main criteria for a diagnosis of Binge Eating Disorder:
Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode (e.g., 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 due to feeling embarrassed by how much one is eating.
Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least once a week for 3 months.
The binge eating is not associated with the recurrent use of inappropriate compensatory behavioirs (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
There may be other warning signs and symptoms that indicate the presence of a binge eating disorder:
Evidence of the consumption of large amounts of food
Secretive eating behaviour
Storing supplies of food
Fluctuations in weight
Periods of depression and loss of motivation
Not eating in public or excusing themselves from family meals
Often engaged (and failing) with different diets
Build-up of medical complications
Gastrointestinal problems
Treatment
The main goal of treatment is to support the person to gain control of their eating behaviours. It is important to have a thorough medical assessment as a starting point, so that any health complications can be identified and addressed. Similarly, a psychiatric assessment will provide the diagnosis and may indicate any other underlying mental illnesses.
Psychotherapy will help with behavioural change and to understand any potential underlying psychological issues or trauma. Education about the disorder will help to reduce shame and introduce strategies to support behaviour change.
The components of a treatment programme for binge eating disorder may include:
Full medical assessment
Ongoing medical treatment to resolve medical complications
Psychiatric assessment and diagnosis
Psychodynamic therapy
Identification of any other mental health illnesses
Psychotherapy, including a strong Cognitive Behavioural Component
Involvement of family through a planned family programme
Nutritional planning, counselling and support to establish healthy eating
Psychoeducation and counselling
How we will treat you
At The Kusnacht Practice, we have developed our programme for the treatment of eating disorders based on effective evidence-based interventions, alongside our experience and expertise of working with clients with eating disorders. The core of our method is to take a person-centred approach to our work. We believe that the relationship with the client can help form the foundation to recovery. So we work with the client and the family, establishing goals, treatment plans and boundaries — each step of the way. We work with Eating Disorders using a trauma-informed approach, which we believe is indispensable in understanding the symptoms of those in our care.
The first steps of the programme will be with our dedicated Medical and Clinical Team, who will work to ensure that all current and potential medical issues are diagnosed and addressed. The stabilisation of medical issues can take some pressure off the client and their families, and it provides a good platform for the other teams — psychiatry, psychotherapy and BIO-R® nutrition and lifestyle — to engage with and support the client.
It is important for families and loved ones to know that there is no quick fix. Often, residential treatment is one of the early phases of a much longer continuum of care. We will work with our clients and their families to establish an aftercare programme to help maintain the gains made in treatment, and to navigate the potential ups and downs on the recovery journey.
The Kusnacht Practice is renowned for its absolute, dedicated attention and precision, honesty and transparency in a warm and empathetic environment for all. With the pure waters of Switzerland’s Lake Zurich lapping on its nearby shores and among nature and clean air, the treatment centre offers a holistic, 360 degree, mind, body and soul rebalancing and restoration. Its state-of-the-art facility combines Swiss standards of excellence, luxury and cutting-edge, innovative technology with world-renowned medical expertise, compassion and sensitivity. Each and every patient is treated uniquely and privately in their own sumptuous, five-star residence and provided with the highest standards of professionalism, care and discretion.
We have successfully treated many people with eating disorders and we never judge. We will provide a safe, kind and friendly environment where discretion and privacy are key. And our tranquil location and luxurious surroundings will help you relax and foster your recovery in a place where we can concentrate on nothing more than improving your health and supporting you onto a path of recovery.
Our team of professionals will seek to scratch beneath the surface to identify the roots of your issues. We wish to give you back control of your life and to learn coping strategies for a more content future. Our treatment plans are unique and absolutely personalised, but simply opening up about your problem to a discreet professional is a big first step — alongside other therapies, naturally. We will organise everything for you, with no detail overlooked.
In order to learn more about eating disorder treatment at The Kusnacht Practice contact our specialists.
