Eating Disorder Treatment

Types, Symptoms and Treatment of Eating Disorders

Eating disorder treatment requires a multifaceted approach due to its complex nature and challenges. Did you know that people with eating disorders may appear healthy; yet, be extremely ill?
Eating disorders can affect people of all body weights, ages, genders and racial/ethnic backgrounds. Although eating disorders often emerge during the preadolescence or teen years, they may also develop during childhood or later in adulthood.

What is an eating disorder?

An eating disorder is a serious mental health condition characterised by excessive concerns about body image, eating, shape or weight. These concerns lead to unhealthy and disordered behavioural patterns, including limiting food intake, starving, extreme calorie counting, self-induced vomiting, misuse of laxatives and diuretics or excessive physical training. These behaviours can dramatically affect all major domains of an individual’s functioning: physical, psychological and social.

Once an eating disorder progresses, it can easily become deep-seated and difficult to manage.

Eating disorders affect people of all shapes, sizes, socio-economic backgrounds and ages. Eating disorders are not a lifestyle preference. They are a life-threatening mental condition that has the highest mortality rate from suicide and medical complications of any psychiatric illness.

Therefore, if you have concerns that you or someone close to you has an eating disorder, it is necessary to take the matter seriously and seek medical advice to explore available treatment options.

Main Types of Eating Disorders

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) recognises five main types of eating disorders:

Anorexia Nervosa (AN)

Anorexia Nervosa features continuous restricted food intake resulting in substantially low body weight. It accompanies a penetrating fear of gaining weight or relentless behaviour that prevents necessary weight gain. For an individual with AN, self-worth is often very much based on shape, weight or control over food intake. People also often perceive their body image in a distorted way. They believe that they are markedly overweight. However, in reality, they are alarmingly skinny.

There are two subtypes of Anorexia Nervosa:

The restricting type refers to people severely restricting the type and amount of food they eat. They may also engage in other weight control activities, such as excessive physical training.
The binge Eating/Purging type also involves severe restriction, but it combines with episodes of binge eating and compensatory behaviours (purging).

Bulimia Nervosa (BN)

The main characteristics of Bulimia Nervosa are recurrent episodes of binge eating, followed by compensatory behaviours.

What is binge eating? Binge eating comprises two components:

Eating a large amount of food within a fairly short period of time (e.g., within two hours).
Losing control over eating (e.g., you could not resist starting or could not stop eating).

What are those compensatory behaviours that follow binge eating in bulimia nervosa?

Compensatory behaviours are ways of trying to control body shape or weight. This includes self-induced vomiting, misusing diuretics or laxatives, starving, excessive physical training, or misusing different medications to control weight.

People who meet the criteria of BN are engaged in a vicious cycle of binge eating and attempting to compensate. This usually results in feeling guilty, ashamed and embarrassed. Preoccupation with fear of weight gain, eating and body image perpetuates the vicious cycle. People with bulimia often keep their eating habits and compensatory behaviours secretive so that nobody can detect them.

Other Specified Feeding or Eating Disorders (OSFED)

An individual with OSFED presents with some symptoms of other eating disorders (Binge Eating Disorder, Anorexia Nervosa or Bulimia Nervosa) but does not match the complete criteria. Nevertheless, OSFED is not less debilitating and dangerous than other eating disorders.

Binge Eating Disorder (BED)

Binge eating disorder features consistently occurring episodes of binge eating. Unlike Bulimia Nervosa, individuals with BED will not employ compensatory behaviours (such as laxatives, self-induced vomiting, etc.). They will typically eat alone or secretly, as they feel ashamed and guilty about their eating conducts. Many people suffering from binge eating disorders are overweight. However, someone with a healthy weight can also have BED. Furthermore, many people who are overweight or have obesity do not have BED. Thus, it is critical not to confuse obesity with binge eating disorder. I’ll present binge eating disorder and approaches to its treatment in more detail in my next article.

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID characterises a condition where a person struggles to obtain sufficient nutrition without fixating on body shape and weight that feature BN, AN or OSFED. Eating disruptions such as lack of appetite or interest in food, aversion to certain types or qualities of food, or feared outcomes of eating (not shape/weight based) lead to difficulty preserving a healthy weight for them.

The Impact of Eating Disorders

So far, we’ve looked at the five main types of eating disorders. If you are reading this article, you have likely noticed some disordered eating patterns in yourself or someone close to you. We will now examine the impact these eating disorders can have on the lives of individuals suffering from them.

People with eating disorders usually experience substantial emotional, physical, emotional and personality changes, as well as changes to their social and professional lives.

Physical Effects of Eating Disorders

Eating disorders generate both external and internal physical changes. External changes include dry skin and brittle nails, loss of scalp hair or excessive growth of body hair. Internal damage can result from malnutrition, vomiting, and laxative misuse. Individuals with eating disorders often have electrolyte imbalances and heart problems resulting from weight loss and purging. Moreover, they experience critical gastrointestinal and digestive complications, including constipation, bloating, and reflux. In addition, eating disorders often lead to hormonal imbalances, such as amenorrhea or loss of periods in females and decreased testosterone in males, dental damage, deficient bone density, immune deficits and infertility. These physical effects can be life-threatening, and some of them are irreversible.

You should seek a medical examination and advice from an eating disorder specialist if you severely restrict your food, misuse laxatives or vomit, irrespective of your weight.

Behavioural and Emotional Consequences of Eating Disorders

An eating disorder affects more than just people’s physical well-being and body. It also influences the way people think and what they think about. Obsession with eating and food can advance to such an extent that it becomes almost impossible to focus on anything else. This preoccupation with eating (or not eating) and food often substitutes previously enjoyed activities and hobbies.

With the development of disordered eating, people may notice an alteration in their personalities. Malnourishment and disordered eating cause people to become irritable, grumpy, and often anxious and depressed, leading to dramatic personality changes. A person may become more secretive in their day-to-day life, hiding their behaviours from friends and family. These changes are characteristic of eating disorders and are reversible once people get well.

Impact of Eating Disorders on Work and Social Life

Eating disorders can hugely affect people’s social lives and work. Fatigue and obsession with eating and food can disturb your concentration at work. Workplaces can also become places of extreme anxiety due to attempts to hide troubled eating habits. Furthermore, those with eating disorders often experience changes in their social functioning. They may avoid being around people due to being afraid others might judge their behaviour. Additionally, compensatory behaviour such as excessive physical exercising may become prioritised over social activities, increasing their withdrawal.

Therapy for Eating Disorders

Treatment options for eating disorders include psychological therapy and counselling, coping skills training, medications, nutritional coaching, medical care and monitoring or a mixture of these procedures.

The main treatment goals are:

Ceasing binge-eating and binge-purge episodes
Reducing excessive physical training
Bringing weight to an adequate state
Reanimating healthy nutrition

Non-pharmacological interventions, such as psychotherapy, cognitive-behavioural therapy, counselling and skills training can effectively treat some eating disorders. Research also reveals that pharmacological interventions may help treat some eating disorders with co-occurring conditions, such as depression or anxiety.

If your symptoms are disrupting your daily life, it’s important to consult a general practitioner to discuss treatment options and find the right course. The choice of eating disorder treatment will depend on the type of the eating disorder and usually includes psychological interventions, sometimes combined with medications. Most individuals with an eating disorder will have individual therapy, but those with a binge eating disorder may greatly benefit from group therapy. You may also need regular health examinations if your eating disorder impacts your physical health. An eating disorder counsellor may offer you a guided self-help programme as an intervention if you have a binge eating disorder or bulimia.
Therapeutic options for other specified feeding or eating disorders (OSFED) will be based on the type of eating disorder your manifestations are mostly symptomatic of. For example, if you predominantly manifest the symptoms of anorexia, your therapeutic interventions will be similar to the therapy for anorexia.

Analogous to fever, some eating disorders emerge as nonspecific reactions resulting from a wide spectrum of underlying causes. Therefore, while the primary objective is to alleviate the distressing manifestations of an eating disorder, it’s recommended to address the psychological causes of these manifestations for a holistic and enduring resolution.

Eating Disorder Treatment: Summing up

Eating disorders can be profoundly damaging to your health. Even mildly disordered eating patterns are alerting as they can result in an eating disorder. The main types of eating disorders include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant/Restrictive Food Intake Disorder (ARFID) and Other Specified Feeding and Eating Disorders (OSFED). Individuals with eating disorders may experience dramatic changes in their psychological, physical and emotional functioning. Moreover, they may experience negative changes in their social and professional life.

Eating disorder treatment often involves psychological interventions, sometimes combined with medication. Psychotherapy, cognitive-behavioural therapy, counselling and coping skills training help many people stop disordered eating behaviours and establish and maintain healthy eating routines.

Individuals displaying eating disorder symptoms that disrupt their daily lives should consult a general practitioner or psychiatrist for medical guidance.

Bibliography

American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders (4^thEdition) (DSM-IV) Washington DC: APA
Anorexia Nervosa. https://www.ncbi.nlm.nih.gov/books/NBK459148/
Avoidant/Restrictive Food Intake Disorder (ARFID). https://www.ncbi.nlm.nih.gov/books/NBK567717/
Bulimia Nervosa. https://www.ncbi.nlm.nih.gov/books/NBK562178/
Eating and impulse-control disorders. https://doi.org/10.1093/med/9780198795551.003.0009
Eating Disorders. https://www.ncbi.nlm.nih.gov/books/NBK567717/
Eating Disorders. https://www.nimh.nih.gov/health/topics/eating-disorders
OSFED. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8388009/

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