Introduction to Eating Disorders

The Emily Program recognizes National Eating Disorders Awareness Week each February with education surrounding the illness that affects our clients and their families. Similar to other kinds of awareness campaigns, this national campaign aims to increase public understanding and support for the cause. Eating disorder awareness is especially important, because although they are common mental health conditions, they are often misunderstood.

Nearly 30 million Americans experience an eating disorder in their lifetime. Unfortunately, many of these individuals will not receive treatment due to stigma, misinformation, and treatment access barriers. Making eating disorders visible as a serious illness is essential to improving the detection and intervention of the disorder. In this blog, we discuss the types, causes, signs, and consequences of eating disorders, as well as an overview of the multidisciplinary team that treats them. 

Types of Eating Disorders

Eating disorders are complex mental health conditions characterized by disturbances in eating behaviors and thoughts about food and weight. Eating disorders are not simply a diet or a lifestyle choice, they are serious illnesses that impair psychosocial functioning and physical health. With the second-highest mortality rate of all mental illnesses, eating disorders can be deadly if left untreated. It is estimated that one American dies every 52 minutes as a direct result of an eating disorder.

Eating disorders fall under five primary diagnoses, respectively characterized by the following criteria:

• Anorexia nervosa: Prolonged and extreme food restriction and malnourishment that causes dramatic and sustained weight loss. This often presents with a genuine fear of gaining weight and other body image issues.
• Bulimia nervosa: Food is consumed but then expelled by self-induced vomiting, laxatives, or other methods. This is often present with a genuine fear of gaining weight and other body image issues.
• Binge eating disorder (BED): Excessive and uncontrolled consumption of food or a particular food without the regular use of compensatory measures to counter the binge eating; often present with a pattern of “yo-yo dieting.”
• Avoidant Restrictive Food Intake Disorder (ARFID): A feeding or eating disorder that is characterized by fear, a lack of interest in food, or an avoidance of certain foods that results in persistent failure to meet adequate nutritional needs.
• Other Specified Feeding and Eating Disorders (OSFED): A feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.

Eating disorders do not discriminate; they affect people of all races, ages, socioeconomic statuses, sexualities, genders, cultural backgrounds, and abilities. The stereotype as a “thin white woman’s disease” has prevented so many people from seeking help, and it’s simply not true. Some parts of the population are disproportionately affected and undertreated, including:

• Transgender individuals experience eating disorders at significantly higher rates than cisgender individuals (NEDA).
• Black teenagers are 50% more likely than white teenagers to experience bingeing, purging, and other bulimic behaviors (Goeree, Sovinsky, & Iorio, 2011).
• BIPOC with eating disorders are half as likely to be diagnosed or to receive treatment (STRIPED, Academy for Eating Disorders, & Deloitte Access Economics).

What Causes Eating Disorders?

Despite the misconception that eating disorders are a choice, they are actually biological, brain-based illnesses impacted by complex psychological and social factors. The biopsychosocial factors are different depending on the person, but commonly include elements such as:

Biological:

• Genetics and epigenetics
• Puberty/menopause
• Dieting or changes in food exposure/security
• Gut health

Psychological/Traits:

• Anxiety, depression
• Substance use
• Trauma
• Stressors, including life transitions, relationship changes, or major illness or injury
• Self-image

Social/Environmental:

• Weight/appearance pressures
• Comments or teasing related to weight, size, or other aspects of appearance (e.g., height, developing early or late)
• Media, including social media

One of these components alone cannot cause an eating disorder. Rather, a combination of them will increase the likelihood of one developing. Multiple biopsychosocial factors must coincide for an eating disorder to develop.

Once an eating disorder develops, it is kept going by changes in one’s individual biology and psychology. The illness actually changes one’s brain shape and function as it takes hold, and the damage is then exacerbated by a lack of nutrition.

What Are the Warning Signs of Eating Disorders? 

You cannot detect an eating disorder in someone just by looking at them; the signs can be much more subtle and difficult to spot. Even those who seem “healthy” can be suffering immensely with the disorder. Dieting is so normalized in our thin-obsessed culture that it can be hard to differentiate disordered eating from a potential eating disorder. Restrictive eating or excessive exercise behaviors often go unseen or, on the opposite end, are even celebrated.

There are some key signs to look out for, however. Prominent indications of an eating disorder include:

• Dramatic weight gain or loss
• Frequently talking about food, weight, and shape
• Rapid or persistent decline or increase in food intake
• Excessive or compulsive exercise patterns
• Purging, restricting, binge eating, or compulsive eating
• Abuse of diet pills, laxatives, diuretics, or emetics
• Denial of food and eating problems, despite the concerns of others
• Eating in secret, hiding food, disrupting meals, feeling out of control with food
• Medical complications, such as menstrual irregularity, dizziness, fainting, bruising, dry skin, leg cramps, hair loss, brittle hair, osteoporosis, diarrhea, constipation, dental problems, diabetes, chest pain, heart disease, heartburn, shortness of breath, organ failure, and other serious symptoms

How Are Eating Disorders Treated?

Eating disorders require a multidisciplinary treatment team that can address the medical, psychological, and nutritional components of the illness. Each member of the care team plays an important role in developing and delivering a comprehensive treatment plan.  

• Medical: Medical professionals evaluate, diagnose, treat, and monitor physical ailments related to an eating disorder. At The Emily Program, our medical team includes physician assistants, nurse practitioners, nurses, medical assistants, and more. Their main objective is to manage the medical complications that persist with eating disorders.
• Psychological: Licensed therapists and other members of the therapeutic team provide individual, family, and group therapy to help patients acquire the skills, behavior, and knowledge to challenge their eating disorder. Leveraging a variety of approaches including Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family-Based Treatment (FBT), this team engages and coach patients in therapeutic interventions.
• Nutritional: Registered dietitians and dietetic technicians help clients choose food options that lead to a healthier lifestyle and nutritional balance. Our dietitians go beyond the typical role of a dietitian, offering clients nutritional evaluation, counseling, education, and meal-planning services to promote mindful, nourishing eating patterns.

Though eating disorders are complex, serious, and potentially life-threatening illnesses, recovery is possible with proper care and support. Find more information about The Emily Program’s full continuum of care for children, adolescents, and adults online or by calling 1-888-364-5977.

Learn more about eating disorders and the role of multidisciplinary support in treating them at our upcoming webinar series, taking place during National Eating Disorders Awareness Week. Find additional information and register at the links below:

• Eating Disorders 101: Monday, February 21st, 9–10:30am PT, 11am–12:30pm CT, 12–1:30pm ET
• RD 101: Tuesday, February 22nd, 9–10:30am PT, 11am–12:30pm CT, 12–1:30pm ET
• MD 101: Wednesday, February 23rd, 9–10:30am PT, 11am–12:30pm CT, 12–1:30pm ET
• ARFID 101: Thursday, February 24th, 9–10:30am PT, 11am–12:30pm CT, 12–1:30pm ET
• Binge Eating 101: Friday, February 25th, 9–10:30am PT, 11am–12:30pm CT, 12–1:30pm ET