Overview
Eating disorders have the highest mortality rates of any mental illness.
It may seem alarming to begin with such a jarring statement, but we feel it’s important in any discussion of eating disorders, to always be clear and aware of their dangers.
Eating Disorders are a type of mental illness in which a person’s life is negatively affected by disordered thoughts and behaviors about food, body and weight. While the onset of many eating disorders is common around the age of puberty, they can affect anyone regardless of age, gender, socio-economic status or background.
Causes
Similar to other mental illnesses, eating disorders have a range of complex causes and attributing factors. They can be biological, psychological and cultural. In addition, new research is suggesting links can exist between eating disorders and genetics.
Genetics and Biology
Research shows that people with a close relative who has an eating disorder are nearly 60 percent more likely to develop an eating disorder of their own. People tend to inherit similar brain functioning (how a brain sends signals), thus things such as mood, energy, appetite and other nervous system functions related to eating disorders can “run in the family.”
Psychological
Many eating disorders can begin because a person wants to feel in control of something, and controlling the amount of food eaten can be their choice. Unfortunately, eating disorders are very convincing liars, and when they spiral out of control, a person’s brain can tell them they must continue this maladaptive behavior.
Symptoms
The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Some other eating disorders are rumination disorder and avoidant/restrictive food intake disorder. There are many symptoms both common and different to each eating disorder.
Below are general definitions of eating disorders, however eating disorders exist on a continuum and many people do not fit into a single category. Eating disorders come in many shapes and sizes, and anyone struggling with food, body and weight issues is encouraged to seek help, even if they feel they don’t fit into any of the following definitions.
Anorexia Nervosa
Anorexia (an-o-REK-see-uh) nervosa – commonly known as anorexia is characterized by sometimes-excessive weight loss. The person struggling will have an intense fear of weight gain and will adopt many maladaptive eating behaviors in order to restrict calorie intake. People suffering from anorexia nervosa have the inability to see what their body truly looks like because they have a distorted body image. As the person becomes more emaciated, their image of themselves becomes more distorted.
These behaviors can lead to an unhealthily low body weight, plus other physical health complications, along with troubles in school or career, in relationships, and life.
Resources:
Signs of Anorexia
Bulimia Nervosa
Bulimia (boo-LEE-me-uh) nervosa – referred to as bulimia- is an eating disorder in which the person consumes a large number of calories in a short amount of time, usually done in secret due to the fear of gaining weight. The person then purges the food, usually through self-induced vomiting, or through the use of laxatives and/or excessive exercise.
Similar to anorexia, if you have bulimia you may have a distorted view on the appearance of your body, inaccurate to the reality.
Resources:
What are the signs of Bulimia and how can you help?
Binge Eating Disorder
Binge-eating disorder is an eating disorder in which the person struggling consumes an abnormally large amount of food in a short period of time, but does not purge the food. Typically, the person feels a lack of control during this binge and a cycle of immense shame most often follows.
Resources:
Overcoming Shame by Taking Steps to Conquer it
Avoidant or Restrictive Food Intake Disorder
ARFID is often described as being a form of “extreme picky eating.” Avoidant/Restrictive Eating Disorder (ARFID) is an eating disorder centered on the fear of food and/or the consequences of eating. Those suffering from ARFID can literally, or subconsciously, believe consuming certain foods can be fatal to them. The physiological constriction of the mouth tissues, throat, and digestive tract from the fear stops the ability to eat a variety of foods. Malnutrition from ARFID causes many medical issues, including fatigue and loss of motivation. Because ARFID is a sensory disorder as well as an eating disorder, its cure is through somatic treatment.
OSFED – This category describes someone with symptoms of an eating disorder that cause clinically significant stress or impairment in the person’s life regarding food, body or weight.
Pica is persistently eating nonfood items, such as soap, cloth, talcum powder or dirt, over a period of at least a month. Eating these nonfood items can result in medical complications such as poisoning, intestinal problems or infections.
Rumination Disorder
Rumination disorder is the constant regurgitation of food after a meal. Unlike vomiting, food rises back from the stomach, through the throat and into the mouth involuntarily without the effects of nausea and/or gagging.
This disorder can have severe health implications due to the body not receiving the nutrients from the food that was consumed. Rumination disorder is most commonly seen in infants or those with mental disabilities.
Risk Factors
Eating disorders affect all genders and can occur across a wide age range. Most commonly, anorexia or bulimia have been found affecting teenage girls and emerging adults often in their early 20s.
There are many influences that may elevate the risk of developing an eating disorder:
Family History
People with parents and siblings that have or had eating disorders are more susceptible to developing an eating disorder.
Mental Health Disorders
Pre-existing mental health conditions like anxiety, post traumatic stress disorder, depression, and obsessive-compulsive disorder also play a role in eating disorders.
Dieting and Starvation
Dieting isn’t the cause of eating disorders but can often lead to over-controlling the amount of food you consume and a fixation on body and weight.
Stress
From minor to major life events, such as relationship problems, a new job, a lack of finances, or even moving, stress can contribute to someone starting an eating disorder, or it can contribute in an eating disorder becoming more severe.
Enduring Complications
Eating disorders can have many negative effects on mental and physical well-being, especially in the long term. This is why it’s important for someone struggling with an eating disorder to seek treatment. Eating disorders can lead to these complications, and others:
- Anxiety and Depression
- Substance abuse
- Trouble maintaining professional and personal relationships
- Damage to the brain
- Lack of motivation
- Suicidal behavior
- Death
Prevention
Early intervention can be an essential step in helping to avoid an eating disorder, and so knowing some of the signs and symptoms can be important. It’s also very important for families to have healthy and positive conversations around food, body and weight that are non-diet based and avoid judgment. Avoid judgment based on body size, or the “right kind” of food to eat.
Communicate
Having regular discussions about body image can be beneficial. Almost everyone can find something about their own body to be critical about, but it’s important to remind ourselves and others of the wonderful things our bodies can do, and remind ourselves that the “ideal” body images presented in media are unrealistic.
Avoid focusing on dieting or losing weight
To help everyone in the family maintain a healthy attitude about food, body and weight, avoid “going on diets” and focusing on losing weight. Instead, talk about healthy eating and the benefits of nutritional foods. Parents should also consider not having a scale in the house.
Practice good mental health hygiene
Stress and anxiety can lead to eating disorders, so practicing good mental health in our daily lives can offer amazing benefits. Examples include learn coping skills, giving adequate time and space in life for relationships, and learning some self-care techniques.
Be mindful of body image
Be positive of your body image as well as with others around you, regardless of their shape or size. Try making a list of some of the favorite things your body allows you to perform (such as swimming or walking in nature). A solid foundation in a positive self-image will help younger people develop good self-esteem and an understanding of the importance of a healthy eating lifestyle in their teen and adult years.
Seek help
Doctor visits can be very insightful to see if there are any early signs of an eating disorder. During a physical, the doctor may ask you questions relating to your eating habits as well as thoughts on physical image. Regular doctor visits may be a way to detect any early signs of eating disorders.
Express your concern to a loved one or family member if you notice signs of an eating disorder. Be compassionate. This subject can be very sensitive, and others may feel most encouraged when you approach them with kindness and empathy.
Eating Disorder Screening
Do you feel you may be struggling with disordered eating? Are you concerned a family member or friend might have an eating disorder? Healthy Futures offers this FREE online screening to guide you in determining whether to seek further help and/or a professional care.
This tool serves as a reference guide and should not serve as a substitute for a professional evaluation. Please call us with concerns at (480) 451-8500.
Some Dos and Don’ts
Dos:
Do trust your recovery team. For those working on recovery, your treatment team will sometimes suggest changes that seem overwhelming or frightening. Do listen and trust the process.
Do be patient. Recovery from eating disorders can be a long process and sometime it may feel like “one step forward, two steps back,” but understand the recovery journey is the right place for you.
Do be engaged. Stay social and involved with the family, friends, and co-workers who want to see you healthy and successful.
Don’ts:
Don’t do it alone. If you feel you may have an eating disorder, please ask for help. Because eating disorders involve a complicated mix of biological, emotional, environmental and social factors, trying to overcome one alone is extremely difficult.
If you are in recovery, don’t be discouraged if you encounter a setback and slip into old behaviors. This is expected, common and part of the process of recovery.
Don’t obsess over your weight. Weight is one small factor in countless health indicators and is simply a number.
Don’t keep it a secret. Life can be difficult and stressful and sometimes it feels easier to deal with these issues alone. Please talk with someone when life raises your anxiety level.
Reduce Stress & Anxiety
Stress and anxiety are common contributors to increasing the risk of developing an eating disorder. Some supplemental approaches that can promote mental repose and increase a sense of well-being are:
- Yoga
- Mindfulness/breathing techniques (DBT skills)
- Massage therapy
- Acupuncture
- Meditation
- Sound therapy
Here is a quick Progressive Relaxation Technique you can try at home when you’re feeling overwhelmed.
Coping & Support
It’s difficult to manage all of the mixed messages you may be receiving by the media, society in general, and even your own friends and family. Please know that the support of your loved ones can be critical to a healthy recovery. Never hesitate to reach out to your doctor or mental health professional to find out the most effective ways to cope with your eating disorder.
Urging a Loved One to Seek Treatment
When challenges arise, it’s human nature to internalize and cope with problems on our own at first. Sadly, the “default setting” rarely involves seeking medical treatment.
The result is that eating disorders can remain unnoticed for quite a long time. It’s important to express your concern if you see any symptoms or signs in a loved one. Do your best to be a good listener, and to remain understanding and empathetic. Recognize that it may take some time for them to open up and share their feelings with you. Remember the importance of listening and being present for your loved one.
Here are some examples of what to look for:
- Constantly skipping meals
- Eating large quantities of food
- Always talking about weight or appearance
- Frequent dieting
- Not eating in front of others
- Extreme fluctuation in weight or mood
- Heavy use of dietary supplements
- Excludes themselves from social settings
- Oral damage from excessive vomiting
- Depression and anxiety
- Negative talk about self-image
If you’re concerned a friend or loved one is showing early signs of an eating disorder, contact your doctor and/or your insurance company to ask for an eating disorder specialist referral.
Diagnosis
If your healthcare provider suspects an eating disorder, he or she might perform additional tests to accurately diagnose the disorder (or lack thereof), but most often a family doctor will refer the patient to an eating disorder treatment center for a diagnosis.
Additional tests and assessments may include the following.
Physical Examination
This will help the medical professional accurately assess the situation and exclude any other medical causes that may be contributing to your disorder. Eating disorders can cause damage to vital organs, so doctors may do further physical testing such as blood tests and EKGs.
Psychological Evaluation
A psychological self-assessment may be included as well as questions from your mental health professional about your emotions and eating habits to get a better idea of the relationship you have with food.
Treatment
There are several levels of care within eating disorder treatment and recovery. Sometimes a patient might move from one level to another. Where treatment begins depends upon the history and severity of the eating disorder, and what treatments have already been tried, if any. Thus, a thorough evaluation is an important piece of the recovery process.
Very generally, eating disorder treatment can include individual and group therapy, family therapy, nutrition and exercise education, and monitoring physical health as they are a key to recovery.
Levels of Care
Outpatient
This level of care involves the patients taking part in one to three hours of treatment programming weekly by a few providers weekly (such as therapists, doctors, dietitians.)
IOP
IOPs include 7 to 15 hours of programming per week, including group, family, and individual therapy, nutrition education, recreational therapies, movement education and some meals.
PHP
PHP care is similar to IOP treatment, but the patient attends for longer periods of time each day (between 4 to 8 hours daily). Like all previous levels of care, the patient lives independently.
Residential
With this level of care, the patient lives at the facility where he or she is receiving eating disorder treatment.
Inpatient (hospitalization)
Most acute level of care and is reserved for patients facing life-threatening medical complications caused by low body weight and malnutrition. At this level, the primary focus is regaining physical health.
Mental Health & Psychotherapy
Psychotherapy usually involves talking to a trained mental health expert in order to help improve life and recover from disorders, addictions, anxiety and depression. Different types of psychotherapy include:
Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy (DBT) is an evidence-based psychotherapy in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesize them, in a manner comparable to the philosophical dialectical process of hypothesis and antithesis, followed by synthesis.
DBT began with efforts to treat borderline personality disorder, but evidence shows DBT can be useful in treating eating disorders, mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm, and substance abuse.
Somatic Experiencing (SE)
Somatic experiencing (SE) is a short-term naturalistic approach to the resolution and healing of trauma developed by Dr. Peter Levine.
Somatic Experiencing promotes awareness and release of nervous system arousal and physical tension that remains in the body in the aftermath of trauma. This arousal and tension in the body occurs because the survival responses (fight, flight or freeze) of the autonomic nervous system are aroused but are not fully discharged after the traumatic situation has passed.
This can have a profound effect on the trauma survivor’s emotional, physical and spiritual well-being. Nervous system arousal symptoms may include anxiety, depression, anger, addiction, chronic pain and more. Somatic Experiencing interventions allow a trauma survivor to track his or her “felt sense,” using the body to restore the nervous system’s inherent capacity to self-regulate and return to a state of relaxed alertness, promoting a holistic sense of well-being.
Interpersonal psychotherapy (IPT)
Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery.
It is an empirically supported treatment that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks.
IPT is based on the principle that relationships and life events impact mood and that the reverse is also true.
Acceptance and Commitment Therapy (ACT)
Acceptance and commitment therapy (ACT) is a form of counseling and a branch of clinical behavior analysis.
It is an empirically based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy developed by Francine Shapiro in the 1990s in which the person being treated is asked to recall distressing images; the therapist then directs the patient in one type of bilateral sensory input, such as side-to-side eye movements or hand tapping.
The goal of the back-and-forth stimuli is to facilitate the accessing and processing of traumatic memories and other adverse life experience to bring these to an adaptive resolution.
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) is a talk therapy in which the therapist works with the patient to identify cognitive distortions and how they might relate to emotional dysregulation and mal-adaptive behaviors.
The goal is to develop coping strategies with the therapist to help reduce or mitigate those thoughts and behaviors, and to improve the quality of life.
Preparing for Your Assesment
The intake process varies by level of care being sought, and by specific clinic or hospital. In general, an intake process will include a comprehensive mental and physical health assessment. This assessment likely will ask about:
Your physical symptoms all your symptoms including ones that you may think are unrelated, what medications, vitamins, or supplements you may currently be taking, your medical history, and personal information about recent events in your life.
Getting Started & What to Expect
The intake process varies by level of care being sought, and by specific clinic or hospital. In general, an intake process will include a comprehensive mental and physical health assessment. This assessment likely will ask about:
Your physical symptoms all your symptoms including ones that you may think are unrelated, what medications, vitamins, or supplements you may currently be taking, your medical history, and personal information about recent events in your life.
If you choose Healthy Futures as your recovery team, we try to make the intake process as convenient as possible. To assist you, we have three main people you may be talking to in the process. You first will talk with one of our Intake Specialists, who will answer your questions about our programs. She also will help answer any questions about fees and insurance coverage and the how-tos of this process.
The next step is an assessment. This can be done virtually, or in person, depending on your comfort level. Currently we do have some requirements in place to help guard the health of everyone.
The purpose of the assessment is to gauge which level of care you need, and to develop an initial treatment plan. To do that we ask that you fill out comprehensive paperwork and come to an assessment. We will e-mail you the paperwork ahead of time to save time the day of your assessment. If you are a minor, your parent or guardian also will be required to complete some paperwork.
If our IOP is not the best level of care for you, we will offer you referrals to outpatient therapy with us or with another provider. You also may be recommended for inpatient care; again, referrals will be given to you at this time.
If Healthy Futures is not going to be your first step, we will do everything we can to make the next step easy for you, including sending our written assessment to your referred treatment provider. We want you to have the best care for your specific situation at the right time; sometimes that’s with us and sometimes that is by starting somewhere else. We hope that once our level of care is appropriate for you (outpatient and intensive outpatient) we will see you again!
Once the assessment is completed, the next step is admission. If entering our IOP, your insurance will be called to give clinical information to get authorization for our services. We will work to get detailed information to you on your financial responsibility and payment arrangements will be made at this time. Also, you will need to secure medical clearance from your physician if you have not already done so. Here’s a link to download a printable copy of the medical clearance form.
Once we have authorization from your payment source and your medical clearance is received, you will receive a start date. Typically, this is the very next scheduled IOP day. You will be asked to come approximately 45 minutes early (or stay late) for this first day to complete our orientation process.
Fees & Insurance
Most treatments are covered by major health insurance providers. If you have questions about whether your assessments or treatments will be covered, we encourage you to speak directly with our intake specialist. They will assist you in managing your costs, and answer any questions regarding payment and insurance.
After your initial assessment, and once a treatment plan is developed and initiated, we will contact your insurance provider directly for authorization of the treatment.