In my practice I have encountered a multitude of examples of disordered thinking. This could be anything from obsessive thoughts/behaviors to unrealistic ideals and expectations. However one of the most pervasive and dangerous thought patterns is that of an Eating Disordered (ED) patient. While the community at large may use the language of eating disorders regularly, most people may not be able to identify the pathology or symptoms of someone suffering from an Eating Disorder. In this article I hope to shed some light on the significance of these disorders and help others to recognize the signs so that they may help themselves or their loved ones in getting treatment.
“In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified (EDNOS)” (Wade, Keski-Rahkonen, & Hudson, 2011), and these are just the numbers of reported people who sought medical/mental health treatment. Individual and societal expectations begin to impress upon a person much earlier than many would believe. “By age 6, girls especially start to express concerns about their own weight or shape. 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming too fat. This concern endures through life” (Smolak, 2011). With constant media and social influences bombarding our psyche it is difficult to avoid the impact on our body image.
You might be thinking that at some point everyone has concerns about their body/shape/weight. But Eating disorders are much more than average concern. In contrast, the ED patient has an illness that seriously affects everyday diet and exercise routines. A person may be restricting their food intake to extremely small amounts of food or severely overeating-binging. These binge episodes may also be accompanied with purging where the person vomits or uses laxatives to rid the body of their food intake. Others may exercise at extremely high levels in an effort to counteract caloric intake. Being able to recognize symptoms of an eating disorder requires knowledge of the patient behaviors which may be obtained through patient report and/or regular observation.
Anorexia Nervosa: is characterized by extreme thinness (emaciation); relentless or obsessive pursuit for thinness with an unwillingness to maintain regular body weight; intense fear of gaining weight; distorted body image and diminished self-esteem as related to physical appearance; and extremely restricted eating behaviors
Physical signs: osteoporosis, brittle hair and nails, yellowing or dry skin, growth of fine hair all over the body (lanugo), anemia, muscle wasting, constipation and lowered blood pressure, multi-organ failure, and infertility.
Bulimia Nervosa: is characterized by recurrent episodes (several times/week to several times/day) of eating unusually large portions of food and feeling a lack of control over these episodes. The binge is then followed by behavior to counteract the binge including forced vomiting, use of laxatives or diuretics, fasting or excessive exercise. Patients suffering from Bulimia may be of average weight or slightly overweight but experience dissatisfaction with their weight and body image.
Physical signs: chronic sore throat, swollen salivary glands in neck and jaw, worn tooth enamel, acid reflux, intestinal distress, severe dehydration, and electrolyte imbalance that may lead to cardiac arrest.
Binge Eating Disorder: is characterized by loss of control over eating habits, leading to repeated binge eating episodes. However these behaviors are not followed by a purge behavior, which often results in patients becoming overweight to obese. Binge episodes also produce feelings of guilt and lowered self-esteem which trigger further binge behaviors.
Physical signs: greater risk of cardiovascular disease and high blood pressure and other weight related issues.
Because “eating disorders are real, treatable medical illnesses (and) they frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders,”(NIMH.NIH.GOV) it is necessary to address both the physical and psychological needs of the patient. Patients suffering with Anorexia may require medical treatment to return them to safe and healthy body weight. Bulimics and Binge eating patients will need medical evaluation as well to determine any risk factors. In addition to medical supervision, there may be psychiatric medications recommended to address mood and other psychological conditions that may be contributing to the ED. Individual, group and family based therapy is recommended to address disordered thought and behavior patterns. This may include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT) and other forms of psychotherapy. Providing nutritional counseling is also recommended to assist patients in developing safe and healthy nutrition plans and reasonable weight goals. Depending on the severity of the disorder, there are a range of treatment options available including hospitalization and inpatient treatment, partial hospitalization programs, Intensive Outpatient programs and outpatient therapy. In addition to traditional face to face programs, online tele-therapy options have recently come available.
If you or someone you know is struggling with an eating disorder I encourage you to seek professional assistance as these illnesses can be life-threatening.
Bright Heart Health: is the first online face-to-face eating disorder treatment program. Clients are treated by therapists, dietitians, and other experts through online, live video group and individual sessions. Bright Heart is making treatment more convenient, private, and effective.