Mental health is becoming less stigmatized and more widely discussed every day. As more people open up about their mental health, others recognize shared symptoms and seek out treatment. Does this mean more people are suffering? Or that more people are recognizing issues that would have been overlooked in years past?
It is difficult to firmly say whether the rise in diagnoses is due to an increase in the prevalence of mental illness, or due to increased awareness. But more people seeking help means more people receiving the treatment they need to stay alive and healthy.
Many people are familiar with mental disorders like depression, anxiety disorders, and schizophrenia. But another category of mental disorders, one that has even more severe health consequences for patients, has also gained visibility. What is an eating disorder?
Eating disorders are being more widely recognized and diagnosed. Like with other mental health conditions, it is difficult to say whether more people are suffering, or if more careful diagnostic procedures and decreased stigma are leading more people to seek treatment. In any case, it is important that people understand eating disorders, and know how to recognize them, in themselves and in their loved ones.
Defining The Term: What Is An Eating Disorder?
An eating disorder is best defined as a serious mental illness characterized by abnormal eating habits, distorted body image, and an intense preoccupation with weight, food, and appearance. It goes beyond mere dietary choices and becomes a deeply ingrained pattern of behavior that negatively impacts physical, emotional, and psychological well-being.
An eating disorder causes clinically significant distress in a patient’s body or mind. A person who is concerned about weight gain and takes healthy steps to lose weight would not fit the definition. But people that severely restrict food intake, engage in purging behaviors or binge episodes, and have an irrational fear of gaining weight are often experiencing eating disorder symptoms. If these symptoms persist, they may qualify for a diagnosis.
Eating disorders are differentiated from other mental health conditions because they directly impact nutrition, one of the key elements of bodily health. Other mental health conditions can influence eating behaviors, including depression. But eating disorders are defined by their direct relationship to eating habits, and an obsessive focus on eating and/or on weight gain or weight loss.
The History of Eating Disorders
As noted above, eating disorders have been frequently overlooked or misdiagnosed in the past. Understanding the history of these conditions can help health care providers (and others) to recognize how societal concepts around eating have changed over time.
The “Discovery” of the Eating Disorder
The study of eating disorders can be traced back to the late 19th and early 20th centuries when pioneering individuals began to recognize and document the complex nature of conditions that precluded healthy eating. While our understanding of eating disorders has evolved significantly over time, the early contributors played a crucial role in laying the foundation for future research and clinical advancements.
William Gull and the discovery of anorexia nervosa
One of the first individuals to study eating disorders was Sir William Gull, a British physician who is often credited with describing and naming anorexia nervosa in the late 19th century. Gull observed cases of extreme self-starvation and recognized it as a distinct mental illness. He coined the term “anorexia nervosa” to describe the condition and provided detailed clinical descriptions of its symptoms, including emaciation, amenorrhea (the cessation or absence of menstrual periods), and a distorted body image.
Gull’s research pioneered the study of eating behavior. Previously, irregular eating habits had been understood as physical signs of other mental illnesses, or as evidence of an underlying physical condition. Gull recognized that some people dealt with distinct mental health conditions that revolved around food. As the study of nutritional value advanced, so too did the study of eating patterns, and the social factors that influenced them.
Hilde Bruch: Recognizing the role of the family
In the early 20th century, Hilde Bruch, a German-born psychiatrist, made significant contributions to the field of eating disorders. Bruch conducted extensive research and clinical work with individuals suffering from anorexia nervosa and bulimia nervosa.
Bruch emphasized the psychological and familial factors underlying these disorders, highlighting the role of family dynamics and disturbed self-perception. Bruch’s groundbreaking work provided valuable insights into the psychosocial aspects of eating disorders.
Bruch recognized that shame from parents during childhood and young adulthood often precipitated the intense fear of weight gain that afflicted her clients. To this day, the most common eating disorders often stem from lessons learned in childhood about body weight and appearance. Healthy eating habits are learned in childhood, and people with eating disorders frequently attribute their issues to things they experienced as children.
Christopher Fairburn: Applying CBT to Eating Disorders
During the latter half of the 20th century, researchers such as Christopher Fairburn made notable contributions to understanding and treating eating disorders. Fairburn, a British psychiatrist, expanded an existing modality called cognitive-behavioral therapy (CBT).
CBT is a type of therapy that helps people change their thoughts and behaviors to improve their mental wellness. In CBT, a therapist works closely with the person to identify unhelpful or negative thoughts and beliefs that may be causing distress or contributing to problems, like a fixation on binge eating or body weight. Together, they explore how these thoughts influence feelings and behaviors. The therapist helps the person develop new, more positive ways of thinking and encourages them to practice new behaviors.
Fairburn felt that CBT could be a highly effective treatment approach for bulimia nervosa and later extended it to other eating disorders. His work focused on addressing the cognitive distortions and dysfunctional beliefs associated with eating disorders.
Janet Treasure: Involving the Family
Janet Treasure, also from the United Kingdom, has been instrumental in advancing the field of eating disorders through her research on anorexia nervosa and family-based therapy. She emphasized the importance of involving families in the treatment process and developed the Maudsley Model, which has become a leading evidence-based approach for treating adolescents with anorexia nervosa.
The Maudsley Model is used to treat adolescents with an eating disorder diagnosis, particularly anorexia nervosa, a common eating disorder. The main focus of the Maudsley Model is on actively involving the family in the treatment process. As many eating disorders being in early childhood, this is an effective way of targeting the cause of eating disorders. In this model, parents take an active role in helping their child recover from the eating disorder by becoming the primary agents of change, in both gaining weight and maintaining their child’s progress.
The therapy typically involves three phases: 1) weight restoration, where parents take control of their child’s meals and supervise their eating as they gain weight; 2) returning control over eating to the adolescent while providing ongoing support and guidance; and 3) establishing a healthy identity and ensuring continued progress.
The Maudsley Model recognizes the importance of family support and collaboration, aiming to empower both the adolescent and their family in overcoming the challenges associated with an eating disorder. It has also shown promise for avoidant restrictive food intake disorder, a similar eating disorder.
Common Types of Eating Disorders
What is an eating disorder? The symptoms, causes, and treatments for eating disorders vary within this broad category of diagnoses. The National Eating Disorders Association notes that eating disorders affect millions of Americans, and millions more are at risk of developing eating disorders. Not all of them struggle with the same eating behaviors.
The following are some of the most common eating disorders that clinicians see today. All of the following eating disorders can be treated by the clinicians at Turning Point of Tampa, who have specialized training in combating the types of eating disorders described below.
Anorexia nervosa, or simply anorexia, is a complex and potentially life-threatening eating disorder characterized by severe food restriction, an intense fear of gaining weight, and a distorted body image. It primarily affects adolescents and young adults, predominantly females, although it can occur in individuals of any age or gender. Patients obsess over their eating, frequently dieting.
Understanding the symptoms, causes, and treatment options for anorexia nervosa is essential for early detection, intervention, and successful recovery. Notably, anorexia has the highest mortality rate of any mental illness.
Symptoms of anorexia nervosa
Symptoms of anorexia nervosa typically include significant weight loss resulting from extreme calorie restriction, a relentless pursuit of thinness, and an intense fear of gaining weight. Individuals with anorexia may exhibit obsessive preoccupations with food, body weight, and body shape, and typically have a low body weight. Healthy body weight is determined by body mass index, which factors in height and biological sex to assign healthy weights for people of all types.
They often engage in rigid dietary rules, adopt excessive exercise regimens, and may exhibit ritualistic behaviors around food, including skipping meals or severe picky eating. Other physical symptoms can include brittle hair, fatigue, dizziness, low blood pressure, lanugo (fine hair growth on the body), and dry skin.
causes of anorexia nervosa
There is evidence to suggest a genetic predisposition to eating disorders, with individuals having a family history being at increased risk. Psychological factors, including low self-esteem, body dissatisfaction, and perfectionistic tendencies, play a significant role. Societal pressures, cultural ideals, and exposure to media promoting thinness also contribute to the development of dysmorphic body image and disordered eating behaviors.
treatments for anorexia nervosa
Effective treatment for anorexia nervosa involves a comprehensive and multidisciplinary approach. The primary goals of treatment are to restore and maintain a healthy weight, address psychological and emotional issues, and develop healthy eating habits and coping mechanisms. Treatment often involves a combination of medical, nutritional, and psychological interventions.
Medical management typically involves close monitoring of physical health, as individuals with anorexia nervosa are at risk of severe malnutrition, electrolyte imbalances, cardiac complications, and other medical issues. Regular medical check-ups and ongoing supervision are crucial throughout the recovery process.
Nutritional therapy is a vital component of anorexia nervosa treatment. It involves working with a registered dietitian or nutritionist to establish a balanced meal plan. Gradual weight restoration is an essential aspect of nutritional therapy, aiming to bring the individual back to a healthy weight range.
Psychological interventions are essential in addressing the underlying psychological factors contributing to anorexia nervosa. Family therapy, particularly the Maudsley Model, involves parents or caregivers playing an active role in supporting their child’s recovery by closely monitoring meals, promoting weight restoration, and fostering a supportive home environment.
Atypical Anorexia Nervosa
Atypical anorexia nervosa shares all the symptoms listed above, but the individual in question is at a normal weight. Atypical anorexia has been frequently misdiagnosed in the past, as clinicians mistakenly thought a person had to have low body weight to suffer from anorexia nervosa.
Bulimia nervosa shares many of the same risk factors, causes and psychological symptoms as anorexia, including an obsession with body shape and weight distorted body image. It is differentiated by the inclusion of episodes of binge eating, followed by inappropriate compensatory behaviors- typically attempts to purge the body of the binge food intake.
purging vs non purging
Bulimia nervosa is separated into two types. Purging behaviors are the key distinction. People with purging type bulimia induce vomiting or abuse laxatives after binge eating to purge the food they have consumed and thus not gain weight.
People with non purging bulimia do not vomit or use laxatives. They instead engage in extreme exercise or fast after an episode of binge eating. Extreme exercise is sometimes referred to as “orthorexia,” although this is not an officially recognized diagnosis in the Diagnostic and Statistical Manual (DSM), the guide used by psychiatric professionals.
People with bulimia nervosa suffer from many of the same physical symptoms as anorexia, but have additional symptoms related to their purging behaviors. This can include bloodshot eyes, bruised knuckles, and eroding tooth enamel, due to the stomach acid that enters their mouth when they purge.
Binge Eating Disorder (BED)
Although it receives less attention than others, binge eating disorder is the most common eating disorder. It shares many symptoms and risk factors with bulimia nervosa. People who are hungry, eating fast, and obsessively over-consuming may not recognize that they are dealing with an eating disorder, as unlike most eating disorders, it does not entail an unhealthy obsession with weight.
Differences from bulimia nervosa
The difference between bulimia nervosa and binge eating disorder is that people with binge eating disorder do not purge after eating, and often do not have a low weight. Nor do they engage in the extreme exercise or fasting that non-purging bulimia nervosa sufferers do.
People with binge eating disorder may be preoccupied with their weight, but not to the same degree as bulimia nervosa or other eating disorders. Binge eating disorder can still cause serious health complications , as it can lead to damage to digestive organs, with people during binge episodes eating more than their body can handle.
Avoidant Restrictive Food Intake Disorder (AFRID)
Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new diagnostic category that describes a feeding or eating disorder. Unlike the eating disorders described above, ARFID is not driven by concerns about body appearance or weight but is primarily related to sensory or aversive aspects of food, as well as a lack of interest in eating. It is essentially a diagnostic term for obsessive “picky eating.”
Symptoms of ARFID
The defining warning signs of ARFID include the avoidance or restriction of certain foods or food groups, resulting in inadequate nutrition and weight loss or failure to achieve expected weight increases in children. This feeding disorder (or eating disorder, depending on the age of the patient) is easily observed by examining eating behaviors, but many may not differentiate it from normal picky eating.
The avoidance can be related to various factors, including the sensory characteristics of certain foods, such as texture, taste, or smell. Individuals with ARFID may also have a limited range of preferred foods or rigid eating patterns, leading to nutritional deficiencies.
consequences of ARFID
ARFID can cause significant medical complications. Nutritional deficiencies and inadequate caloric intake can lead to malnutrition, weight loss, stunted growth in children, and impaired physical health. The condition can also cause emotional distress, social isolation, and interfere with daily functioning.
treatment for ARFID
Treatment for ARFID typically involves a multidisciplinary approach that addresses both the physical and psychological aspects of the disorder. In some cases, a gradual exposure approach called systematic desensitization can help individuals expand their range of acceptable foods.
One of the less common eating disorders, rumination disorder still can cause severe medical complications. Rumination disorder entails an involuntary regurgitation and re-chewing or spitting out of food. People with this disorder cannot swallow food normally.
Rumination disorder symptoms are different from those of other eating disorders in that they are apparently totally involuntary. The body learns to contract its abdominal muscles upon having food enter the esophagus.
People with rumination disorder either re-chew (ruminate) the food, or expectorate it (spit it out). In either instance, there can be serious health complications, as stomach acid can affect the mouth or teeth even if the food is swallowed again, and spitting the food out prevents the patient from digesting it and gaining the included nutrients.
Turning Point of Tampa – Treating Eating Disorders
If you or a loved one is suffering from an eating disorder, seek help from a trained psychiatric professional and a dietitian. Turning Point of Tampa is equipped with staff that can treat the psychological and physical effects of these disorders and many others.
Since 1987, we have been helping women and men recover from eating disorders. Specializing in eating disorders, addiction, and dual diagnosis, our medical and clinical team can help you or your loved find a new path.
Call our admissions department to day and we will gladly help you on your journey to recovery.