These days, it’s not always easy to have a healthy relationship with food. However, there is a difference between feeling guilty after eating dessert and feeling out of control when it comes to when and how you eat. When someone’s relationship with food becomes distorted enough to affect their mental and physical health in a clinically significant way, it’s likely that they could be suffering from an eating disorder.
Only anorexia, bulimia, and binge eating disorder are recognized by the American Psychological Association as eating disorders, though there are other disorders that are similar to eating disorders — such as ARFID and pica.
Anorexia, bulimia, and binge eating disorder, though all eating disorders, can have very different symptoms, habits, and causes, and therefore require different treatment approaches.
What Is an Eating Disorder Described As? How to Identify an Eating Disorder
An eating disorder is a relationship with either self-image, body, and/or food that includes a sense of lack of control, shame, or inability to cope. The term “eating disorder” is an umbrella expression to cover a number of different conditions, but essentially they all have one thing in common: a misaligned relationship with food.
Many people think of eating disorders as something someone chose or is inflicting upon themselves. However, the reality is that those caught up in eating disorders no longer have control over what they are doing. An eating disorder is a disease that needs treatment exactly the same as any other disease. Untreated eating disorders can, in the worst-case scenario, cause multiple kinds of illness and even death.
The good news is that there are treatments for eating disorders and, as with any illness, the sooner that an eating disorder is diagnosed, the better chance there is of dealing with it and the underlying causes that brought it on in the first place.
Underlying Causes of Eating Disorders
The exact cause of eating disorders is still unknown. However, there are some common factors that those who have an eating disorder tend to share, which can be grouped into three main factors. These factors are as follows:
- Psychological factors: It’s extremely rare for someone happy and thriving in life to develop an eating disorder. An eating disorder can be considered as a form of self-harm or self-abuse, and as such, often develops in people suffering psychologically in some form or another. Depression, feelings of low self-esteem, stress, lack of control or a sense of overall inadequacy can sometimes lead to the development of an eating disorder of one kind or another. Hating oneself and the way one looks can contribute to eating disorders, and that self-hatred can either come from inside or from others—though it can often be a result of societal beauty standards and values of skinniness and other specific, often unattainable, body types.
- Biological factors: Scientists are exploring the premise of whether eating disorders are hereditary or not, and in some cases, it has been shown that the condition often runs in families. One study found that the presence of certain (very rare) mutations of two genes — ESRRA and HDAC4 — can increase the likelihood of someone developing an eating disorder at some point in their lives. There are also questions about whether chemical imbalances in the brain can contribute to an eating disorder or not, specifically imbalances in the chemicals that control one’s hunger and appetite.
- Environmental/social factors: This is a big one and ties into the psychological factors touched on above. In the Western world, many struggle under the constant pressure to have the “perfect body.” We are bombarded by advertising and TV commercials showing models telling us that we could look like them as well. Many people can’t help but compare how they look to the idea of how they “should” look—an impossible standard that, often, the people pictured don’t even meet. This leads to self-esteem issues that can trigger an eating disorder. Outside of the media images that tell people how to look, there’s also peer pressure from friends, especially teenagers. Other environmental/social factors can come from early abuse or trauma, leading to the use of disordered eating as a maladaptive coping mechanism.
It needs to be stressed that any given person with any given eating disorder may not be suffering from their disorder because of any one of the above factors—in reality, the truth is more opaque, and it’s often a combination of all or some of them that end up causing a full-fledged disorder. It’s also true that someone can experience any or all of the factors that are believed to lead to eating disorders and not have a disorder at all. In the end, it’s all down to the individual person.
Prevalence of Eating Disorders
The typical image of someone suffering from an eating disorder is a teenage girl or young woman, and though that stereotype isn’t wrong in terms of the general population of people with eating disorders, that isn’t the whole truth. In reality, everyone is susceptible to developing an eating disorder, and characteristics like age, gender, race, and sexuality can contribute to various different kinds of disorders.
The majority of people who are diagnosed with an eating disorder are girls and women between the ages of 12 and 25 years old. There are certainly cases outside of this age group but most will fall into it. Females are estimated to be 3 times more likely than males to develop an eating disorder.
However, in a world where the Western image of beauty is considered the best, a study in 1996 showed that Asian, Black, and Latina seventh-grade girls were more likely than white girls to be dissatisfied with their body shapes, which could lead to possible problems in the future.
Men also suffer. 25% of people struggling with eating disorders are men, and because many people assume that men can’t or don’t develop eating disorders, they are at a higher risk of death due to late diagnosis.
Which Eating Disorder Is the Least Common?
Surprisingly to some, anorexia nervosa is the least common eating disorder of the three. Though anorexia is often what many people think about when they think of eating disorders, both binge eating disorder and bulimia are more common.
Understanding Eating Disorders: Types and Symptoms
As mentioned earlier, the American Psychological Association recognizes three different types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. Each of these disorders has its own set of distinct symptoms, and, therefore, requires specific treatment in order to help an individual manage their triggers, behaviors, and symptoms.
Anorexia Nervosa: Signs and Treatment
Anorexia is the stereotypical eating disorder, as it’s more than likely what people think of when they think of eating disorders. It’s the most deadly of all eating disorders, and in fact the deadliest of any mental illnesses.
Anorexia nervosa isn’t solely the act of starving yourself of food in order to reach a desired weight that you have in your mind as ideal for you. Oftentimes, anorexia is not actually about food, but more about being that ideal person in your mind that you are not. In many situations, it’s about control more than anything.
Those with anorexia will always see themself as overweight, no matter how thin they actually are. In the mind of someone with anorexia, they will never reach their desired weight, causing them to starve themselves more, making it very hard to reorient to the current reality of their weight and body image.
Signs of Anorexia
There are many signs and symptoms that can indicate a problem with anorexia, including the following:
- Obsession with the scale, consistently weighing themselves
- Intense calorie counting
- Skipping meals and always having an excuse for not eating (“not hungry”, “already ate”, etc.)
- Obsessively exercising
- Withdrawal from usual family or social life, friends, and activities
- Moodiness, irritability
- Setting high, if not impossible, standards for themselves
- Rapid weight loss
- Loss of hair
- Brittle nails
- Weakness and general loss of muscle strength
- Bad breath
- Lack of concentration on anything
- Low tolerance of cold—feeling cold all of the time as the body temperature drops
- The growing of downy hair (called lanugo) on the face and the body in order to try to keep the body warm.
It’s important to keep in mind that, though many people experience this, not everyone with anorexia struggles with low weight or looks too thin—in fact, that is only one of anorexia’s many physical symptoms.
Many people with larger bodies can struggle with anorexia and exhibit multiple signs of having an eating disorder, but due to their size and weight, they are dismissed or even congratulated for restricting their diet or “working hard” to lose weight. Anorexia is not healthy for anyone, no matter their size or gender, and requires professional treatment in order to heal.
The end result of untreated anorexia is death. The body, starved of calories and nutrients, eventually shuts itself down. However, this is only the worst-case scenario–there are many effective treatments available to help people with anorexia recover.
Treatment for Anorexia
Treatment for anorexia is a two-pronged approach. Often, the first thing to do is to get the patient well again with a supervised weight gain plan. This will address the most severe threats to their health and halt the damage that has been done due to the starvation of the body.
This needs to be done with plenty of family support as well as professional support. In some cases, hospitalization will be necessary if one’s body is especially malnourished. From then on, they’ll work with a trained eating disorder professional who will teach the individual how to adjust their relationship with food to become healthier and more balanced.
Bulimia: Breaking the Cycle and Seeking Help
After anorexia, bulimia is often the next eating disorder that people think about when asked. Bulimia is the act of binge eating and then (often, but not always) purging in some way—self-induced vomiting, laxative use, or over-exercising.
The main difference between anorexia and bulimia is the fact that anorexia’s signature is that food is avoided at all costs. People with bulimia are generally at a healthier body weight but engage in a cycle of binging and purging, something inside them compelling them to secretly gorge on food and then purge it.
It’s generally not hunger that causes people with bulimia to eat in excess. Something will drive them to eat an exorbitant amount of something very fast and then purge themselves afterward. This is driven by a complete lack of control over their consumption, caused by any number of psychological conditions—from depression to a lack of confidence or self-esteem.
One way to think about bulimia is that to a bulimic, food is a crutch to be relied on when needed. When they overeat, they eat so much that the feelings of shame and despair afterward force them to get rid of that food inside of them. Most of the time, someone with bulimia will do one of four things:
- Vomit the food back up
- Take laxatives or diuretics
- Exercise to excess
- Fast for a couple of days
With bulimia, it’s not a question of just grabbing something from the fridge—during a binge, people can eat until they feel uncomfortably full, sick, or even vomit.
Signs of Bulimia
The more obvious symptoms and signs of bulimia include:
- Binge eating
- Hiding stashes of food around the house
- Constant sore throat
- Discolored teeth
- Disappearing after eating
- Calluses or marks appearing on the backs of hands from forcing them down the throat to vomit
- Fluctuations in weight (either up or down)
- Constant thirst and dehydration
- Stomach ulcers
Treatment for Bulimia
Treatment for bulimia can include weight stabilization (if necessary) and an in-depth assessment of the person’s health, as bulimia can cause dangerous electrolyte imbalances that require immediate medical attention and monitoring as well as extreme dehydration and stomach ulcers.
While people with bulimia are often at a healthy weight, this can be due in part to water retention due to binge/purge cycles and is not always indicative of overall health.
A mental health professional who specializes in eating disorders will work with a person with bulimia to help reset the individual’s relationship with food to try to lessen its importance as an emotional crutch. Many people with bulimia are prescribed a course of antidepressants in order to help them overcome the urge to binge eat, but counseling is key for this condition.
Binge Eating Disorder: Managing Compulsive Eating
Although this disorder lacks the notoriety of anorexia or bulimia, binge eating disorder (BED) is a fully recognized eating disorder in its own right by the American Psychiatric Association as well as other organizations. It’s actually the most common eating disorder, affecting more people than any of the others.
Like bulimia, binge eating disorder is characterized by someone using food as an emotional crutch and overeating to excess. Unlike bulimia, though, persons suffering from binge eating disorder typically do not try to expel or purge their food after eating it. In the end, the practice of binge eating becomes a vicious, uncontrollable cycle — a person’s attempt to feel better and self-soothe instead making them feel terrible about binge eating, and so the pattern goes.
Signs of Binge Eating Disorder
Almost always, a person with binge eating disorder will display some of the following symptoms of BED:
- Binge eating at least twice a week for at least six months
- Steady weight gain
- Overeating to excess—continuing to eat even when feeling full
- Lack of control over eating, being unable to stop even if they want to
- Eating normally when in company, but gorging when alone
- Stockpiling food around the house
- Feeling constantly stressed or on edge, only feeling relieved when eating
- Not enjoying the food while eating, but continuing to eat anyway
Outside of the signs listed above, there are also all the usual health problems associated with obesity like type 2 diabetes, heart disease, high blood pressure, cholesterol, and so on.
Treatment for Binge Eating Disorder
Treatment for binge eating focuses on the psychological aspects of the disorder as well as the medical consequences. It’s based on re-teaching the person how to reprogram their relationship with food and to get to the bottom of what is triggering the bouts of binge eating.
Individual counseling with an eating disorder expert is usually the first place to start, but group therapy sessions alongside individual therapy can also be a good idea.
In the end, getting BED into remission is about finding other, more positive ways to manage emotions and life challenges, such as stress and depression, in order to change one’s relationship with food so that it is no longer an emotional crutch.
Building a Life Beyond Eating Disorders
The goal of eating disorder treatment is to help those with eating disorders change their unhelpful coping strategies, heal their relationship with food, and set them up to live a happy and fulfilling life.
As previously stated, the best way to do this is to get expert support from professionals trained to treat eating disorders, such as a physician, psychiatrist, and/or psychotherapist. Eating disorder care requires treating your mind and body, which is why it’s important to have a care team so that you receive care on multiple fronts.
Outside of therapy and medical care, it’s good to develop relationships and personal support systems with people you can be open with. Direct communication (i.e. checking in on each other, being there for hard conversations, etc.), even after treatment, can be very beneficial for your recovery.
Compassionate Counseling for Eating Disorder Recovery: Long-Term Recovery Success
In terms of therapeutic approaches, a systems therapy approach can be effective, as it targets your environment such as family, living situation, and support systems. In truth, eating disorder recovery involves the whole family. Though they are not always the cause, your family and support systems can have a substantial effect on your mental health and recovery.
The intensity and involvement of eating disorder treatment can vary depending on the severity of your disorder and your symptoms. Unless your disorder is of very low severity, it’s likely that you will have to develop a care team, as healing will require more than one-on-one work with a psychotherapist or counselor.
Finally, it’s best to take a lifelong approach to healing your relationship with food, as it will require consistently working to shift and maintain your view of yourself and your worldview. Remember, though—healing will not always be as challenging as it is now. Over time, these positive patterns will become more and more automatic.
Types of Eating Disorder Therapy: Eating Disorder Therapy Techniques
Therapy for eating disorders should always be somewhat unique to the person being treated. However, there are some approaches and techniques that have been found to be especially effective for treating eating disorders. Here are some examples of the most common approaches.
Cognitive Behavioral Therapy (CBT)
The most commonly used therapeutic approach for eating disorders is cognitive behavioral therapy. It is one of the most versatile therapeutic approaches and focuses on the connection between someone’s emotions and their thoughts and behaviors. By making these connections, CBT works to change unhelpful thoughts and behavioral patterns, thereby impacting one’s emotional states and ability to regulate their emotions.
This is an extremely important process for people with eating disorders, as their actions are often triggered by their emotions. By changing the thoughts and behaviors causing the triggering emotions, they can adjust their perspective and create healthier habits and coping mechanisms.
Family-Based Therapy (FBT)
As stated previously, effective eating disorder treatment almost always involves looking at someone’s family system through family-based therapy. Family-based therapy informs family members about eating disorders and the complexities of treating them, allowing them to become a strong support system for the person struggling with the disorder.
This approach also works to evaluate family dynamics, identify any unhelpful patterns or communication issues, and resolve conflicts that have negative effects on the family. This allows the family to problem-solve and support each other in a collaborative, empathetic way.
Much like the other approaches named, this approach would happen alongside medical interventions, individual therapy, family-based therapy, and other treatments as part of a multi-pronged treatment plan. This type of therapy is led by a dietician or nutritionist with the goal of getting their clients to a healthy weight (if necessary) and repairing their relationship with food.
Nutritional counseling involves learning about what healthy food intake looks like, how much people of different body types need to eat in order to adequately nourish their body, how metabolism works, and how to recognize true signs of hunger and fullness.
Each of these approaches has an important place in holistic eating disorder treatment. Without the work of one of these methods, treatment can be less effective, making it less likely that any changes made to your habits and mental health will be sustained over time. Though it may be slow, deliberate work, over time, you will learn to effectively manage your eating habits and emotions, allowing you to live a happier and more fulfilling life.
How to Choose the Right Therapist
If you are looking for help treating your eating disorder, or are wondering whether you might be struggling with disordered eating, Thriveworks can help. Our knowledgeable therapists, counselors, and psychiatric nurse practitioners are ready to help you address the negative patterns in your life and work with you to create an effective treatment plan.
Get your healing journey started and book a session with an experienced Thriveworks clinician today.