Eating Disorders

You may have assumed that eating disorders are solely the result of our modern culture that glorifies thinness and places value on people based on their physical appearance. This is not completely true. While cultural pressures have clearly played a role in the frequency of eating disorders, written accounts of the disorders have emerged since the seventeenth century.

In 1667, Martha Taylor, an eighteen-year-old English girl, became somewhat of a celebrity in Great Britain because of her apparent self-starvation and extreme weight loss. From letters and written accounts of events, it is clear that she would have been diagnosed with anorexia nervosa today. In 1689, Richard Morton, an English physician, published the first medical account of anorexia, what he called “nervous consumption,” in a text entitled A Treatise of Consumption. A number of case reports of the disorder appeared throughout the eighteenth and early nineteenth centuries, but it was Dr. Charles Lasègue, a French physician, who first used the term “anorexia” to describe the disorder in a set of papers published in 1873. From written accounts, anorexia appeared to be a relatively rare disorder until the latter half of the twentieth century.




Characteristic Symptoms

The signs and symptoms of eating disorders vary with the specific disorder and its stage of progression. The most common eating disorders have different symptoms, but share a set of common characteristics.

Alterations in weight are common in eating disorders. While unusually marked weight loss is a common symptom of anorexia nervosa, individuals can be close to, at, or even above their ideal body weight and still have an eating disorder.

Preoccupation with body image including spending an inordinate amount of time looking in the mirror, making negative comments about one’s physical appearance, insisting that she is overweight when she is not and wearing baggy clothing to hide their body shape are common in the eating disorders.

Disruptions in eating patterns may include the extreme restriction of eating and/or binging on large amounts of food. Individuals with an eating disorder may stop eating with their family, develop strong dislikes to previously enjoyed foods, become preoccupied with counting calories and fat grams, develop strange eating rituals and go to the bathroom after immediately after meals to vomit what they just ate.

 

Types of Eating Disorders

Anorexia Nervosa 

Anorexia Nervosa is characterized by a body weight of less than 85% of that minimally expected for age and height. This dangerously low body weight is usually maintained by dieting, fasting, or excessive exercise. These individuals evaluate themselves solely on their body weight or shape; and even though significantly underweight, they are intensely fearful of gaining weight and becoming fat. Though potentially in life-threatening circumstances, they will often deny the seriousness of their low body weight.

Bulimia Nervosa

Bulimia Nervosa is characterized by regular episodes of binge eating followed by inappropriate compensatory behaviors meant to prevent weight gain. These compensatory behaviors include purging (self-induced vomiting and the abuse of laxatives, diuretics, or enemas), the misuse of weight-loss medications, fasting, and excessive exercise. For a diagnosis of bulimia nervosa, the binge eating and compensatory behaviors must have occurred at least twice a week for at least three months. Similar to anorexia, persons with bulimia evaluate themselves almost solely on their body weight or shape. Individuals with bulimia are usually normal weight, but they can be slightly underweight or overweight.

Binge Eating Disorder

Binge Eating Disorder is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. Binge-eating disorder occurs in normal weight, overweight and obese individuals.


Prevalence and Age of Onset

Eating disorders are relatively rare compared to other psychiatric conditions. The estimated lifetime prevalence rates for the eating disorders in women are as follows; 0.5% for anorexia nervosa, 1-3% for bulimia nervosa, and 1.4% for binge-eating disorder. Eating disorders occur most often in women, with less than 10% of all cases diagnosed being in men. The peak age of onset is between fourteen and eighteen years old, with few cases occurring before puberty. While these disorders are predominantly seen in female adolescents and young women, the onset of the disorder can occur at any age prior to thirty-five, with commencement after that age being very rare.

 


Treatment & Support

Eating disorders can be effectively treated, and early diagnosis and intervention significantly increase the chances of a positive outcome. As with all mental disorders, a comprehensive initial assessment is the first step in effectively treating the problem. This assessment will determine the medical, nutritional, and psychological status of the individual and give the treatment team the information necessary to begin an appropriate intervention.

Inpatient Hospitalization

In treating anorexia nervosa, the acute management of severe weight loss is the top priority. This treatment is normally done in an inpatient hospital setting. Problems related to malnutrition are the focus in this phase of treatment, and in many cases intravenous and/or tube feeding are recommended to restore weight. In addition to medical care and monitoring, the patient also receives nutritional counseling and the initial stages of psychotherapy in this setting.

Psychotherapy

The two most common psychotherapeutic approaches taken in treating eating disorders are cognitive behavior therapy and interpersonal therapy. In cognitive behavior therapy, the focus is on helping the individual gain control of unhealthy eating behaviors and on altering the distorted (deceptive) thinking (e.g., body dissatisfaction) that is prevalent in this disorder. In the interpersonal approach, the therapist focuses on issues in the patient’s life, including circumstances and relationships that might lead her into unhealthy eating behaviors. Families are often included in the therapeutic process.

Antidepressant Medication

Research has shown that the selective serotonin reuptake inhibitors (SSRIs; e.g., Zoloft) can be effective in treating eating disorders. Individuals with anorexia nervosa do not respond well to the SSRIs when they are malnourished and underweight. Once a normal weight and diet have been established, however, the SSRIs are effective in helping to maintain long-term remission of symptoms and to prevent relapse. SSRIs are often used in the initial phases of treating individuals with bulimia nervosa for problems related to mood or impulse control.

 

A Spiritual Perspective

In eating disorders we clearly see how a spiritual deception (e.g., one’s worth is based on physical appearance) can take advantage of a physical vulnerability (e.g., HPA dysregulation, overactive serotonin system) and result in the symptoms of a mental illness (e.g., negative self-image, purging, self-starvation). Eating disorders aren’t really about food but rather about how individuals view themselves.

The Scriptures teach us that we have been fearfully and wonderfully made (Psalm 139:14) in the very image and likeness of God (Genesis 1:26). He formed us in our mother’s womb (Psalm 139:13), planned out our days (Psalm 139:16), and brought us into this world (Psalm 22:9). By faith, we have received spiritual birth (John 3:3–6). His Spirit has taken up residence in our bodies (1 Corinthians 6:19), and we are without fault in His eyes (Ephesians 1:4). Indeed we are the very children of the living God (1 John 3:1). These are the truths we must continually bring to the minds of those struggling with an eating disorder. The lie that is at the core of this disorder must be replaced by the foundational truth of who we are in Christ. It is only then that true healing can begin.

  

Finding Care

The links and information below will provide you with a starting point in terms of finding mental health care providers, treatment facilities and support groups for those struggling with eating disorders.

Mental Health Care Providers

When assisting an individual with an eating disorder it is important to help them find the right type of mental health care provider. These links will assist you in beginning your provider search. Knowing and building relationships with providers in your area can prove invaluable. Both in aiding the individual in getting an appointment, as well as, being able to better support them once they begin receiving professional treatment.

An individual struggling with an eating disorder will most likely need to see both a clinical psychologist / therapist for psychotherapy (talk therapy) and a psychiatrist for medication.

By providing your zip code the following search engines will give you information about local mental health care providers.

Clinical Psychologists / Therapists Psychiatrists


Treatment Facilities

In some people, an eating disorder can become so severe that a hospital stay is needed. This may be necessary if the individuals seeking your care can’t take care of themselves properly or are in immediate danger of harming themselves or someone else. Psychiatric treatment at a hospital can help keep them calm and safe until their mood improves.

Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.

By providing your zip code the following search engine will give you information about mental health treatment facilities in your area.

Substance Abuse and Mental Health Services Administration American Residential Treatment AssociationNational Eating Disorder Association

 

Support Groups

Recognizing that community is one of the factors necessary for successful recovery, attending support groups can be a powerful and meaningful way to connect with others facing similar challenges. Support group experiences allow people affected by mental health difficulties and disorders to connect in a safe and supportive environment. Support groups are led by trained facilitators and teach coping skills, help reduce anxiety, build resiliency and provide a place for people to share common concerns and receive emotional support.

These links will give you information on support groups in your area.

Overeaters Anonymous National Alliance on Mental Illness Grace Alliance  National Eating Disorder Association


Supporting the Family

Many times the family caring for an individual with a mental illness is overlooked. They are often the front line support for the individual. The responsibility of care can take a physical and psychological toll on caregivers. Many times the caregiver needs as much support as the individual that has the illness. Caregiver support groups are available for the families of those struggling with eating disorders.

These links will give you information on caregiver (family) support groups in your area.

National Alliance on Mental Illness – Family Support Group National Alliance on Mental Illness – Family to Family Support GroupGrace Alliance




Educational Resources

Here are some links to aid you in learning more about eating disorders. The more information you have, the better you will be able to help those seeking your guidance.

National Institute of Mental Health Mental Health America


Downloadable Resources 

First Step – What to do once a diagnosis has been made.

Daily Steps – Developing a holistic mental health care plan.

Difficult Steps – Navigating destructive behavior and legal issues.