• Eating Disorders

An Eating Disorder is Serious and Potentially a Life-threatening Problem

It is characterised by extreme attitudes, behaviours and emotions about eating, body image and weight. Behaviours can include extreme restriction in food intake, overeating, compulsive exercise, and various methods of purging.

Types of Eating Disorders and their symptoms

Anorexia Nervosa (AN)

Is a condition characterised by self-starvation, excessive weight loss, and an intense fear of gaining weight.

Symptoms include:

  • Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level
  • Intense fear of weight gain or being “fat”
  • Feeling “fat” or overweight despite dramatic weight loss
  • Loss of menstrual periods
  • Extreme concern with body weight and shape

Complications:

AN is associated with several potentially life-threatening physical symptoms, including: osteopenia (thinning of the bones), mild anaemia and related muscle loss/weakness, low blood pressure and slowed pulse, delayed growth lethargy, severe constipation and drop in internal body temperature.

Bulimia Nervosa (BN)

Is a condition characterised by a cycle of binge eating and compensatory behaviour.  Binge eating is defined as eating a large amount of food in a limited period of time while feeling unable to stop eating.  Compensatory behaviours are untaken to rid the body of calories (i.e., to “undo binge eating) and include both purging (e.g., self-induced vomiting, laxatives, diuretics) and non-purging (e.g., fasting, excessive exercise) forms.  Unlike individuals with AN, individuals with bulimic nervosa are normal weight or overweight.

Symptoms include:

  • Repeated episodes of bingeing and purging
  • Feeling out of control during a binge and eating beyond the point of comfortable fullness
  • Purging after a binge, (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting)
  • Frequent dieting
  • Extreme concern with body weight and shape

Complications:

BN is associated with several potentially life-threatening physical symptoms, including: severe dehydration from purging fluids, swollen glands in the neck and jaw, chronically inflamed throat, gastroesophageal reflux disorder, electrolyte imbalances, and worn tooth enamel.

 

Binge Eating Disorder

Is a condition in which individuals engage in frequent binge eating that causes significant guilt and distress but do not engage in compensatory behaviours such as self-induced vomiting or exercise.  Individuals with binge eating disorder are often overweight or obese and experience feelings of guilt and shame about the binge eating, which often lead to more binge eating.  It is also common for individuals to struggle with loneliness, anxiety and depression and physical conditions related to being overweight, such as diabetes and hypertension.  Currently, Binge Eating Disorder is classified under the category of “Eating Disorder Not Otherwise Specified.”

Other Eating Disorders:

Many individuals experience several symptoms of eating disorders without meeting full criteria for either AN or BN.  Treatment is frequently warranted because the symptoms cause significant distress and impairment.  These individuals are typically diagnosed with “Eating Disorder, Not Otherwise Specified.”

What Causes Eating Disorders?

There is no one cause of eating disorders.  Risk factors are generally understood as a combination of genetic, biological, psychological, social, and cultural factors.

Genetic
Recent research suggests strong evidence that eating disorders run in families.  Several different genes and genetically transmitted traits have been implicated as potential sources of genetic risk factors.  However, more research is needed before any conclusions can be made.

Biological
Research has found some evidence that individuals with eating disorders have low levels of serontonin, a chemical in the brain associated with both mood and appetite.  There is also some evidence that chemicals associated with stress levels are abnormally high among individuals with eating disorders.

Psychological
Low self-esteem, perfectionism, depression, anxiety, feelings of lack of control or inadequacy and a tendency to experience negative emotions (i.e., neuroticism) have all been suggested as risk factors for eating disorders.

Social
Family conflict, teasing or pressure from peers about weight, and experiences of trauma, especially early in life have all been identified as potential risk factors for eating disorders.  In addition, there is some evidence that difficulties in romantic relationships increase risk for eating disorders.

Cultural
Cultural norms that value thinness and beauty and place emphasis on having the “perfect body” have frequently been identified as risk factors for eating disorders.   As a result, the media has often been implicated in the rise of eating disorders over the past 30 years, because images of thin celebrities are thought to perpetuate unattainable ideals of thinness and beauty.

What Treatments Are Available?

Anorexia Nervosa
Treatment for AN involves two primary components: weight restoration and psychotherapy.

1.  Weight restoration
The first and most important goal of treatment for AN is weight gain.  Malnutrition, low energy, and other consequences of self-starvation make typical psychotherapy a significant challenge.  Thus, treatment should initially focus on restoring the individual to a healthy weigh through collaboration with a medical doctor and/or nutritionist.

2.  Psychotherapy
Cognitive Behavioural Therapy (CBT):  CBT for AN focuses on
1) Providing the patient with psycho education about the nature and consequences of AN;
2) Identifying, challenging, and reshaping the patient’s distorted thoughts about food, eating, and body image;
3) Exposing patient to “feared foods,” such as those high in fat and/or calories to reduce the patient’s fears about consuming such foods, reducing restriction, and normalizing eating behaviour

Family Therapy
1) Traditional Family Therapy: Therapies such as Structural Family Therapy focus on roles, conflicts, interaction patterns and alliances within the family that likely contribute to or sustain the patient’s eating disorder

2) Family-Based Therapy: Time-limited therapy that places parents in charge of feeding and monitoring the patient. Parents generally maintain control until the patient has returned to a healthy weight and can demonstrate at least some willingness and ability to manage her own eating behaviours.  Parent training has also recently been translated to the treatment of eating disorders.  This form of family therapy instructs parents in behaviour management to help them reinforce healthy behaviours and reduce unhealthy behaviours in the patient by using traditional behavioural strategies, such as rewards and punishment.

Other Psychotherapies:  Other therapies that have been shown to be helpful in the treatment of AN include Interpersonal therapy and psychodynamic approaches.  Recently Acceptance and Commitment (ACT) has also been translated for the treatment of AN.   ACT utilizes mindfulness and acceptance-based principles to encourage individuals with AN to consider alternatives, namely in the form of valued action, to the emotional and psychological traps of control around eating and body image.

Bulimia Nervosa and Binge Eating Disorder
Like AN, treatment for BN and, to a lesser extent BED, involves consultation with medical doctors and nutritionists who can monitor the patient’s health and provide the patient with an appropriate meal plan.

Psychotherapy
Cognitive Behavioural Therapy (CBT).  Research strongly supports the effectiveness of CBT to treat BN.  CBT can be done individually or in groups.  Treatment focuses on:
1)Providing psycho education about the nature and consequences of binge eating and purging (when applicable).
2)Identifying, challenging and reshaping faulty thinking about food and body image.  For instance, therapists will help patients identify “all or nothing” thinking about food and challenge assumptions about the importance of appearance.
3)Identifying triggers for binge eating (and purging when applicable).
4)Developing alternative behaviours to cope with stress and difficult emotions, such as sadness and anger.
5)Reducing extreme dieting behaviours, such as fasting, restriction, and binge eating.

Family Therapy.  Family therapy for BN and BED are similar to the options described above for AN.
Other forms of psychotherapy.  Other therapies shown to be effective for treating BN include Interpersonal Therapy, Acceptance and Commitment Therapy (ACT) (see above for description) and Dialectical Behavioural Therapy (DBT).  DBT focuses helping patients experience and accept emotional and behavioural struggles while, at the same time, providing them with skills to cope and change these problems.  Skill instruction focuses on four primary areas: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.  It remains unclear whether these therapies are also effective for BED.

Medications.  The FDA has approved the use of Prozac (Fluoxetine), which has been shown to reduce binge eating and purging, reduce chances of relapse, and improve attitudes about eating.