Eating Disorders

Copyright © 2018 by Edwina Rogers.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Rev. date: 11/21/2018

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Contents

Part I: Overview of Eating Disorders

Chapter 1: When Food Becomes the Enemy

Chapter 2: Types of Eating Disorders, Part 1

Chapter 3: Types of Eating Disorders, Part 2

Part II: Causes, Symptoms, and Effects of Eating Disorders

Chapter 4: Risk Factors and Underlying Causes

Chapter 5: Sexual Orientation and Eating Disorders

Chapter 6: Dancers, Athletes, and Making Weight

Chapter 7: The Effects of Pregnancy and Medical Complications

Part III: The Way Forward—Research and Treatment

Chapter 8: Psychodiagnosis and Research Methodologies For Eating Disorders

Chapter 9: Psychological Treatments and Cognitive Behavioral Therapies

Chapter 10: Medications and Hospitalization

Chapter 11: Nutrition and Eating Disorders

Chapter 12: Preventing and Recovering from Eating Disorders

Recommended Resources

References

PART I

Overview of Eating Disorders

CHAPTER 1

When Food Becomes the Enemy

K aty is a sixteen-year-old girl who was brought to the clinic by her mother. Her mother has a growing concern about her daughter’s eating habits, saying she has lost a significant amount of weight in the last few months. Katy has stated several times she is too fat and wants to lose weight. Her mother reports she is irritable and constantly shuts down at home, especially when her mother tries to get her to eat more.

Katy’s mother said she has noticed her daughter takes careful consideration in the foods she eats, only eating raw vegetables and crackers, drinking lots of water, and refusing to eat what her mom makes for dinner. Although Katy sometimes takes a pastry with her from the house on her way to school, Katy’s mother is worried she may not be eating it or anything else the rest of the day. Katy’s teachers have reported Katy seems to have low energy at school and often falls asleep in class, whereas in previous years she has been a straight-A student.

Katy’s mother has brought her to the doctor because she says Katy passed out at home the day before. Her mother believes it is because Katy is not eating enough to sustain her throughout the day. Katy’s mother is worried about her and doesn’t know how to help her daughter.

Eating Disorders

It’s a familiar story. Eating disorders are a complicated mix of significant weight-related issues. In the United States, approximately 1% to 3% of women are diagnosed with an eating disorder. But the number of young adult women who report engaging in unhealthy eating practices and yet do not meet criteria for eating disorder diagnoses is considerably higher. Sixty-one percent of college women have indicated that they either occasionally or regularly used extreme measures to control their weight, such as fasting, appetite suppressants, diuretics, or purging after eating.

Eating disorders feature serious and obsessive behaviors that are exhibited in extremely inappropriate eating habits due to body image distortion, a need for control in their life, or as a coping mechanism for stress. In the eight distinct eating disorders that are outlined in the DSM-5, some of the symptoms do overlap and most of the resulting health issues are similar but each one exhibits behaviors that are specific to that disorder. All result in seriously negative psychological, physical and social consequences. Often an eating disorder follows drastic attempts to control weight that develop into repeated obsessions or ritualistic behavior that the person feels compelled to perform.

Eating disorders affect people of all ages and both genders, though they are seen 2.5 times more often in females. Often the underlying cause of anxiety and stress begins in childhood. They most often appear in teens but can develop in adults even in older adults. Eating disorders are an expression of mental illness and can be treated. Many times eating disorders coexist with other mental illness, substance abuse and anxiety disorders. Diagnosis is often difficult due to the fact that the symptoms are the same as many other health issues, can be hidden, and require close observation to recognize.

Eating disorders can be life threatening if treatment is not received. Anorexia nervosa is associated with mortality more than any other psychiatric disorder. The research shows that eating disorders are complicated and can result from genetic, biological, psychological, and social factors all interacting together. Brain imaging has allowed medical professionals to study the target areas that are affected by eating disorders. Knowing how the brain functions in connection to such obsessions with food will give clues to better treat such illness.

As in all medical issues, prevention is the ultimate goal. Understanding the progressive effect on the brain can help guide further prevention and treatment efforts. Knowledge of symptoms of the underlying mental illnesses must be a focus in prevention of full blown eating disorders. Having strategies in place, including the education of the public and medical professionals can greatly advance prevention of the eating disorder. Parental awareness of signs and symptoms of such tendencies that appear inappropriate or obsessive must be increased as well.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

While they have been found to have many similarities, there are enough distinctive eating behaviors to warrant their definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as eight separate yet related disorders:

1. Anorexia Nervosa (AN)

2. Bulimia Nervosa (BN)

3. Avoidant/Restrictive Food Intake Disorder (ARFID)

4. Binge Eating Disorder (BED)

5. Pica

6. Rumination Disorder

7. Other Specified Feeding or Eating Disorder (OSFED)

8. Unspecified Feeding or Eating Disorder (UFED).

The last two, OSFED and UFED, were once combined and referred to as Eating Disorders Not Otherwise Specified (EDNOS).

Other Specified Feeding or Eating Disorder now refers to some other specific sort of disordered eating, like night eating disorder, or compulsive over-eating, that are not officially recognized and don’t yet have agreed upon diagnostic criteria, but nonetheless do occur, and can even be quite common.

Unspecified Feeding and Eating Disorder is reserved for instances where there is clearly an eating disorder but it may be quite idiosyncratic or is not (yet) clearly defined or describable.

An emerging disorder, orthorexia nervosa, while not yet clinically recognized, centers around the individual’s obsession with what they claim is healthy eating.

Causes of Eating Disorders

Eating disorders are complex illnesses that can be triggered by a wide variety of biological and environmental variables. It is important to note that the person with an eating disorder did not wake up one day with this disease. It is created within the person over time as he or she attempts to cope with issues in life that are stressful. And although girls and women are the focus of many eating disorder studies, there are many boys and men who suffer from this disease as well.

Eating disorders include a range of conditions characterized by an intense obsession with food, weight, and appearance. The obsession is often so strong that it disrupts an individual’s daily activities, health, social and familial relationships, and career. It is estimated that over ten million people in the United States suffer from eating disorders such as anorexia, bulimia, and binge eating disorder, and the numbers are growing.

Cultural Pressure

Researchers have identified a variety of causal agents. Especially in young women, identification with extreme thinness as a beauty ideal is a well-established predictor of eating disorder symptoms. Ideals for thinness refer both to an individual’s awareness of sociocultural pressures to fit a thin prototype and to the internalization of the thinness beauty standard. It is believed that social pressures to conform to the thin body shape ideal have contributed to the increased incidence of eating disorders among young women.

One way to approach the influence of exposure to ideal-looking models in the media on body image is through social comparison theory. First described by social psychologist Leon Festinger (1954), this theory proposes the common-sense notion that people have an innate tendency to compare their attributes, including physical appearance, to others as a method of self-evaluation. Theoretically, media exposure most often produces a negative body image, because when individuals compare their appearance to ideal-looking models, it generally leads to upward comparison, whereby individuals deem themselves as less attractive than the models.

It must be remembered that most people are repeatedly exposed to body images in the media and the vast majority do not develop eating disorders. Research findings have consistently shown that, as the internalization of ideals for thinness increase, so do eating disorder symptoms. More specifically, it is internalization rather than awareness alone that consistently accounts for more of the variance associated with measures of eating disorder symptoms, suggesting that it is the embracing of these ideals, and not just the exposure to them, that is associated with eating disorder symptomatology.

Aside from cultural influences, there are many other factors that may lead an individual to embrace an eating disorder.

Biochemical and Biological Causes

Scientists are researching possible biochemical and biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be unbalanced. Brain imaging studies have shown that people with eating disorders may have altered brain circuitry that contributes to eating disorders. These differences may help to explain why people who develop anorexia nervosa are able to inhibit their appetite, why people who develop bulimia nervosa have less ability to control impulses to purge, and why people who develop binge eating disorder are vulnerable to overeating when they are hungry.

Genetics

Eating disorders often run in families. Current research indicates that there may be significant genetic contributions to eating disorders. Increasing numbers of family, twin, and adoption research studies have provided compelling evidence to show that genetic factors contribute to a predisposition for eating disorders. This suggests that individuals who are born with certain genotypes are at heightened risk for the development of an eating disorder.

Trauma and Psychological Issues

Psychological causes of an eating disorder may include low self-esteem, feelings of inadequacy or lack of control in life, depression, anxiety, anger, stress, or loneliness.

Interpersonal issues may include a history of physical or sexual abuse, troubled personal relationships, difficulty expressing emotions and feelings, or a history of being teased or ridiculed based on size or weight.

Traumatic events such as physical or sexual abuse sometimes precipitate the development of an eating disorder. Eating disorders can become a mechanism with which to cope with rape, incest, and other trauma. Survivors of trauma often struggle with shame, guilt, body dissatisfaction and a feeling of a lack of control, and eating disorders are common for adult survivors of childhood sexual abuse and for survivors of sexual assaults as adults. The eating disorder may emerge as a distorted expression of self-medication or misdirected self-punishment for the trauma. It can thus be seen as the individual’s attempt to regain control or cope with these intense emotions.

For some survivors of sexual abuse, developing an eating disorder is a way to avoid sexuality and its painful memories. In stressful events like rape or molestation, the victim often feels that their control over their own body has been taken, and may seek extreme ways to increase their sense of control. In other cases, an eating disorder may be a way to hide anger or frustration and seek the approval of other people.

Common Traits in Eating Disorders

Even a partial eating disorder that has not been diagnosed or classified can be dangerous and lead to death. Family and friends often see the problem as something other than an eating disorder. And even though eating disorders may each have different pathologies, they often share three things in common:

1. A recurring inappropriate behavior.

2. The fear of changing their habits.

3. Denial that the problem is serious.

In unspecified eating disorders the binge eating and purging may occur less frequently than in the classic type, or an individual might maintain a normal weight and still have bouts of anorexic behaviors.

Eating disorders are similar to all addictive behaviors and often occur at the same time. They are all coping behaviors to deal with stress and to manage