What are eating disorders?

There is a commonly held misconception that eating disorders are a

lifestyle choice. Eating disorders are actually serious and often fatal illnesses
that are associated with severe disturbances in people’s eating behaviors
and related thoughts and emotions. Preoccupation with food, body weight,
and shape may also signal an eating disorder. Common eating disorders
include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Therapy

Cognitive behavioral therapy (CBT) uses a combination of talk therapy

and behavioral modification techniques. It may involve addressing past
trauma, which could have caused a need for control or low self-
esteem. CBT can also involve questioning your motivations for
extreme weight loss. Your therapist will also help you develop
practical, healthy ways to deal with your triggers.

Family therapy may be recommended for adolescents and children. It

aims to improve communication between you and your parents, as well
as teach your parents how to best support you in your recovery.

Your therapist or doctor may also recommend support groups. In these

groups, you can talk with others who have experienced eating
disorders. This can provide you with a community of people who
understand your experience and can offer helpful insight.

Psychological treatment
Family based treatment (Maudsley approach)
Family based treatment (FBT) is the treatment with the best evidence for helping a young
person who has AN and atypical anorexia nervosa. There is also some evidence that FBT also
works for ARFID.
FBT is an intensive outpatient (not staying in hospital) treatment that empowers parents and
encourages them to be proactive and take charge of their child's eating and behaviour. The
focus is mainly on returning the young person to their healthy weight and previous physical
health.
The family works with a trained therapist and a specialist team to present a united front in their
fight against the eating disorder. The young person is also medically monitored by doctors and
nurses throughout FBT to ensure that they are safe to continue their treatment as an outpatient.
Individual psychological treatment
Cognitive behavioural therapy (CBT) is a psychological treatment that has been found to be
effective for BN. CBT focuses on identifying and challenging the abnormal thoughts about food
and body image that are associated with bingeing and vomiting behaviours.
It often involves the young person monitoring their own behaviour and using strategies to
reduce the amount of bingeing and purging they do. This type of treatment is generally provided
in a one-on-one setting.

Medical treatment
Starvation can lead to problems with heart rate, blood pressure, low bone density, puberty and
growth. A young person diagnosed with an eating disorder will need to attend regular medical
appointments with their GP, paediatrician or clinical nurse consultant. The frequency of these
appointments will vary depending on how unwell the child is.
It is important any hospital or specialist service knows who your GP is, so the GP can be sent
copies of any blood tests or treatment plans.

Nutritional consultation by your treatment team

The team treating your child consults with a dietitian when needed. The dietitian gives the team
nutritional advice that will help them support parents/guardians to provide a healthy and
balanced diet for their child.

Hospital admissions
Eating disorders can be so harmful to a young person's health that it is not safe for the young
person to be at home. This is often referred to as being medically unstable.
A young person is medically unstable when there are significant changes in their heart rate,
blood pressure, hydration or electrolytes (salts that are essential for the normal functioning of
the cells in the body). If a young person with an eating disorder is medically unstable they will be
admitted to hospital until the treatment team considers them to be medically safe and there is an
appropriate treatment plan in place.

Key points to remember

 Eating disorders are serious mental illnesses, with the highest mortality rate out of all
psychiatric illnesses.
 They include anorexia nervosa (AN), atypical anorexia nervosa, bulimia nervosa (BN)
and avoidant restrictive food intake disorder (ARFID).
 Eating disorders involve a serious and unhealthy preoccupation with eating, exercise
and body weight.
 Eating disorders require psychological treatment as a family or individual, and in severe
cases hospitalisation is needed

What are the signs and symptoms of eating disorders?

Anorexia nervosa

Anorexia nervosa is a condition where people avoid food, severely restrict

food, or eat very small quantities of only certain foods. They also may weigh
themselves repeatedly. Even when dangerously underweight, they may see
themselves as overweight.

There are two subtypes of anorexia nervosa: a "restrictive" subtype and a

"binge-purge" subtype.

 In the restrictive subtype of anorexia nervosa, people severely limit the

amount and type of food they consume.
 In the binge-purge subtype of anorexia nervosa, people also greatly restrict
the amount and type of food they consume. In addition, they may have
binge-eating and purging episodes—eating large amounts of food in a short
time followed by vomiting or using laxatives or diuretics to get rid of what
was consumed.

Anorexia nervosa can be fatal. It has an extremely high death (mortality)

rate compared with other mental disorders. People with anorexia are at risk
of dying from medical complications associated with starvation. Suicide is
the second leading cause of death for people diagnosed with anorexia
nervosa.

Bulimia nervosa

Bulimia nervosa is a condition where people have recurrent and frequent episodes of
eating unusually large amounts of food and feeling a lack of control over these episodes.
This binge-eating is followed by behavior that compensates for the overeating such as
forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a
combination of these behaviors. People with bulimia nervosa may be slightly
underweight, normal weight, or over overweight.

Symptoms include:

 Chronically inflamed and sore throat

 Swollen salivary glands in the neck and jaw area
 Worn tooth enamel and increasingly sensitive and decaying teeth as a result of
exposure to stomach acid
 Acid reflux disorder and other gastrointestinal problems
 Intestinal distress and irritation from laxative abuse
 Severe dehydration from purging of fluids
 Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and
other minerals) which can lead to stroke or heart attack
Binge-eating disorder

Binge-eating disorder is a condition where people lose control over their eating and
have reoccurring episodes of eating unusually large amounts of food. Unlike bulimia
nervosa, periods of binge-eating are not followed by purging, excessive exercise, or
fasting. As a result, people with binge-eating disorder often are overweight or obese.
Binge-eating disorder is the most common eating disorder in the U.S.

Symptoms include:

 Eating unusually large amounts of food in a specific amount of time, such as a 2-hour
period
 Eating even when you're full or not hungry
 Eating fast during binge episodes
 Eating until you're uncomfortably full
 Eating alone or in secret to avoid embarrassment
 Feeling distressed, ashamed, or guilty about your eating
 Frequently dieting, possibly without weight loss

Avoidant restrictive food intake disorder

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating
disorder, is a condition where people limit the amount or type of food eaten. Unlike
anorexia nervosa, people with ARFID do not have a distorted body image or extreme
fear of gaining weight. ARFID is most common in middle childhood and usually has an
earlier onset than other eating disorders. Many children go through phases of picky
eating, but a child with ARFID does not eat enough calories to grow and develop
properly, and an adult with ARFID does not eat enough calories to maintain basic body
function.

Symptoms include:

 Dramatic restriction of types or amount of food eaten

 Lack of appetite or interest in food
 Dramatic weight loss
 Upset stomach, abdominal pain, or other gastrointestinal issues with no other known
cause
 Limited range of preferred foods that becomes even more limited (“picky eating” that
gets progressively worse)

What are the risk factors for eating disorders?

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights,
and genders. Eating disorders frequently appear during the teen years or young
adulthood but may also develop during childhood or later in life.

Researchers are finding that eating disorders are caused by a complex interaction of
genetic, biological, behavioral, psychological, and social factors. Researchers are using
the latest technology and science to better understand eating disorders.
One approach involves the study of human genes. Eating disorders run in families.
Researchers are working to identify DNA variations that are linked to the increased risk
of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For
example, researchers have found differences in patterns of brain activity in women with
eating disorders in comparison with healthy women. This kind of research can help
guide the development of new means of diagnosis and treatment of eating disorders.

How are eating disorders treated?

It is important to seek treatment early for eating disorders. People with eating disorders
are at higher risk for suicide and medical complications. People with eating disorders
can often have other mental disorders (such as depression or anxiety) or problems with
substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the
following:

 Individual, group, and/or family psychotherapy

 Medical care and monitoring
 Nutritional counseling
 Medications

Psychotherapies

Family-based therapy, a type of psychotherapy where parents of adolescents with

anorexia nervosa assume responsibility for feeding their child, appears to be very
effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo

cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a
person learn how to identify distorted or unhelpful thinking patterns and recognize and
change inaccurate beliefs.