About Eating Disorders

Eating disorders are serious physical and mental health conditions that can have life-threatening consequences for the people who suffer from them. The causes of eating disorders are complex, and can result from a combination of genetic, societal, interpersonal, and psychological factors.

Anorexia Nervosa: Affects approximately 1 out of every 100 young women. People with anorexia often become very fearful of food and weight gain, and can have distorted thinking surrounding shape and weight.

Bulimia Nervosa: Occurs in another 2 to 5 out of every 100 young women. This disorder is characterized by a sense of loss of control when eating; often individuals will consume large quantities of food in one sitting and then engage in compensatory purging behaviors (i.e. vomiting, laxative use and/or compulsive exercise).

Binge Eating Disorder: Affects about 10-15% of mildly obese individuals, and is marked by repeated episodes of uncontrolled overeating. This disorder can lead to conditions of overweight and obesity.

Other Specified Feeding and Eating Disorders (OSFED): Is a diagnostic category that represents individuals with eating disordered behaviors that resemble anorexia nervosa or bulimia nervosa but whose eating behaviors do not meet one or more essential diagnostic criteria.

The following are physical, behavioral and emotional signs and symptoms of eating disorders. If you are concerned that you or a loved one may be suffering, it is important to seek professional help. 

Physical:

• Significant weight loss or gain in a short period of time
• Abdominal pain
• Feeling full or bloated
• Dry hair or skin, dehydration, blue hands/feet
• Alteration or loss of menstrual cycle
• Chronic constipation
• Low blood pressure/feeling cold

Behavioral:                 

• Dieting or irregular food intake
• Pretending to eat, throwing food away
• Exercising for excessive periods of time
• Obsession with food
• Frequent trips to the bathroom
• Wearing baggy clothing to hide very thin body
• Isolation

Emotional:

• Complaints about appearance
• Fear about being or feeling fat
• Sadness, depression, feeling worthless
• Perfectionist attitude
• Feelings of helplessness
• Prone to stress and anxiety
• Denial and inaccurate perception of body image/weight

Use the National Eating Disorder Association’s (NEDA) free online screening tool here

Eating Recovery Center’s Start the Conversation Signs and Symptoms Diagram

There are several factors that contribute to the development of anorexia, bulimia, or binge eating. Eating disorders are complicated, so it is important to know what signs or symptoms to look for. Below are several red flags that may indicate that a person is struggling and they need help!

• Constant thoughts about their weight
• Enjoys cooking for others but not themselves
• Finds that their weight determines their mood for the day
• Avoids eating with family and friends
• Feels guilty after they eat
• Frequently compares their body size and shape to others
• Weight fluctuates drastically over short time spans
• Compulsively exercises
• Preoccupation with the eating behaviors of others
• Menstrual irregularities
• Eating to relieve stress or depression
• Self-induced vomiting
• Laxative/Diuretic abuse
• Constant concern of being fat
• Difficulty concentrating
• Increased isolation
• Hair loss
• Preoccupation with nutrition, calories, food, cooking, and exercise
• Frequent weighing of self
• Binge uncontrollably on large amounts of food to the point of feeling sick
• Participation in frequent diet fads
• Lying to others about eating patterns
• Insomnia or difficulty sleeping
• Dizzy spells, fainting, or blackouts
• Always feeling good
• Fine body hair on their body
• Swollen, puffy cheeks
• Feels confused about their emotions or have fear of expressing them
• Skips school or work because they feel fat or sick
• Eats the same rigid foods all the time
• Extreme exercise regiment, even when injured or sick, or no exercise at all
• Declines social engagements because they must work out
• Loss of things they used to enjoy
• Purchase clothing based on the size instead of the fit

*Adapted from Center for Discovery, centerfordiscovery.com

Research indicates that around 95% of eating disorders begin between the ages of 12 and 25. That means it’s especially important for parents, teachers, and other trusted adults to know how to identify eating disorders in this population.

Learn the signs and how to help with EDRC and Equip.

What if you suspect or know that someone has an eating disorder? Should you say something? What would you say? Should you talk to the person who has the problem or someone else?

The most important thing to remember is that bringing up the subject of an eating disorder with a person who is suffering from one can be a tremendous help. It plants the seed about your concern for what she/he is doing and brings her/his focus to the issue. Even though it may be difficult, saying something is better than ignoring a dangerous and painful behavior.

Eating disorders can be life threatening. If you suspect the person is in any kind of medical danger (fainting, weak, suicidal), do not hesitate to get them help immediately. Call her/his physician or take her/him to the emergency room for assessment.

If you are a parent, arrange for medical and psychological care for your child immediately. You may not know how serious an eating disorder is, but an initial consultation will help sort out if your child is suffering from an eating disorder and determine what’s really going on.

If you are a young person concerned about your friend or sibling, it is important to tell a trusted adult as soon as possible. You may want to speak to your friend or sibling privately first, but it is essential that you contact a parent, teacher, coach, nurse, school counselor, or other trusted adult about your concern. Since you may not know how serious the problem is, don’t wait. Though your friend may be upset with you now, this will be likely to change when he or she begins to recover from the eating disorder.

Consider these ideas before speaking to the person you are concerned about:

1. Who would be the best person to do the talking? Parents can decide who would be the best person to speak with their child. If you are not close to this person but are worried, there may be a teacher, school counselor, nurse, other relative, or mutual friend that could help talk to the person about it.

2. Find a time to talk with the individual when you are calm and will not be interrupted. The more you are able to stay composed and centered, the more this may help your friend understand that you truly care and are worried about his or her health. Be as supportive and kind as you can, but be clear in your concern.

3. Write down what you might say ahead of time. You don’t have to follow it perfectly, but it helps you to focus and stay on track. Talking directly about your feelings and what you have been noticing is helpful. Something simple like “I have been worried about you because…”, can get the conversation started.

4. What is your intent in talking to them? Be realistic. Sometimes just bringing the issue up helps them to admit they want guidance. Do you need to talk about how the eating disorder is affecting your relationship with them? Do you want the person to get help from a doctor or another professional? Offer to help find solutions.

5. Support the person in any way you can. Perhaps the person needs information about the impact of eating disorders, or about places they can get help. Listen to them and check back with them to be sure they are on track to getting help.

*Adapted from National Eating Disorders Association, 2002, www.NationalEatingDisorders.com

Eating disorders are both psychological health and physical health issues, and require more than just weight gain and nutritional counseling to overcome. Complex family, social, and individual psychological issues or biochemical predispositions often impact eating disorders. These complex factors may cause an individual to turn to restricting, binge eating, purging, or compulsively exercising as a means of coping.

The most important thing to know about eating disorders treatment is that early intervention makes a difference in success! The sooner an individual suffering from an eating disorder receives treatment, the more likely she or he will be to recover.

Treatment involves an overall assessment, including history, current symptoms, physical status, family or personal issues, and the presence of other disorders, such as anxiety disorders, depression, and / or substance abuse. The most effective treatments of eating disorders include psychotherapy or psychological counseling along with medical and nutrition support and guidance. A team of professionals such as nutritionists, medical professionals, and therapists work together to develop a treatment plan that is individually tailored to meet the specific problems, needs, and strengths of the individual. Individuals suffering from eating disorders are subject to a variety of physical and medical concerns. Careful medical monitoring is essential to all forms of therapy, including outpatient therapy.

Psychological counseling needs to address both the eating disorder behaviors and the underlying psychological, interpersonal and cultural forces that contributed to the eating disorder. It is important for those struggling with an eating disorder to find a mental health professional they trust to assist in developing and coordinating their treatment plan.

Treatment Options:

Depending on the severity of the eating disorder, the patient may undergo group therapy, individual therapy, outpatient hospital care, or partial hospitalization, intensive outpatient, residential treatment care, or inpatient hospital care. Eating disorder therapy strategies may include (but are not limited to) cognitive behavioral therapy, interpersonal psychotherapy, family therapy, and behavioral therapy. Psychiatric medications have an established role in the treatment of eating disorders and may be part of an individualized treatment plan.

Outpatient Therapy: Sessions have proven effective for many individuals with eating disorders. This form of therapy may involve weekly meetings between the client and health professionals and participation in support groups. Nutritional counseling is done, preferably by a registered dietitian specializing in eating disorders.

Partial Hospitalization Programs: Are usually daylong programs for clients who may need more structure and contact than outpatient treatment can provide. These programs provide structured eating situations and active treatment interventions while allowing the individual to spend evenings at home and, in many cases, continue to work or attend school.

Intensive Outpatient Therapy: Is simply a more intense form of outpatient therapy. Clients attend therapy sessions several days per week for several hours at a time.

Residential Care Facilities: Provides long-term treatment for individuals with progressed eating disorders. The treatment needs of individuals will vary.

Inpatient Programs: Provides a structured treatment environment in which the client has access to clinical support 24 hours a day. Many programs are affiliated with day and outpatient programs that allow clients to step up or down to the appropriate level of care depending on their clinical needs.

Remember:

Eating disorders are physically and emotionally destructive! People with eating disorders need to seek professional help immediately. If not identified or treated in their early stages, eating disorders can become chronic, debilitating, and life threatening.

*Adapted from the Eating Disorder Referral and Information Center at www.edreferral.com/treatment.htm

If you, or someone you know, has an eating disorder, it’s important to seek treatment as soon as you can. Eating disorders can cause serious medical concerns, but with prompt and targeted treatment, these risks can be reduced and recovery is possible.

As a parent or guardian, learning about eating disorder terminology, their pathology, and how to help support others suffering from eating disorders are vital in promoting the recovery process. The National Eating Disorder Association (NEDA) created a comprehensive document with details across a wide variety of topics in the eating disorder space. This free resource is available at the link below:

https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/ParentToolkit.pdf

NAMI Santa Clara County and the Santa Clara County Mental Health Department have co-authored the “AB 1424Form”, to assist families in organizing and distributing vital information to authorities about the psychiatric condition of a loved one who is being considered for involuntary psychiatric treatment. This free resource is available here.

In addition, we have provided a DSM-V Diagnostic Card that can be printed and brought to physician meetings.

Eating disorders are common in the LGBTQIA+ community. Research has consistently shown that LGBTQIA+ adults and adolescents are more likely to experience eating disorders than their cisgender and/or heterosexual peers.

While the cause of eating disorders remains elusive, strong evidence suggests that genetic, environmental, and cultural influences are involved. For LGBTQIA+ individuals, there are additional factors to consider when selecting treatment options

Within Health provides an overview of eating disorder treatment programs for LGBTQIA+ people and how to help those who struggle with eating disorders to find meaningful care that can lead to long term healing.

Read more here.

In addition to the significant negative effects on an individual affected by an eating disorder, these illnesses also have a large impact on families, colleagues, and the economy. The Eating Disorders Coalition (EDC) found that eating disorders incur the highest average cost and longest length of stay for inpatient treatment when compared against any other primary mental health diagnosis.

You can learn more by watching the EDC webcast, “COVID-19 and Eating Disorders: How Untreated Eating Disorders Impact Americans, Medicare and the Economy” here. Materials related to the presentation are available below:

Nutrition CARE Act inforgraphic

Social and Economic Cost of Eating Disorders visual report

Nine Truths about Eating Disorders That You Might Not Know!

1. You can’t tell by looking at someone whether they
   have an eating disorder.
2. Families are not to blame.
3. Families can be the patients’ best allies in
   treatment.
4. Eating disorders are not choices, but serious
   biologically-influenced mental illnesses.
5. Eating disorders affect people of all genders, ages,
   races, ethnicities, sexual orientations, socioeconomic
   statuses, weight and body size.
6. Eating disorders carry an increased risk for both
   suicide and physical/medical complications.
7. Genes play a role in eating disorders, but
   environment also influences their development.
8. Genes are not destiny when it comes to eating
   disorders.
9. Full recovery from an eating disorder is possible.

*Produced in collaboration with DR. Cynthia Bulik, PhD, Professor of Eating Disorders in the School of Medicine in the University of North Carolina.