Eating Disorders FAQ
Bulimia Nervosa is an eating disorder characterized by a cycle of binge eating offset by behaviors such as self-induced vomiting or other ways to compensate for binge eating. Binge eating can be described as a very large amount of food or just overeating, as determined by the person with Bulimia.
Yes. Anorexia Nervosa is an eating disorder characterized by weight loss or a drive for weight loss/thinness, and a tendency to have a distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat and many will exercise compulsively, purge via vomiting and laxatives or other means.
Food Addiction is not the same thing as an addiction to alcohol or drugs. There is no such thing as being addicted to food itself. Although there are many who believe this to be the case, no real evidence of it exists. Eating pleasurable foods, for example, lights up the same area of the brain as listening to music. However, when using food to help you numb your emotions, that is the behavior that describes an addiction. Food addiction is essentially an addiction to using food to cope with life.
We have a variety of methods to help you recover from an eating disorder. We offer individual counseling so you can meet with a counselor one on one and talk privately. We hold group counseling so you can be supported by those who feel just as you do. We periodically offer an intensive workshop so you can go deeper into your growth and healing. We come from a Health at Every Size™ approach, so you can learn to treat your body well, while letting go of societal rules around food and body image.
Frequently Asked Questions About Eating Disorders
There is no one sign of an eating disorder, however there are red flags. These can include excessive “fat, weight or calorie talk,” a pattern of eating a limited choice of low-calorie food or a pattern of occasional binge eating of calorie-dense foods. People with anorexia nervosa may excessively exercise or excessively stand, pace or fidget. Affected individuals may severely limit the amount of calories they consume or may avoid weight gain following meals by inducing vomiting or abusing laxative, diuretic and diet pills. Feeling self-conscious about one’s eating behavior is common. Affected individuals often avoid social eating settings and eat alone.
Not necessarily and not over the long term. Having an eating disorder means you are trying to control the natural processes of your body that manages weight. Interfering with your body’s natural weight by attempting to lose weight will likely lead to a slower metabolism, hyper focus on food, poor body image, health concerns, and other challenges. These issues can be with you throughout your life and could cause many years of potentially painful and expensive recovery from an eating disorders.
A therapist is the one who can help you understand and face the underlying emotional issues that led to and continue your eating disorder behaviors. It’s important to work with a therapist who is a specialist or understands eating disorders in a deeper way. This person can help you really understand the ways it’s not about food. This person can also understand the issues that are going on underlying the eating disorder behaviors and thoughts, and help you work directly on those specific issues. For example, a need for control is a very common experience of someone with an eating disorder. Usually underlying this need for control is a fear of feeling emotions. Therefore, a therapist will help you move toward the emotions, so you won’t need to try to control what isn’t in your control, like weight. A therapist / counselor can help you live a full and authentic life.
Absolutely, if it’s a dietitian that has an understanding and expertise in eating disorders. This person can help you work on your relationship with food while your counselor helps you work on the underlying emotional reasons and thoughts related to your eating disorder. A dietitian that doesn’t understand eating disorders is more likely to do harm to someone with an eating disorder because that person is likely to prescribe diet behaviors and or thinking. The eating disorder part of you will grab ahold of diet mentality, will not let go, and therefore will lead to an increase in the eating disorder.
Nutritionists do not have the same training or degree as Dietitians. I would therefore recommend a Dietitian. See above answer for more information.
Many doctors will not be well versed in eating disorders or working from a weight neutral perspective, which is imperative with working with eating disorders. A doctor who does work with eating disorders and has a weight neutral perspective can be extremely helpful for recovery from an eating disorder. This person can help monitor your health, which can help motivate you to get better, and can help prevent complications from having an eating disorder.
Positive relationships of any kind can help with eating disorder recovery as well as with any healing. The importance is on the relationship being positive (but not perfect). For some, that means distancing from family may be necessary. But if your family is a positive influence and is willing to support you in healing, then this is a very good thing! You may need to teach them how to talk about food and bodies/weight and you may need to teach them how to talk to you but having good relationships with your family will help you.
Depending on the severity of your eating disorder depends on the help you will need. Perhaps the best way to start the process is to contact a counselor that specializes in eating disorders. This person can help assess what treatment you need and can help you find the help that’s best for you. It could be that out-patient treatment is enough. It might mean that you start at the in-patient level of care. It might be helpful to have a team of providers like a medical doctor and a dietitian helping. Often a counselor is the best place to start the process and add help from that point.
Let your friend know that you are concerned and why you are concerned. Tell your friend which behaviors concern you the most, such as “I notice you don’t eat a lot and I’m concerned you are undereating on purpose.” Don’t be afraid to just name it but also recognize your friend may not be ready to accept your help or feedback. If your friend becomes angry, it may be best to let it go for now. Please bring it back up again, however. Even if your friend seems upset with you, they likely really are glad you “see” them and are willing to let them know you are concerned. Ultimately, it is up to your friend to get the help, not you. You can’t make them get help but you can certainly tell them how you feel and encourage them to get help.
Antidepressants can at times help with eating disorders. However, it’s best not to rely on them for treatment. It’s important to get help from an eating disorder trained counselor and/or dietitian and other providers to get support that only working with other human beings can provide.
CBT is an acronym for Cognitive Behavioral Therapy. It is a type of therapy in which you will learn more about your thoughts and behaviors and how the two interact. It is helpful to understand the eating disorder thoughts that lead to disordered behaviors and what eating disorder behaviors might lead to disordered thoughts. However, in CBT treatment, emotions are typically not the focus and possibly left out. It is important to understand that emotions also drive the eating disorder and therefore addressing emotions is a very important aspect of treatment. Without this emotional work, you may get better in terms of thoughts and behaviors but the eating disorder will return when difficult emotions are present, which is often.
Teachers often are the first to recognize symptoms of eating disorders and other challenges with their students. Therefore, when a teacher is aware of behaviors and/or thoughts that might point to an eating disorder, the teacher can talk with the student about their concerns and encourage them to talk with their parents and/or a counselor. It may be important for a teacher to talk to the student’s parents about the concerns. Teachers can create a safe place for students to talk, which will help students have an adult to confide in, often the first step toward recovery.
Family involvement with an adolescent’s recovery is very important. Family members should also get help from providers of the adolescent as well as their own counseling, as needed.
The best way to stop eating disorders is to stop dieting. The number one cause of eating disorders is dieting. Therefore, if the culture changes in it’s view of weight (i.e. no more weight bias) then the incident of eating disorders would decrease significantly. Our obsession with dieting, being thin, judging others based on weight, small chairs and spaces and other ways that the culture leads people to feel ashamed of their body will lead to dieting and therefore eating disorders.
It is important to understand that there is no such thing as an addition to food itself. There is a lot of misinformation about this topic and that’s dangerous! It is dangerous because this “food addiction” belief will only lead to people to restrict food, which will lead to an eating disorder if one isn’t already present. What is true is that one can use food to help manage or cope with emotions. This is where an addiction to food (or any substance) stems… it’s a focus on food to avoid emotions! In this way, food addiction can be experienced as emotional eating. Emotional eating is eating to avoid feeling. This can happen in the moment of the situation causing the emotions and it can happen as a general way of coping with emotions or both.
When one eats for emotional reasons, what one needs to do is to face the emotions directly. Sometimes this can feel very scary. That’s okay. Start with fear. Feeling fear is an emotion. After feeling the fear, the emotions underneath fear will be available to feel. This process can take minutes or years, if one is avoiding feelings. Once you stop using food to push down emotions and instead allow yourself to experience the emotions, you will no longer feel a need to eat for emotional reasons. You will no longer experience food as an out of your control experience. You will be able to eat a variety of foods without concern or worry or harsh self-criticism. All foods will be just food.
There is no single cause of an eating disorder. We know that genetics play a large role, but genetic vulnerability is only part of the story. Environment plays a role too, especially in triggering onset, which often occurs in adolescence. Pressure to diet or weight loss related to a medical condition can be the gateway to anorexia nervosa or bulimia. For those who are genetically vulnerable to anorexia nervosa, once they lose the first five to 10 lbs, dieting becomes increasingly compelling and rewarding. Looked at another way, if eating disorders were the result solely of social pressure for thinness we would expect eating disorder rates to have increased as obesity has in the past few decades, yet anorexia nervosa and bulimia remain relatively rare and often cluster in families.
Treatment for an eating disorder is challenging. It involves interrupting behaviors that have become driven and compelling. Recovery takes a team, which includes family, friends and other social supports, as well as medical and mental health professionals. Be empathic, but clear. List signs or behaviors you have noticed and are concerned about. Help locate a treatment provider and offer to go with your friend or relative to an evaluation. Be prepared that the affected individual may be uncertain about seeking treatment. Treatment is effective, many are able to achieve full recovery and the vast majority will improve with expert care. Treatment assists affected individuals to change what they do. It helps them normalize their eating and reframe the irrational thoughts that sustain eating disordered behaviors. Food is central to many social activities and the practice of eating meals with supportive friends and family is an important step in recovery.
Eating disorders do not discriminate and can affect anyone. Although they are most common in young women, it is not unusual for older women to have an eating disorder. Some have had one all their life, others were only mildly affected until some life event triggers clinical worsening – a stressor, physical illness or a co-occurring psychiatric illness, such as depression or anxiety. Recent evidence strongly suggests that anxiety disorders, especially social anxiety disorder, and obsessive compulsive personality traits increase individual vulnerability to an eating disorder. Eating disorders occur in men too. An estimated 10 percent of people with anorexia nervosa and bulimia and a third or more of people with binge eating disorder are male.
Overeating on occasion or at festive occasions such as Thanksgiving is normal. By contrast, binge eating is the consumption of a large amount of food associated with a sense of loss of control over eating. Bingeing is usually a secretive behavior associated with feeling embarrassed, depressed and guilty. It often includes eating rapidly, untill uncomfortably full, or when not hungry and feeling disgusted by this behavior. Food addiction is a controversial term used by some researchers to describe parallels between the difficulties some people experience in limiting eating and substance addiction. Unlike in addiction however, where an individual is addicted to one particular class of drug, it is difficult to identify one food that underlies “food addiction.” Similarly the withdrawal syndrome caused by dependence on a drug of abuse is hard to demonstrate in overeaters. Despite the similarities between eating disorders and substance abuse, the neurobiology of binge eating and of drug addiction are not the same.
Research on eating disorders has progressed rapidly in the past decade. We now know that eating disorders are biologically based illnesses and not lifestyle choices. Recent research has focused on identifying who is most at risk for eating disorders genetically. New studies are focusing on epigenetic gene-environment interactions that may help our understanding of the causes and sustaining factors. This is exciting work that holds promise for developing novel treatments in the coming years.
The most effective current treatments are behavioral interventions. In anorexia nervosa, family-based therapy is the treatment of choice in adolescents. For severely ill patients at very low weight who are unable to gain weight in outpatient treatment, admission to a specialized residential or hospital-based treatment program can be lifesaving. The most consistent indicator of relapse after intensive treatment is incomplete weight restoration, so reaching a healthy weight is necessary for recovery. Evidence now suggests that weight gain rates of three to four lbs a week are safe for patients with close medical monitoring and 24-hour nursing care. Some programs utilize feeding tubes. However, behavioral specialty programs are able to achieve weight gain of four pounds a week with oral feeding alone in most cases. Close outpatient follow up care following hospitalization is important as relapse risk is elevated for six months following inpatient treatment.
For bulimia, cognitive behavioral therapy is the most successful outpatient treatment approach. Binge eating also responds to cognitive behavioral interventions. Interpersonal therapy is effective in both bulimia and in binge eating disorder. Some medications may be useful along with these therapies.
With the advent of two federal laws (the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA)) more individuals are now eligible for coverage of treatment for eating disorders. The ACA prohibits insurance from denying coverage for a pre-existing condition and provides for coverage for young adults up to age 26 under their parents’ insurance. This is important as many individuals develop an eating disorder in their teens or early adulthood.
The problem, however, is that inpatient or residential treatment for severe anorexia nervosa may require weeks or even months of treatment for patients to reach a healthy weight. The criteria set by insurance companies to assess medical necessity for ongoing hospitalization or residential care remain very stringent. As a result, even when patients qualify for admission, adequate treatment remains difficult to obtain for many, as insurance will often only cover partial weight restoration. The evidence suggests that only full weight restoration in anorexia is associated with improved prognosis. For more information on insurance-related questions see the National Eating Disorders Association (NEDA) and the Eating Disorders Coalition.
Here are some questions that may be relevant to an admission for treatment of anorexia nervosa include:
- What are your average rates of weekly weight gain? What percentage of your patients reach full weight restoration?
- Do you employ oral refeeding only and if not, what percentage of patients have a feeding tube placed?
- What is the target weight you use and how do you establish it?
- What types of therapy do you offer?
- How are families involved in treatment?
- What are the credentials and training of your staff?
- What medical services do you provide and how do you manage medical complications or co-occurring psychiatric conditions?
Lists of outpatient and inpatient providers are available from the Academy of Eating Disorders and the National Eating Disorders Association.