What is an eating disorder?

Eating disorders do not discriminate and can impact anybody. They often are rooted in secret, leaving many to suffer in silence. A Baylor College of Medicine psychologist explains the effects of eating disorders.

“Eating disorders are disturbances in eating behaviors and attitudes,” said Dr. Alyssa Hertz, clinical affiliate assistant professor in the Menninger Department of Psychiatry and Behavioral Sciences. “Eating disorders are ways to control weight and shape and can have social, psychological and biological consequences. It’s not just an issue with food; it’s also about control and rigidity.”

Disordered eating looks different for individuals and is influenced by a variety of factors. Eating disorders can affect people of any body type, including those with larger body types.

“Atypical anorexia is becoming increasingly recognized in the eating disorder field, which is great. Individuals in larger bodies can still meet diagnostic criteria for anorexia nervosa, and it can be just as psychologically, mentally and medically dangerous for them,” Hertz said.

Eating disorders are transdiagnostic, meaning they share underlying psychological features. Whether one struggles with anorexia, nervosa, binge eating disorder or bulimia nervosa, there is some need to control weight and shape in some capacity. With anorexia, individuals may engage in restrictive eating patterns, or in some cases people might engage in bingeing and purging while remaining underweight.

“With binge eating disorder specifically, it’s eating a larger amount of food that is accompanied with a loss of control. With bulimia nervosa, compensatory behaviors that might include vomiting, laxative abuse or excessive exercise are done with the purpose to get rid of calories.” According to Hertz, these behaviors are used to control weight and shape.

Warning signs

If you or a loved one is concerned about an eating disorder, look out for symptoms.

• Cutting out food or eliminating specific food groups.
• Uptick in exercise behavior, even when hurt or ill.
• Body checking: Looking in the mirror often, trying to maintain a specific clothing size, touching or pinching yourself in certain areas.
• Guilt: Fear and anxiety around mealtime. Eating alone or making excuses for why you cannot eat around friends and family.

When to seek help

When one starts to develop an unhealthy relationship with food and body image, it is time to get help.

“If you are concerned about changes in eating behavior or weight/appearance, it’s better to get evaluated sooner rather than later because disordered eating, while not diagnostic, has the potential to become more significant,” Hertz said. “If we’re seeing significant weight loss, it is a big deal if a female loses her menstrual cycle.”

If you have concerns, go to a trusted doctor, set up an intake evaluation and ask questions.

Treatment

Eating disorder treatment depends on the type of eating behavior and behaviors involved. Enhanced-cognitive behavioral therapy (CBT-E) typically applies to adolescents or adults struggling with binge eating or bulimia, though it can effectively be used to treat anorexia. Stage one focuses on normalizing and reestablishing regular eating patterns such as having three meals with snacks in between and introducing feared foods. Stage two reviews progress made. Stage three focuses on what is maintaining the eating problems, and stage four tackles setbacks and how to maintain changes.

Family-based therapy (FBT) is specifically for adolescents with anorexia. The parent-involved treatment includes the parent fostering eating behaviors of the adolescent. In the first phase, the adolescent gives parents complete control over refeeding and all meals are supervised.

“The assumption is that their brain is so malnourished that they are not able to make appropriate decisions for themselves, so we’re trying to get the weight back on them as soon and safely as possible,” Hertz said.

The second phase of FBT gradually gives them back their autonomy: plating their own meals with supervision or picking out snacks they enjoy. The final phase makes plans with the adolescent and family for their future: school, social life and big life transitions.

Dialectical behavioral therapy (DBT) contains interventions used for emotional regulation, distress tolerance, interpersonal effectiveness and mindfulness-based skills. Disordered eating behaviors might be a way one deals with emotional issues or stress, so DBT can be helpful in treating anorexia, binge eating or bulimia.

Risks

Eating disorders can lead to long-term physical and medical issues, including heart complications. Disordered eating can be lethal, resulting in cardiac arrhythmia or the heart stopping altogether. Those who have disrupted eating patterns can experience dysregulated bowel movements and other gastrointestinal disruption. Individuals who purge or use any kind of laxative may have electrolyte imbalances. Dizziness, headaches and fainting spells also can result from eating disorders.

“There are really minimal areas within the body where an eating disorder does not have roots,” Hertz said.

Psychologists try to assess values in children with “short” long-term goals to help them draw conclusions on how disordered eating disrupts goals: What do you want to do in high school? What do you want to do in college? They do this to understand the person’s interests and to let them understand how eating disorders hinder that.

Support

Approaching conversations about eating disorders must be done delicately. The best way to do this is to come from a place of concern and observation. Minimize any appearance-based talk, which can be triggering for some. Think about the emotional impact and behaviors you notice and show curiosity rather than accusing them: “I notice you’re not eating as much. Can you tell me what’s going on?” instead of “I notice you’re losing some weight.”

“You don’t have to exactly understand what your child is going through, but you need the support, tools and strategies to help them,” Hertz said.

For parents who suffer from eating disorders, Hertz encourages them to seek out professional help to address their own relationship with food and body image. Parents seeking out treatment may also serve as good model for their kids by reminding them that eating disorders don’t just affect adolescents or young adults. Eating disorders affect all ages. You cannot help your child recover if you also are struggling.

By Homa Warren