Eating Disorders
Eating disorders are a serious form of mental illness in which eating behaviors become unhealthy and problematic. Eating disorders are usually accompanied by patterns of negative thinking, obsessive concern about weight and body image, and other significant emotional concerns. If left untreated, eating disorders can significantly interfere with the ability to function normally in everyday life, undermine physical health, and even become fatal.
The American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (DSM) recognizes eight different types of eating disorders.
· Anorexia Nervosa: An intense fear of gaining weight or a disordered perception of weight which leads to severely restricting food and caloric intake, resulting in extreme weight loss and abnormally low body weight.
· Bulimia Nervosa: Characterized by cycles of binge-eating immediately followed by purging behaviors such as self-induced vomiting, laxative abuse, and compulsive exercise. There is often significant overlap between anorexic and bulimic behaviors and emotional issues.
· Binge Eating Disorder: Recurrent and frequent episodes of eating extremely large qualities of food, well beyond what is required to feel full and when feelings of hunger are not present. Binge eating disorder does not include purging behaviors to counter binging episodes.
· Avoidant/Restrictive Food Intake Disorder (ARFID): Formerly called “selective eating disorder”, ARFID involves extremely restrictive eating habits not accompanied by obsession with weight or body shape, but involving nutritional/energy deficiency and extreme weight loss.
· Pica: The consumption of items that do not provide any nutritional value and are not usually considered food.
· Rumination Disorder: The regular regurgitation of food, usually involving the regurgitated food being re-chewed, re-swallowed, or spit out.
· Other Specified Feeding or Eating Disorder (OSFED): An umbrella category to include individuals who may not meet the strict criteria for a diagnosis of anorexia or bulimia, but still have the physical and mental hallmarks of a significant eating disorder.
· Unspecified Feeding or Eating Disorder: Another umbrella category to include patients who demonstrate the symptoms of a feeding or eating disorder, exhibit clinical and mental distress, but do not meet the strict criteria for a diagnosis in one of the other categories.
Although not formally categorized in the DSM, physicians and therapists have begun to acknowledge one additional eating disorder known as Orthorexia, characterized by obsessive behavior regarding “healthful” eating. Generally recognized in the medical community since 1998, there is some disagreement about whether orthorexia is a stand-alone eating disorder or a specific type of obsessive-compulsive behavior.
Treatment Options for Eating Disorders
Treating eating disorders involves reestablishing a healthy relationship with food, as well as identifying and addressing the complex psychological, biological, interpersonal, and even cultural origins of the eating disorder. Moreover, treating an eating disorder generally also involves monitoring and treating any physical and medical consequences of the disorder, especially for patients with chronic and long-standing eating disorders.
Therefore, treatment for the diagnosed eating disorder will almost always involve some combination of therapy, nutritional counseling, and medical intervention/monitoring. If the eating disorder has advanced to the point where the physical health and safety of the patient is at risk, treatment may need to begin in an in-patient setting. This will enable physicians and psychiatrists to treat medical complications, facilitate carefully-phased refeeding, and monitor for risk of suicide.
If the patient is medically and psychiatrically stable, therapy and nutritional counseling can begin immediately, either in an in-patient or out-patient setting. There are a variety of different types of therapy, such as Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Evidence-Based Treatment, and Family-Based Treatment to name a few. As with any mental illness, different types of therapy work for different people, depending on the nature of the illness, their stage of recovery, and the unique nature of the reasons for the eating disorder.
Eating disorders are complex and uniquely difficult to treat. The good news is that with a comprehensive treatment plan, along with hard work and dedication, long-term recovery is possible. As with many mental illnesses, treatment is always easier when recognition and intervention occur early, before the disease becomes chronic. If you believe that you, or someone you love, may be suffering from an eating disorder, we encourage you to seek medical and psychological help immediately.
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