Feeding/Eating Disorders

Anorexia Nervosa

An individual restricts their nutritional intake that results in low body weight, fear of gaining weight and distorted self-image

• Restricting type

• Binge-purge type

Bulimia Nervosa

• Recurrent episodes of binge eating

  • Large amount of food in a 2 hour period

  • Sense of lack of control

• Recurrent inappropriate compensatory behavior to prevent weight gain

  • Self-induced vomiting, laxatives, diuretics, diet pills, fasting, or excessive exercise

• At least once a few for three months

• Preoccupation with body weight and shape

Binge Eating Disorder

• Recurrent episodes of binge eating

• The binge eating episodes are associated with three or more of the following:

  • Eating much more rapidly than normal

  • Eating until feeling uncomfortably full

  • Eating large amounts of food when not physically hungry

  • Eating alone to due feeling embarrassed about amount of food consumed

  • Feeling disgusted with oneself, depressed, or very guilty afterwards

• Marked distress regarding binging behaviors

• At least once a week for 3 months

• No compensatory behaviors following the binge

Avoidant Restrictive Food Intake Disorder (ARFID)

• An eating or feeding disturbance resulting in failure to meet appropriate nutritional needs

  • Lack of interest around food or eating

  • Avoidance based on sensory characteristics of food (choking,vomiting, allergic reactions)

  • Concern about aversive consequences of eating

• Leads to weight loss, failure to achieve growth, or nutritional deficiency

• May lead to need for enteral feeding or oral nutritional supplements

• Marked interference with psychological functioning

Other Specified Food or Eating Disorder (OSFED)

• Applicable to individuals who are experiencing significant distress due to symptoms that are similar to disorders such as anorexia, bulimia, and binge-eating disorder, but do not meet the full criteria for a diagnosis of one of these disorders

  • Atypical anorexia nervosa - weight crtieria not met

  • Bulimia nervosa of low frequency and/or limited duration

  • Binge-eating disorder of low frequency and/or limited duration

  • Purging disorder

  • Night eating syndrome

  • Orthorexia presentation (not official diagnosis)

Pica

• Persistent eating of non-nutritive, nonfood substances for a period of at least one month

• The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual

• The eating behavior is not part of a culturally supported or socially normative practice

• If occurring with another mental disorder or during a medical condition, it is severe enough to warrant independent clinical attention

Rumination Disorder

• Consistent regurgitation of food over a period of 1 month or longer. The food is re-chewed, re-swallowed, or spat back out

• Not related to gastrointestinal condition or another medical condition

Eating Disorder Statistics

• Prevalence: 8% in female identified people, 4% in male identified people

  • 28 million people with EDs in US

• EDs are deadly - 2nd highest mortality rate (after substance abuse)

  • Severe, but incredibly treatable 

• Physical consequences - more than meets the eye

  • Cardiac functioning 

  • Organ failure 

  • Electrolyte/hormone imbalances 

  • Dental problems

  • Bone Density issues 

  • GI issues/gastroparesis 

• Comorbidities - Depression, Anxiety, OCD, PTSD, self-harm, neurodivergent, substance abuse, etc.

Eating Disorder Causes: Biological

Genetics, Family History, Hormonal Changes

Eating Disorder Causes: Psychological

Rigid thinking, Co-occurring MH, Trauma, Perfectionism, Negative BI

Eating Disorder Causes: Social

Diet history, family food culture, sports, peer influences, social media, diet culture

Signs/Symptoms to look out for

• Preoccupied with weight, shape, appearance

• Excessive food talk

• Fad diets, ‘healthy/clean” eating

• Rigidity around food and exercise 

• Noticeable weight fluctuations

• Social withdrawal

• Clothing (baggy, covering up)

• Gastrointestinal complaints 

• Dizziness/fainting

• Difficulty concentrating 

• Dental, skin, hair changes

Eating Disorder Assessment & Treatment

• EDE-Q

• EAT-26/EAT-40 Screener

• Severity, frequency, duration of symptoms

Phases of Treatment

• Stabilization/weight restoration

• Cessation of ED behaviors

• Cognitive/emotional work

• Deeper trauma work 

Interventions

• CBT 

• DBT 

• Exposure Work

• Motivational Interviewing 

• Attachment 

• Emotions focused 

• Systems theory

• IFS

• ACT

• Strengths Based

• Trauma Interventions

Pros of Recovery

• More energy, less exhausted 

• Improved attention and focus in school

• Better relationships with friends/family

• Less health problems

Cons of Recovery

• Possible weight gain

• My ED is how I cope with stress 

• Change is hard and scary

Pros of staying in ED

• People compliment my looks in my ED

• It’s what I know 

• People care about me when I’m thin

Cons of staying in ED

• Health problems may get worse

• Miss out on opportunities - school, social, relationships

• May have to go to treatment 

• ED prevent me from reaching my goals