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“After feeling disconnected for so long, my mind and body
are finally coming back to each other.” —Rupi Kaur
Eating disorders are not a choice. Fortunately, they are treatable mental health conditions. Eating disorders occur all over the world. They can be fatal and are not passing fads. They are unhealthy eating or dieting behaviors that interfere in life. Eating disorders can cause health problems and trouble managing emotions, thoughts, and social relationships.
If you or your child is struggling with food, body image, eating, or exercise, reach out as soon as possible. Whether you contact me or another professional for assistance, early intervention is key and leads to the best outcomes.
What eating disorders do I treat?
Treating adults with eating disorders and helping families of adolescents and children with eating disorders is my area of specialization. I work collaboratively with individuals and families, and I may include primary care doctors, psychiatrists, registered dietitians, or school counselors in the treatment plan, depending on the type of eating disorder, level of care, severity of symptoms, co-occurring concerns, and your preferences.
I treat the following types of eating disorders:
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Anorexia Nervosa (AN) Restricting Type and Binge-Eating/Purging Type
- Bulimia Nervosa (BN)
- Binge-Eating Disorder (BED)
- Other Specified Feeding or Eating Disorder (OSFED)
- Atypical Anorexia Nervosa
- Bulimia Nervosa (low frequency or limited duration)
- Binge Eating Disorder (low frequency or limited duration)
- Purging Disorder
- Night Eating Syndrome
- Unspecified Feeding or Eating Disorder
“Even if a person does not meet the formal criteria for an eating disorder, he or she may be experiencing unhealthy eating behaviors that cause substantial distress and may be damaging to both physical and psychological health.” —Academy for Eating Disorders
What are the symptoms of eating disorders?
You cannot tell if someone has an eating disorder by looking at them. You can have an eating disorder at any body weight or size. Eating disorder behavior can sometimes mimic dieting. But in general, when preoccupation with food, body weight, dieting, and appearance get in the way of your health, or when eating behaviors disrupt your ability to function in other areas of well-being, it may signal an eating disorder.
Specific behaviors and symptoms associated with eating disorders vary by type, but here are some:
- Fear of weight gain
- Not admitting the severity of the problem
- Eating an unusually large amount of food in a short period of time while feeling out of control
- Using laxatives, enemas, or diuretics, or regularly engaging in severe dieting, excessive exercising, or self-induced vomiting
- Preoccupation with shape and weight
- Fasting, skipping meals, dieting, or doing cleanses to control weight
- Mood swings
- Frequent bathroom breaks after eating
- Unexplained weight changes or drastic weight loss
- Eating alone
- Withdrawing from friends or social activities
- Hiding food or throwing it away
- Picky eating
- Following rigid food rules or rituals
What common physical health problems can occur?
Since food is a primary source of energy, growth, and healing, eating disorders often lead to medical problems. According to Jennifer Gaudian, MD, these are some of the most common physical health concerns:
- Bradycardia (low heart rate)
- Hypotension (low blood pressure)
- Gastroparesis (slowed emptying of stomach contents)
- Hypothermia (low body temperature)
- Tachycardia (rapid heart rate with minimal exertion)
- Amenorrhea (absence of menstrual periods)
- Irritable bowel syndrome
- Pelvic floor dysfunction
- Osteopenia and osteoporosis (bone density loss)
- Abnormal blood counts (leukopenia/low white blood cells, anemia/low red blood cells, thrombocytopenia/low platelets)
- Liver test dysfunction, usually due to starvation
- Electrolyte abnormalities of purging, including hypokalemia/low potassium, hyponatremia/low sodium, dehydration, and kidney problems
- Swelling when purging stops
- Fragile skin and poor hair quality
- Parotid gland swelling in those who purge via vomiting
- And others…
For answers to some frequently asked questions, watch psychologist Lisa Firestone, PhD, interview me for the Experts at Home Series about eating disorders.
Who is at risk for eating disorders?
Researchers estimate that, by the age of 40, approximately 1 in 5 females and 1 in 7 males will experience an eating disorder. That means approximately 20 million girls and women, and 10 million boys and men, have an eating disorder. They affect people of all ages, races, ethnicities, backgrounds, body weights, and genders. Eating disorders are serious psychiatric illnesses that often begin in childhood or adolescence and last well into adulthood. They can be life-threatening and have one of the highest overall mortality rates of any psychiatric disorder.
What causes eating disorders?
A mix of genetics, the environment, brain biology, metabolic vulnerability, personality, and cultural and social factors play a role in the development of eating disorders.
Is it possible to recover from an eating disorder?
Yes, full recovery is possible for all types of eating disorders.
“Being recovered to me is when the person can accept his or her natural body size and shape, and no longer has a self-destructive or unnatural relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on a scale. When recovered, you do not use eating disorder behaviors to deal with, distract from, or cope with other problems.” —Carolyn Costin
What is the treatment for an eating disorder?
The good news is that effective treatments are available for eating disorders. Recommended treatments are multidisciplinary and may include some or all of the following: therapy, medical management, nutritional counseling, and psychiatry.
For anorexia nervosa, the most critical step is to reach nutritional restoration with careful monitoring. For bulimia nervosa, the goals are to stop restricting, work to establish eating regularly throughout the day, and stop compensatory behaviors. For binge eating disorder treatment, we look at how to stop binge eating. The goals are to stop dieting and to work to establish eating regularly throughout the day.
For children and adolescents with an eating disorder, their parents or caregivers may lead the interventions in family-based therapy whereby the therapist serves in more of a coaching role, or they may work alongside a team of professionals. A thorough assessment will be conducted that will include medical, psychological, nutrition, and risk-factor evaluations. Then a level-of-care recommendation will be made from the following options:
- Family-based therapy (FBT)
- Outpatient therapy (OP)
- Intensive outpatient program (IOP)
- Partial-hospitalization program (PHP)
- Residential treatment
If therapy is outpatient, we will decide on the type of therapy from a variety of effective treatments (such as FBT, AFT, CBT-E, IPT, DBT, MB-EAT) based on the specifics of the eating disorder, other issues that may be present, and what has already been tried.
For medical care standards and nutrition guidelines for eating disorders, consult Academy for Eating Disorders publications:
“Misconceptions about who eating disorders affect have real consequences, leading to fewer diagnoses, treatment options, and pathways to help for those who don’t fit the stereotype. Understanding that eating disorders don’t discriminate is critical to making sure everyone has access to help and support.” —National Eating Disorders Association
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