Eating Disorders: Treatment Options for Anorexia, Bulimia, Binge Eating, and Other EDs
Helpful Information About Disordered Eating
Get help today to overcome obsessive behaviors so that you can live the healthy life that you deserve.
Many people just like you battle with eating disorders (EDs) such as anorexia, bulimia, or binge eating. But, just like you, they have hope for recovery. With professional assistance, you can develop the ability and strength to put your harmful behavior behind you. You can heal any mental and emotional pain that you carry, learn coping skills, and transcend behaviors that are hurting you. Caring specialists can assist you every step of the way, and they'll help provide you with all of the tools and assistance that you need to restore and renew your health.
So, are you ready to experience the freedom that comes with recovering from your eating disorder and focusing on your overall well-being? Get the help you need to overcome any of the emotional, mental, or physical barriers that are preventing you from leading a healthy life full of optimism for the future.
Eating Disorders Defined
Eating disorders are medical and psychiatric conditions that were recently labeled "feeding and eating disorders" (American Psychiatric Association, 2013) in the medical profession. They include anorexia nervosa, bulimia nervosa, and binge eating disorder. More commonly, these are referred to as "the eating disorders of anorexia, bulimia, and binging." According to the Mayo Clinic, eating disorders are defined as "a group of serious conditions in which you're so preoccupied with food and weight that you can often focus on little else." In each disorder, people have an obsessive concern about body image, weight, and abnormal ways of managing eating and weight.
People with eating disorders are very critical of themselves, often perceiving themselves as having weight issues, such as believing that they're overweight when they're not. They have distorted perceptions which include having imperfect bodies due to an unwanted weight and shape. They also may feel they are likely to have problems if drastic measures aren't taken. Ideas about what is adequate nutrition, good eating habits, ideal weight, ideal body size and ideal body shape are distorted. All of this leads to eating patterns that can cause serious health consequences and require medical attention. Some stages of an eating disorder can even be life-threatening.
Along with disordered eating patterns and unusual beliefs about their bodies, other signs of eating disorders include low self-esteem—even self-hatred—a fear of intimacy, shame and a need to control.
You can take an online eating disorder quiz in order to help you identify whether or not you're dealing with one of those conditions. However, such tests are just screening tools and aren't meant to replace a professional diagnosis. Regardless of whether or not you think you actually have an eating disorder, it's recommended that you seek a professional consultation.
Research shows that nearly 50% of girls aged 6-8 report wanting to be thinner.
Women vs. Men
All eating disorders affect primarily women, although men also can develop them. The causes of anorexia, binge eating, bulimia, and other eating disorders are complex. There is a great deal of emphasis on weight control for women in our culture and overall an emphasis on appearance, and being attractive or desirable. Images in media portray the "ideal" woman as thin. Celebrities, supermodels and other high-achieving women in the public eye such as dancers and gymnasts are often seriously underweight and malnourished. Magazines "photoshop" pictures of already attractive women to make them appear thinner. Sometimes, upon close inspection, these photos are grotesque, having non-human proportions. Unfortunately, these unrealistic images are deeply seated in our minds as what is most desirable (Maine & McGilley, 2010). And those images create a connection between eating disorders and the media.
Such distorted images of the "ideal woman" are related to other issues about today's women. There is still a significant difference in status and power in our culture between men and women. There is also a double standard: one set of rules for women and another for men. Men, for example, are considered attractive if they have bigger muscles and are tall. Men are also considered to "age better" than women, with their sex appeal continuing as they age, while women are thought of as most appealing when young. While not everyone buys into these stereotypes, there are a great many that do.
Girls, teens, and women are bombarded with these images of what it takes to be a "perfect woman." They appear in magazines, on TV, in movies, in the appearance of dolls and cartoon characters, in books, and in advertisements. Female children learn about these "ideals" early. For example, eating disorder statistics show that nearly 50% of girls aged 6-8 report wanting to be thinner (Striegel-Moore & Franko, 2002).
Addiction and Eating Disorders
Some of the symptoms and characteristics of eating disorders are the same as those found in addictions like alcohol and drug addiction and others like gambling, shopping, and sex addictions. Many believe that an eating disorder is an addiction and is helped by addiction-centered treatment approaches. These are some of the ways in which eating disorders and addictions are alike:
- Obsession, or mental preoccupation
- Compulsion, or a felt need to do certain behaviors
- Harmful behaviors continue even though negative consequences occur
- There are distortions in thinking about one's self, others, and the world
- The "solution" to all stress is to do more of these behaviors
- There is denial about the problem
- Relationships are strained or lost
- Daily functioning centers around the obsession
- The problem progresses and as time goes by the person is able to mentally and emotionally "tolerate" more and more starvation although the body cannot
- There is anxiety and distress when prevented from using starvation methods
Anorexia nervosa is the most commonly known eating disorder to people outside the medical profession. Its effects are obvious since body weight is well below normal—typically less than 85% of what would be a healthy weight for one's height and age (UPMC, 2018).
Initially, a choice is made by those with anorexia to become underweight although they do not fully grasp that such low weight is not appropriate. Rather, people with anorexia are typically convinced that they need to lose weight in order to have the "perfect" size and shape. In more severe cases, after the condition has progressed, those with anorexia may have insight into their health problems and begin to want to regain weight and health. Even then, the struggle to do so can be extremely difficult due to other symptoms of the disorder that have nothing to do with weight.
It is more typical for people with anorexia to have what is called image disfigurement. This means that a person can look in the mirror and see fat even if they are emaciated (McQuilken, 2014).
People with anorexia often have a lot of fear. This is manifested in severe anxiety and the need to control themselves, their interactions, and their environment (Costin, 1997). These problems all become focused on a fear of being overweight. Also, substance use, depression, and a history of trauma are common. At times, these related issues can be severe enough to be diagnosed as a separate disorder that needs treatment, too. In fact, it is common.
In anorexia, food intake is severely restricted. Basically, the person begins to starve and tries to reduce even more by becoming dehydrated, using laxatives and enemas or engaging in excessive exercise. People with this condition also engage in secretive eating behaviors designed to hide their starvation from loved ones. They develop "food tricks" such as pretending to eat, but moving food off their plates; reporting that they have eaten when they haven't, and eating only foods with very few calories. They will frequently not eat with others, fill up with water and move things around on their plates to give the appearance of eating.
Anorexia is a very complicated condition.
Stages of Anorexia
There are stages of anorexia that a person will progress through if it goes untreated. The final stage is death by starvation. The progression of untreated anorexia includes the items on the list below. They are in order of the least severe at # 1 and the most severe at #21. This list is only to illustrate how the condition progresses from mild to fatal. Some of the steps are not necessarily in the order of when each person acquires an anorexia nervosa symptom or behavior, but they indicate the overall worsening of the condition as the list moves from 1 toward 21. Keep in mind that anorexia is a very complicated condition and much more will occur mentally, emotionally, and physically as it progresses than is listed here. Typically, a person with anorexia will experience these "milestones" in the condition:
- Is dissatisfied with the shape and size of his/her body
- Becomes determined to take action—whatever action is necessary to "fight fat"
- Restricts calories and perhaps over-exercises to meet a weight loss goal
- Develops an obsession with weight and weight loss
- Does compulsive behaviors to lose weight such as over-exercising, measuring body parts, and inspecting one's self in the mirror
- Becomes isolated from others
- Loses interest in anything other than body shape, size, weight, and behaviors to lose weight
- Is driven by constant anxiety, fear, and insecurity about his/her body and weight
- Misinterprets his/her body's signals of hunger
- Misinterprets his/her body's appearance. For example, he/she might believe that natural skin folds are "fat" and seek to lose them
- Becomes ashamed and secretive
- Has personality changes and mood changes
- Gets into conflict with people who are close and who are concerned about him/her
- Becomes angry, defiant, rejecting, and controlling with others
- Engages in power plays with others, making demands such as "don't look at me when I eat or I won't eat at all"
- Compares to others and feels larger than normal weight, overweight, or obese people
- Inspects his/her clothes and finds them evidence of how "fat" he/she is no matter the size
- Feels special and that others are jealous of his/her control, body size, and shape
- May hide his/her body in layers of clothes to ward off conflict with others about how thin he/she is
- Feels powerful and has a new identity as anorexic. Others talk about him/her and this feels like specialness and empowerment. He/she refuses to give in to other people trying to "control" him/her by encouraging her to be healthier
- Becomes medically unstable, hospitalized, and possibly dies (Bowman, 2007; Levenkron, 2001)
This list highlights how important it is for individuals to seek anorexia treatment prior to reaching the most severe and fatal stages of the condition.
The Physical Effects of Anorexia
There are many physical consequences of the condition. Some of those anorexia symptoms include the following:
- Thinning hair
- Brittle nails and hair
- Low blood pressure
- Slowed heart rate
- Heart palpitations
- Heart failure
- Muscle weakness
- Bone loss
- Brittle bones and fractures
- Kidney stones
- Kidney failure
- Electrolyte imbalances
- Periods stop
- Risk for miscarriage if pregnant
- Low birth weight of newborns
- Post-partum depression
- Easy to bruise
- Dry skin
- Fine hair growth all over body
- Low body temperature
- Yellowed skin (Adapted from Office on Women's Health; U.S. Department of Health and Human Services (WomensHealth.gov, 2012).
A second type of eating disorder is binge eating disorder. It is the most common type of ED in the U.S. (Marx, 2013). Binge eating symptoms include repeated episodes of eating in which a person eats more than others would in the same situation and feels unable to stop.
- Binges are associated with 3 or more of the following:
- Eating faster than usual
- Eating until uncomfortable full
- Eating large amounts when not hungry
- Eating alone due to embarrassment about how much is eaten
- Feeling disgusted or distressed after binging—depressed, guilty, ashamed, etc (Adapted from American Psychiatric Association, 2013)
People with eating disorders typically have methods of "dieting." In binge eating disorder, these often are followed by binges and can trigger binges. Some of these methods are:
- Deprivation—This can involve not eating for long periods of time. For example, fasting for some days or waiting until evening to eat.
- Restricting Calories—People who do this typically eat fewer than the recommended daily requirements.
- Avoidance—This involves avoiding certain foods that are considered "fattening."
These and other such dieting tactics can work for some who use them occasionally and do not develop an eating disorder. Binge eaters, however, tend to practice such methods and binge because they do have disordered eating. They are triggered by the deprivation in each method. Binge eaters will not simply indulge to "break the diet," but will return to uncontrolled eating that causes them distress and poor health.
People with binge eating disorder share many of the problems that people with anorexia do: dissatisfaction with their bodies, poor self-esteem, fear of being overweight, depression, shame, and secretiveness, for example. However, they typically do not tend to have the extremely distorted view of their bodies that people with anorexia do. Even so, it's still important for individuals to seek binge eating treatment in order to start recovering from their disorder.
People with bulimia fear gaining weight just as those with anorexia do.
The third type of eating disorder is bulimia nervosa. It shares characteristics of both anorexia and binge eating. In fact, eating disorders have been described as on a continuum "with anorexia nervosa on one end, binge eating on the other, and bulimia somewhere in between the two" (Hall & Cohn, 2011). Hall and Cohn also describe women who move from one disorder to another in their lives. For example, binging eating for some time, and then developing anorexia.
The symptoms of bulimia nervosa include doing the following at least once per week for 3 months:
- Repeated episodes of binge eating. As in binge eating disorder, a binge is defined as eating a large amount of food that most people in the same situation would not eat, and feeling out of control and unable to stop.
- Engaging in behaviors that are meant to compensate for binging such as vomiting, fasting, exercising excessively, and/or using laxatives and diuretics. These behaviors are called "purging" and are used in an attempt to clean the body of food and calories that were consumed in order to prevent weight gain. (Adapted from American Psychiatric Association, 2013)
Just like those who are anorexic, people who are bulimic fear gaining weight. They frequently wish to lose weight and are unhappy with their body size and shape as well. Unlike in anorexia, however, they are usually at a normal weight and do not become emaciated. Other signs of bulimia include the following:
- Dental damage due to stomach acid from vomiting
- Gastrointestinal problems such as stomach and intestinal irritation
- Sore throat
- Acid reflux (Adapted from the American Depression and Anxiety Association of America, (ADAA, 2014)
Other health effects of bulimia can include:
- Abdominal cramping
- Bloody stool
- Irregular or absent menstrual cycles
- Bone and muscle loss
- Difficulty swallowing
- Rupture of the esophagus
- Cardiac or respiratory arrest
- Death (Hall & Cohn, 2011)
Bulimia also involves intense anxiety, issues of control, and self-loathing.
Other Eating Disorders
Although anorexia, binge eating, and bulimia are the most common eating disorders, there are a few others that can have consequences that are just as serious and also require treatment. They include:
- Avoidant/restrictive food intake disorder (ARFID)—This condition was previously called selective eating disorder (SED). People with ARFID are extremely selective about the foods they eat based on things like how the food looks, tastes, smells, and feels. It's common for individuals with ARFID to have other disorders such as anxiety, autism, or obsessive-compulsiveness.
- Other specified feeding and eating disorders (OSFED)—This disorder replaces the EDNOS (eating disorder not otherwise specified) category. People with OSFED experience many of the same characteristics and symptoms of anorexia, binge eating, and/or bulimia. However, they don't meet all of the criteria to be diagnosed with any of those disorders.
- Pica—This disorder is more prevalent in children. Individuals with pica regularly consume non-food substances such as chalk, dirt, hair, paint, paper, and rocks. As a result, they may suffer from toxin overload, intestinal blockages, bacterial infections and parasites, and nutritional deficiencies.s
Eating Disorder Treatment
Eating disorder recovery should take place with health professionals who are specifically trained (Grilo & Mitchell, 2010). It can be done in a range of settings, but the disorder's severity will determine which. These are listed here in order of most intensive to least intensive: inpatient/residential, partial hospitalization, day treatment, and outpatient. The physical and mental health of the person is considered when recommendations for settings are made. If, for example, a person starts in inpatient, they can move to less intensive settings like day treatment and outpatient as conditions improve (NEDA, 2014).
Here are some things to expect in each type of setting:
Inpatient/residential—Patients stay 24 hours and over a period of time in a facility staffed around the clock. A treatment team consists of at least one doctor, nurses, aides, counselors/therapists, and nutritionists (Herrin & Larkin, 2013). There is a variety of services that can include individual, group, and family therapies, consultations about nutrition and diet, physical health monitoring and treatment, psychiatric services, education, recreation and leisure, stress management, coping skills, and medication if needed.
Partial hospitalization—Clients live in their homes, but get outside treatment for their eating disorders up to 7 days per week from a team of care providers. This arrangement can help ease the transition back home from inpatient care.
Day treatment—In some places, partial hospitalization and day treatment are the same. However, there are specific eating disorder programs that offer fewer hours in treatment per day, and fewer days per week. In that case, day treatment can be another step down in the intensity of treatment, continuing to ease the transition home.
Outpatient—Outpatient treatment is typically done through office appointments with a therapist or counselor. Clients may also attend group therapy for eating disorders and occasionally see a psychiatrist for check-ups and possibly medication, as well as another medical practitioner for continued medical monitoring. Clients may also have occasional appointments with nutritionists. Outpatient treatment is appropriate only for those who are medically stable and who do not have behaviors that harm themselves.
As you can see, the types of anorexia, binge eating, and bulimia treatments—or care for other eating disorders—that patients receive depend on the severity of their illnesses and the symptoms and characteristics that are present. For example, two people diagnosed with anorexia may need entirely different treatments.
For Loved Ones
Having a loved one with an eating disorder can be devastating and frightening. Their conditions defy logic. You cannot understand why he/she is so self-destructive. It is baffling that the damage so obvious to you does not seem obvious at all to your loved one. You will most likely try many things: encouragement, direction, pleas, anger, debates, and even ultimatums. These typically don't work and serve only to increase your fear and frustration. You may find yourself in constant conflict with your loved one who is becoming more and more secretive and deceptive about food and eating. Amidst this emotional turmoil, at some point, you become afraid that your loved one will die.
Eating disorder specialists can help you and the rest of your family learn how to help your loved one appropriately. They can also help you recover from the impact of your loved one's condition. Eating disorders affect everyone connected to the afflicted person in some way, and those who are the closest suffer a great deal. Seek help for yourself and participate in recommended areas of your loved one's treatment. There are ways to help your loved one that most of us cannot fathom until we seek help. If you need assistance in getting your loved one to treatment, call treatment providers in your area for eating disorder information and guidance. Additionally, you can encourage your loved one to join a support group such as Eating Disorders Anonymous.
Eating disorder specialists can help you and the rest of your family learn how to help your loved one appropriately.
Turn Your Life Around Today
With help from a caring professional, you can put your eating disorder in the past. You can start enjoying food again, engaging in social activities around the dinner table, restoring loving relationships, and regaining your confidence and joy for life.
ADAA. (2014). Eating Disorders. Retrieved 2014, October 23. from Anxiety and Depression Association of America (ADAA).
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.) . Washington, DC: American Psychiatric Association.
Bowman, G. (2007). Thin. NY, NY: Penguin.
Costin, C. (1997). The Eating Disorder Sourcebook [Kindle Edition] . Los Angeles, CA: RGA Publishing.
Grilo, C., & Mitchell, J. (2010). The Treatment of Eating Disorders: A Clinical Handbook. NY, NY: Guilford Press.
Hall, L., & Cohn, L. (2011). Bulimia: A Guide to Recovery, 25th Anniversary Edition. Carlsbad, CA: Gurse Books.
Herrin, M., & Larkin, M. (2013). Nutrition Counseling in the Treatment of Eating Disorders. NY, NY: Routledge.
Levenkron, S. (2001). Anatomy of Anorexia. NY, NY: W.W. Norton & Co.
Maine, M., & McGilley, B. (2010). Treatment of Eating Disorders: Bridging the research-practice gap. San Diego, CA: Academic Press.
Marx, R. (2013) New in the DSM-5: Binge Eating Disorder. Retrieved 2013, June 5. from National Eating Disorders Association (NEDA).
Mayo Clinic. (2014). Eating disorders. Retrieved (2014, October 22). from Disease and Conditions.
McQuilken, J. (2014). Eating Disorder Recovery [Kindle edition].
UPMC. (2018). Anorexia Nervosa: Criteria for Diagnosing Anorexia Nervosa. Retrieved 2018, December 10 from University of Pittsburgh Medical Center (UPMC).
NEDA. (2014). Treating Eating Disorders. Retrieved 2014, October 23. from National Eating Disorders Association (NEDA).
Striegel-Moore, R., & Franko, D. (2002). Body Image Issues among Girls and Women. In T. C. Pruzinsky, Body Image: A handbook of theory, research, and clinical practice (pp. 183-191). NY, NY: Guilford Press.
WomensHealth.gov. (2012). Anorexia nervosa fact sheet. Retrieved 2014, October 23 from ePublications.