An eating disorder is characterized by extreme changes in eating behavior, such as acute and unhealthy cutback of food intake, or severe overeating.  You might feel extremely concerned with your body shape or weight. You may also have constant anxiety over your food intake, and you may continue to deal with this anxiety by restricting your food intake, binging, purging, or compulsively overeating.

Eating disorders are real, treatable medical illnesses, and should be treated with the gravity of any other life-threatening disease.  An eating disorder can be physically detrimental to your health, and can lead to serious heart conditions, serious dental problems, electrolyte imbalance, malnutrition, kidney failure, or cardiac problems, all of which can ultimately lead to untimely death.

There are three main types of eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder (compulsive overeating).  Eating disorders usually begin in adolescence, but there are indications that they can happen much earlier or much later in life.  It is quite common for an eating disorder to co-exist with other psychological disorders, including anxiety, depression, or substance abuse.  If you are suffering from an eating disorder, maladaptive patterns of eating may overwhelm your thinking, but you can get help.

Although females are much more likely than males to develop an eating disorder, such as anorexia or bulimia, it is important to recognize symptoms in males as well.  For example, males who take part in several sports are at risk of developing an eating disorder because they are constantly under the pressure to improve their body type, whether it means gaining or losing weight.

Psychotherapy with a licensed psychologist, psychiatrist, psychotherapist, counselor, clinical social worker or psychiatric nurse practitioner can be very helpful in treating eating disorders and help patients alter their dysfunctional behavior.

We will also discuss a condition known as selective eating disorder.

Anorexia Nervosa

Are you consumed with worry about getting fat?  Do you feel like you’re never thin enough?  You might be suffering from anorexia nervosa.  People with this disease see themselves as overweight, even when they are seriously underweight.  Then, self-esteem is related to how thin they are.  Their entire life revolves around the food they eat (or don’t eat), and their eating habits become extremely unusual.  They might keep away from meals and food, choose a few foods and eat only those in small amounts, or watchfully weigh and portion the food they consume.  People with anorexia are constantly concerned with controlling their body weight and might weigh themselves compulsively.  It is quite common for anorexics to purge their calories by means of intense exercise, vomiting, or abuse of laxatives, enemas, diet pills and diuretics.  Sometimes, patients can have a combination of anorexia and bulimia, or alternate between the two illnesses.

Every individual with anorexia experiences the disease differently—some may recover after a single bout, while others may relapse or suffer continuously.  What is clear, however, is that the mortality rate in those with anorexia is high. Most commonly, causes of death are due to complications of the disorder, including electrolyte imbalance, cardiac arrest, starvation or suicide.

Symptoms of anorexia include:

• Extreme fear of gaining weight or becoming fat, even when underweight
• Opposition to maintaining body weight at or above a minimally normal weight for age and height
• Disturbance in the way in which one’s body weight or shape is experienced
• Excessive influence of body weight or shape on self-evaluation
• The denial of the gravity of the current low body weight
• Infrequent or absent menstrual periods (in females who have reached puberty)
• Body weight below 85% of that expected for height and age

Bulimia Nervosa

Do you consume an extremely large amount of food in a short time period and then attempt to purge it soon thereafter?  Do you feel like binging and purging food has taken over your life? Do you get a high from vomiting? If you answered, “yes” to any of these questions, you might have bulimia nervosa.  Someone with bulimia nervosa is extremely unhappy with his or her body, and fears gaining weight.  However, they are usually of normal weight for their age and height because only small amounts of the calories they eat are absorbed.  They might hide their habits because they feel ashamed when they binge, and relieved when they purge.  Many bulimics actually get a feeling of being high when they vomit. They describe themselves as feeling compelled to vomit and feel it has gotten out of their control.

Symptoms of bulimia include:

• Recurring episodes of binge eating, illustrated by consuming an extreme quantity of food within a short period of time with a sense of lack of control over eating during the period
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or abuse of laxatives, diuretics, diet pills, enemas, or other medications (purging), fasting, or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months 
• Self-evaluation is overly influenced by body shape and weight 

Psychotherapy is highly effective in helping to remove the causes and situations that trigger these individuals to binge and purge.  This helps to facilitate better eating habits and put an end to these negative eating behaviors.  Medication can often be helpful, particularly for those who are emotional eaters.

What is Binge-Eating Disorder (Compulsive over-eating)?

Do you sometimes eat a large amount of food in a short period of time, even after you are full?  If this is the case, you may be facing binge-eating disorder (compulsive over-eating).  Only recently has this illness officially become classified as a disorder, but has always been clear that it is just as dangerous an eating disorder as anorexia or bulimia.

If you have binge-eating disorder, your eating feels out of control.  Similar to those with bulimia nervosa, you consume enormous amounts of calories without being able to control yourself.  You may feel disgusted or ashamed of yourself, which only leads to binging again, thereby causing a vicious cycle to ensue.  The difference, however, is that bulimics purge the excess foods, while binge-eaters do not.  Thus, those with this disorder are usually overweight for their height and age.  In addition, binge-eaters often eat a tremendous amount of calories at night.

Symptoms of binge-eating disorder include:

• Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
• The binge-eating episodes are linked with at least three of the following factors: eating much more quickly than ordinarily, eating until feeling uncomfortably full, consuming large amounts of food when not feeling physically hungry, eating foods of high-caloric value, eating by yourself because you are embarrassed by how much you are eating, feeling depressed, revolted with yourself, or feeling very guilty after overeating 
• Distinct distress about the binge-eating behavior 
• The binge eating occurs, on average, at least two days a week for six months 
• The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise)  

Psychotherapy is highly effective in helping binge eaters and compulsive eaters to remove the causes of overeating and in identifying thoughts and situations that trigger overeating.  This helps to facilitate better eating habits and end negative eating behaviors.  Medication can often be helpful, particularly for those who are emotional eaters.

Selective Eating Disorder

Does your child avoid particular foods?  He or she may have been called a picky or fussy eater, but it has come to be known as a valid eating disorder called selective eating disorder.  It is usually seen in children, and is usually overcome with age.  However, the disorder can be found in any age group.  The range of foods deemed “acceptable” may be extremely small, and body weight and health can vary as well.  Anxiety will ensue if the individual is forced to eat outside their range of foods.

What treatment can I find for my eating disorder?

If you have an eating disorder, help is absolutely possible if you reach out and ask.  As with any serious medical illness, the sooner it is diagnosed and treated, the more chance there is for recovery.  Treatment for anorexia nervosa, bulimia nervosa, binge-eating disorder, and selective eating disorder are slightly different, but they all aim towards the same goal—to help you achieve a healthy physical and psychological state.

Treatment for anorexia nervosa

Phase I: restoring the weight that has been lost

Phase II: addressing and treating psychological issues, including body image distortion, low self-esteem, and interpersonal conflicts

Phase III: full recovery, or at least achieving long-term remission and rehabilitation

Once weight has been stabilized, medication can provide relief from symptoms of anxiety and mood, which have played a part in the etiology of the eating disorder.  Once the patient is healthy enough, they can begin psychotherapy in order to resolve issues of low self-esteem and distorted thought and behavior.  It is often helpful for the family to be included in therapy.

Treatment for bulimia nervosa

In treating bulimia, psychotherapy and, occasionally, medication can be helpful.  It is vital to establish healthy eating habits that eliminate binging and purging completely and improve attitudes toward food.  Exercise should be encouraged in healthy amounts, and potential anxiety and depression must be treated (possibly with medication).

Treatment for binge-eating disorder

Those with binge-eating disorder follow similar treatment strategies as those with bulimia nervosa. 
 
Those with an eating disorder do not usually recognize or admit that they are ill.  They are so consumed with their own perceptions and obsessions that they often fail to see that they are destroying their health.  Consequently, they may fervently resist seeking or remaining in treatment, therefore, making it vital for loved ones to make sure that the person receives help. 

Treatment for the disorder is geared towards helping the individual with the disorder to gain awareness, achieve positive behavioral change, and improve functioning in school, work, and relationships.

It is important for someone with an eating disorder to seek psychotherapy and/or medication as soon as possible from a licensed psychologist, clinical social worker, psychotherapist, counselor, psychiatric nurse practitioner or psychiatrist.  In a confidential, supportive, non-judgmental atmosphere, psychotherapy or counseling with a psychologist or psychotherapist can help the individual gain awareness and insight into their situation, dysfunctional thinking and distortions. A reparative relationship can develop with the therapist which can help achieve positive changes. Dysfunctional thoughts, feelings and behaviors will be identified so that new ways of viewing situations, yourself, and others will emerge. More adaptive behaviors will increase which will lead to greater interpersonal, social and professional satisfaction. Through therapy, one develops a healthier more confident way of viewing oneself and the world. Medication is often useful for the person with an eating disorder because of the frequency of an underlying mood disorder and anxiety.  Medication can be prescribed by a psychiatric nurse practitioner or psychiatrist. The sooner treatment is begun, the sooner the eating disorder can go into remission.

If you or someone you know is suffering from an eating disorder, and you would like more information about treatment, want to discuss your specific needs, or make an appointment, call our office today to speak to someone. We have licensed psychologists, psychotherapists, psychiatrists, counselors, clinical social workers, and psychiatric nurse practitioners, qualified and experienced in effectively treating eating disorders, and we can help suggest the therapist that best meets your needs.  Our telephone number is 212-996-3939.