Mental Health Matters: Eating disorders

According to the National Alliance for Eating Disorders, 29 million Americans will have an eating disorder in their lifetime. This means that at some point during their lives, these 29 million people will meet clinical criteria for a diagnosis such as anorexia nervosa, bulimia nervosa, binge eating disorder, pica, avoidant/restrictive food intake disorder (ARFID) or other specified feeding or eating disorder (OSFED).

This lifetime prevalence does not include disordered eating which is characterized by eating behaviors that deviate from societal norms. In contrast, an eating disorder is disordered eating which also causes distress and impairment.

Anorexia nervosa, perhaps the most recognized by the general population, has the lowest prevalence but also the most deaths of any eating disorder. In fact, many sources say it is the most lethal mental illness while others say it is second only to substance use disorders. For this reason, it is very important to seek specialized help should you or a loved one restrict food intake to reach an unhealthy weight, usually defined as a body mass index (BMI) of 17 or lower.

One frequent misconception is that everyone who has an eating disorder is underweight. Most people with an eating disorder range from normal weight to overweight. Part of the reason for this is that eating disorders are not exclusively about wanting to be thin. For example, those with binge eating disorder will have at least one episode a week for three months in which they eat much more than an ordinary person and feel out of control or unable to stop eating, which causes them distress. Those with a more severe case of binge eating disorder will binge more than three times a week.

Other specified feeding or eating disorder (OSFED) is a category of eating disorder that accounts for most of the eating disorder diagnoses. OSFED includes atypical presentations of other eating disorders as well as eating disorders not formally recognized in the Diagnostic and Statistical Manual (DSM).

One of these disorders is called orthorexia, which can be described as an obsession with healthy eating. The National Eating Disorder Association (NEDA) says that “people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being and experience health consequences such as malnutrition and/or impairment of psychosocial functioning.”

Pica and avoidant/restricted food intake disorder (ARFID) tend to be less well-known among the general population. Pica is a disorder in which a person compulsively eats nonfood substances that offer no nutritional benefit. Eating these substances can lead to malnourishment and even gastro-intestinal blockage which may be life-threatening.

ARFID is most often seen in children but may persist in adulthood or develop in adulthood. As with anorexia nervosa, there may be significant weight loss and related health consequences. Unlike anorexia nervosa, the avoidance and restriction of food is due to a lack of interest in food, dislike of texture of food or fear of what may happen (i.e. choking) if one eats a risky food. For example, a person may have had a choking episode and then refuse to eat anything but soft foods.

People often wonder what could possibly cause a person to adopt behaviors that are not only distressing but could put one’s life in danger. From what is currently understood, there are genetic, environmental and psychological factors that lead to a person developing an eating disorder. Having a first-degree relative with an eating disorder is partially predictive, but not fully. Genes that affect our metabolic processes as well as genes that cause anxiety and depression play roles; but so do the environment one grows up in, personality and learned coping skills.

The treatment approach for eating disorders depends, in part, on whether the patient’s life is in danger. Some may need to begin treatment with a hospital stay to stabilize metabolic function and gain enough weight to sustain physical and mental functioning.

Other types of treatment include individual and group therapy. In therapy, insight about having an eating disorder can be built as well as skills related to adopting more typical eating habits. Skills include recognizing hunger cues and the sense of fullness, which can be lost or ignored by those with an eating disorder. In addition to eating behaviors, therapy will also address concerns such as body image, control issues and relationships, all of which have an impact on recovery.

Should you or a loved one have or suspect having an eating disorder, more information and directories for professionals who treat eating disorders can be found on these websites:  www.nationaleatingdisorders.org and www.allianceforeatingdisorders.com.

Nora Sinclair is a licensed professional counselor and a national certified counselor based in Lexington, S.C.