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Eating Disorders

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An eating disorder is not a diet.
It is not a passing phase.
An eating disorder is life-THREATENING AND REQUIRES IMMEDIATE MEDICAL ATTENTION, ASSESSMENT, and intervention.

Eating disorders, such as anorexia and bulimia, are serious psychological and physical responses to underlying emotional issues. The symptoms are food- and weight-related, but the causes run more deeply including significant psychological factors and influences. The toll is great, not only to the individual suffering, but also to families and loved ones who witness their suffering.

Eating disorders have “complex, underlying psychological and biological causes,” according to the National Institute of Mental Health. The NIMH also reports that eating disorders frequently co-exist with other psychological issues like depression, substance abuse, and anxiety disorders. Eating disorders have the highest mortality rate of any other psychological illness.

For this reason, it’s important to get help as early as possible. Eating disorders are treatable and full recovery is possible in a safe, supportive environment with knowledgeable, compassionate professionals.

If you’re concerned that you or someone you love has an eating disorder, we hope this information will help you make the decision to seek help or support a loved one in need.

Below you will find information provided by the National Association of Eating Disorders, NEDA, regarding specific eating disorders, including the warning signs and symptoms:

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Specific Eating Disorders

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  • Dramatic weight loss

  • Dresses in layers to hide weight loss or stay warm

  • Preoccupation with weight, food, calories, fat grams, and dieting. Makes frequent comments about feeling “fat.’

  • Resists or is unable to maintain a body weight appropriate for their age, height, and build

  • Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

  • Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum

  • Has calluses on the back of the hands and knuckles from self- induced vomiting

  • Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting, and tooth sensitivity 

  • Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

  • Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem

  • Steals or hoards food in strange places

  • Creates lifestyle schedules or rituals to make time for binge sessions

  • Evidence of binge eating, including the disappearance of large amounts of food in a short time period or a lot of empty wrappers and containers indicating consumption of large amounts of food

OTHERWISE SPECIFIED FEEDING OR EATING DISORDER

Because OSFED encompasses a wide variety of eating disordered behaviors, any or all of the following symptoms may be present in people with OSFED.

  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
  • Self-esteem overly related to body image
  • Dieting behavior (reducing the amount or types of foods consumed)
  • Expresses a need to “burn off” calories taken in
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER

  • Dramatic weight loss
  • Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens)
  • Fears of choking or vomiting
  • No body image disturbance or fear of weight gain

It goes beyond picky eating and can lead to significant nutritional deficiencies, weight loss, or failure to grow (in children).  Some people with ARFID have heightened sensitivity to taste, texture, smell, or appearance of food. It’s common in individuals with autism spectrum disorder, but it’s not exclusive to them.

  • The persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value

  • Typical substances ingested tend to vary with age and availability. They may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice.

  • Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out

  • If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention

Other Food & Behavior Concerns

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  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)

  • An increase in concern about the health of ingredients; an inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’

  • Spending hours per day thinking about what food might be served at upcoming events

  • Body image concerns may or may not be present

  • Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or occurs when the individual exercises despite injury or other medical complications

  • Intense anxiety, depression and/or distress if unable to exercise

  • Exercise takes place despite injury or fatigue

  • Increasing neglect of diabetes management; infrequently fills prescriptions and/or avoids diabetes related appointments

  • Secrecy about diabetes management; discomfort testing/injecting in front of others

  • Fear that “insulin makes me fat”

  • Restricting certain food or food groups to lower insulin dosages

  • A1c of 9.0 or higher on a continuous basis

Special thanks to the National Eating Disorder Associations website. For more information on the specifics of the provided information please go to their website at: National Eating Disorder Association

Eating disorders are mental illnesses that have physical and medical manifestations. Eating disorders come in all shapes and sizes. You can’t look at somebody and see whether they have an eating disorder or not.

—Jennifer L. Gaudiani, MD, CEDS, FAED

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