“I am forever engaged in a silent battle in my head over whether or not to lift the fork to my mouth, and when I talk myself into doing so, I taste only shame. I have an eating disorder.” ~ Jena Morrow, Hollow: An Unpolished Tale 

Today’s discussion of Eating Disorders is part one of a two-part series on this all too common, often debilitating, and potentially lethal condition.  According to Wikipedia, “Eating Disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and mental health.”  A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point the urge to eat less or more spiraled out of control.  Severe distress and concern over body weight, or shape, may also characterize an eating disorder.  Eating disorders affect both men (an estimated 1 million in the U.S.) and women (an estimated 5-10 million) and often appear during the teen or young adult years, but can also develop during childhood or later in life.

Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating disorder are the more common eating disorders found in the United States.  Although studies have found that eating disorders are on the rise throughout the world there is evidence suggesting women in the Western world are at the highest risk of development, and the extent of westernization increases the risks.  The precise cause of eating disorders is not entirely understood, but there is evidence that it may be linked to other medical conditions and situations as well as genetic factors.

Eating disorders are real, treatable medical illnesses. They frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders.  While proper treatment can be highly effective for many of the specific types of eating disorders, the consequences of eating disorders can be severe, including death.  People with anorexia nervosa are 18 times more likely to die early compared with people of similar age in the general population

In order to bring a more comprehensive perspective on Eating Disorders and its treatment to Healthy Mind – Healthy Future readers, I met with Linda Wells, LCSW, Clinical Director of the Eating Disorder Center of Santa Barbara.  Ms. Wells has over 24 years of private practice experience specializing in the areas of eating disorders and child abuse.  She received her Masters degree as a Clinical Social Worker from San Jose State University, and has been in practice here in Santa Barbara since 1990.  She is a past Clinical Director of CALM, and has been an outpatient therapist and supervisor for the Eating Disorder Center of California since 1992.  Ms. Wells is also the immediate past President of IAEDP (International Association of Eating Disorder Professionals) Central Coast.

Dr. Miller:  What characterizes an eating disorder?

Ms. Wells:  Serious eating disorders usually start innocently enough—with a diet. What starts out as a desire to lose a few pounds escalates for many into serious and potentially life threatening eating disorder behavior.  These disorders include Anorexia and Bulimia Nervosa, Eating Disorder, NOS (EDNOS) and Binge Eating Disorder. The criteria for Anorexia Nervous includes a refusal to maintain body weight at or above a minimal normal weight for age and height, leading to a body weight less than 85% of that expected.  Anorexia Nervosa also involves a fear of gaining weight or becoming fat, even if underweight, a disturbance in perception of one’s body weight or shape, and in post-menarcheal females, amenorrhea, which is the absence of a menstrual cycle for three consecutive months or more. The criteria for Bulimia Nervosa involves recurring episodes of binge eating, characterized by eating a large amount in a discreet period of time (e.g. within 2 hours), that is definitely larger than most people would eat in a similar period of time or circumstance.  A sense of lack of control during episodes and a feeling of that one cannot stop eating, followed by a recurrent inappropriate compensatory behavior following a binge to prevent weight gain. Such behaviors may include: self-induced vomiting, laxatives, diuretics, enemas, and fasting or excessive exercise.  Eating Disorder, Not Otherwise Specified (EDNOS) is a category for disorder eating that does not meet the criteria for any specific eating disorder.  For example, someone meets the criteria for Anorexia Nervosa, except that the individual’s weight, despite significant weight loss, is still within normal range. Binge Eating Disorder is defined as recurrent episodes of binge eating within a discrete period of time, a sense of lack of control over how much one eats, and is often associated with eating more rapidly than normal, feeling uncomfortably full, and eating large amounts when not feeling physical hunger. Often there are also feelings of great embarrassment and guilt after overeating.

Dr. Miller:  What causes or leads to the development of an eating disorder?

Ms. Wells:  Often the initial behavior of “dieting” leads to an obsessive/compulsive focus on weight, shape, calories, control, and perfectionism.  The initial “high” experienced by restricting one’s caloric intake, however, is quickly replaced with a sense of anxiety and low-grade depression. Eventually, people with eating disorders tend to lose sight of what is important for a happy, healthy life, and instead become reliant on a rigid focus on food, weight and shape to define them selves and to feel a sense of personal control.  The result is that individuals with eating disorders often become isolated, eat alone, avoid social situations involving food, and practice “ritualized” eating disorder behaviors, all in the hopes of controlling their body and their relationship to food. Typically, relationships begin to deteriorate, medical complications can develop, health deteriorates, and body images often become even more distorted as eating disorder behaviors and thinking intensifies.

Dr. Miller:  How common are eating disorders?

Ms. Wells:  It is difficult to know how many people suffer from an eating disorder.  According to Carolyn Costin, MFT (author and owner of Monte Nido and Affiliates Treatment Programs), five to ten million people (young girls, women, boys and men) in the United States are suffering from eating disorders.  4% of college women have Bulimia and 1% of female adolescents have Anorexia. It is estimated that 2 % of adults in the United States have Binge Eating Disorder (BED).

Dr. Miller:  What are the indications that someone is at risk for having or developing an eating disorder?

Ms. Wells:  The following signs and symptoms may indicate that there may be a problem and that it’s time to get a medical assessment:

v  Unable to eat with others or is uncomfortable eating food prepared by others. May prepare food for others, but does not eat the food themselves.

v  Uses the restroom immediately following meals.  Abuses laxatives or exercises excessively to “purge” calories. Exhibits unusual food related behaviors, including cutting food into tiny pieces, chewing food excessively, avoiding many foods, phobic fear of carbohydrates, fats, sugar, etc., and eats in isolation.

v  Focuses obsessively on weight loss, including reading articles and books about weight loss. Exhibits obsession with weight, size and shape of body.  In addition, an extreme fear about gaining weight or a perceived weight gain is often an early indication that someone may be developing distorted body image and is at risk for developing an eating disorder.

v  Food disappears from the house, unusually high grocery bills, stealing food, purchases laxatives, dietetics or diet pills.

v  Physical indicators may include:

• swollen glands behind ears (due to vomiting)
• blood shot eyes
• appears frail
• has hair loss
• bones showing
• develops slight growth of hair (lanugos) over entire body.
• loss of menstrual cycle
• low blood pressure or heart rate
• low body temperature (feels cold all the time)
• complains of stomach aches and constipation

Dr. Miller:  Please tell me more about the remarkable rise in the number of people being diagnosed with eating disorders.

Ms. Wells:  Eating disorders have dramatically increased over the past two decades.  The increased focus on weight and shape, reinforced by unrealistic ideals of “thinness” promoted by Hollywood and the fashion industry, has created a wave of eating disorders that has reached epidemic proportions.  More people die every year from eating disorders than any other psychiatric illness.  Furthermore, eating disorders are no longer a problem limited to adolescent girls.  Increasingly, therapists and medical doctors treat college and middle-age women, men and boys for eating disordered behaviors.

Dr. Miller:  What are the treatment options for eating disorders and what is the prognosis?

Ms. Wells:  If you think you or someone you care for has an eating disorder, it is important that you seek, or encourage another to seek, professional help.

Eating disorders are treatable.  Because eating disorders are a progressive disorder, however, they often become worse over time. Whereas most people don’t die from an eating disorder, they are at risk to develop additional medical and psychological complications without treatment.  Sadly, many people do die every year from medical complications, as well as an increased risk of suicide from years of emotional suffering, due to their eating disorder. Treatment is imperative!

If someone is concerned, I recommend starting out by seeking a clinical therapist who has a strong background in the treatment of eating disorders. This professional will be able to help assess the need for treatment and seriousness of the current eating disorder behaviors. Often eating disorders can be treated on an outpatient /private practice basis.  Ideally, the eating disorder specialist will recommend a medical evaluation to make sure it is safe to be treated on an outpatient basis. The therapist is likely to suggest working with a dietician that also specializes in eating disorder treatment. This two-pronged approach is very effective, and often is enough to turn an eating disorder around. However, sometimes it becomes evident that a client would benefit from a higher level of care, due to the severity of their eating disorder. Fortunately, there are now several effective treatment options, both locally and across the country.  Many of these accept insurance. To find specialist in the field, I recommend checking the yellow pages in your area or consulting the Eating Disorder Referral List (www.edreferral.com) for your area.  Many practitioners in the field believe everyone can fully recover from an eating disorder. The key is to seek treatment as early as possible.   If someone is concerned that they or a loved one has developed an eating disorder or may be at risk for developing one, I strongly encourage reaching out for support and getting a professional assessment.  Early treatment can help avoid serious medical risks, and mark the start back to an enriched and fulfilling life and lifestyle.

In Part Two of this two-part series to run next Saturday I will continue my informative and enlightening conversation with Linda Wells, LCSW discussing guidelines for family members and friends when someone they care deeply about may have an eating disorder.

The Eating Disorder Center of Santa Barbara is located here in town at 27 East Victoria Street, Suite D.  Ms. Wells can be reached for a confidential consultation by calling (805) 965-1651.