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Eating Disorders 101 www.NationalEatingDisorders.org Helpline: 1-800-931-2237 Business Line: 212-575-6200 What are Eating Disorders? Eating disorders (EDs) involve extreme emotions, attitudes, and behaviors surrounding weight, food, and size. They are serious health disorders with both emotional and physical problems that can have potentially lifethreatening consequences for people of all genders, ages, races, religions, ethnicities, and sexual orientations. • Anorexia Nervosa (AN) • Bulimia Nervosa (BN) • Binge Eating Disorder (BED) • Avoidant-Restrictive Food Intake Disorder (ARFID) • Other Specified Feeding or Eating Disorder (OSFED) Who Do Eating Disorders Affect? Eating disorders affect everyone; they are not exclusive to young white women. 10 million men will struggle with an eating disorder at some point in their lives. (Hudson et al., 2007) Eating disorders are at Teenage girls from least as prevalent low-income families among people of color are 153% more likely as they are among to be bulimic than white populations in girls from wealthy the US, but people of families are. color are less likely to (Eisenberg et al., receive help. 2011) (Marques et al., 2011) Anorexia Nervosa… … is characterized primarily by self-starvation and excessive weight loss. Symptoms include: Inadequate food intake leading to a weight that is clearly too low Disturbance in the experience of body weight or shape Intense fear of weight gain, obsession with weight, and persistent behavior to prevent weight gain Inability to appreciate the severity of the situation Health Consequences of Anorexia Dry hair; hair loss Muscle loss; overall weakness Fainting & fatigue Abnormally low heart rate; low blood pressure; risk of heart failure Severe dehydration; kidney failure Osteoporosis (reduction of bone density) Warning Signs of Anorexia Nervosa • Dramatic weight loss • Preoccupation with weight, food, calories, and dieting • Refusal to eat certain foods, progressing to restrictions against whole categories of food • Consistent excuses to avoid mealtimes or situations involving food • Withdrawal from usual friends and activities Bulimia Nervosa… …is characterized primarily by a cycle of binge eating and compensatory behaviors, such as self-induced vomiting, in an attempt to undo the effects of binge eating. Symptoms include: Frequent episodes of consuming very large amounts of food followed by behaviors to prevent weight gain, such as vomiting, laxative abuse, and excessive exercise Feeling of being out of control during the binge-eating episodes Extreme concern with body weight and shape Most people are of a normal weight Health Consequences of Bulimia Tooth decay Esophageal inflammation & possible rupture Electrolyte imbalances; heart failure Chronic irregular bowel movements & constipation Warning Signs of Bulimia Nervosa • Frequent trips to bathroom after meals • Excessive, rigid exercise regimen; compulsive need to “burn off” calories taken in • Discoloration or staining of the teeth • Withdrawal from usual friends and activities • Continued exercise despite injury • Calluses on the back of hands and knuckles from self-induced vomiting Binge Eating Disorder… …is a type of eating disorder characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating. Symptoms include: Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior Feelings of strong shame or guilt regarding the binge eating Health Consequences of BED Musculoskeletal problems Gallbladder disease High blood pressure; high cholesterol; heart disease Type II diabetes Warning Signs of Binge Eating Disorder • Secretive about eating or bingeing episodes • Repeated episodes of dieting or attempts at weight loss • Large amounts of food may be missing from pantry or found in trash • Larger than normal amounts of money spent on food • Secret stashes of food or empty wrappers Avoidant-Restrictive Food Intake Disorder (ARFID)… …is a type of eating disorder characterized by lack of interest in food, fears of negative consequences of eating, and selective or picky eating. Symptoms include: Reduced food intake and frequent complaints of bodily discomfort with no apparent cause Lack of appetite or interest in food, with a range of preferred foods narrowing over time Health Consequences of ARFID Dry hair; hair loss Musculoskeletal problems Gallbladder disease Osteoporosis (reduction of bone density) Warning Signs of ARFID • Restricted or reduced food intake • Frequent complaints about bodily discomfort with no organic cause • Lack of appetite or interest in food • Fear of negative effects of eating food (e.g., choking, vomiting) • Inability or reluctance to eat in front of others • Picky eating that is unresolved by late childhood Other Specified Feeding or Eating Disorder (OSFED) A feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder. Atypical Anorexia Nervosa: criteria for AN met but weight is not below normal Subthreshold Bulimia Nervosa: criteria for BN met but with less frequent occurrences Subthreshold Binge Eating Disorder: criteria for BED met but occurs at a lower frequency Purging Disorder: purging without binge eating Night Eating Syndrome: excessive nighttime food consumption Warning Signs of Other Specified Feeding or Eating Disorder (OSFED) • Preoccupation with weight but not as consistent as found in AN, BN, BED • Increased isolation, depression, or irritability • Compulsive or obsessive exercising Serious, Life-Threatening… but Treatable . Eating disorders are not fads or phases. Eating disorders have the highest mortality rate of any psychiatric disorder. They are real, complex, and devastating illnesses that can have serious consequences for health, productivity, and relationships. Early intervention is key. The earlier a person seeks treatment, the greater the likelihood of physical and emotional recovery. Contributing Factors •Genetic effects account for 59-88% of the liability for developing anorexia and bulimia •Difficulty expressing emotions •Weight-based bullying •Traumatic experiences Biological •Low self-esteem •Feelings of inadequacy •Depression, anxiety, anger, or loneliness Psychological Interpersonal Social •Cultural norms that overvalue appearance •Body dissatisfaction •Drive for thinness Co-Occurring Disorders It is not uncommon for someone struggling with an eating disorder to have a co-occurring diagnosis. Up to 50% of Up to 69% of patients individuals with eating Depression and other with anorexia and 33% mood disorders codisorders abused of patients with bulimia alcohol or illicit drugs, a have a coexisting occur with eating disorders quite rate five times higher diagnosis of obsessivefrequently. (Mangweth compulsive disorder. than the general population. (National (National Center on et al., 2003 & McElroy et al., 2006) Center on Addiction & Addiction and Substance Abuse) Substance Abuse) Prevalence of Eating Disorders Eating disorders have maintained high prevalence rates, illustrating the need for more research, resources, and treatment for these illnesses. As many as 20 million females and 10 million males in the United States will struggle with a clinically significant eating disorder at some point in their life. (Hudson et al., 2007) Mortality & Eating Disorders Eating disorders are serious illnesses with potentially fatal consequences. A review of nearly fifty Risk of death from years of research suicide or medical confirms that anorexia complications is nervosa has the highest markedly increased for mortality rate of any individuals with eating psychiatric disorder. disorders. (Crow et al., (Arcelus et al., 2011) 2009) For 15- to 24-year-old women who suffer from anorexia nervosa, the mortality rate associated with the illness is twelve times higher than the rate of all other causes of death. (Sullivan, 1995) How to Help a Loved One Do: •Learn as much as you can about eating disorders •Be honest and vocal about your concerns •Be caring, but be firm •Compliment your loved one’s inner qualities •Be a good role model, practice what you preach •Tell a trusted adult, if applicable Don’t: •Place shame, blame, or guilt •Make rules or promises that you cannot or will not uphold •Give simple solutions •Ignore or avoid the situation until it is severe or life-threatening Check out NEDA’s Parent Toolkit for more information: www.myneda.org/parent-toolkit Treatment of Eating Disorders Ongoing Support Intervention Professional Treatment Recovery Seeking Treatment Meet with a medical professional for initial assessment and diagnosis Interview providers to find best fit for individual’s needs • Review different treatment modalities and approaches. • Determine the level of care needed. • Recommended treatment involves a multidisciplinary team of professionals (e.g., therapist, nutritionist, psychiatrist, physician). Communicate with all involved people and parties Develop ongoing maintenance plan • Connect with your insurance provider regarding coverage. Read your full insurance policy in advance. • Communicate with the treatment team about how best to support your loved one. • Coordinate with treatment team to ensure ongoing treatment plan, particularly after stepping down care (e.g., leaving inpatient). • Support from loved ones is beneficial to sustaining recovery. Levels of Care Inpatient • Patient is medically unstable (e.g., unstable/depressed vital signs, acute health risk, complicating co-occurring conditions) • Patient is psychiatrically unstable (e.g., rapidly worsening symptoms, suicidal) Residential Treatment • Patient is medically stable and requires no intensive medical intervention • Patient is psychiatrically impaired and unable to respond to partial hospital or outpatient treatment Partial Hospitalization • Patient is medically stable but the eating disorder impairs functioning (without immediate risk) and/or needs daily assessment of physiologic and mental status • Patient is psychiatrically stable but unable to function in normal situations and/or engages in daily bingeing, purging, restricting, or other weight control techniques Intensive Outpatient/Outpatient • Patient is medically stable and no longer needs daily medical monitoring • Patient is psychiatrically stable, able to function in normal situations, and make progress towards recovery Talking About Eating Disorders Eating disorders are serious illnesses that should be discussed in a careful and responsible manner. Keep in mind: Don't provide ‘tips’ or play the numbers game. Watch out for ‘anorexia chic.’ Emphasize the seriousness of eating disorders without portraying them as hopeless. Don't focus on images or descriptions of the body at its unhealthiest point. For more information, check out: www.myneda.org/guidelines-sharing-your-story-responsibly Recovery is Possible! The path to recovery is different for everyone, and each person’s experience with an eating disorder is unique. NEDA Helpline: Call, Chat, or Text Call: (800) 931-2237 Chat: www.myneda.org/helplinechat Crisis Text Line: Text NEDA to 741741 To learn more or to get involved in raising awareness, please visit: www.NationalEatingDisorders.org Business Phone: (212) 575-6200 Email: [email protected]