National Eating Disorders Awareness Week – Expert Resources & Advocacy Guide

The Four Most Common Eating Disorders

Anorexia Nervosa (AN) is an eating disorder and psychiatric illness marked by significantly low body weight, fear of becoming fat, and distorted body image that affects 0.9 percent of females and 0.3 percent of males. Onset typically occurs in mid- to late-adolescence.

Those with AN typically have many rules about eating and peculiar eating habits, such as eating very slowly, cutting food into tiny pieces, chewing and spitting out food, or needing to eat at a certain time and in a certain order.

Unfortunately, AN has among the highest mortality rates of all psychiatric disorders. The cause of death is equally likely to be from suicide as it is from medical complications associated with being underweight. But 50 percent of people with AN achieve full recovery. (One-third of individuals partially recover and remain partially symptomatic, while one-fifth remain ill over the long term.)

Bulimia Nervosa (BN) is an eating disorder that is recognizable by a pattern of binge eating episodes in which an individual eats a large amount of food in one sitting, but may skip meals outside of these episodes. Other behaviors aimed at preventing weight gain may occur, such as self-induced vomiting, fasting, excessive exercise, and the use of laxatives.

BN is slightly more common than AN. About 1.5 percent of adult females and 0.5 percent of adult males have BN, but the rates are predicted to be underestimated. Mortality rates are lower than AN and about 40 to 45 percent of those with BN who seek treatment recover.

Binge Eating Disorder (BED), which is characterized by recurrent episodes of out of control eating followed by distressing feelings of regret afterward, is the most common eating disorder.

It affects 0.9 to 2.8 percent of adults.

During binging episodes, individuals with BED tend to eat faster than usual to the point of physical discomfort in the absence of hunger, usually when they are alone. Outside of episodes, individuals may skip meals and count calories due to a deep concern with body shape and weight.

Mortality rates are lower than for other eating disorders, but there is an increased risk of obesity with BED. Forty to 60 percent of people who seek treatment are able to stop binging. The onset tends to be later than other eating disorders; patients tend to seek treatment when they are middle-aged.

Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by a consistent failure to meet appropriate nutritional needs, without the body shape or weight concerns seen in other eating disorders. Compared to other eating disorders, those with ARFID are more likely to be younger and male.

Having ARFID is not equivalent to being a picky eater. Individuals with this disorder may have a lack of interest in food or fears/anxiety about food, a limited list of foods they will eat, and difficulty eating in social situations, which ultimately lead to nutritional deficiency. Those with ARFID have notably higher rates of anxiety than with other eating disorders, as well as higher rates of OCD and depression.

There are other eating disorders that are not on this list, such as Pica and Rumination, which are less common. In the next section, we will discuss treatment options available for different eating disorders, explained by Nikki Pagano.

Most Effective Treatments for Eating Disorders

Treatment begins with the individual admitting that they have a problem, which can often be a difficult first step, either because they are unaware that there is a problem, they are afraid or ashamed to seek help, or they simply don’t want to give up their concerning behaviors. Once the individual is finally able to recognize the disorder and is ready to accept help, there are a number of routes that can be taken, depending on their particular disorder.

Levels of care range in intensity from outpatient treatment to inpatient hospitalization. Teams often include a combination of therapists, psychiatrists, dieticians, and medical providers to create a treatment team that can aptly help the individual recover.

“I utilize approaches that have been empirically validated and shown to be the most effective treatments,” Pagano said.

Pagano is certified in Family-Based Treatment, sometimes referred to as FBT or the Maudsley Method, “which places parents in charge of eating and exercise initially and gradually hands back control to the child or adolescent,” she said.

FBT, not to be confused with traditional family therapy, is usually performed in outpatient settings, although there are some residential and partial hospitalization (PHP) programs that use FBT. In this treatment, the eating disorder is viewed as an external force that is affecting the patient. Rather than being blamed for the disorder, parents are empowered to become a part of the healing process.

FBT centers treatment around meal planning and preparation. Parents are encouraged to take charge of nourishing their child with an eating disorder by serving and supervising all meals. If purging is an issue, they supervise after meals and implement strategies to prevent purging, excessive exercise, or other eating disorder behaviors.

“Interpersonal Psychotherapy (IPT) is a therapy that focuses on how our interactions in relationships impact our mood and has shown to be effective for disorders with binge-eating,” Pagano said.

This idea came to be through the work of psychiatrist Harry Stack Sullivan, who believed that an individual’s personality is significantly influenced by his or her interpersonal relationships.

During the first phase, the therapist identifies specific interpersonal problems to focus on throughout the treatment. In the second phase, the therapist encourages the patient to facilitate changes in interpersonal relations. In the third phase, the therapist’s role evolves more toward helping the patient maintain interpersonal gains and preventing relapse.

“Enhanced Cognitive Behavioral Therapy (CBT-E) has the most evidence base for eating disorders,” Nikki Pagano said. “This approach is transdiagnostic, meaning it can be used across diagnoses.”

CBT-E isn’t a one-size-fits-all treatment; it is highly individualized. In the first steps, therapists seek to identify the factors that maintain the eating disorder psychopathology. Most patients tend to be hyper-focused on their weight, body image, and feeling in control. For these individuals, negative self-image and critical self-evaluations become automatic. These patterns need to be broken down and replaced with healthy thoughts.

Sessions may include weighing the patient, reviewing homework assignments, meal monitoring, recording behavioral and weight trends, and identification of barriers and overall treatment progress. CBT-E termination sessions will include a review of the patient’s treatment progress, relapse prevention planning, identification of eating disorder concerns and obstacles to recovery, and support planning after completion of treatment.

Psychopharmacology is also utilized with some eating disorders. While psychotherapy is usually the first choice, antidepressant treatment has been shown to be effective for Bulimia Nervosa and Binge Eating Disorder.

“Other treatment approaches and adaptations using behavioral principles, including Dialectical Behavior Therapy (DBT), which may be useful, but more research is needed to establish efficacy,” Pagano said.

DBT is a comprehensive skills-based therapy that aims to teach patients a broad range of healthier coping strategies, based on the idea that mental health problems are largely caused by an inability to handle our emotions properly. It focuses on four major therapy skills: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.

How long does recovery take? “This is a tough question to answer because it depends on the severity and the duration of the illness,” Pagano said. “It also depends on what level of care is required for the individual. Some eating disorders have a better prognosis than others, but all eating disorders are treatable and full recovery is possible.”

Resources for Eating Disorders Awareness

Below is a list of resources that are useful for students, people with eating disorders, and those who are concerned about a loved one with an eating disorder.

• The team at the Columbia Center for Eating Disorders offers a free online education course called preparED. Its six different modules (diagnosis, treatment, assessment, risk factors, medical complications, and obesity) are geared towards students in the medical and psychiatric fields. The course also includes assessment resources and referral tools that can be printed or referenced later.
• For immediate support, you can contact NEDA’s Helpline for resources and treatment options. Helpline volunteers are trained to help you find information and support.
• NEDA now hosts a Covid-19 forum to provide a safe space to discuss concerns about Covid-19 and to get support for your eating disorder.
• You can find a list of family-based treatment certified therapists by state on the Training Institute’s website.