The Types of Eating Disorders and Their Treatments
Written by ‘Ai Pono Hawaii Staff Writer
Eating disorders refer to a group of mental illnesses that are characterized by abnormal eating patterns which foster a negative view about one’s body and can potentially harm one’s health.
Anyone of any age and background can struggle with an eating disorder. In fact, according to the National Eating Disorder Association, almost 70 million people suffer from an eating disorder, with Americans accounting for roughly 30 million of them.
Certain people are more at risk of this condition, such as those who had anxiety or mood disorders in their childhood years, or experienced major stressors like trauma and bullying. Eating disorders are also linked to other mental health conditions such as anxiety and depression.
When left untreated, eating disorders can lead to a variety of complications, such as (but are not limited to) dehydration, fatigue, low body temperature, low blood pressure, abnormal or low heart rate, muscle wasting or weakness, and even death. The National Association of Anorexia Nervosa and Associated Disorders reported that at least one life is lost to an eating disorder every 62 minutes, making eating disorders the leading cause of mortality among mental illnesses.
Researchers believe that eating disorders result from a combination of psychological, biological, and sociocultural factors. Although they are serious, the good news about eating disorders is that they are treatable.
The Main Types of Eating Disorders
In general, eating disorders can take a variety of forms, but mainly involve:
overeating
undereating
purging
Each of the eating disorders has its own unique set of signs and symptoms that distinguish it from the others.
There are currently more than a dozen types of recognized eating disorders. However, there are five types that are listed as formal medical diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD), manuals used by medical doctors and psychologists in diagnosing health conditions.
The five main types of eating disorders are:
1. Anorexia Nervosa
Perhaps the most commonly known among the eating disorders, anorexia nervosa (or AN) is also considered the most serious in some ways because it has the highest reported mortality rate among all mental illnesses. Often referred to as simply anorexia, patients who have AN severely restrict their food intake, and may also perform excessive exercise and other purging behaviors.
Most people with anorexia also have a distorted body image, along with insufficient weight for their age, height, and stature. They usually limit their caloric intake and the kinds of food they eat. Some people with anorexia also exercise compulsively, display purging behaviors (such as the use of laxatives and self-induced vomiting), and/or binge eat.
People struggling with anorexia often exhibit these signs and symptoms:
Profound fear of weight gain
Rapid weight loss
Consistently being underweight
Refusal to accept that their excessively low body weight can be dangerous
Amenorrhea (i.e., absence of menstruation)
Heart damage
And so on
Due to starvation, the body of people with anorexia often have limited nutrients for optimal functioning. Eventually, their body might slow down important biological processes in an effort to save their energy, and this can lead to serious health consequences. For instance, electrolyte imbalance and cardiac arrest are both possible—and deadly—complications of anorexia, which makes prompt treatment for this condition extremely important.
2. Bulimia Nervosa
Often shortened to just bulimia, bulimia nervosa is the typical diagnosis for a person who persistently binges on massive amounts of food and then purges it or resorts to compensatory behaviors, including self-induced vomiting, consumption of laxatives and/or diet pills, excessive exercising, and so on. Binging and purging both have detrimental effects on one’s health.
Some of the common signs and symptoms of bulimia include these:
Dizziness and/or fainting
Dry skin and brittle nails
Muscle weakness
Always feeling cold
Slow healing of wounds
Noticeable weight fluctuations
Stomach cramps or other non-specific gastrointestinal issues
Sleep problems
Concentration issues
Abnormal laboratory findings (low blood cell counts, slow heart rate, anemia, low thyroid and hormone levels, low potassium, etc.)
Lowered immune functioning
And so on
The repeated binge-and-purge cycles that characterize bulimia can jeopardize a person’s digestive system and cause chemical imbalances, which can damage various organs.
3. Muscle Dysmorphia
The majority of eating disorders affect more women than men, with muscle dysmorphia being the exception. Diagnosed in more men than women, this disorder is characterized by an abnormal obsession with one’s physique and musculature. This is a subcategory of Body Dysmorphic Disorder (BDD), wherein a person is preoccupied with the belief that his body is not lean or muscular enough.
4. Binge Eating Disorder (BED)
Binging episodes on large quantities of food is the main sign of BED, the most prevalent eating disorder in the United States. Unlike bulimia, BED does not include purging behaviors. Technically, a binge refers to when a person eats an excessive amount of food within only two hours. As expected, weight gain among BED patients is quite common. Most people who suffer from BED become overweight or obese due to their binging, with as many as two-thirds of them considered as clinically obese.
BED is one of the eating disorders that’s just recently formally listed in the DSM-5. It was previously only a subtype of Eating Disorder Not Otherwise Specified (EDNOS), which is now called Other Specified Feeding or Eating Disorder (OSFED). Binges often happen in a trance-like state, and patients usually feel shame and guilt after such episodes. On average, the binge happens at least once a week for 3 months.
A person who suffers from BED might exhibit some of these:
Noticeable weight fluctuations
Stomach cramps and other non-specific gastrointestinal issues
Concentration issues
Withdrawal from friends and usual activities
Having rituals (such as consuming only certain food items or food groups [e.g., condiments]) or lifestyle schedules that accommodate binge sessions
Stealing or hoarding of food
Signs of binge eating, such as disappearance of large quantities of food in the house, or plenty of food wrappers and containers in one’s room or work area
Fear or discomfort when eating in public or in the presence of other people
Health complications due to BED are similar to those linked with obesity and weight cycling (also known as yo-yo dieting).
5. Other Specified Feeding or Eating Disorder (OSFED)
Other types of eating disorders that don’t seamlessly fit into the four previously listed categories are often put under OSFED. This type of eating disorder serves as a “catch-all” for atypical cases that have some features of the major types of anxiety disorders, as well as for all other eating disorders.
Included in this category are the following:
Purging Disorder- Patients with this condition exhibit recurrent purging behavior, but do not binge eat.
Atypical Anorexia Nervosa: Patients with this condition meet all the criteria for anorexia, except significant weight loss.
Bulimia Nervosa (of low frequency and/or limited duration): Patients with this condition meet all the criteria for bulimia, but exhibit them at a lower frequency and/or for less than three months.
Binge Eating Disorder (of low frequency and/or limited duration): Patients with this condition meet all the criteria for BED, but exhibit them at a lower frequency and/or for less than three months.
Night Eating Syndrome: Patients with this condition have recurrent episodes of night eating, in which they eat after being awakened from sleep, or eat excessively after their evening meal. Moreover, this behavior is not better explained by another mental health disorder, or any social or environmental cause, as well as leads to significant distress or impairment.
Levels of Care or Treatment For Eating Disorders
Most patients are initially treated at the outpatient level, but attending health providers might recommend a higher level of care when necessary. Often, treatment begins with a comprehensive medical evaluation to check the patient’s health status. Severe cases (such as when patients are already suffering from malnutrition, dehydration, or a physical illness) may first require hospitalization prior to proceeding with the treatment for the eating disorder.
The main levels of care for patients with eating disorders are the following:
Outpatient
This is the lowest type and least restrictive treatment level. Patients may visit a therapist, nutritionist, and other professionals around two to three times per week.
This treatment level is ideal for patients who need to keep attending school or performing their job. It’s also best for patients who don’t have insurance coverage to seek higher levels of care.
Intensive Outpatient (IOP)
This treatment level is ideal for patients who can benefit from greater support compared to standard outpatient treatment, but still need to keep their job or attend school.
Treatment at this level typically involves set times for each patient, which happens around 2-5 days per week. Treatment plans at this level usually include personalized therapy, one-on-one nutrition consultation sessions, topic-focused groups, and even family support groups.
Residential
Patients who opt to receive residential care will stay 24/7 in an eating disorder rehab center or facility. They will receive constant medical supervision, which is ideal for patients who have certain health conditions that need to be monitored round-the-clock.
Treatment plans at the residential level are typically highly structured, enabling patients to focus their time and energy on their healing. The recovery center, meal plans, and activities included in residential treatment are all designed to promote patients’ holistic healing from their eating disorder.
Inpatient/Hospital Setting
As mentioned earlier, this is the highest level of care, set in a hospital. Patients who receive hospital or inpatient treatment are those who require urgent medical stabilization and weight loss intervention. Most patients who are given this level of care stay in the hospital for only a maximum of three weeks. Once they’re medically stable, they are normally transferred to a residential treatment facility, where treatment for their eating disorder can commence.
After receiving residential or inpatient care, patients are usually given the option to receive continuing care, which includes recurring sessions with their therapist and nutritionist to ensure constant support in their healing journey. Just how often these sessions should occur are typically set or recommended by the treatment team prior to the patient’s discharge from the treatment facility.
Utilizing other resources for recovery is also recommended. Examples include joining eating disorder support groups or using self-help strategies (such as following a meal plan and writing in a journal).
Existing Treatments for Eating Disorders
Treating an eating disorder involves following a personalized treatment program that’s designed specifically for each unique patient. It takes into account the patient’s specific type of eating disorder, general health, severity of eating disorder, existence of co-occurring or comorbid disorders, and other relevant personal factors.
In general, the goals of treatment are to:
Challenge (and later on, replace) negative thoughts about one’s body and weight
Replace disordered eating behaviors with healthier eating habits
Restore physical and mental health
Set a realistic plan for avoiding as well as managing relapse
To accomplish those objectives, a treatment plan will usually include one or more of these types of treatment:
Psychotherapy
Often (but not always just) in the form of talk therapy, this therapy type empowers patients to understand and manage their thoughts, emotions, and behaviors. Therapy is usually delivered to the individual, but may also include group therapy and family therapy.
Nutritional counseling
An experienced nutritionist or dietitian can help a patient acknowledge his or her relationship with food, and design a healthy and balanced eating plan that will suit the patient’s nutritional needs.
Medications
In a nutshell, there is currently no medication that can completely treat an eating disorder, but certain medications—such as antidepressants, anti-anxiety drugs, antipsychotics, and mood stabilizers—are available to help patients manage various symptoms related to their disorder. Studies have shown that alternative or complementary therapies such as meditation, yoga, meditation, and relaxation techniques may also provide benefits.
General medical care and monitoring
Medical providers are available both in hospitals as well as eating disorder rehab centers to monitor patients’ health status. This is an integral component of eating disorder treatment, since eating disorders have the potential to cause physical and mental health issues.
It is best to seek treatment as early as possible for an eating disorder, because it can increase a person’s risk for health complications and even suicide. Many people who suffer from an eating disorder also have a comorbid disorder (like depression or anxiety disorder) or struggle with substance use.
In spite of all of these, it’s crucial to keep in mind that complete recovery from an eating disorder is possible.
Again, it’s important to note that every patient with an eating disorder will have his or her own treatment plan that’s designed specifically just for him or her, so no two treatment plans will be alike.
Here are some of the major therapies used to treat different types of eating disorders:
Cognitive Behavioral Therapy (CBT)
One of the most popular forms of psychotherapy, CBT focuses on eliminating negative patterns of thinking and irrational beliefs that foster such thought patterns. CBT empowers patients by teaching them skills for identifying and challenging their dysfunctional beliefs. CBT may also include educational elements and the creation of a meal plan, along with strategies for coping with psychological, familial, and societal factors that contribute to one’s eating disorder.
Dialectical Behavioral Therapy (DBT)
DBT is a form of psychotherapy that combines cognitive and behavioral methods to help patients manage distressing emotions, making it particularly helpful for patients who react to stressful situations by displaying extreme behaviors. DBT usually includes a mindfulness program and exercises for emotional regulation.
Mindfulness Based Cognitive Therapy (MBCT)
MBCT combines the powerful therapeutic techniques of CBT and mindfulness to empower patients in understanding and taking control of their thoughts and feelings. The CBT component of MBCT guides patients in acknowledging their destructive thought patterns and replacing those with rational thoughts. Just like in CBT, patients are given homework assignments and taught how to do a body scan and formal meditation. Through mindfulness, they learn how to be fully present in each moment and accept reality. MBCT is typically done as group therapy, but may likewise be conducted individually, with every weekly session (totaling eight weeks) lasting around 2 to 2.5 hours.
Narrative and Metaphor Therapy
Narrative and metaphor therapy harnesses the power of stories in recreating a patient’s life. This therapy is based on the belief that an eating disorder is influenced by the stories that a patient has developed about his or her identity. It teaches patients to separate themselves from their eating disorder and reclaim their power to transform their life story. Instead of simply looking at the eating disorder itself, this therapy examines holistic and multidimensional factors such as the patient’s social circle, consumed media, and cultural values. Narrative and metaphor therapy is an effective complement to existing treatments like CBT, interpersonal psychotherapy (IPT), and others. It’s also used when traditional therapies are unable to give lasting results in a patient.
Somatic Therapy
Somatic psychotherapy (or simply somatic therapy) prioritizes the mind-body-spirit connection. It is a holistic and multidimensional therapy that focuses on the patient’s body for his or her healing from the eating disorder. It teaches patients how to perform self-protective physiological responses to release their pent-up energy, which are believed to stem from unresolved trauma. In contrast to traditional therapies like CBT, which are centered on the mind, somatic therapy includes not only conventional talk therapy but also physical exercise, meditation, massage, vocal exercises, and other mind-body activities.
Horticultural Therapy
Horticultural therapy promotes healing from eating disorders through the active process of performing gardening activities, rather than focusing on just the end result. Usually given as a complement to conventional therapies, horticultural therapy improves task initiation, memory, language skills, and socialization, along with providing other therapeutic benefits. It enables patients who are struggling with an eating disorder to learn new skills and re-learn lost or forgotten ones.
Sound Therapy
Numerous studies have shown that sound has phenomenal effects on people. Sound therapy is founded on the science of how auditory stimuli can impact the symptomatic state of someone struggling with an eating disorder. Guided by a trained sound therapist, the right sound (e.g., soothing, stimulating, reflective) can influence patients’ brainwaves, leading them into an altered state of consciousness (ASC) similar to that achieved from meditation, which is ideal for therapy. Often used to complement conventional therapies, sound therapy also teaches patients effective strategies in reflecting on their recovery journey.
Medical Nutrition Therapy (MNT)
MNT is a holistic treatment for a variety of health conditions and their associated symptoms. It’s characterized by personalized meal plans that are often created by a registered dietitian. MNT includes nutritional assessment, dietary modifications, as well as patient education.
Art Therapy
In this form of psychotherapy, patients harness the power of art as a creative outlet for expressing themselves and for healing. Art therapists guide patients in expressing their thoughts, feelings, experiences, and dreams through various art forms, such as drawing, painting, sculpting, and so on.
And more…
There are a handful of other therapies that are already being used as well as still being developed to treat eating disorders.
Effective Treatment For Eating Disorders
‘Ai Pono Hawaii has over 35 years of track record in providing effective and holistic treatment for different types of eating disorders.