Mental Health Resources: Eating Disorders

Anorexia Nervosa Symptoms

• Severely restricting food intake through dieting or fasting
• Exercising excessively
• Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products
• Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
• Frequently skipping meals or refusing to eat
• Denial of hunger or making excuses for not eating
• Eating only a few certain "safe" foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as spitting food out after chewing
• Not wanting to eat in public
• Lying about how much food has been eaten
• Fear of gaining weight that may include repeated weighing or measuring the body
• Frequent checking in the mirror for perceived flaws
• Complaining about being fat or having parts of the body that are fat
• Covering up in layers of clothing
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Insomnia
• Reduced interest in sex

Bulimia Nervosa

• Being preoccupied with your body shape and weight
• Living in fear of gaining weight
• Repeated episodes of eating abnormally large amounts of food in one sitting
• Feeling a loss of control during bingeing — like you can't stop eating or can't control what you eat
• Forcing yourself to vomit or exercising too much to keep from gaining weight after bingeing
• Using laxatives, diuretics or enemas after eating when they're not needed
• Fasting, restricting calories or avoiding certain foods between binges
• Using dietary supplements or herbal products excessively for weight loss

Binge Eating Disorder

• Eating unusually large amounts of food in a specific amount of time, such as over a two-hour period
• Feeling that your eating behavior is out of control
• Eating even when you're full or not hungry
• Eating rapidly during binge episodes
• Eating until you're uncomfortably full
• Frequently eating alone or in secret
• Feeling depressed, disgusted, ashamed, guilty or upset about your eating
• Frequently dieting, possibly without weight loss

Diabulimia

Diabulimia is an eating disorder in someone with diabetes, typically type 1 diabetes. It often includes restricting insulin in order to lose weight. Sometimes it begins with body image issues or a desire to lose weight, and sometimes it begins as diabetes burnout. Treatment can be challenging as individuals with type 1 diabetes tend to show higher dropout rates and poorer treatment outcomes than other patients. Treatment regimens must address both the diabetes and eating disorder aspects of the disorder. It may be diagnosed as purging disorder if the person is eating normally and restricting insulin or anorexia nervosa if the person is severely restricting both food and insulin.

• Increasing neglect of diabetes management
• Secrecy about diabetes management
• Avoiding diabetes related appointments
• Fear of low blood sugars
• Fear that “insulin makes me fat”
• Restricting certain food or food groups to lower insulin dosages
• Discomfort testing/injecting in front of others
• Infrequently filled prescriptions

Avoidant Restrictive Food Intake Disorder

• Sudden refusal to eat foods.
• Fear of choking or vomiting.
• No appetite for no known reason.
• Very slow eating.
• Difficulty eating meals with family or friends.
• No longer gaining weight.
• Losing weight.
• No growth or delayed growth.

Rumination Disorder

Rumination syndrome is a condition in which people repeatedly and unintentionally spit up (regurgitate) undigested or partially digested food from the stomach, rechew it, and then either reswallow it or spit it out.

• Effortless regurgitation, typically within 10 minutes of eating
• Abdominal pain or pressure relieved by regurgitation
• A feeling of fullness
• Bad breath
• Nausea
• Unintentional weight loss

Eating Disorder Not Otherwise Specified (EDNOS) or Other Specified Feeding and Eating Disorder (OSFED)

EDNOS is a classification of disordered eating that falls outside of the criteria of anorexia, bulimia and binge eating. EDNOS represents a majority of those with eating disorders. EDNOS covers those who fail to meet all guidelines for eating disorders, which means that they may not qualify for coverage for their illness. Current guidelines give those with an EDNOS an incentive to get worse, so they can receive coverage for their illness. Types of EDNOS include the following:

Pica

Pica is a compulsive craving for eating, chewing or licking non-food items, such things as paint chips, chalk, plaster, glue, rust, ice, coffee grounds or cigarette ashes. It is sometimes linked to deficiencies of minerals, such as iron or zinc. Pica can lead to medical conditions such as lead poisoning, malnutrition, abdominal problems, intestinal obstruction, hypokalemia, hyperkalemia, mercury poisoning, phosphorus intoxication and dental ailments.

Prader-Willi Syndrome

Individuals with Prader-Willi Syndrome, which is caused by a defect in the hypothalamus, have an insatiable appetite. It can result in sleep disorders, rage, compulsive behavior and even psychoses. Physical conditions may include obesity, delayed motor development, abnormal growth, speech impairments, stunted sexual development, poor muscle tone, dental problems and diabetes type II.

Night Eating Syndrome

Those with night eating syndrome typically eat little or nothing during the morning, but binge during the evening. Resulting conditions may be the same as for binge eating, with the addition of sleep disorders.

Bigorexia or Muscle Dysmorphia

Also known as muscle dysmorphia or reverse anorexia, individuals with bigorexia worry that they are too small and go to great lengths to increase their muscle mass. The disorder is common among body builders, whose steroid use and extreme high-protein diets can lead to kidney failure and other ailments.

(Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/symptoms-causes/syc-20353591; Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615; About Kids Health, https://www.aboutkidshealth.ca/article?contentid=275&language=english; NEDA, https://www.nationaleatingdisorders.org/diabulimia-5; Healthline, https://www.healthline.com/health/pica#symptoms; Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/symptoms-causes/syc-20377330; Walden, https://www.waldeneatingdisorders.com/popular-searches/ednos/)

Cognitive-Behavioral Therapy (CBT)

It’s based on the idea that negative actions or feelings are the results of current distorted beliefs or thoughts, not unconscious forces from the past. CBT is a blend of cognitive therapy and behavioral therapy. Cognitive therapy focuses on your moods and thoughts. Behavioral therapy specifically targets actions and behaviors.

Family-based Therapy

This is the only evidence-based treatment for teenagers with anorexia. Because the teenager with anorexia is unable to make good choices about eating and health while in the grips of this serious condition, this therapy mobilizes parents to help their child with re-feeding and weight restoration until the child can make good choices about health.

Dialectical Behavior Therapy (DBT)

This therapy helps you not just develop new skills to handle negative triggers but also helps you develop insight to recognize triggers or situations where a non-useful behavior might occur. Specific skills include building mindfulness, improving relationships through interpersonal effectiveness, managing emotions and tolerating stress.

Interpersonal Psychotherapy

This therapy addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills.

Nutrition Education

Dietitians can design an eating plan to help you achieve healthy eating habits to avoid hunger and cravings and to provide good nutrition.

Group Therapy

Group therapy is where people can find support and openly discuss their feelings and concerns with others who share common experiences.

Outpatient Programs

Some eating disorder programs may offer day treatment.

Diaphragmatic Breathing

Used for Rumination Disorder, this prevents abdominal contractions and regurgitation.

Biofeedback

Biofeedback is part of behavioral therapy for rumination syndrome. During biofeedback, imaging can help you or your child learn diaphragmatic breathing skills to counteract regurgitation.

Medications

Zyprexa

Used to aid in increasing weight.

Prozac

The only FDA-approved antidepressant for treating bulimia.

Vyvanse

The first FDA-approved medication to treat moderate to severe binge-eating disorder in adults.

Topamax

Normally used to control seizures, topiramate has also been found to reduce binge-eating episodes.

Ativan

Sometimes prescribed to reduce anxiety related to eating.

(Healthline, https://www.healthline.com/health/depression/cognitive-behavioral-therapy; Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/diagnosis-treatment/drc-20353597; Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa#management-and-treatment; Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/bulimia/diagnosis-treatment; /drc-20353621; Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/diagnosis-treatment/drc-20353633; verywellhealth, https://www.verywellhealth.com/avoidant-restrictive-food-intake-disorder-treatment-5186650; Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/diagnosis-treatment/drc-20377333)

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