It’s Time to Talk

Story By Ann E. Butenas

Observed each February, National Eating Disorders Awareness Week is designed to increase awareness and heighten understanding of those who suffer from this form of mental illness.

While it may seem like a rather new form of mental illness, eating disorders, also referred to as EDs, have been around for centuries. In fact, they have been described as dating back clear to the 12th century. Purging was actually an ancient practice after over-indulging in food and drink like the wealthy Romans did during the time of Caesar. Purging was also a way to prevent diseases that were believed to be brought on by certain types of food. In some cultures, women would starve themselves under the belief that a desire for food was a sin. In the late 1800s, anorexia nervosa was recognized by the medical community as a psychiatric condition. By 1979,  Gerald Russell, a British doctor, characterized bulimia nervosa as a form of anorexia.

The National Eating Disorders Association (NEDA) is the largest non-profit organization focused on helping individuals who suffer from this disorder, as well as providing support for their families. For more than three decades, this week-long event held in February provides a time for people to come together in support of those who struggle daily with an ED. It is also a time to shed light on some of the common misconceptions about this illness.

During the week of February 20-26, 2023, you can participate in many ways:

  • Volunteer on a helpline, speaking to those who struggle with an eating disorder and providing encouragement and emotional support.
  • Educate yourself to become a better ally. Maintain an open mind and listen to the stories of those who are dealing with this issue in their lives.
  • Share your experiences if you have personally struggled with an eating disorder.

A therapist can help those struggling with an ED to help them further understand their condition and to create a plan to work towards healthier eating habits. Brooke Wesley, LSCSW, CEDS, and Co-Owner of Bellatore Recovery, and Jennifer Hannon, LMSW of Jennifer Hannon, LLC, are local therapists who work with individuals struggling with EDs. They offered their insight to provide increased understanding of the indicators, types of EDs, triggers, demographics, and treatment options for those who are dealing with such a sensitive issue.

 Indicators of an eating disorder

 Due to the many signs and symptoms that could signal an ED, it can be a challenge to fully recognize when someone may be struggling in this regard.  However, Wesley indicated the primary red flags of an ED can include:

*Obsessive thoughts focused on weight, body shape, and food.

*Avoiding eating in front of other people

*Displaying a disconnected or disordered mood

*Rigid behavior.

From a physical standpoint, Hannon noted other indicators that can also be indicative of an ED can include but are not just limited to, sudden weight loss or gain, gastrointestinal upset, concentration issues, dizziness and/or fainting, and hair loss.

Types of eating disorders

 According to Hannon, the types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, and OSFED (other specified feeding and eating disorders).

“Many diagnoses fall under this category because some people play ‘whack a mole ‘with behaviors,” she explained. “When we address one behavior, it can sometimes trigger another. For example, when we treat anorexia and start re-feeding the patient, they are still figuring out hunger/fullness cues, so sometimes it can lead to binge eating behaviors,” she explained.

Conversely, Hannon noted someone could have all of the symptoms of anorexia but fall within a “normal” body weight. Further, another type of ED is orthorexia, which is not recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), but it refers to those who become preoccupied with health, food ingredients, and exercise.

Triggers to an eating disorder

“Genetics loads the gun; environment pulls the trigger.”  This is the metaphor Hannon applied to EDs, to which she referred as a biophysical issue. An ED can arise from a biological, psychological, and/or social aspect.

Biologically speaking, a pre-existing mental illness can become a trigger or perhaps develop in conjunction with an ED.  Psychologically, one with an ED may suffer from low self-esteem, neglect, or abuse, or perhaps have experienced traumatic life events, such as a death, a birth in the family, or a significant transition. From a social perspective, the media can play a huge role in triggering an ED, highlighting unrealistic expectations (perfectionism) from others and from the individuals themselves.

Demographics of eating disorders

 ED’s can actually occur at any age,” noted Wesley. “We see patients from ages eight to 75. In general, we see disrupted body image, and the thought of using weight, shape, food, and exercise as a means to manage emotions begin around the beginning of puberty.”

Wesley further noted that while males can be affected by EDs, about 15% of all women suffer from an ED at some point in their lifetime while that percentage drops to roughly 5%-8% for males.

Treatment options for eating disorders and related success rates

 Fortunately, there are various levels of care available. Residential facilities are also available if someone is deemed medically unstable.

“If a person is medically stable and does not meet criteria for a higher level of care, there are eating disorder therapists who can treat an individual at the outpatient level,” emphasized Hannon.

Wesley set forth the levels of treatment options available:

*Outpatient with an individual therapist, dietician, and a medical doctor

*Intensive outpatient with a therapist, dietician, a medical doctor, and a certain number of hours of group work per week.

*Partial hospitalization, which includes a certain number of hours per day, six days per week.

*Residential treatment, which is a live-in option.

How to help someone with an eating disorder

“Don’t be afraid to tell someone when you are worried. Remember, though, that just because it may cause distress does not mean you shouldn’t say it,” emphasized Wesley.

Hannon further stressed the importance of educating yourself and finding resources within the community. It is also a good practice to avoid discussing weight issues, body size, shape, and form, and even types of foods and diets. She highlighted the importance of asking your loved one how you can help. This may include just listening to their feelings or even offering solutions.  The key, she noted, is to allow them space and what they need in the moment.