This page provides a comprehensive overview about struggles related to eating and body image. It includes information about subclinical problems as well as “clinical” eating disorders. Sections are as follows:
Introduction
Common Signs of an Unhealthy Relationship to Food
Blog Posts about Eating Disorders and Healthy Eating
Assessment Tools
Overview of “Eating Disorders” from the National Institute of Mental Health (NIMH)
Further Resources – Self-help and Professional Contacts
Introduction
Not having a “100% healthy relationship to food” is common for most people in the developed world. We all know what it’s like to eat when we’re not truly hungry, sometimes overindulging in unhealthy treats, at other times just eating out of boredom or nerves. Many of us, especially women, have chosen to restrict our intake of food when we were indeed hungry and needed the nutrients, as an attempt to “look better” or perhaps connect with some semblance of control when the world around us was spinning.
While food is both necessity and (potentially) pleasure, it can also be used in more deleterious ways as a means of coping with painful emotions and life stressors. Like all psychological and behavioral difficulties, problems relating to food range from mild to severe. When they are on the more severe end of the spectrum, they may qualify for a clinical diagnosis of an “eating disorder,” such as bulimia, binge-eating disorder, or anorexia nervosa.
As most would guess, body image is often a factor when it comes to eating disorders, whether mild, moderate or severe. In addition to projecting unrealistic ideals of beauty, we live in a culture that minimizes feelings and compartmentalizes mind and body, all of which lead to disconnection from our true physiological and socio-emotional needs. No wonder so many people struggle with lifelong diets and body weights that may yo-yo up and down.
“By fourth grade, nearly 80% of all girls have already been on a diet.”
– Jeanne Rust, Ph.D., Specialist in Eating Disorder Treatment
While females are more likely to suffer from eating disorders, many men do as well. Below is a chart denoting the lifetime prevalence of the 3 most common types of clinical eating disorders. As you can see below, nearly 6% of females in the US will develop a clinically diagnosable eating disorder at some point in their life. For men, it’s just under 3%.
| Clinical Disorder | Women (%) | Men (%) |
| Anorexia nervosa | 0.9 | 0.3 |
| Bulimia nervosa | 1.5 | 0.5 |
| Binge eating disorder | 3.5 | 2.0 |
| TOTAL | 5.9% | 2.8% |
| Source: Samhsa – Lifetime Prevalence | ||
Again, these refer to statistics about the most severe forms of eating dysfunction – conditions that are complex and sometimes devastating. Hundreds of thousands more in the US and beyond, struggle on a subclinical level, expending excessive psychic energy on body image and food.
Common Signs of an Unhealthy Relationship to Food
There are many possible indications of an unhealthy relationship to food. Below are the more common ones:
–obsessive thoughts related to food and eating
–compulsive behaviors related to food and eating
–distorted body image (e.g., feeling “fat” even when having a healthy body weight)
–carrying extra weight per objective report (e.g., your MD tells you so)
–intense fear of weight gain
–self-esteem connected to your weight
–physiological changes not explained by something else (see NIMH section below)
–eating when full
–eating very large amounts of food, especially when under stress
–eating large amounts of food and then wanting to purge and/or doing so
–over-exercising out of fear of weight gain
–eating unhealthy food on a regular basis
Blogs & Posts
Below you can find links to thoughtful blog posts and articles to help learn more about eating disorders and healthy eating.
Fat is Not a Feeling: How to Combat a Negative Body Image, by Laney Cline King, LCSW
Does Every Woman Have an Eating Disorder? The author of this blog and book with the same title, clinical psychologist Stacey Rosenfeld, writes “My contention is that nearly every woman has some form of disordered relationship with food or her body– not necessarily anorexia, bulimia, or binge eating disorder, but a fixation on food/ weight/shape that is unhealthy, unwanted, and undying.”
Don’t’ Diet, Live It!, by Andrea Wachter, Psychotherapist and Author and national expert on healthy eating. This short piece describes her approach to “live it” rather than diet by focusing on four key areas in one’s life to help develop a healthy relationship to food: physical, emotional, intellectual and spiritual.
10 Principles of Intuitive Eating. “Intuitive Eating” – what a great phrase. Registered Dietician and former nutrition expert for Good Morning America, Evelyn Tribole and co-author, Nutritional Therapist, Elyse Resch produce this blog and note that “Intuitive eating is an approach that teaches you how to create a healthy relationship with your food, mind, and body–where you ultimately become the expert of your own body…It’s also a process of making peace with food—so that you no longer have constant “food worry” thoughts.”
Stress and Eating Disorders A more academic piece written by Mirasol, a holistic treatment center for anorexia, bulimia and binge eating. They write “We believe that eating disorders are chronic stress-related conditions, and we apply the same techniques that have been used to successfully treat other chronic conditions such as chronic fatigue syndrome, fibromyalgia and IBS…Our model of treatment for eating disorders is based on an integrative medical approach to mind-body-spirit healing. We help clients recover from chronic stress and trauma using a combination of cognitive as well as experiential therapies.”
Assessment Tools
Below are a few assessment tools you can try if you’re concerned you might have an eating disorder. As with any self-adminstered assessment tool, this is no replacement for a comprehensive evaluation offered by a trained medical professional.
1.) Do I Have an Eating Disorder? 37 questions online, by Mirasol Eating Disorders Recovery Center
2.) SCOFF Screening – Two or more “yes” responses indicate that an ED is likely.
- Do you make yourself Sick [induce vomiting] because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone* (14 pounds) in a 3-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
Source: SAMHSA (Substance Abuse and Mental Health Services Administration, US Gov’t)
3.) The Eating Attitudes Test (a 26-item version of the original 40-question Eating Attitudes Test)
4.) My Body Screening (developed by the National Eating Disorders Association)
NIMH Eating Disorders Overview
Note: the following information enclosed in quotes is from the National Institute of Mental Health (NIMH) and covers information related to “clinical eating disorders” – conditions to be distinguished from subclinical level struggles people have with food and eating.
“What are eating disorders?
The eating disorders anorexia nervosa, bulimia nervosa, and binge-eating disorder, and their variants, all feature serious disturbances in eating behavior and weight regulation. They are associated with a wide range of adverse psychological, physical, and social consequences. A person with an eating disorder may start out just eating smaller or larger amounts of food, but at some point, their urge to eat less or more spirals out of control. Severe distress or concern about body weight or shape, or extreme efforts to manage weight or food intake, also may characterize an eating disorder.
Eating disorders are real, treatable medical illnesses. They frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders. Other symptoms can become life-threatening if a person does not receive treatment, which is reflected by anorexia being associated with the highest mortality rate of any psychiatric disorder.
Eating disorders affect both genders, although rates among women and girls are 2½ times greater than among men and boys. Eating disorders frequently appear during the teen years or young adulthood but also may develop during childhood or later in life.
What are the different types of eating disorders?
Anorexia nervosa
Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. People with anorexia nervosa typically weigh themselves repeatedly, portion food carefully, and eat very small quantities of only certain foods. Some people with anorexia nervosa also may engage in binge eating followed by extreme dieting, excessive exercise, self-induced vomiting, or misuse of laxatives, diuretics, or enemas.
Symptoms of anorexia nervosa include:
- Extremely low body weight
- Severe food restriction
- Relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body image and self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
- Lack of menstruation among girls and women.
Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness.
Other symptoms and medical complications may develop over time, including:
- Thinning of the bones (osteopenia or osteoporosis)
- Brittle hair and nails
- Dry and yellowish skin
- Growth of fine hair all over the body (lanugo)
- Mild anemia, muscle wasting, and weakness
- Severe constipation
- Low blood pressure, or slowed breathing and pulse
- Damage to the structure and function of the heart
- Brain damage
- Multi-organ failure
- Drop in internal body temperature, causing a person to feel cold all the time
- Lethargy, sluggishness, or feeling tired all the time
Bulimia nervosa
People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feel a lack of control over these episodes. This binge eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.
Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge eating and purging cycle can happen anywhere from several times a week to many times a day.
Other symptoms include:
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel, and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration from purging of fluids
- Electrolyte imbalance—too low or too high levels of sodium, calcium, potassium, and other minerals that can lead to a heart attack or stroke.
Binge-eating disorder
People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa, periods of binge eating are not followed by compensatory behaviors like purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure. They also experience guilt, shame, and distress about their binge eating, which can lead to more binge eating.
How are eating disorders treated?
Typical treatment goals include restoring adequate nutrition, bringing weight to a healthy level, reducing excessive exercise, and stopping binging and purging behaviors.
Specific forms of psychotherapy, or talk therapy—including a family-based therapy called the Maudsley approach and cognitive behavioral approaches—have been shown to be useful for treating specific eating disorders. Evidence also suggests that antidepressant medications approved by the U.S. Food and Drug
Administration may help for bulimia nervosa and also may be effective for treating co-occurring anxiety or depression for other eating disorders.
Treatment plans often are tailored to individual needs and may include one or more of the following:
- Individual, group, or family psychotherapy
- Medical care and monitoring
- Nutritional counseling
- Medications (for example, antidepressants).
Some patients also may need to be hospitalized to treat problems caused by malnutrition or to ensure they eat enough if they are very underweight. Complete recovery is possible.
What is being done to better understand and treat eating disorders?
Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, psychological, and social factors. But many questions still need answers. Researchers are studying questions about behavior, genetics, and brain function to better understand risk factors, identify biological markers, and develop specific psychotherapies and medications that can target areas in the brain that control eating behavior. Brain imaging and genetic studies may provide clues for how each person may respond to specific treatments for these medical illnesses. Ongoing efforts also are aimed at developing and refining strategies for preventing and treating eating disorders among adolescents and adults.” (End Source: National Institute of Mental Health)
Further Resources
If you’re concerned about yourself or a loved one, a good place to start is by speaking with your primary care physician or other allied health professional. Below are additional resources to help get you on the path to healthy eating and living. More mild and moderate issues may be able to be addressed through self-help or outpatient interventions. More severe issues may require inpatient or intensive outpatient programs.
Mild Issues
- The Diet Cure by Julia Ross, The Nutritional Therapy Institute Clinic.
- Dr. Joel Fuhrman’s program, featured on PBS (the “Nutritarian” philosophy that focuses on maximizing micronutrient foods per calorie).
- Dr. Sears Wellness Institute – can find certified nutritional counselors and coaches.
- American Dietetic Association – provides a list of registered dietitians to work with.
- How to Stop Binge Eating in 3 Unusual Steps, by Glenn Livingston, PhD.
Moderate to Severe
- National Eating Disorders Association – overview of the treatment process
- Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.). A list of treatment resources by State and country can be found here.
- Mirasol – Eating Disorders Recovery Center
- American Dietetic Association – provides a list of registered dietitians to work with.
- National Association of Anorexia Nervosa and Associated Disorders. A list of resources by State is at http://www.anad.org/get-help/treatment-centers/
General Resources:
- Community behavioral health centers and other behavioral health specialists, including psychotherapists and clinical social workers that specialize in eating disorders.
- Hospital psychiatry departments and outpatient clinics.
- Employee assistance programs (EAPs) through one’s employer.