Eating Disorders
The 3 most common eating disorders are anorexia, bulimia, and binge eating disorder. For information on signs, symptoms, and treatment options, go to something-fishy.org, anad.org, or nationaleatingdisorders.org.
Eating disorders often arise from dissatisfaction with one’s body and a desire to achieve a more desirable shape. What follows is an ongoing battle with food, a search for the perfect set of rules which will produce that ideal body and the life it will bring. Sadly the more someone works to find the perfect strategies, the less successful they feel and the more their self-esteem drops.
It’s common to find problems with depression, anxiety, and relationships appearing as the struggle with the eating disorder continues. There may be more conflicts with friends and family or even the complete loss of relationships as the eating disorder takes over the person’s life.
Dr. Ross has been treating people with eating disorders for 24 years. Eating disorders often become so overwhelming that they take over a person’s life. Robin believes treatment should be done in stages so that each small success builds toward a full recovery. Changing behavior, thoughts, social relationships, and the way one deals with emotions are key elements in the search for longterm recovery. As a cognitive-behavior therapist, Dr. Ross puts a lot of effort into helping clients change the way they see themselves (body image) and to create a more flexible way of thinking about themselves and their life including food. Robin works with her clients to create individualized strategies for mastering each stage of the recovery process. She believes it is important to collaborate with families, physicians, and dietitians while respecting the privacy of the individual.
Anorexia Nervosa
Anorexia is a disorder in which the individual progressively restricts the amount and types of foods they will eat. They may begin with a diet or a desire to be more “healthy”, but in many cases the restriction takes on a life of its own. Over time, the individual makes more and more rules governing what they will and won’t eat, where and how they will eat, and what activities they will participate in. Relationships with friends and family often suffer as the person loses their ability to be in situations where they cannot rigidly control their food such as parties, family meals or going into new restaurants. This disorder is progressive; the sufferer seeks the point at which they feel good or successful enough about themselves but never reach that point.
As food intake becomes more restricted, body and brain are negatively affected. The person may become irritable, moody, or angry. Lost in their thoughts about food and body, they are often unaware of the impact of their moods and behavior on others. They are often perfectionistic individuals who become ever more driven as their bodies shrink. Students may spend incredible amounts of time studying, partly because they have to work harder to keep their minds focused. Those who exercise excessively often continue to exercise even as their body weakens, fearing a loss of control if they stop.
Anorexia nervosa is the most dangerous of all mental health disorders. Because the body’s ability to maintain basic regulation is affected, sufferers can die or suffer heart attacks or strokes when electrolytes go out of balance. The liver, which is designed to process fats, can be severely damaged by malnutrition. The reproductive system in females is often affected by malnutrition; this can lead to infertility. Calcium is leached out of the bones with malnutrition, leading to osteoporosis. The brain, which is comprised largely of fat, is also affected. There can be permanent brain shrinkage. Suicide rates are also high as a result of the depression and anxiety which accompany severe malnutrition. It is vital to be under the care of both a therapist and a physician skilled in treating anorexia to help minimize the risks of damage and to promote recovery.
Anorexia rarely improves without treatment. It can become a lifelong disorder if not treated promptly and properly. It is important to find a skilled therapist to work with clients who have this disorder. In many cases, it is important that the therapist also work with the family or with the family therapist in order to help break the grip that this disorder often has on families. Experienced therapists also use the services of doctors, psychiatrists, and nutritionists to help promote recovery from this serious condition.
Bulimia
Bulimia is similar to anorexia in that it often begins as a way to lose or manage weight. When sufferers feel that they have eaten too much, they purge to eliminate the excess food and the distress they feel. Purging can involve vomiting, laxatives, or excessive exercise to “burn off” the calories consumed. Many bulimics will alternate between periods of restriction and binge/purge episodes. A less common variant of bulimia is one in which individuals chew foods they normally don’t allow themselves to eat, then spit it out before swallowing. Bulimics may be underweight, normal weight or even overweight.
While anorexia is a disorder of over-control, bulimia is characterized by poor regulation. Food intake, the frequency of purging, mood swings, exercise levels, and even the ability to function in school or work can vary widely with this disorder. Shame and poor self-regulation can lead bulimics to withdraw from friends and family, thus weakening needed support relationships.
Bulimia can lead to chronic gastrointestinal problems, reproductive difficulties, cardiovascular problems, depression, and anxiety. It is important to find both a therapist, a medical doctor and often a nutritionist skilled in the treatment of eating disorders. Effective treatment should be aimed at normalizing food and exercise patterns and learning to regulate moods without the use of self-destructive behavior.
Binge Eating Disorder
In Binge Eating Disorder (BED), sufferers eat large amounts of food, well in excess of what most people eat and in excess of what their bodies need. This is not a problem of “liking food too much”. In fact, people with BED often report that they don’t even taste the food they are consuming. The binge eating may occur in specific episodes in which the person eats a large volume of food over some period of time. My clients report eating anywhere from 3-5,000 calories over a 2 to 3 hour period when they have binges. Binge eating disorder may also take the form of grazing in which the person eats small amounts of food so often that they do not give their body a chance to get hungry. Nocturnal binge eating occurs when the person awakens in the night and has a binge.
The binge eating does not seem to be triggered by the presence of food. Instead, people with this disorder tend to binge when they are upset, nervous, angry, bored or lonely. The food temporarily numbs away these feelings; unfortunately they come back quickly. In order to keep the uncomfortable feelings away, sufferers can wind up in “binge cycles” in which they eat more and more food in an attempt to keep themselves numb or comforted.
Effective treatment involves learning to manage painful feelings without food. Once this goal is reached, the next step is to normalize the eating patterns. Those who graze would learn to eat clearly defined meals. Those who eat overly large portions would be able to learn portion control once the emotions are dealt with. If the person with BED tries to diet before learning these crucial skills, they may wind up even more overwhelmed by uncomfortable feelings which can lead to even more binging. We typically recommend that people with BED not attempt a diet until they have made the needed progress and sustained it for 3 months or more.