Eating Disorder Rehab

It’s often thought that eating disorders are a lifestyle choice, but they are categorized as illnesses that stem from an underlying mental condition. Obsessions with food, shape, and body weight are psychologic and require treatment to dig at the root of the disorder and re-establish healthy eating behaviors.

What Are Eating Disorders?

According to the National Institute of Mental Health, eating disorders typically develop in adolescence or early adulthood, but may be triggered in childhood or later in adulthood. They usually start after a single or series of negative mental cues have been etched in their brain, so to speak, causing them to develop a distorted body image and unhealthy relationship with food.

Traumatic events like rape, bullying, accidents, physical abuse, verbal abuse, and mental abuse are all factors that can and have led to eating disorders. Even some environmental nods like advertisements and outward cultural expectations may play a role. As a result, the person loses a sense of self-worth and identity.

They get the idea that if they achieve a certain body type they will be happy internally, but also receive the acceptance of their family and peers. However, with some eating disorders, even if they meet the challenge of attaining the body they had in mind, new, greater limitations are place. What they see in the mirror is never enough.

Unlike substance abuse, no one may even know they are struggling with an eating disorder.

They may start out eating smaller or larger amounts of food than they usually do. Then, as the disease progresses, actually develop urges or impulses to eat even more or less, especially during times of distress or when they feel lowest about their body shape or weight. Over time, the habit becomes routine and a natural part of their daily activities.

But believe it or not, a lot of shame comes with having an eating disorder, which is why many hide their addiction and plan for how they are going to carry out characteristics of the disease. For instance, with purging types of eating disorders, they may carry mouthwash or a toothbrush with them to cleanse their breath of vomit or wait for everyone to leave the restroom before purging. These restroom breaks can be frequent and typically happen right after taking in a meal.

Types of Eating Disorders

Eating disorders aren’t one-size-fits-all. There are six and though they mimic one another, they are categorized and defined differently.

  • Anorexia nervosa

  • Bulimia nervosa

  • Binge-eating disorder

  • Pica

  • Rumination disorder

  • Avoidant/restrictive food intake disorder

The last three fall into the category of Other Specified Feeding or Eating Disorder (OSFED), however they mimic anorexia nervosa, bulimia nervosa, or binge-eating disorder--and vice versa.

Eating Disorders: Size Doesn’t Matter, Signs Do

A person’s size bears no weight on whether they develop an eating disorder. Someone may develop a disorder whether overweight, at weight, or underweight. And the signs or reinforcement they receive while in active illness may further their habit.

At Weight or Underweight

At weight or underweight individuals with eating disorders typically are anorexic or bulimic. They may also have an Other Specified Feeding or Eating Disorder. Binge-eating is far less common as this group tries to achieve a lower body weight than what they have or had before the addiction started.

If the person is already thin or within their recommended body mass index, losing weight through food reduction may not come across as hazardous or abnormal, especially if their pursuit is to fit certain body size guidelines developed by their surrounding social networks. A positive reinforcement from this group would also further poor eating behaviors.

If they are the gorging and purging type and take in massive amounts of food in front of others yet still keep a slim frame, others may think they are the type of person who is naturally thin or has a high metabolism.

Overweight

Those who are overweight but either lose drastic weight, maintain their weight, or gain weight can have any of the six types of eating disorders.

If the person is overweight or of the average body size for a person living in America--size 16 or 18 for a woman--it will seem they are transitioning into a healthier lifestyle if they are cutting back on food and increasing physical activity. Those around her may notice a weight change upon the onset of this eating disorder and complement her, even reward her for her will-power and ability to take what they believe to be healthy measures, unintentionally reinforcing poor eating behaviors.

If they are the gorging and purging type yet appear to be at weight or losing weight, they are more likely to do this behavior in private. Here, they are able to still indulge in food but because it’s expelled they don’t pack on the pounds from the high caloric intake. It can feel like a win-win.

In either scenarios, food is used as tool.

Signs of an Eating Disorder

Signs of an eating disorder can be difficult to detect. Many people with these illnesses are quite smart when it comes to concealing them. They can go for months or years before anyone notices a problem.

That said, these are common traits of a person with an eating disorder:

Anorexia

People suffering from anorexia nervosa see themselves as overweight even if they are underweight. They think about their weight constantly and monitor every morsel put into their body. There is high consideration given to calories in food.

They may:

  • Incessantly weigh themselves

  • Severely restrict the food they eat

  • Only eat certain foods and in small portions

 

Other signs include:

  • Extremely thin

  • Dramatic weight loss, far beyond doctor-recommended weight goals

  • Constantly dieting and exercising

  • Anxiety

  • Obsessive compulsion

  • Lack of ability to concentrate on anything other than calories and weight

  • Brittle hair and nails

  • Depression

  • Loss of menstrual period or infrequent periods

  • Fatigue

  • Always cold

To achieve extreme weight loss, they may diet, fast, or exercise a lot. This is the restricting type of anorexia. The binge-eating/purging type consists of self-induced vomiting or abusing enemas, laxatives or diuretics.

Physically they are emaciated, but the war rages mentally. They often relentlessly pursue being thin and become aggressive or agitated when they gain any pounds. There is an intense, irrational fear of weight gain and their self-esteem is tied to their or others’ perceptions of body shape and weight.

Bulimia

With bulimia nervosa, the person eats frequent, hefty meals. They feel a sense of lack of control when it comes to eating and often feel guilt after every session. To remove those negative feelings, they often vomit, fast, use laxatives or diuretics, or workout a lot.

If this purging methods sound similar to anorexia, you’d be right, except with bulimia the person usually maintains their body weight at or above what is considered normal and healthy. They may have met a goal weight or fear weight gain and engage in risky food behavior to keep it, or at least be close to it.

Some easy signs to look for are:

  • Overeating

  • Frequent bathroom breaks, especially after meals

  • A foul smelling-odor (vomit) coming from the bathroom

  • Tooth decay or tooth discoloration

Binging and purging episodes often increase during times of stress or when there is an emotional disturbance, but may also occur out of boredom or because of negative feelings they have about their body.

Binge Eating Disorder

Binge-eating disorder is similar to bulimia. The person eats large amounts of food--more than some of the hungriest people you know--and has a compulsion with food. They may feel unable to control themselves, especially during times of stress and when they feel low about their body. But unlike bulimia, they do not purge, fast, or exercise frequently. Because of this, they are more likely to be overweight or obese.

Tell-tale signs of this disorder are:

  • Binge eats at least once a week for six months

  • Eating rapidly, often more than normal

  • Eating passed the point of being stuffed

  • Is not hungry but continues to eat and in large portions

  • Marked stress and anxiety from not being able to control their addiction to food

  • Depression

  • Dieting frequently, with no appearable loss of weight

Another common trait is they often eat alone out of embarrassment over their food habits.They often feel repulsed or guilty about how much they ate after eating. Their negative views about themselves, coupled by outside stimuli, make for repeated cycles despite their offense to eating.

Avoidant/Restrictive Food Intake Disorder (AFRID)

With this disorder, the person avoids or restricts their food intake. It affects more infants and children, but may also affect some adults. AFRID usually starts in infancy or early childhood then follows them into adulthood. They are picky-eaters who lack interest in food or eating. They’ve often had bad past experiences with food--it didn’t smell right, taste right, feel right or look right. And ever since they’ve developed a process of eliminating those and other foods from their diets, leaving them with little options to eat.

Signs of avoidant restrictive food intake disorder are:

  • Unable to meet expected weight gains in infancy and childhood

  • Malnourished

  • Thinness

Also, these individuals usually don’t participate in mealtimes with others, even during social events or activities.  

Pica

Pica is a disorder that occurs when someone eats non-food items with frequency. It may be pebbles, toilet paper, paper, paint, dirt, hair, gum, chalk. Despite their obsession with these items, they may still eat regular foods. It can be a child, teen, or adult and typically have a mental disability.

You may notice:

  • They eat unusual items and often

  • The period of the behavior lasts at least one month

This particular group is susceptible to bowel ruptures and intestinal blockages. If they eat dirt, they may also catch disease or infection from E. coli and other bacteria in the soil.

Rumination

Rumination disorder can happen at any age and occurs when the person regurgitates their food after eating, pulling up previously swallowed food into their mouths, re-chewing and then either spitting it out or re-swallowing. Vomiting often occurs on-command; it’s not voluntary and they show no signs of nausea or reaction to the process of throwing up.

Their characteristics are as follows:

  • Constant regurgitation of food, with the period lasting a month or more

  • Malnourished

  • Underweight

  • Has no gastrointestinal or other medical condition to explain the regurgitation

Behaviors of regurgitating and re-ingesting or disposing of food are often soothing or stimulating to them. For this reason the behaviors may take place in front of others, but they may attempt to hide the process by coughing or covering their mouths with a hand or napkin.

Harmful Effects of Eating Disorders

The fluctuations in meal portions rob the body of vitamins and nutrients and put great stress on the body’s functions as it tries to make up for what is being lost. Chronic eating disorders harm normal body composition and function, and can even be so harmful as to cause organ failure and death.

People suffering from eating disorders may present with multiple physical health issues, varying widely from the acute to chronic stage.

Acute Health Effects

Acute health effects occur in the early stages of eating disorders and include:

  • Drop in pulse or blood pressure

  • Irregular heartbeat

  • Slowed digestion

  • Constipation

  • Swollen glands

  • Severe dehydration and electrolyte imbalance

  • Difficulty concentrating

  • Numbness and tingling in extremities

  • Muscle cramps

  • Dizziness or fainting

  • Hormonal imbalance

  • High cholesterol levels

  • Anemia

  • Dry skin and brittle hair

  • Infertility

  • Fatigue

  • Intestinal bloating

Of all the eating disorders, anorexia nervosa carries the highest mortality rates. Some succumb to complications stemming from starvation, while others perish due to suicide--an indicator that this and other disorders are psychological.

Chronic Health Effects

Once the eating disorder has advanced, more troubling health complications that require hospitalization or medical attention crop up, like:

  • Heart attack

  • Heart failure

  • Kidney failure

  • Muscle deterioration

  • Stomach or esophageal rupture

  • Intestinal blockage, perforation or infection

  • Pancreatitis

  • Seizures

  • Bone loss and increased risk of bone fractures

  • Hypothermia

  • Type 2 diabetes

  • Brain damage

It should be noted that while medical attention or hospitalization can occur in the early stages of an eating disorder when they appear, professional help is usually sought in the advanced stages. Again, this ties back to the characteristics of the disease being elusive to others, but also the person with the illness may notice their health plunging downward, however their goal of achieving a certain body shape or weight takes precedence over seeking help.  

If you or someone you know has an eating disorder, treatment can save them from the pain and discomfort associated with the disease, if not save their life.

Treating Eating Disorders

Eating disorders aren’t impossible to treat, but they can be complex to treat. Scientific research still struggles to understand the behavioral, biological, and social substructures of these illnesses. What complicates treatment is when the disorder is combined with substance abuse or a coexisting psychiatric disorder like depression, anxiety, PTSD, and obsessive compulsion.

And since depression and anxiety about food and self-image comes with most eating disorders, it’s conceivable that most people with eating disorders have an underlying psychiatric underpinning.

Specialists at the treatment eating disorder treatment centers thus have to open wounds to get to the root of the disorder, then perform surgery, so to speak, by rewiring their thinking. They have to help them develop positive associations with food and their body, while at the same time address psychological conditions. It’s why treatment calls for a five-pronged approach.

Inpatient

Inpatient treatment is typically reserved for those who are medically unstable. Patients often arrive malnourished, dehydrated or with severe illness. They show irregular or low vital signs, tests show they are at acute health risk, and they have a coexisting medical complication like diabetes. Psychologically, their symptoms seem to be worsening and suicide becomes a real danger.

The patient has poor motivation to change or cooperate in treatment, and is rather led by intrusive repetitive thoughts about food and body image.

Those ideal for this facility type therefore have:

  • Severe stage eating disorders

  • Body weight less than 70 percent of what;s ideal

  • To be fed by PEG or nasogastric feeding

  • Severe electrolyte or fluid balance

Because the patient’s health is the most critical factor--without it treatment would be moot--inpatient medical teams attempt to first stabilize the patient’s health by running medical tests, quickly restoring lost fluids, administering the appropriate medications, and introducing nourishing foods that counteract deficiencies leading to disease and health complications. Medication is also given to reduce states of extreme depression and anxiety. At times when they can go no further in medical treatment, surrounding medical hospitals pick up where they leave off.

Once stabilized, the patient is fully assessed to determine the intensity of the program they will follow, which could be a combination of any of the following:

  • Full-time, on-site psychiatrists

  • 24/7 medical supervision

  • Monitored meals and bathroom breaks

  • Trauma recovery therapy

  • Body-image programming

  • Nutritionists and nutritional programs

  • Family-involved therapy sessions

  • Individual and support group sessions with multidisciplinary care professionals

  • Psycho-educational programming

  • Activities and recreation

The foundation, therefore, of inpatient eating disorder treatment begins with medical and mood stabilization, followed by programs geared toward weight restoration and psycho-social support.

Along the way, the team prepares the patient to step down to residential treatment.  

Residential

Residential treatment programs further the efforts started in inpatient treatment. They help the patient alleviate their symptoms, while also addressing underlying psychological issues. Relationships here are based on mutual sharing and support, with the community inspiring one another to develop and gain the strength to beat their addiction to food. They also help one another decrease the shame and stigma that comes with eating disorders, the idea being that with openness and acceptance, perpetuating symptoms can be managed or rid.

This facility type offers many of the same benefits as inpatient, including:

  • Treatment tracks for coexisting disorders like PTSD

  • Nutritious meal plans

  • 24/7 nursing care

  • Access to physicians, psychiatrists, lab services

  • Psychotherapy groups

  • Individual and family therapy

  • Trauma recovery

  • Body image reprogramming

  • Activities and recreation

As you can see, this level of care follows the same structure and schedule from when they were in inpatient treatment. What makes residential treatment different, however, is that the person is medically stable and less resistant to treatment.

This allows residential treatment centers to supply the ongoing support still required to help the patient fully come to terms with the layers of their food and body-image addiction.

Partial Hospital Program (PHP)

Partial hospital programs mimic the inpatient and residential treatment, implementing all the same therapies and modalities. For this, PHP can either be an entry point into treatment or act as a step-down from the more intensive programs (inpatient and residential), depending on the severity of the disorder.

This makes PHP ideal for:

  • Those with an eating disorder who are beginning recovery

  • Those transitioning from a more intensive program

  • Those looking to develop skills and abilities to manage their lives independently

  • Those who don’t require the intense level of supervision and care found at an inpatient treatment center

What separates PHP is that the setting is less structured and patients focus more on putting the skills learned in inpatient and residential into practice. Patients live off-campus but spend their full days at the PHP facility gaining the skills to start living independently again.

They learn things like:

  • How to shop for food

  • How to deal with social situations that involve food and eating

  • How to apply and interview for jobs

  • How to pay financial obligations on time

These are things most people take for granted, but something those living with an eating disorder struggle with everyday. Their lives have been so consumed with food choices, calorie counting, body image, and concealing their condition that they often lose these and social skills.

Intensive Outpatient

This is also a step-down program for those transitioning from more intensive care, but can also be used as a step-up for those with mild eating disorders. The patient will receive therapy and life skills found in the other aforementioned therapies, but at a lesser level.

Intensive outpatient is then ideal for those who:

  • Require flexibility to continue daily routines

  • Are stable enough to function alone

  • Have skills to carry out basic responsibilities

 

What they will receive here is:

  • Cognitive behavioral therapy

  • Exposure therapy

  • Individual and group psychotherapy

  • Dialectical behavioral therapy

  • Anger and stress management

  • Emotional regulation and behavioral modification

  • Guided imagery progressing

  • Nutritional counseling

  • Activities and recreation

  • Family counseling

Outpatient

With outpatient treatment, the person is functioning and capable of living independently, but they still require support to keep from relapsing. Rather than attend daily, they may go in for tune-up therapy sessions several times a week. They also attend support groups regularly.

Outpatient is ideal for those who’ve gone through the previous four stages, but need someone or something to keep them accountable and track. If they are in the midst of crisis and find themselves wanting to return to unhealthy behaviors, a trip or call to their outpatient team can mean the difference between slipping back or moving forward.

 

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