Types of Eating Disorders and How Counselors Can Help
Nearly 1 in 10 people in the U.S. struggl
e with an eating disorder at some point in their lives, according to a recent Deloitte report. Sadly, the report also found that 10,200 people die from eating disorders each year in the U.S alone.
While people of all ages and from all races and socioeconomic backgrounds can develop eating disorders, some people are more susceptible. Young women, for example, experience eating disorders at higher rates than the general population. However, members of the LGBTQ community, women with physical disabilities, people with Type 1 diabetes, and athletes do as well. The common misperception that only young white women develop eating disorders has resulted in the underdiagnosis of people with eating disorders outside that demographic, especially people of color and men.
Eating disorders can cause long-term health effects, such as damage to internal organs, premature osteoporosis, and cardiovascular problems. The high cost of treatment can also affect people financially, as can the loss of productivity eating disorders cause. The Deloitte report estimates that the U.S. spent around $4.6 billion dollars in expenses associated with eating disorders in 2018-2019.
Clearly, the devastating consequences of eating disorders call for a strategic and compassionate response. Comprehensive treatment can play a key role in grappling with the various types of eating disorders, and those in counseling roles can serve as vital allies in the fight.
What Is an Eating Disorder?
Eating disorders are a serious mental health condition marked by a preoccupation with food and weight. They disrupt a person’s ability to function both socially and psychologically and can lead to significant physical health problems. Though each eating disorder has unique symptoms, an unhealthy, often obsessive relationship with food and a negative body image characterize most of them.
Eating disorders tend to take over people’s lives with excessive thoughts about food and weight. Those thoughts often center on restricting food intake, binging and purging. Underlying feelings of low self-worth and often repressed trauma cause these symptoms and behaviors, which may serve as a way to avoid dealing with uncomfortable emotions.
Eating disorders serve as coping mechanisms, however maladaptive. Individuals with eating disorders use food to relieve stress, achieve more control over their lives or provide themselves comfort in what may feel like an unsafe or unfriendly world.
Impact on Health and Well-Being
The preoccupation with food, weight and body image associated with eating disorders causes unhealthy behavioral patterns. These behavioral patterns damage a person’s physical and emotional well-being.
Disordered Thinking Patterns
Eating disorders affect a person’s mind and leads to frequent disordered thinking patterns that are hard to control, ignore or redirect. The thoughts relate to food or weight and consume the person’s attention. Rather than focusing on the completion of a school or work assignment or dealing with pending responsibilities, someone with an eating disorder may feel overwhelmed and debilitated by thoughts about calories, food they want to eat or guilt about food they have eaten.
This negative channeling of energy can prevent people with eating disorders from engaging in fulfilling relationships, achieving personal goals and enjoying daily life.
Eating disorders usually cause people to perceive themselves inaccurately. When looking in the mirror, people with eating disorders may see themselves as overweight when in fact they are underweight. This distorted self-perception feeds into disordered thinking patterns and adds to a person’s low self-esteem.
Inability to Regulate Emotions
People with eating disorders can struggle to regulate their emotions. Even mild stress may trigger them to feel overwhelmed and overreact to situations. This inability to regulate emotions can create feelings of embarrassment. It often prevents people from coping with everyday interactions and events, which can then affect relationships. It is not unusual for people with eating disorders to withdraw from friends and family, feeling incapable of managing those relationships.
Feelings of Isolation and Shame
People often feel ashamed of their eating disorders and want to keep them secret. This can lead them to isolate themselves to hide their behaviors and avoid confrontations. As connections break down, it becomes harder for family and friends to intervene and offer an outside view to the person locked inside their distorted perceptions and shame.
Though eating disorders usually start by affecting people’s minds, the behaviors associated with them often lead to medical complications. Habits of binging and purging, as well as the effects of undernutrition resulting from food restriction, result in a prevalence of health problems.
Long-Term Effects of Eating Disorders
Over time, disordered eating habits can accumulate into serious health problems. Ongoing binging, purging and inadequate nutrition damage the body’s organs and weaken the immune system. This can make the body more susceptible to sickness and aggravate preexisting chronic illnesses.
Behaviors common to the different types of eating disorders harm the body’s systems in distinct ways.
When a body doesn’t get enough calories, it begins to break down and use its own tissue for energy. This leads to muscle atrophy throughout the body, including the heart. Excessive food restriction over time weakens the heart, depriving it of sufficient energy to pump blood. This leads to a drop in blood pressure and pulse and increases the risk of heart failure.
Conversely, binge eating leaves the body with extra energy, which it turns into fat tissue. When fat tissue becomes excessive, the heart strains to pump blood. The additional blood needed also puts pressure on the arteries, raising blood pressure. Fatty deposits may accumulate in the arteries, making them narrower and reducing blood flow. This can lead to heart attacks and strokes as well.
Purging depletes the body of electrolytes, which help the heart beat and contract. This can result in an irregular heartbeat and, over time, it puts a person at risk of heart failure.
Insufficient nutrition and vomiting disrupt the normal processes of the gastrointestinal system. They compromise the stomach’s ability to digest food fully and at an appropriate pace. This can lead to stomach pain, blood sugar fluctuations and blocked intestines. It can even lead to intestines too weak to expel digested food from the body.
Binge eating strains the gastrointestinal system’s ability to digest food. In rare cases, it can rupture the stomach, an effect that can be life-threatening.
The endocrine system, responsible for the hormones that control functions such as metabolism, sleep and wake cycles and reproduction, depends on adequate calories and fat to work.
Food restriction prevents the endocrine system from secreting necessary hormones at the proper levels. This can interfere with menstruation and damage fertility, and cause bone loss.
Additionally, the body can become resistant to the hormone insulin and develop Type 2 diabetes in response to it.
What Are the Different Types of Eating Disorders?
Binge eating disorder (BED), bulimia nervosa and anorexia nervosa are among the most common eating disorders. While these disorders share some similar traits, each has its own behavioral patterns, symptoms and associated health problems.
Binge Eating Disorder
People with BED experience episodes in which they eat extremely large quantities of food in an out-of-control fashion. They may want to stop eating but feel unable to do so. These binges occur within short periods of time and last well past the point of the person feeling full. During and after binging, the person engaged in the behavior feels disgust and guilt. The person also feels depressed and may make promises to themselves to not do it again.
Unlike bulimia nervosa, binge eating is not followed by purging. Though individuals with BED tend to be overweight or obese, they may also be a standard weight.
Symptoms of BED
Weekly episodes of binge eating for three months or more
Loss of sex drive
Eating large amounts of food in the absence of hunger
Eating to the point of discomfort
Feelings of shame after binging
Health Problems Associated with BED
High blood pressure
Liver and gallbladder disease
Bulimia nervosa involves cycles of binge eating and purging. The disorder takes a severe emotional and physical toll on those who live with it. Like BED, bulimia nervosa is characterized by episodes of out-of-control binge eating. However, after consuming large amounts of food, people with bulimia nervosa frantically search for ways to get rid of the calories.
Some methods of purging include forced vomiting, excessive exercise and laxative abuse. Though people living with bulimia nervosa want to stop binging and purging, their urges to engage in the behavior overwhelm them, and the cycle is repeated. People with bulimia nervosa may be underweight, but more frequently they are standard weight or slightly overweight.
Symptoms of Bulimia Nervosa
Cycles of binge eating and purging
Poor body image
Shame and guilt over disordered eating
Withdrawal and isolation from family and friends
Obsessive thinking about food and weight
Health Problems Associated with Bulimia Nervosa
Damage to teeth from frequent vomiting
Inflamed or ruptured esophagus
Chronic sore throat
People living with anorexia nervosa restrict their food intake to the point of self-starvation. No matter how much weight they lose, they continue to obsess over weight loss and cutting calories out of their diets. They also intensely fear weight gain. Despite their lack of food consumption, people with anorexia nervosa frequently exercise compulsively with the hope of becoming thinner. While most anorexic behavior is marked by a refusal to eat, it may also include intermittent cycles of binge eating and purging.
People living with anorexia nervosa often develop rituals when eating food. They may meticulously measure food, cut it into very small bites or chew it excessively. If not allowed to practice these rituals, they may feel extreme anxiety. Sometimes these rituals are intended to make the person feel full despite the small portions of food eaten. Other times the rituals are designed to make the food taste bad to decrease the desire to eat it.
Many people with anorexia nervosa are extremely underweight; however, in some cases, the individuals may be slightly overweight. Nonetheless, a recent study published in Science Daily found that regardless of weight, people with anorexia nervosa experience similar health problems.
Symptoms of Anorexia Nervosa
Denial of hunger and refusal to eat
Overwhelming fear of being “fat”
Refusal to eat in public and the desire to eat alone
Withdrawal and isolation from family and friends
Obsession with diet and exercise
Abuse of diet pills and diuretics
Rejection of specific food categories, such as carbohydrates or fats
Health Problems Associated with Anorexia Nervosa
Loss of menstruation
Slow pulse and low blood pressure heart rate
Bone density loss
Lanugo (a thin layer of soft hair all over the body)
The Link Between Eating Disorders and Mental Health
No single issue causes an eating disorder to develop; studies have revealed that a web of complex factors contributes to their development. This web involves interactions between a person’s environment, genes, behaviors and psychology, all of which can affect mental health. Research has consistently found a link between eating disorders and mental health.
How Environment, Culture and Emotional Factors Impact Eating Disorders
Many factors can cause a person to develop an eating disorder as a coping mechanism. Consider how culture, environment and emotional factors can each play a role.
Environments can influence emotional health and may play a role in the development of an eating disorder. Experiences such as bullying and teasing about one’s appearance by peers or family members can create self-doubt and negatively affect body image. A poor self-image can lead a person to engage in disordered eating habits to both console themselves and take control.
What people witness in their environment or experiences growing up can also play a role in the development of an eating disorder. For example, if parents model emotional eating or disordered eating patterns, their children may emulate those behaviors and slip into a full-blown eating disorder. Similarly, if a person works in an environment that places a great deal of emphasis on appearance, that pressure could lead to extreme dieting, which could then lead to an eating disorder.
Societal pressure to achieve unrealistic beauty standards can affect how people view themselves and make them overly concerned with what they eat and how much they weigh, both risk factors for developing an eating disorder.
Today’s diet culture and the media’s idealization of thinness lead many to connect specific body types to success and beauty. In response, some people take extreme measures in pursuit of these ideals. Such a cultural environment can also lead to severe body dissatisfaction, which also sets people up to develop eating disorders.
Low self-esteem brought on by a history of abuse, trauma or difficult relationships, along with other factors, may trigger people to turn to eating disorders as a way of coping with unresolved or painful feelings.
Perfectionism, impulsivity and inflexibility also make individuals more prone to developing eating disorders. Additionally, studies have shown that many people experience problems with anxiety and obsessive-compulsive symptoms prior to developing eating disorders.
Other Factors That Contribute to the Development of Eating Disorders
In addition to environment, culture and emotional factors, genetics and significant life changes may contribute to behavioral patterns that can lead to the development of eating disorders.
Genetics and Biology
People who have close relatives with eating disorders have a higher probability of developing one themselves. The same holds true for other mental health conditions — having a parent or sibling with an addiction, depression or anxiety puts a person at greater risk for developing an eating disorder.
These findings suggest genetics play a role in the development of eating disorders. This has prompted the examination of DNA to locate variations linked to eating disorders.
Biology may also factor into the eating disorder equation. Brain imaging has revealed that people with eating disorders have distinct brain activity patterns compared to people without eating disorders. Additionally, evidence in numerous studies, including one recently published in European Psychiatry, have found serotonin plays a role in some eating disorders, further indicating biology can influence a person’s vulnerability to eating disorders.
Significant Life Events
Significant life events that cause stress or require major adjustments may also trigger behavior patterns that develop into eating disorders. Entering adolescence, heading off to college, getting married and pregnancy often spark strong feelings that people use food to cope with.
How Eating Disorder Counseling Can Help
Mental health counselors play a vital role in helping individuals overcome the different types of eating disorders. They work with individuals at various stages of recovery, teaching them skills to manage obsessive thoughts and behaviors and then replace them with healthy ones.
Strategies Counselors Use to Address Eating Disorders
Counselors employ several strategies to address eating disorders, including the following:
Identifying and Addressing Contributing Factors
Effective treatment plans identify the factors that contribute to a person’s eating disorder and devise tangible solutions to address them. For example, depression may cause someone to binge eat to soothe emotional pain. With effective therapeutic techniques, counselors can help alleviate a person’s depression, and this can lessen the need that person feels to binge eat.
Additionally, as already mentioned, many people use eating disorders as coping mechanisms. By teaching healthy coping skills, counselors can help their clients manage their pain, feelings of isolation and low- self-esteem in productive ways.
Counselors can also teach their clients mindfulness practices to help them recognize and redirect invasive thought patterns about food. This serves as a critical first step for replacing disordered thinking. Likewise, it can serve as a useful tool for teaching people how to regulate emotions that trigger cycles of binging and purging and other destructive behaviors.
By setting measurable, achievable benchmarks, counselors can help their clients focus on what they need to do to recover. Goals offer guidance toward healthy coping mechanisms, and they help ensure that people do not replace one destructive behavior with another.
Starting with small goals can build confidence. Once patients achieve one goal, they often feel empowered and ready to go after bigger ones. Some manageable goals to begin with might include the following:
Unfollowing social media that triggers low self-esteem
Sticking to a meal plan for a full day
Countering negative thoughts with a positive mantra three times a day
Enhanced Cognitive Behavioral Therapy
Mounting evidence suggests that enhanced cognitive behavioral therapy (CBT-E) is especially effective for treating people with different types of eating disorders. An F1000Research study found that CBT-E achieves high levels of remission, with nearly 45% of those who received it reporting no binging, vomiting or misuse of laxatives after treatment.
CBT-E involves four stages:
Stage one focuses on building an understanding of the problem at hand and trying to stabilize the person’s disordered eating behaviors.
Stage two involves reviewing the progress made and planning next steps.
Stage three concentrates on examining the processes that keep the eating disorder going and developing methods that address body image and eating concerns and deal with daily life and moods.
Stage four considers strategies for managing setbacks and progress maintenance.
Collaborating to Develop Comprehensive Therapeutic Plans
Successful treatment of eating disorders requires a multipronged approach to properly address the associated physical and psychological problems. Counselors may work with dieticians, psychiatrists and other health professionals to build a cohesive therapeutic plan that emphasizes healthy coping habits and nutrition education.
Dieticians can help assess issues of malnutrition, provide education on topics about nutrition and offer critical advice about a patient’s nutritional needs. Without addressing these needs, progress in recovery may stall or not even lift off the ground. Additionally, many cases of anorexia demand urgent weight gain, which requires the expertise of dieticians.
To address biological factors that contribute to eating disorders, counselors can collaborate with psychiatrists. Chemical imbalances may play a part in a person’s compulsive or obsessive behavior, depression and other contributing factors. However, appropriate medications can help address those issues. With a psychiatrist on the recovery team, people in recovery can get the prescriptions they need.