It is estimated that 20 million women and 10 million men in the United States will have an Eating Disorder at some point in their lives. Eating Disorders are serious but treatable mental health conditions that may affect anyone of any age, sex, gender, ethnicity, race or socioeconomic group.
So what are the different types of Eating Disorders and what are the different types of treatment available? According to the DSM-5:
Anorexia Nervosa is defined as:
1) Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health.
2) Intense fear of gaining weight or becoming fat, even though underweight.
3) Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.
Bulimia Nervosa is defined as:
1) Recurrent episodes of binge eating characterized by both of the following:
-Eating in a discrete period of time ( a 2 hour period) , an amount of food that is larger than most people would eat during a similar period of time and under similar circumstances
-A sense of lack of control over eating during the episode
2) Recurrent inappropriate compensatory behavior in order to prevent weight gain such as self induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
3) The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
4) Self- evaluation is unduly influenced by body shape and weight.
5) The disturbance does not occur exclusively during episodes of anorexia nervosa.
Binge Eating Disorder is defined as:
1) Recurrent and persistent episodes of binge eating
2) Binge eating episodes are associated with three or more of the following
-Eating much more rapidly than normal
-Eating until feeling uncomfortably full
-Eating large amounts of food when not feeling physically hungry
-Eating alone because of being embarrassed by how much one is eating
-Feeling disgusted with oneself, depressed, or very guilty after overeating
3) Marked distress regarding binge eating
4) Absence of regular compensatory behaviors ( such as purging)
Avoidant Restrictive Food Intake Disorder ( ARFID) is defined as:
1) An eating or feeding disturbance ( apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and / or energy needs associated with one ( or more) of the following:
-Significant weight loss ( or failure to achieve expected weight gain or faltering growth in children)
-Significant nutritional deficiency
-Dependence on enteral feeding or nutritional supplements
-Marked interference with psychosocial functioning
2) The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
3) The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
4) The disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder.
While there are some people whose symptoms may fit neatly into one of these diagnostic criteria, there are others that may experience symptomatology encompassing multiple disorders or may not represent a full syndrome eating disorder. These people may fall into the diagnostic criteria known as Other Specialized Feeding or Eating Disorder and consequences of the disorder are no less serious than Anorexia, Bulimia, Binge Eating Disorder or ARFID .
Regardless of the diagnosis, early and appropriate intervention is necessary and is associated with the best outcomes. Eating disorders carry the highest mortality rate of any mental health disorder. The high mortality rate may be due to either medical complications or suicide. Well coordinated care is essential for patients with eating disorders as eating disorders are very complicated medically as well as psychologically and need to be monitored by professionals who understand and are well versed in how to manage the potential risks. There are various treatment levels or settings of care that are available to conduct treatment. The level of care may be largely based on the patient’s medical stability or past history of treatment. Levels of care may include:
(From least restrictive to most intensive)
1) Outpatient treatment
2) Intensive Outpatient Treatment
3) Partial Hospitalization or Day Treatment Programs
4) Residential Treatment
5) Hospital Based Treatment
Regardless of the treatment level, multiple professionals are typically involved in patient care with each having a distinct role on the team. Adolescent Medicine physicians (board – certified medical doctors who specialize in teens and young adults) have obtained special training in medical management of patients with eating disorders and are often the physicians charged with medical monitoring of patients with eating disorders. Other vital members of the treatment team include therapists and nutritionists with expertise in eating disorders. It is imperative that all members of the treatment team maintain open communication and collaborate so that patients can be supported adequately in the recovery process.
Eating Disorders are complex both medically and psychologically. During this week of awareness and every day, let’s support those who are struggling by letting them know that help is available. You are not alone. Reach out for help. Recovery is possible!
Stephanie Strozuk, MD, FAAP is the founder of Evolved Adolescent and Young Adult Medicine- New Jersey's only private integrative medical practice dedicated exclusively to the health and wellbeing of tweens, teens and young adults. Dr. Strozuk is board certified in both Pediatrics and Adolescent and Young Adult Medicine. She has held academic positions at the Mount Sinai School of Medicine and at Rutgers - Robert Wood Johnson School of Medicine. She has also obtained additional training through the Institute for Functional Medicine and uses a functional medicine approach in her practice.