By Mary Anne Knapp, MSW, LCSW

	Introduction		Obesity
	Anorexia Nervosa		Treating Eating Disorders
	Bulimia Nervosa		Outpatient Services
	Binge-Eating Disorder

 

Introduction

According to the American Dietetic Association, more than five million Americans experience eating disorders. The “culture of thinness” and “fat phobia,” combined with the complex, intense demands of growing up and taking on the increasing responsibilities of adulthood, have made eating disorders and “body battling” a serious and common problem for many young people in our culture.

Generally, eating disorders are classified within three categories: Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorders. Below are brief descriptions of each from the National Institutes of Health (NIH).

Anorexia Nervosa

An estimated 0.5 to 3.7 percent of females will suffer from anorexia nervosa in their lifetime.Symptoms of anorexia nervosa include:

• Resistance to maintaining body weight at or above a minimally normal weight for age and height
• Intense fear of gaining weight or becoming fat, even though underweight
• 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
• Infrequent or absent menstrual periods (in females who have reached puberty)

Bulimia Nervosa

An estimated 1.1 percent to 4.2 percent of females will experience bulimia nervosa in their lifetime. Symptoms of bulimia nervosa include:

• Recurrent episodes of binge eating, characterized by eating an excessive amount of food over a relatively short period of time and by a sense of a lack of control over eating during the episode
• Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics (fluid pills), enemas, or other medications (purging); fasting; or excessive exercise
• Both binge eating and inappropriate compensatory behaviors occurring, on average, at least twice a week for three months
• Self-evaluation that is unduly influenced by body shape and weight

Binge-Eating Disorder

It is estimated that between two percent and five percent of Americans will experience a binge-eating disorder lasting six months. Symptoms of binge-eating disorder include:

• Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of a lack of control over eating during the episode
• Binge-eating episodes are associated with at least three of the following behaviors:

 

1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of being embarrassed by how much one is eating
5. Feeling disgusted with oneself, depressed, or very guilty after overeating

• Marked distress about the binge-eating behavior
• Binge eating occurs, on average, at least 2 days a week for 6 months

Obesity

Some experts have begun to classify obesity as an eating disorder. Although there is currently some controversy in the scientific community about defining obesity and the numbers of Americans who fall within this category, scientists agree that obesity is a dangerous condition that increases a person’s risk of illness and death due to diabetes, stroke, coronary artery disease, hypertension, high cholesterol, and kidney and bladder disorders.

Treating Eating Disorders

Eating disorders are multidimensional disorders that impact physical, mental, social, and spiritual aspects of a person’s life. As a result, people often require several types of interventions in order to recover. Although eating disorders are serious illnesses, therapy can be very successful. The severity of the condition will also determine the kind of treatment that’s appropriate.

A therapist can help assess your situation and work with you to determine the type of evaluation and individualized treatment plan you or your loved one may need. It is important to seek help from someone who is familiar with eating disorders, and who will coordinate with other treatment providers. Counseling should address both symptom relief from eating disordered behaviors and should also deal with underlying psychological, interpersonal and cultural influences that have contributed to or maintain the eating disorder.

A clinical social worker often will provide psychotherapy while acting as a bridge to connect you to additional resources for a medical evaluation and nutritional assessment/counseling, both of which are also critical arenas for intervention.

Here are some options to consider as part of an eating disorder treatment plan.

Outpatient Services

• Psychotherapy can be in an individual, couples, family, and/or group format. Many individuals who are seen as an outpatient may require more than one kind of therapy. For instance, for a college student who is attending college away from home, a psychotherapy plan might involve weekly individual and group counseling sessions, along with intermittent family therapy sessions.
• The individual’s general physician,who can evaluate their health status and provide treatments, can often provide medical evaluation and follow up care.
• A registered dietician can provide nutrition assessment and counseling. This is especially important if the person needs help learning or remembering what normal eating is.
• Psychiatric evaluation/follow-up is important for some people with eating disorders, especially for those who also struggle with depression and anxiety. Antidepressant medications, especially SSRIs (Selective Serotonin Reuptake Inhibitors), are often prescribed to treat depression and/or to reduce cravings.
• Psychoeducational activities can include specific skills training, such as relaxation or assertiveness training. They can also include recommended readings about eating disorders and recovery.
• Self-help groups such as 12 Step programs, including Overeater’s Anonymous, can provide support and a philosophy of recovery.
• Intensive outpatient programs (also sometimes called partial hospitalization) are usually full day or evening programs that include eating meals with other residents along with psychotherapy.
• Hospital based care can include inpatient and or/residential care in an eating disorders specialty unit or facility. Hospitalization is necessary:

1. When an eating disorder has gotten to a point of causing a medically dangerous condition
2. When it is associated with serious psychological issues such as suicidal thinking
3. When it has led to serious self-injury, or when the intensity of the disorder does not respond to outpatient treatment alone

The length of a hospital stay may range from a day or two to stabilize medical conditions to a month or more in an intensive residential treatment program.

It is important to be persistent in seeking treatment for an eating disorder. Factors such as general stress level, other emotional issues, the intensity of the treatment chosen, and readiness for recovery can make a difference in whether a particular course of treatment is successful.

For further details about Seeking Treatment and Treatment Referrals visit the website of the National Eating Disorders Association at: http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=337

###The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.