Focus Areas

Disordered Eating

Too often individuals, family members, and/or healthcare providers are looking for a formal diagnosis to determine a need for treatment. Eating disorders and disordered eating exist on a spectrum. Given the substantial toll on emotion, physical health, and cognition, we believe in prevention, and addressing any thoughts and behaviors keeping an individual from living their best life. Disordered eating may include emotional, behavioral, and/or physical signs and symptoms.

***Emotional and behavioral* *symptoms***

In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
Is preoccupied with weight, food, calories, fat grams, and dieting
Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
Makes frequent comments about feeling “fat” or overweight despite weight loss
Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
Denies feeling hungry
Appears uncomfortable eating around others
Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
Skips meals or takes small portions of food at regular meals
Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

Fear of eating in public or with others
Steals or hoards food in strange places
Drinks excessive amounts of water or non-caloric beverages
Uses excessive amounts of mouthwash, mints, and gum
Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories
Withdraws from usual friends and activities
Shows extreme concern with body weight and shape
Frequent checking in the mirror for perceived flaws in appearance
Feels lack of control over ability to stop eating
Purges after eating (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)
Mood swings

***Physical* *symptoms***

Noticeable fluctuations in weight, both up and down
Body weight may be underweight, within the normal weight range, or be overweight
Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
Difficulties concentrating
Dizziness
Feeling cold frequently
Sleep problems
Dry skin
Dry and brittle nails
Thinning of hair on head, dry and brittle hair
Cold, mottled hands and feet or swelling of feet
Impaired immune functioning

Depression

Depression is the most common mental disorder, and is treatable. Depression can exist on a spectrum of severity, and diminish quality of life even in mild cases. People with depression may experience a lack of interest and pleasure in daily activities, weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt, and recurrent thoughts of death or suicide.

Depression may worsen eating disorders and eating disorders may worsen depression. The malnutrition of disordered eating can affect serotonin production and affect the brain, worsening mood and impairing sleep, concentration, and energy. Patients may struggle with distressing negative body image or persistent thoughts about food and body, further lowering their mood. Depression may diminish motivation for recovery. Despite the combined clinical picture of these coexisting disorders, treating both the eating disorder and the depression can improve both conditions. With treatment for depression, patients may stabilize their eating disorders through improved nutrition, improved energy, strengthened coping skills, and improved insight into the psychological symptoms of their eating disorder. When patients are on track with eating, evidence-based treatments for depression, such as psychotherapy and/or medication, work better, and patients have more energy and emotional space to recover from depression.

Bulimia Nervosa

Bulimia nervosa – better known as “bulimia” – is an eating disorder characterized by patterns of bingeing (consuming a large amount of food in a short amount of time) and purging (eliminating calories consumed). The binge-purge cycles may happen several days a week or several times a day.

There is no one cause of bulimia. A number of different biological, psychological and sociocultural factors contribute to the development of this condition. Other conditions, including substance use, anxiety disorders, and mood disorders can co-occur with bulimia.

There are many serious health risks associated with bulimia, including cardiac complications (irregular heartbeat and heart failure stemming from electrolyte imbalances), dehydration, edema (stemming from periods of purging cessation), ulcers, and pancreatitis.

Treatment for bulimia involves a thoughtful balance of medical, psychiatric, therapeutic and dietary interventions. See the link for further information on BN.

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia

Avoidant Restrictive Food Intake Disorder (ARFID)

ARFID is a newer disorder in the DSM-5 and was previously called “Selective Eating Disorder”. ARFID involves restriction around variety and volume of food and does not include any body image distress or fear of weight gain. The effect of consistently not consuming enough calories and/or micronutrients can lead to negative impacts on an individuals growth and development. ARFID can affect those who avoid food based on sensory aspects of food, those who fear aversive consequences of eating and/or those with a lack of interest in food. A common goal in treating ARFID involves food exposures and sensory activities to increase variety and volume of nutritional intake daily. See the link for further information on ARFID.

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid

Anxiety

People suffering from anxiety may experience some or all of the following symptoms: anxiety and worry (apprehensive expectation), occurring more days than not about a number of events or activities (such as work or school performance). It may feel difficult to control the worry, and the anxiety and worry may be associated with feelings of restlessness, being easily fatigued, having difficulty concentrating, Irritability, muscle tension, and/ or sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). Anxiety disorders can be categorized as generalized anxiety, phobias, agoraphobia, panic disorder, separation anxiety, or social anxiety.

In some cases, anxiety may precede an eating disorder. In struggling with anxiety, for instance, being able to control aspects of one’s life, such as food, weight, and exercise, may indirectly give a person a false sense of control, which can temporarily relieve symptoms experienced due to anxiety. However, with time, the disordered eating and focus on food and weight begin to exacerbate and worsen anxiety.

Anorexia Nervosa

Anorexia Nervosa is a restrictive eating disorder diagnosis that has two subtypes, Anorexia Nervosa-Restricting Type and Anorexia Nervosa-Binge/Purge Type, that can occur alone or together. Though presentations vary among each individual, the DSM-V includes the following in its diagnostic criteria: a) Persistent restriction of energy intake, leading to low body weight or failure to meet growth trajectories, b) Intense fear of weight gain or becoming fat, and c) Disturbance in how the body is experienced or undue influence of shape and weight on self-evaluation. Anorexia Nervosa, as with all eating disorders, can impact those of all genders, sexes, race/ethnicities, sexual orientations, and ages. A common goal in treating Anorexia Nervosa is establishing consistent and appropriate nutritional intake as well exploring distortions around one’s body and weight. See the link for further information on AN.

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia