National Eating Disorder Awareness Week sponsored by NEDA is a week to spread awareness and education about eating disorders, including how to break down barriers and highlight treatment options. Understanding eating disorders is the first step in relieving the stigma behind eating disorders. Many individuals who are not in the eating disorder world confuse bulimia nervosa with anorexia nervosa and so on. Although many eating disorders do have many overlapping signs and symptoms; each disorder is unique in diagnosis, presentation, and management. It is essential to educate the public about the different eating disorders so individuals cannot only be more informed on eating disorders but also work to eliminate the stigma that is tied to the eating disorder community.
What is binge eating disorder?
Binge-eating disorder is characterized by eating an excessive amount of food within a 2-hour period and is associated with an extreme lack of self-control and shame during this episode. It is possible for an individual diagnosed with a binge-eating disorder to consume as much as 3,400 calories in little more than an hour, and as much as 20,000 calories in eight hours. Unlike bulimia and anorexia nervosa, there is no compensatory purging such as self-induced vomiting, excessive exercise or laxative abuse associated with a binge-eating disorder. For a binge-eating disorder to be diagnosed an individual must partake in binging episodes on average at least once a week for a three-month duration, the individual must have feelings of marked distress over these binging episodes and have a loss of control over the amount of food they eat. Additionally, at least three of the following factors must be present:
- Rapid eating
- Eating until feeling uncomfortably full
- Feeling disgusted with oneself, depressed, or very guilty afterward
- Eating alone because of feeling embarrassed by how much is being eaten
- Eating large amounts of food when not feeling physically hungry
What is anorexia nervosa?
Anorexia nervosa is an eating disorder classified by the unhealthy disturbance in body shape and image resulting in the refusal to maintain minimum body weight. Individuals will go to extreme measures not only to starve themselves but also to rid their bodies of any caloric intake they consumed through self-purging mechanisms such as self-induced vomiting, laxative, diuretics, and extreme exercise. There are two subtypes of anorexia nervosa known as the restricting type and the binge-eating/purging type. Most individuals associate anorexia with having the restricting subtype. This subtype is characterized by the severe limitation of food as the primary means to lose weight. The second subtype is known as binge-eating/purging subtype which is characterized by periods of binging followed by self-induced purging behaviors such as vomiting, diuretic abuse, laxative abuse or excessive exercise. This devastating eating disorder is the number one killer out of all the mental health disorders.
What is bulimia nervosa?
Bulimia nervosa is characterized by consuming a large amount of food within a short period (binging) followed by self-induced ways to rid the body of food and calories that were consumed during the binge (purging). Examples of purging often seen in both bulimia nervosa and the binge-eating/purging subtype of anorexia include self-induced vomiting, laxative abuse, diuretic abuse, and excessive exercise. Unlike anorexia, individuals with bulimia nervosa are often of average weight or are overweight, and this is the key defining factor between these two disorders.
Where to get help for an eating disorder?
The National Institute of Mental Health (NIMH) emphasizes that the goals of an eating disorder treatment team are to improve both physical and psychological functioning by addressing emotional and psychological issues while maintaining physical health to reduce or eliminate maladaptive behaviors or thoughts that lead to disordered eating. The following are resources to use when navigating where to find an eating disorder treatment specialist:
- National Association of Eating Disorders (NEDA)
- Psychology Today
- Eating Disorder Hope
- National Association of Anorexia Nervosa and Associated Disorders (ANAD)
- Your primary care physician (they will refer you)
- College community health center (they will see you)
Pharmacological treatments for eating disorders
Medications are generally not used to treat eating disorders, especially for anorexia nervosa. However, selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are useful in treating both bulimia nervosa and binge-eating disorder. Fluoxetine (Prozac) is the only known SSRI approved by the US Food and Drug Administration (FDA) to treat bulimia nervosa and binge-eating disorder. When fluoxetine is not tolerated, other SSRIs as well as other selective serotonin/norepinephrine reuptake inhibitors (SNRIs) used to treat depression can be used to treat these disorders as alternative therapies.
Psychotherapy treatments for eating disorders
Psychotherapy is the mainstay treatment approach for treating anorexia and bulimia nervosa as well as binge-eating disorder and include the following:
• Cognitive behavioral therapy (CBT)
• Interpersonal psychotherapy (IPT)
• Group therapy
• Family-based therapy (FBT)