Eating disorders are the least talked about, least treated, yet the most deadly of mental illnesses.
National surveys estimate “20 million women and 10 million men in America will have an eating disorder at some point in their lives,” states National Eating Disorders Association, nationaleatingdisorders.org.
National Eating Disorders Awareness Week, which intends to shed light and open the lines of communication about eating disorders in our communities, ended early this month.
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) refers to three specific types of eating disorders: anorexia nervosa, bulimia nervosa and binge-eating disorder.
Registered dietitian and licensed mental health clinician Chrisanna Harrington-Wright from Nutegra Medical Nutrition Therapy in Punta Gorda, spoke with the Sun about how to spot common symptoms of eating disorders, what to say to someone who is struggling, and what not to say to avoid hurting feelings.
Wright stressed the importance of using a team approach when treating any eating disorder: family practitioner, possibly a psychiatrist, a registered dietitian and a psychotherapist.
“Nutrition is paramount, if you do not have a well-nourished body, it doesn’t matter how many times you’re going to a psychotherapist, it’s not going to work,” she said.
Her advice on each disorder:
Anorexia is an eating disorder characterized by weight loss. Sufferers will often restrict the amount of calories they take in, exercise compulsively, or purge.
Wright said common signs she notices in someone suffering from anorexia, includes protruding bones and tiny white hairs that grow on the face, arms, chest, and back, as a result of severe fat loss. The hairs are the body’s attempt to keep itself warm. She will test skin turgor, when the skin on the back of the hand is pulled and released, whether or not the skin remains elevated. If it does, this often means severe dehydration, and the person needs to go to the hospital.
Other signs of anorexia are being critical of self and others, for example fat-shaming, and dysfunctional behavior, neglecting of self.
According to the DSM-5, tell-tale signs of anorexia include: restriction of food below what is appropriate for proper age/sex/developmental trajectory and overall physical health, significantly low body weight, an intense fear of gaining weight or becoming fat, and a disturbance in the way they perceive their own body. The person will often have a lack of recognition of the seriousness of their current body weight.
How to help:
- Wright cautions parents to watch how they talk about their own bodies and how they talk about food around their children, as kids adopt this outlook. Instead of saying things like “Do you think I’m fat?” or “Do you think I ate too much?” Wright said to use affirming language about your body, like “I eat to nourish,” it may help to say “No, honey, you’re 12-years-old, your body is doing what it’s supposed to.”
- Eating the same foods, together as a family, and talk
- about each family member’s day, and not about the meal. This helps to restore normalcy around food and reinforces that food is not meant to be secretive.
- Seeing a registered dietitian can help establish a meal plan and create a boundary to combat any disordered thoughts or rules, and create a sense of safety for the sufferer, that they’re not going to listen to disordered thoughts.
National Eating Disorders Association — nationaleatingdisorders.org — is a great place to start for a sufferer or loved
- one to receive information about the disorder, and resources for treatment and healing.
- Looking into anti-anxiety or selective serotonin reuptake inhibitors (SSRI) to help ease anxiety around mealtimes, situations involving food. Wright said the sufferer should be honest with their doctor about their anxiety and fear.
Do not discuss:
- Nutritional components of food
“These are all triggers,” Wright said.
Bulimia is an eating disorder characterized by a cycle of binge-eating, than engaging in compensatory behavior such as vomiting, improper use of laxatives, diuretics, or enemas.
The DSM-5 classifies in two parts: the patient exhibits recurrent episodes of binge eating and recurrent compensatory behaviors to avoid weight gain. Binge-eating is considered eating any amount of food in a period of time, larger than what most individuals would eat in the same time period under similar circumstances, or feeling a lack of control over eating during the episode. For example, if a person feels they cannot stop eating or control how much they’re eating.
How to help:
- Say something such as: “You don’t look like your normal self, how can I help you?”
- Wright recommends seeking psychotherapy at Charlotte Behavioral Health or Coastal Behavioral Healthcare.
What not to say:Wright said that bulimics can maintain a healthy weight or even be overweight. If a person comes public with their eating disorder, never to say anything like “but you don’t
like you ha
- ve an eating disorder.” That statement leaves the person feeling like they have no support or help.
- And the aforementioned “weight, nutrition, diet.”
Binge Eating Disorder
Binge Eating Disorder is classified by episodes of binge-eating, taking in large quantities of food, often in a short period of time, to where the person is uncomfortably full, then engaging in compensatory behaviors, in attempt to reverse the affects of the binge.
The DSM-5 classifies binge-eating disorder by two categories: eating a larger amount than most people would in a period of time under similar circumstances or feeling a lack of control during that time, and three or more of the following: eating more rapidly than normal, eating until uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much they are eating, feeling disgusted, depressed or guilty afterwards.
Wright cautioned that binge-eating disorder has nothing to do with willpower, it is a result of lack of nutrition education, a dieting mindset and often the person suffering has experienced some sort of trauma. If the sufferer has experienced trauma, it is possible that they view the extra weight as a buffer, and believe that losing the weight would make them vulnerable. The hormones in the body become off-balanced, and don’t know when the body is full, and when to turn the hunger switch off. Wright said the sufferer may have to heal from childhood trauma, and move to a place of valuing themselves and practicing functional behavior.
How to help:
- Wright suggested if you suspect someone in your life is a binge-eater to say: “I value you in my life, I want you to be in my life a long time, I want you to be healthy as well. How can I support you?”
- Seeing a psychotherapist to talk about what triggers episodes of over-eating.
- Establish a meal plan, and trust the meal plan over the eating disorder thoughts.
- Sharing meals with family to establish normalcy around eating, mealtimes.
Although there are not many support groups centered on recovering from disordered eating in our area, there are countless support groups available online or by phone that you can call into on a daily basis.
As Wright said, “eating disorders hijack the body.” But true healing cannot take place until the sufferer has some insight about their disorder and is ready to accept help.