Eating Disorders

An eating disorder is a mental health condition defined by irregular eating behaviors that negatively impact one’s physical and mental well-being.

Some facts about eating disorders:

• Eating disorders are increasing among diverse ethnic and sociocultural communities despite beliefs that this only affects underweight, white females. 
• Eating disorder behaviors in individuals who are over-concerned with body image are a physical manifestation of severe inner struggle.
• Eating disorders affect over 30 million people in the United States.
• Eating disorders are coping mechanisms that individuals have created to manage difficult experiences or feelings.
• Eating disorders frequently coexist with other psychiatric disorders, such as depression, substance use, OCD, PTSD, ADHD, or anxiety disorders.
• Eating disorders have the second highest mortality of any psychiatric diagnosis following opiate addiction.

The SCOFF questionnaire is a valid and reliable five-question screening measure that assesses the probability that you are struggling with an eating disorder. It was developed by Morgan and colleagues in 1999.

SCOFF stands for Sick, Control, One, Fat, Food. Answering "yes" to two or more of the following questions indicates you may have anorexia nervosa, bulimia nervosa, or other eating disorders. Take the screening now:

• Do you make yourself Sick (induce vomiting) because you feel uncomfortably full?
• Do you worry you have lost Control over how much you eat?
• Have you recently lost more than One stone [approximately fifteen pounds] in a 3-month period?
• Do you believe yourself to be Fat when others say you are too thin?
• Would you say that Food dominates your life?

If you answered "yes" to two or more of the questions above, schedule an assessment with one of our registered dietitians. Our integrative approach involves a registered dietitian, a therapist, a physician, a nurse practitioner, or a physician assistant. Our treatment team and diagnostic testing can diagnose an accurate eating disorder and comprehensive care plan.

If you answered "no" to two or more questions but believe you may have a problem, if a loved one is concerned about your eating or exercise behavior, or if you are experiencing body image concerns, you should still seek help. The SCOFF questionnaire may not pick up all eating disorders or disordered eating behaviors, so it is important to consult with our treatment team to get help if you are struggling in silence.

The following are the eating disorders we currently treat at RCBM:

Anorexia Nervosa
Anorexia is a type of eating disorder characterized by extreme weight loss, excessive exercise, and severe restriction of food intake, leading to starvation. People with anorexia often have a distorted body image and are constantly driven to lose weight, feeling they're never thin enough. This obsession with weight loss and dieting can lead to serious health issues.

Bulimia Nervosa
Bulimia is an eating disorder characterized by cycles of binge eating followed by purging. This harmful pattern of indulgence and self-loathing can cause serious physical damage and requires prompt treatment. The desire to maintain a certain weight and body image often drives the cycle of losing control over food. Like anorexia, bulimia can lead to severe medical complications.

Binge Eating Disorder
Binge eating disorder is the most common type of eating disorder in the United States. BED affects an estimated 2.8 million people in the United States, according to a national survey. Binge eating is an eating disorder characterized by episodes of extreme overeating in a short period, leading to loss of control, followed by feelings of distress, guilt, shame, or disgust. It differs from overeating since it involves a lack of control and emotional turmoil. Binge eating often serves as a coping mechanism for stress, anxiety, or depression. 

Addressing the underlying issues is crucial for recovery, but treatment does not focus on weight loss, as this can exacerbate the disorder and underlying trauma. Normalizing eating patterns is key to managing binge eating disorder and can help achieve overall health goals.

Other Specified Eating or Feeding Disorders (OSFED)
Individuals with Other Specified Feeding or Eating Disorders (OSFED) often display disordered eating behaviors, distorted body image, and intense fear of gaining weight. OSFED is the most commonly diagnosed eating disorder among both adults and adolescents, affecting both males and females. Examples of OSFED include Bulimia Nervosa or Binge Eating Disorder with low frequency or limited duration; Atypical Anorexia Nervosa, where individuals exhibit restrictive behaviors but do not meet low weight criteria; Purging Disorder characterized by recurrent purging without binge eating, and Night Eating Syndrome involving recurrent episodes of eating during the night not explained by other factors. 

Individuals with OSFED have the same serious health risk factors as all other eating disorders, and low frequency/limited duration Binge Eating Disorder is not focused on weight loss, as this can exacerbate the disorder.

Avoidant Food Intake Restrictive Disorder (ARFID) 
Avoidant/Restrictive Food Intake Disorder (ARFID) doesn't involve distress about body shape or size, unlike other eating disorders. It can affect both children and adults. While picky eating is common in childhood, ARFID goes beyond normal pickiness, leading to inadequate calorie intake for proper growth and development in children and basic bodily functions in adults. ARFID can cause difficulties at school or work due to challenges eating with others and extended meal times. Symptoms may include a lack of interest in food, avoidance based on food's sensory characteristics, and concern about the negative consequences of eating, resulting in persistent failure to meet nutritional needs and compromised physical health.

Genetics/Biology:

• Eating disorders can run in families. Genetic factors may make you more susceptible to experiencing an eating disorder.
• Biological factors such as neurotransmitter imbalances, hormonal irregularities, and abnormalities in brain structure can contribute to the development of eating disorders.
• Often, an eating disorder develops as a result of a diet. 
  • If an individual has a family history of an eating disorder and never embarks on a weight loss diet, they then have a protection factor.
  • If an individual has a family history of an eating disorder and embarks on a weight loss diet, this activates the reward pathway, like drug and alcohol addiction.
  • A reward pathway, or reward system, refers to a group of brain structures that are activated by rewarding stimuli. 
  • The brain's most crucial reward pathway is the mesolimbic dopamine system. Though there are other existing reward pathways, the dopamine reward system is a key detector of rewarding stimuli.
  • In this way, eating disorders may be classified as an addiction.

Cultural/Environment (Media):

• Sociocultural factors, including media portrayal of unrealistic body ideals, contribute significantly to the development of eating disorders.
• Pressure from peers, societal expectations, and cultural norms regarding body image can also play a role.

Triggers:

• Triggers for eating disorders vary widely and can include traumatic events, stress, major life changes, relationship issues, and societal pressures.
• Triggers can exacerbate underlying genetic predispositions and contribute to the onset or worsening of eating disorder symptoms.

Other Mental Health Issues:

• Eating disorders often co-occur with other mental health conditions, such as depression, anxiety disorders, ADHD, trauma, obsessive-compulsive disorder (OCD), and substance abuse.
• These comorbidities can complicate diagnosis and treatment, making it essential for healthcare providers to assess and address all underlying mental health issues.
• In addition, at least 30% of individuals diagnosed with an eating disorder have experienced trauma in their lives.

Overall, understanding the interplay between genetics/biology, cultural/environmental influences, triggers, and comorbid mental health conditions is crucial for effectively preventing, diagnosing, and treating eating disorders.

The relationship between eating disorders and addiction is complex and multifaceted. While they are distinct conditions, they can co-occur and share some similarities regarding underlying physiological and psychological processes and behaviors. 

Whether it is restricting, bingeing, purging, dieting, or any means to lose weight (compulsive exercise, weight loss medications), similar patterns of neural activation in someone with an eating disorder are also implicated in addictive-like behavior and substance dependence:

• Elevated activation in reward circuitry in response to food cues and behaviors such as restricting, bingeing, and purging.
• Reduced activation of inhibitory regions (hippocampus and insula) in response to food intake  and other eating disorder behaviors
• Dopamine and endogenous opiates released.
• The individual may continue to crave the “high” from flooding the nucleus accumbens with behaviors.

Binge-eating and using addictive substances, such as alcohol and drugs, are working through the same neurotransmitter systems and regions in the brain. Sugar and dopamine-enhancing stimulant drugs (e.g., cocaine or amphetamine) show strong similarities in their motivational mechanisms. Attempts to treat binge eating using pharmacological interventions have demonstrated further similarities and relationships in the addictive process.

The treatment for eating disorders typically involves a combination of medical, nutritional, and psychological interventions. Here are some common approaches:

Medical Monitoring:  Initially, it's important to address any physical complications caused by the eating disorder, such as electrolyte imbalances, heart irregularities, or organ damage. Medical professionals may monitor vital signs, conduct blood tests, and address immediate health concerns.

Nutrition Counseling:  Registered dietitians can help individuals develop healthy eating habits and meal plans. They work to restore proper nutrition and normalize eating patterns.

Therapy:  Various types of therapy, such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), are often used to address the psychological aspects of eating disorders. Therapy helps individuals explore the underlying issues contributing to the disorder, develop coping strategies, challenge distorted thoughts about food and body image, and improve self-esteem.

Medication: In some cases, medication may be prescribed to address co-existing conditions such as depression, anxiety, or obsessive-compulsive disorder (OCD) that often accompany eating disorders. However, medication alone is usually not sufficient for treating eating disorders and is typically used as an adjunct to therapy.

Support Groups:  Participating in support groups or group therapy sessions can provide individuals with a sense of community, understanding, and encouragement. It allows them to connect with others who are going through similar experiences and share coping strategies.

Family-Based Treatment (FBT):  Particularly for adolescents with eating disorders, FBT involves the family as an integral part of the treatment process. It focuses on empowering parents or significant others to take an active role in their loved one’s recovery and restoring healthy eating habits within the family.

Holistic Approaches:  Some individuals benefit from holistic approaches, such as yoga, mindfulness practices, art therapy, or acupuncture, as complementary therapies to traditional treatment methods.

Hospitalization or Residential Treatment:  In severe cases where there's a risk of serious medical complications or when outpatient treatment isn't effective, hospitalization or residential treatment programs may be necessary. These programs are available for any and all eating disorders across the spectrum, along with co-occurring disorders. These programs provide intensive medical and psychological support in a controlled environment.

Overall, the treatment plan should be tailored to the individual's needs, considering factors such as the type and severity of the eating disorder, coexisting conditions, and personal preferences. Treatment needs to be comprehensive, addressing both the physical and psychological aspects of the disorder, and for individuals to receive ongoing support throughout their recovery journey.

At RCBM, we offer a multidisciplinary approach that includes medication prescribers, therapists, and dietitians, all crucial team members in treating eating disorders. Prescribers can monitor physical health, address medical complications, and provide necessary medications. Therapists offer psychological support, help patients explore underlying issues, and develop coping strategies. Dietitians provide nutritional guidance, help normalize eating patterns, and support patients in establishing a healthy relationship with food. This collaborative approach and the evidence-based interventions listed below ensure comprehensive care, address various aspects of the disorder, and increase the likelihood of successful treatment outcomes.

Anorexia Nervosa:

The treatment of Anorexia nervosa, like other eating disorders, requires a team approach. The first treatment priority is establishing a consistent eating routine to prevent long-term health complications. Individuals are provided the necessary support to establish a healthy weight for their body that ensures a regular menstrual cycle, sufficient cardiac health, adequate energy levels, and normal lab values. Many tests are completed by a physician to rule out other factors that may be contributing to weight loss and/or loss of appetite and to ensure immediate health concerns are addressed. A dietitian works with the individual to safely increase intake, address nutritional deficiencies, and ensure adequate intake. Many individuals utilize restrictive behaviors to cope with life’s challenges and to create a false sense of control. Therapists can work with individuals to make these connections and identify healthy alternative coping mechanisms. Compensatory behaviors, obsessive thoughts about food and dieting, and concerns about body image are also addressed by the care team. Meal support to provide accountability and alleviate anxiety with foods may also be incorporated into the treatment plan. Depending on the age and needs of the individual, family-based treatment may also be integrated. 

Bulimia Nervosa:

Bulimia nervosa treatment is similar to anorexia nervosa, with an emphasis on providing education about the negative long-term effects of compensatory behaviors. Lessening behaviors such as intentional vomiting, laxative use, and/or compensatory exercise is a treatment priority. The treatment team will work with the individual to identify triggers for these behaviors and develop healthy alternative coping mechanisms to replace compensatory behaviors.

Binge Eating Disorder:

Addressing the underlying issues of binge eating disorder is crucial for recovery. Still, treatment does not focus on weight loss, as this can exacerbate the disorder and underlying trauma as childhood trauma factors into up to 75% of individuals with BED. A total of 60% of people with BED have been diagnosed with complex PTSD. In turn, a weight loss regimen is another form of trauma to the body.

Normalizing eating patterns is key to managing binge eating disorder and can help achieve overall health goals.

Individuals feel extreme shame and confusion about binge eating. They have tried to stop many times on their own, including dieting, and their inability to control this behavior is a source of deep embarrassment. When treatment focuses on helping individuals understand that binge eating develops principally as an adaptation to complex trauma as a means of self-protection and from the deprivation created by dieting, self-compassion begins to develop. 

Binge eating is a survival tool that develops when little else is available. As a result, changing the behavior is often terrifying. Breaking the cycle can feel impossible, not because individuals are weak or lack willpower, but because they are trying to change a protection they have relied on for a long time. Once an individual can understand the reasons binge eating may be protective for them, their shame about going to food to cope can decrease.

Dieting to combat binge eating disorder is futile and dangerous, setting one’s self up for a cascade of events as described above.

OSFED

We take all other eating disorders seriously. Depending on how this eating disorder's diagnosis presents itself, this will guide the treatment using interventions used in anorexia nervosa, bulimia nervosa, and binge eating disorder.

ARFID

Avoidant Restrictive Food Intake Disorder treatment involves a thorough assessment to determine if food aversion and/or fear of choking or allergic reaction are present. Registered dietitians assess for nutritional deficiencies and adequate intake.Therapists work with individuals to improve distress tolerance with food exposures. 

If you are a current patient at RCBM, don't hesitate to contact our office at (248) 608-8800. If you are new to RCBM, you can initiate the admission process by completing a new patient registration form. Once you submit the form, we will match you with one of our qualified prescribers, therapists, and registered dietitians specializing in eating disorders treatment. Please note that individuals must be residents of Michigan. We are committed to helping you throughout your recovery journey and look forward to working with you.