Eating disorders are a complex set of psychological illnesses that can lead to significant medical complications.
Eating Disorders: 7 to Know
Anorexia Nervosa (AN) is only one of seven eating disorders listed in the the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. The other eating disorders currently listed include:
- Bulimia Nervosa
- Binge Eating Disorder
- Avoidant Restrictive Food Intake Disorder (ARFID)
- Rumination Disorder
- Other Specified Feeding or Eating Disorder
The previous DSM-IV (2000) listed only three eating disorders: Anorexia Nervosa, Bulimia Nervosa and Eating Disorder Not Otherwise Specified.
Eating Disorders: The Numbers
National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. The lifetime prevalence of Anorexia Nervosa is between 0.5% to 2%. It has the highest mortality rate of any psychiatric illness.
What is Anorexia?
Anorexia is a complicated and multifactorial illness. For a long time it has been incompletely understood. Thanks to ongoing research we now know that anorexia results from a complex interface between genetic and biological predisposition, some specific psychological traits, and a variety of environmental and sociocultural influences.
What is for certain is that there is no single cause of anorexia. In addition, it is not an illness chosen by patients nor caused by families.
While we continue to diagnose anorexia most often in adolescent females, we now see it in other populations, including males, younger patients, and formerly obese patients. The peak onset age for anorexia has been identified between 13 and 18 years of age. If we are able to diagnosis a patient early in the course of illness we often have more success with treatment.
Anorexia may present in a variety of different ways but will usually include restriction of caloric intake and dramatic weight loss or poor growth. Individuals are often preoccupied with food and weight and will refuse to eat foods they once enjoyed or avoid social meals. Development of food rituals is also common. Over-exercise may also be a component of anorexia and some individuals avoid weight gain by inducing vomiting or abusing laxative, diuretic and diet pills.
How We Diagnose Anorexia
While previous diagnostic criteria for anorexia required that individuals express fear of weight gain or body image distortion, that is no longer the case.
The current minimal diagnostic criteria according to DSM-V includes:
- A restriction or energy intake relative to requirements leading to a body weight less than minimally expected
- Persistent behavior that interferes with appropriate weight gain
- Persistent lack of recognition of the seriousness of low body weight
How We Treat Anorexia
Treatment for anorexia is challenging and requires a multidisciplinary team approach including physicians, nutritionists, mental health providers, family and social supports.
The goal of treatment is to disrupt the compelling behaviors that have led to restrictive eating behaviors and unsafe weight loss. While some individuals may improve in a traditional outpatient setting with a comprehensive team, some may require a higher level of care in Intensive Outpatient Programs (IOP), Partial Hospitalization Programs (PHP) or Residential Treatment Programs. Unfortunately some individuals may lose so much weight that they become medically unstable and require hospitalization and medical intervention.
Recovery from anorexia is challenging. We know that adolescents are more likely to recover if they are identified and treated as soon as possible. Recent research also shows that a strong focus on weight restoration, reducing blame, and providing family support early in the treatment process is essential.
If you would like to learn more about eating disorders or how to support someone with an eating disorder, please take a look at the National Eating Disorders Association (NEDA) website, https://www.nationaleatingdisorders.org/ .
Please also note that there will be a Vermont NEDA walk on April 14, 2018. Learn more about it at https://www.nedawalk.org/burlington2018.
Erica J. Gibson, MD, is an adolescent medicine specialist at the University of Vermont Children’s Hospital. She is also assistant clinical professor of pediatrics at the Larner College of Medicine at UVM. She works closely with the Vermont Child Health Improvement Program.
DSM-V website, https://www.psychiatry.org/psychiatrists/practice/dsm
National Eating Disorders Association website, https://www.nationaleatingdisorders.org/
Peebles et al. Eating Disorders in Children and Adolescents: State of the Art Review. Pediatrics 2014;134; 582.
American Psychiatric Association, https://www.psychiatry.org/patients-families/eating-disorders/expert-q-and-a