Types of Eating Disorders and Treatment Options

1. Types of Eating Disorders and Treatment Options hello@couragetonourish.com couragetonourish.com 301-202-4532

2. What is an Eating Disorder? • An eating disorder is a severe, but treatable, mental health condition that can affect people of all ages, genders, races, religions, ethnicities, sexual orientations, body shapes, and sizes • There is no specific cause for an eating disorder but they can develop due to a combination of biological, psychological and sociocultural factors *cited from the National Eating Disorder Association

3. What is Health at Every Size? "The Health At Every Size® (HAES®) approach is a continuously evolving alternative to the weight-centered approach to treating clients and patients of all sizes. It is also a movement working to promote size- acceptance, to end weight discrimination, and to lessen the cultural obsession with weight loss and thinness. The HAES approach promotes balanced eating, life- enhancing physical activity, and respect for the diversity of body shapes and sizes." *cited from the Association for Size Diversity and Health (ASDAH)

4. What is Health at Every Size? 5 Principles: 1. Weight Inclusivity 2. Health Enhancement 3. Respectful Care 4. Eating for Well-Being 5. Life Enhancing Movement

5. Anorexia Nervosa Must meet all current DSM-V criteria to be diagnosed (Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.) ○ Restriction of food intake leading to weight loss or failure to gain weight resulting in a “significantly low body weight” of what would be expected for individual’s age, sex and height ○ Fear of becoming fat or gaining weight ○ Having a distorted view of themselves and their condition Two sub categories ○ Restricting type: stereotypical view of AN - does not regularly engage in binge eating ○ Binge Eating/Purging Type: regularly engages in binge eating and purging behaviors (including: self induced vomiting, misuse of laxatives or diuretics) ■ Note: this is similar to bulimia nervosa BUT there is not weight loss criteria for bulimia nervosa ● ● *cited from the National Eating Disorder Association

6. Atypical Anorexia Nervosa • Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss • Important to note as these individuals continue to be at risk for negative health complications despite being undiagnosed • Falls under category OSFED (Other Specified Feeding and Eating Disorder) • Weight stigma centered • Some individuals find it difficult to receive treatment and/or care due to not being underweight *cited from the National Eating Disorder Association

7. Bulimia Nervosa • To be diagnosed an individual must meet the following DSM-V Criteria: • Recurrent episodes of binge eating • Eating within 2 hour period an amount of food that is considered larger than what most people would eat in a similar period of time • Lack of control over eating during episode (feeling unable to stop or control oneself) - also can include: • Eating faster than usual • Eating until feeling uncomfortably full • Eating large amounts of food when not feeling physically hungry • Eating alone because of feeling embarrassed by how much one is eating • Feeling disgusted with oneself, depressed, or very guilty afterwards • Recurrent compensatory behavior to prevent weight gain (self induced vomiting, misuse of laxatives, diuretics or other medications, fasting, excessive exercise) • Both bingeing and compensatory behaviors must occur on average at least 1x/wk for 3 months to have a specific diagnosis (despite this criteria diagnosis will still require treatment) Self evaluation influenced by body shape and weight • • *cited from the National Eating Disorder Association

8. Orthorexia ● Fixation or obsession with “healthy eating” in a way that damages an individual’s well being ● Behaviors include: ○ Compulsive checking of ingredient lists or labels ○ Increased concern over the health of ingredients ○ Cutting out a large number of food groups ○ Inability to eat anything that is not considered “healthy” or “pure” ○ Exhibiting high levels of distress when safe or healthy foods are not available ○ Body image concerns may or may not be present *cited from the National Eating Disorder Association

9. Binge Eating Disorder • Recurrent episodes of binge eating (see bulimia nervosa for definition) • Binge eating occurs on average at least 1x/wk for 3 months • The difference between Binge Eating Disorder and Bulimia Nervosa is that no compensatory behaviors take place • It is extremely important to note that weight or appearance is not part of the diagnostic criteria for binge eating disorder *cited from the National Eating Disorder Association

10. Disordered Eating Describes a range of irregular eating behaviors that may or may not warrant a complete diagnosis of an eating disorder ● Narrow criteria for eating disorders exclude a majority of people suffering with disordered eating ● Often times those with disordered eating will be diagnosed with EDNOS (eating disorder not otherwise specified) however EDNOS, along with all other EDs has specific narrow criteria that must be met in order for the patient to receive diagnosis ● Disordered Eating is a descriptive phrase - NOT a diagnosis per DSM-5 ● Signs/Symptoms ○ Frequent dieting, yo-yo dieting ○ Skipping meals, restricting specific foods ○ Chronic weight fluctuations and shifts ○ Rigid rituals and routines with food and/or exercise ○ Feelings of guilt or shame associated with eating certain foods ○ Preoccupation with food, weight, body image which negatively impacts quality of life ○ Feelings of loss of control around food, compulsive eating habits ○ Using exercise, food restriction, fasting, purging to make up for “bad” foods consumed ● *cited from the The Academy of Nutrition and Dietetics

11. Avoidant Restrictive Food Intake Disorder (ARFID) ARFID is more than just picky eating Individuals will avoid and restrict food for reasons not related to body image disturbance, but due to anxiety or phobia around food/eating, sensory characteristics of food, or lack of interest in eating ○ Restriction: the individual shows little or no interest in food and/or eating ○ Avoidance: the individual avoids certain foods based on sensory characteristics (smell, sight, taste, texture) ○ Aversion: the individual has a fear or phobia of aversive consequences of eating (vomiting, choking, allergic reactions) Can cause significant weight loss, nutrient deficiencies, and interference with psychosocial functioning Can look like: ○ A very limited list of preferred foods ○ Dramatic restriction of amount or types of food eaten ● ● ● ● *cited from the National Eating Disorder Association

12. Rumination Disorder ●Repeated regurgitation of food for at least 1 month, typically every day, at every meal, usually within 30 minutes of eating ●Regurgitated food might be re chewed, re swallowed, or spit out ●This is not occurring on purpose or due to another medical condition ●The individual does not appear to be distressed, upset or disgusted *cited from the National Eating Disorder Association

13. Compulsive Exercise ● Compulsive exercise is a descriptive phrase - NOT a diagnosis per DSM-V ● Compulsive exercise interferes with day to day activities, daily functioning, and relationships ● Brings up feelings of anxiety, guilt or depression with rest or inactivity ● Exercising to “burn off” or “earn” food ● Feeling of never being good enough, strong enough, fast enough ● Maintaining a rigid exercise regime despite weather, illness, fatigue, injury ● Exercising at inappropriate times or in inappropriate settings *cited from the National Eating Disorder Association

14. Diabulimia ● Purposeful misuse/restriction of insulin in a diabetic in order to lose weight ● Can be classified as a bingeing, purging or restrictive behavior ○ Bingeing and then restricting insulin ○ Eating “normally” and then restricting insulin ○ Severely restricting food and insulin *cited from the National Eating Disorder Association

15. Other Specified Feeding and Eating Disorders ● This encompases individuals who do not meet the strict diagnostic criteria for other eating disorders per the DSM5 but still have significant eating struggles ● This is just as severe as any other diagnosed eating disorder ● Examples: ○ Atypical Anorexia ○ Purging Disorder ○ Binge Eating Disorder (of limited frequency and/or limited duration) ○ Bulimia nervosa (of limited frequency and/or limited duration) *cited from the National Eating Disorder Association

16. Other Specified Feeding and Eating Disorders Atypical Anorexia Nervosa Purging Disorder ● Recurrent purging to influence body weight, shape and size but without bingeing ● All criteria for Anorexia Nervosa are met, except despite significant weight loss, the individual’s weight is within or above the “normal” range ● This is very weight stigma centered *cited from the National Eating Disorder Association

17. Other Specified Feeding and Eating Disorders Binge Eating Disorder (of limited frequency and/or limited duration) Bulimia Nervosa (of limited frequence and/or limited duration) ● All criteria for BED are met, except at a lower frequency and/or for less than three months. ● All criteria for Bulimia Nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months. *cited from the National Eating Disorder Association

18. No Formal Diagnosis? ● A diagnosis is not necessary to receive treatment ● Even without a formal eating disorder diagnosis, your eating struggles are valid! ● You are still deserving and worthy of receiving treatment

19. Treatment Options ● There are an array of treatment options available for Eating Disorders ● Treatment is most successful when working with a multidisciplinary care team ● Examples include, but are not limited to: ○ Group Therapy ○ Individual Therapy ○ Working with a Dietitian ○ Support Groups ○ Higher Levels of Care ■ Residential Treatment ■ PHP: Partial Hospitalization ■ IOP: Intensive Outpatient

20. Why is a Dietitian Important For Eating Disorder Treatment? • Part of eating disorder treatment focuses on nutritionally restoring an individual back to a well nourished state. Dietitians help do this by: • Supporting nutrition restoration • Challenging diet culture • Supporting flexible eating • Setting an individualized, flexible meal plan • Understanding and enhancing health* • Teaching how to trust the body’s inner wisdom *Reminder: the definition of “health” varies from person to person. So, a dietitian supports an individual in achieving personalized health goals to the best of the client’s ability, if “health” is a value of the client.

21. Why Choose a Health At Every Size (HAES) Dietitian? • HAES dietitians accept and respect the diversity of body shapes and sizes • HAES dietitians do not prescribe weight loss • HAES dietitians will help you make peace with movement, food, and your here and now body • HAES dietitians listen to your lived experiences and offer feedback and support without judgement • HAES dietitians help you learn how to challenge diet culture

22. How Do I Find a Dietitian? • Courage to Nourish website: https://couragetonourish.com/ • Check with your insurance • Google “HAES dietitians in your area” • Referrals from your PCP • If you are seeing another health professional (therapist, psychologist, etc.), consider asking them for referrals

23. Citations • https://nedc.com.au/eating-disorders/eating-disorders-explained/t ypes/ • https://www.nationaleatingdisorders.org/ • https://www.eatright.org/health/diseases-and-conditions/eating-di sorders/what-is-disordered-eating