What is an eating disorder?

For many of us, the holiday season brings thoughts of friends, family, parties, and large meals. We look forward to the traditional holiday dishes, including many sweet desserts and treats. But for millions of Americans, the holiday traditions bring fear and anxiety associated with eating disorders. What appears to many people as a fun celebration with rich foods is for some a painful battle for control of emotions, thoughts, and body image.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), an eating disorder is “an unhealthy relationship with food and weight that interferes with many areas of a person’s life. . . . A person who struggles with an eating disorder can have unrealistic self-critical thoughts about body image, and his or her eating habits may begin to disrupt normal body functions and affect daily activities. . . . People begin to use food as a coping mechanism to deal with uncomfortable or painful emotions or to help them feel more in control when feelings or situations seem over-whelming.”

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders recognizes four categories of eating disorders:

• Anorexia nervosa — “A person with anorexia may have an intense fear of gaining weight or becoming fat. Someone with anorexia may practice unhealthy behaviors such as: restricting calories, only eating specific foods or skipping meals frequently.”

• Bulimia nervosa — “A person with bulimia may . . . be intensely afraid of becoming fat or gaining weight. Someone with bulimia may eat large amounts of food in a short period of time (binge) and then eliminate the food and calories (purge).”

• Binge eating disorder — “This disorder involves [frequently] eating very large amounts of food rapidly (to the point of feeling sick or uncomfortable). . . . When binge eating, a person feels like they cannot stop eating or control what or how much is eaten.”

• Other specified feeding or eating disorder (OSFED) — This is “a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.”

Eating disorders are mental illnesses. Their causes include genetics, psychological issues, and social issues, which include cultural and media images that promote thinness. Depression and anxiety frequently coexist in a person struggling with an eating disorder as well as within that person’s family. Many factors influence how an individual sees himself or herself and how that individual views the role of food and exercise in his or her life. Eating disorders also affect loved ones, friends, coworkers, and family members of the people struggling with them.

Who is at risk?

Eating disorders affect individuals of all ages and of both genders. According to the National Eating Disorders Association (NEDA), “In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life.” The age of highest risk for the onset of eating disorders is before 20. Since women are more likely than men to develop an eating disorder, female teenagers are the group at highest risk. Among adolescents, anorexia is the third most common chronic illness. Approximately half of individuals struggling with an eating disorder meet the criteria for depression; however, only ten percent of those individuals receive any kind of treatment.

Eating disorders have many health-related consequences. Persons suffering from anorexia can experience low blood pressure, a slowed heart rate, osteoporosis, muscle weakness, severe dehydration, and hair loss. Those with bulimia face electrolyte imbalance, tooth decay, ulcers, and possible ruptures of the stomach and the esophagus. Binge eating disorder leads to high blood pressure, high cholesterol, heart disease, and diabetes.

The ANAD reports that “eating disorders have the highest mortality rate of any mental illness.” This fact is often overlooked since more often the medical complications of a person’s death are reported instead of details about the eating disorder. These complications include heart failure, organ failure, and malnutrition. Many persons with eating disorders take their own lives.

Signs and symptoms

The lists of signs and symptoms for the different types of eating disorders are long and extensive, so we’ll look at just a few given by the American Psychiatric Association.

Symptoms of anorexia nervosa include inadequate food intake, low weight, obsession with and fear of weight gain, and selfesteem overly related to body image. Symptoms of bulimia nervosa include frequent episodes of consuming very large amounts of food followed by behaviors to prevent weight gain, such as self-induced vomiting; feeling out of control during binging; and, as with anorexia, self-esteem overly related to body image. Those living with binge eating disorder demonstrate similar symptoms as bulimics, including binging and purging and feeling out of control during binging. They also show feelings of significant shame or guilt in relation to the binging. Signs of OSFED include significant distress or impairment, but not to the level of other disorders. One example of OSFED is night eating syndrome (excessive nighttime food consumption).

Treatment

Treatment for eating disorders depends upon the type and severity of the disorder and the health complications experienced by the individual. Some persons require hospitalization, and others can be treated on an outpatient basis. According to NEDA, “The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or psychological counseling, coupled with careful attention to medical and nutritional needs.”

Addressing only one or a small subset of the signs and symptoms of eating disorders is insufficient. Eating disorders are complicated and involve one’s overall health — emotional, psychological, and physical. Treating a person with an eating disorder must be coordinated by a trusted healthcare professional.

Effects on loved ones

Psychotherapist Abigail H. Natenshon explains, “Eating disorders are family diseases. Everybody who comes in contact with the eating disordered individual suffers, including parents, siblings and grandparents.” From recognizing signs and symptoms to working with the patient in recovery, the family is involved. Natenshon says, “Parents tend to be the primary diagnosticians of an eating disorder in their child. Eating disorders show up around kitchen tables, and in family bathrooms, rarely in the doctor’s office.” An individual’s progress in recovery is aided by family members who not only understand the recovery process but who also make their own parallel personal changes in order to accommodate the needs and requirements of the person and the family.

Loved ones also need to recognize and address their own suffering. Natenshon explains, “They often need personal support and bolstering in the face of what can be an extended, convoluted and at times discouraging recovery process” for the family member struggling with the disorder. Natenshon recommends family therapy. Like many diseases and mental illnesses, healing of the patient includes and involves the healing of the family and loved ones.

What can you do?

Since eating disorders can affect persons of any age and gender, churches must be aware that their faith community may include people who struggle with them. Parents and volunteers working with youth and children need to be educated on the signs and symptoms of eating disorders. Pastors, youth directors, and children’s ministers must keep on hand referral lists that include health-care professionals trained in diagnosing and treating eating disorders.

Churches can offer both education and support groups by health-care professionals for families and loved ones. Small groups may provide material, emotional, and spiritual support. Pray for those afflicted with eating disorders and their families. Understand that eating disorders are diseases and mental illnesses that affect both the individual and the family unit. Realize that treatment and recovery are usually long-term and difficult. Offer support as you would for any other individual or family living with mental illness or another chronic disease.

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