When we reach February, the first thing that crosses our minds tends to be Valentine’s Day. All the heart-shaped balloons and chocolate-covered strawberries kind of take over. But did you know February also happens to be Eating Disorder Awareness Month?
In fact, at least 30 million people—of all ages and genders—suffer from an eating disorder. In other words—this is a real problem that should be addressed. So we spoke with Dr. Stephanie Setliff, the regional medical director at the Eating Recovery Center in Dallas, about what parents should know about eating disorders and recovery.
What are the symptoms of an eating disorder? Is there a wide spectrum of eating disorders? Dr. Stephanie Setliff: There are four main types of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant/restrictive feeding and intake disorder (ARFID). Anorexia nervosa is characterized by restriction of food intake (usually amount and type of foods consumed) and a failure to maintain weight within a healthy weight range, although this may not always be the case if someone starts out at a higher weight.
Bulimia nervosa is characterized by eating large quantities of food in short periods of time, having a sense of lack of control during those episodes and recurrent compensatory behaviors—such as purging, laxative abuse or over-exercising. A common symptom between anorexia nervosa and bulimia nervosa is the undue influence of body weight and shape; most people with these diagnoses struggle with significant body image concerns.
Like bulimia nervosa, binge eating disorder involves a person eating a large amount of food in a short period of time and having a sense of lack of control during those episodes. Unlike bulimia, binge eating disorder does not include the compensatory behavior. As a result, people with binge eating disorder tend to be overweight or obese.
Finally, ARFID is an eating or feeding disturbance manifested by failure to meet appropriate nutritional and/or energy needs. Symptoms include significant weight loss, significant nutritional deficiency, dependence on enteral feeding or oral supplements and marked interference with psychological functioning. This disorder does not exclusively occur during the course of anorexia nervosa or bulimia nervosa, and ARFID doesn’t involve a disturbance in one’s experience of body weight or shape.
There are a lot of individual differences within these four disorders. Some people may be very thin, and some people may appear normal weight or overweight. It is important to not let weight and body shape be a major factor in determining if someone has an eating disorder or not. Also, eating disorders do not discriminate and can impact all genders, ethnicities and levels of socioeconomic status. Whereas it used to be believed that eating disorders only impacted women, there are many men that are diagnosed and treated for eating disorders (about 1 in 4).
What are some things parents should keep an eye out for? Things to look for are: weight (falling off their growth curve), eating habits, exercise habits (including those of athletes), obsession with food/talking about food, low mood, high anxiety, perfectionism and people-pleasing.
Most individuals will not outwardly share their struggles, so asking the right questions is important. Some questions to ask are:
- Do you spend most of your day thinking about food?
- Are you unhappy with your body?
- Does this unhappiness with your body keep you from doing things you enjoy?
- After you eat, do you feel urges to “get rid of it?”
- Do you notice that food is intertwined in your emotions (e.g., if you are sad, you cannot eat or if you are happy, you eat a lot?)
- Do you feel out of control when you eat?
What are the long-term effects of an eating disorder? The long-term effects can be severe if someone doesn’t receive adequate treatment early in the development of their eating disorder. Eating disorders often significantly impact the long-term physical health of those who suffer from it. This can include osteoporosis, heart disease, heart arrhythmia (irregular heartbeats), cardiomyopathy (weakening heart), electrolyte and hormone imbalances, tooth decay, reproductive issues and cognitive impairments.
How should a parent approach their child if they feel like their child is going down that path? It is important for parents to validate their child’s concerns and provide a space to listen to their child. It is also crucial to have a child evaluated by a professional quickly to determine the appropriate level of care. Increasing their knowledge about eating disorders can help parents provide adequate emotional and nutritional support to help a child achieve recovery from their eating disorder as well.
Why do you think it’s important to have an Eating Disorder Awareness Month? Is this a problem that should be talked about more? Eating disorders are often hidden in plain sight. Individuals that struggle with eating disorders often experience a lot of shame and guilt around their behaviors, which makes being secretive about behaviors and struggles a common occurrence. Early detection is important to recovery, so being able to notice warning signs and diagnose eating disorders early on is key. Eating disorders, specifically anorexia nervosa, have the second highest mortality rate of all mental illnesses.
As a child and adolescent psychiatrist who specializes in eating disorders, I often get asked what causes them. There is no one cause of an eating disorder and we view them by looking at a biopsychosocial model. That is, there are biological, psychological and social impacts that can contribute to the onset of an eating disorder, such as family history of anxiety, depression, perfectionistic characteristics, body dissatisfaction, exposures to and internalization of the thin ideal.
Increasing knowledge about eating disorders is also important because eating disorders commonly occur with other diagnoses, such as anxiety and depression. At times, suicidality goes along with depression and increases the mortality risk for those with eating disorders.
Expert Recommended Resources
Want to educate yourself more on eating disorders and what to look out for? Check out these recommendations from Dr. Setliff:
- The National Eating Disorders Association
- Surviving an Eating Disorder: Strategies for Families and Friends, by Michele Siegel, Ph.D., John Bresman, Ph.D., and Margo Weinshel, MSW
- Father Hunger: Fathers, Daughters, and Food, by Margo Maine, Ph.D.
- A Parent’s Guide to Anorexia and Bulimia, by Kathryn Bryne
- Bulimia: A Guide for Families and Friends, by Robert Trattner Sherman, Ph.D. and Ron A. Thompson, Ph.D.
- Bulimia: A Guide to Recovery, by Lindsey Hall and Leigh Cohn
- Anorexia Nervosa: A Guide to Recovery, by Lindsey Hall and Monika Ostroff
Also, check out our other article Eating Disorders: Through the Eyes of an 18-Year-Old for a perspective from a young woman who recovered from anorexia.
Photo courtesy of The Eating Recovery Center.