What We Treat

Eating Disorders Are Complex, Chronic Conditions and Can Be Life-threatening

Most people think of an eating disorder as a lifestyle decision or a diet “gone too far.” In fact, eating disorders are serious mental health conditions with life-threatening implications if left untreated. The mortality rate for people with eating disorders is the highest of all psychiatric illnesses, and more than 12 times higher than that for people without eating disorders. Successful treatment that can lead to full recovery goes beyond symptom control. It requires a continuum of care and a collaboration of specialists experienced in treating medical, nutritional, and mental health aspects of an eating disorder.

Is an Eating Disorder an Addiction?

Eating disorders and addictions often occur together – and there are many similarities in both risk factors and characteristics. Both disorders can be triggered by stress or are often related to histories of abuse and neglect. And both are chronic diseases with high relapse rates.

Recovery, however, can be very different with each disorder. The substance abuser must abstain from the substance; the individual with an eating disorder cannot abstain from the food since it is needed to sustain life. Abstinence for those with eating disorders involves abstinence from its symptoms - starvation, rigid dieting, binge eating, purging, and body loathing. Rather than ending the relationship with the substance, the individual with an eating disorder must work to form a healthy relationship with food, while the substance abuser traditionally severs the relationship with the substance(s) of abuse completely.

Eating disorders like Anorexia and Bulimia should not be treated as merely an addiction, even if there is a co-occurring substance use disorder or chemical addiction. The Department of Health and Human Services recommends evidence-based treatment from a coordinated treatment team that specializes in eating disorders treatment and incudes these interventions:

  • Medical stabilization
  • Nutritional rehabilitation
  • Pharmacotherapy
  • Psychosocial treatment

The medical complexities of an eating disorder and the unique treatment demands require treatment from facilities that specialize in eating disorders treatment. When you are seeking treatment for your eating disorder, you should look for the following criteria:

  • Accredited to treat eating disorders at Residential, Partial Hospitalization, and Intensive Outpatient by the Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission or similar accrediting organization
  • Therapists and dietitians certified by the International Association of Eating Disorders Professionals (IAEDP)
  • Continuity of care options to provide comprehensive levels of care with cohesive treatment team
  • Specialized processes to manage meals and behaviors associated with eating disorder symptoms
  • Medical oversight and routine lab work for residential and partial hospitalization

The most common eating disorders are Anorexia Nervosa (extreme restriction of food intake), Bulimia Nervosa (obsessive purging or intentional vomiting of food), and Binge Eating Disorder (uncontrollable eating of large amounts of food in a short time period).

Anorexia Nervosa

Anorexia Nervosa is characterized by excessive dietary restriction, failure to maintain an adequate body weight, and a body image disturbance. Patients with Anorexia have an intense fear of gaining weight or becoming fat, or persist in behavior that interferes with weight gain.

Unfortunately, patients generally do not recognize the seriousness of their current body weight and do not seek Anorexia treatment. Low self-esteem, difficulty with conflict and negative emotions, and a need to please others are some of the personality characteristics that may put an individual at risk for developing Anorexia. Self-induced vomiting and laxative abuse may accompany the disease. An estimated nine out of every 1,000 women will meet the diagnosis for Anorexia at some point in their life.

Anorexia typically begins during early-to-mid adolescence, but can manifest at any age. Having Anorexia puts a woman at risk for medical conditions such as bone loss, difficulties with temperature regulation, loss of menstrual periods, and low blood pressure and heart rate.

An individual with Anorexia generally won’t have all of these signs and symptoms at once, and warning signs and symptoms vary across eating disorders, so this isn’t intended as a checklist. Rather, it is intended as a general overview of the types of behaviors that may indicate an eating disorder. If you have any concerns about yourself or a loved one, please seek additional medical help.

Emotional and behavioral signs of Anorexia Nervosa

  • Dramatic weight loss
  • Dresses in layers to hide weight loss or stay warm
  • Is preoccupied with weight, food, calories, fat grams, and dieting
  • Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
  • Makes frequent comments about feeling “fat” or overweight despite weight loss
  • Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  • Denies feeling hungry
  • Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)
  • Cooks meals for others without eating
  • Consistently makes excuses to avoid mealtimes or situations involving food
  • Expresses a need to “burn off” calories taken in 
  • Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury 
  • Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive
  • Seems concerned about eating in public
  • Has limited social spontaneity
  • Resists or is unable to maintain a body weight appropriate for their age, height, and build
  • Has intense fear of weight gain or being “fat,” even though underweight
  • Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight
  • Post-puberty loss of menstrual period
  • Feels ineffective
  • Has strong need for control
  • Shows inflexible thinking
  • Has overly restrained initiative and emotional expression

Physical signs of Anorexia Nervosa

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
  • Menstrual irregularities—amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
  • Difficulties concentrating
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  • Dizziness
  • Fainting/syncope
  • Feeling cold all the time
  • Sleep problems
  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)
  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity
  • Dry skin
  • Dry and brittle nails
  • Swelling around area of salivary glands
  • Fine hair on body (lanugo)
  • Thinning of hair on head, dry and brittle hair (lanugo)
  • Cavities, or discoloration of teeth, from vomiting
  • Muscle weakness
  • Yellow skin (in context of eating large amounts of carrots)
  • Cold, mottled hands and feet or swelling of feet
  • Poor wound healing
  • Impaired immune functioning

Bulimia Nervosa

Bulimia Nervosa is characterized by consuming large amounts of food while feeling out of control and engaging in compensatory behaviors to prevent weight gain. These behaviors may include self-induced vomiting, misuse of laxatives, diuretics, or other medication, fasting, or excessive exercise. This disorder develops when individuals are unduly influenced by body shape and weight.

The typical age of onset of Bulimia is mid-to-late adolescence and often has underlying causes such as a catastrophic trauma or attachment trauma. Anxiety, depression, attachment trauma, and difficulties with impulse control in other areas often accompany Bulimia. Early warning signs of Bulimia include frequent trips to bathrooms after meals, swelling of the face, calluses on knuckles from using the fingers to self-induce vomiting, and the disappearance of large amounts of food.

Symptoms of Bulimia Nervosa

  • Frequent episodes of consuming very large amounts of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge-eating episodes.
  • Self-esteem overly related to body image.

Many people with Bulimia also struggle these co-occurring conditions

  • Self-injury (cutting and other forms of self-harm without suicidal intention)
  • Substance abuse
  • Impulsivity (risky sexual behaviors, shoplifting, etc.)

According to the DSM-5, the official diagnostic criteria for Bulimia Nervosa are:

  • Recurrent episodes of binge eating characterized by both of the following:
    • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Binge Eating Disorder

Binge Eating Disorder is characterized by binge eating without the compensatory behaviors characteristic of Bulimia. Often dismissed as emotional eating or compulsive eating, only recently has the medical community recognized binge eating as a disorder. The binge-eating episode may be accompanied by eating more than normal, eating until uncomfortably full, eating large amounts of food independent of physical hunger, eating alone because of the embarrassment about the large quantities consumed, and feeling guilty after consuming large amounts of food. Research suggests that Binge Eating Disorder is the most common eating disorder. Most people with Binge Eating Disorder are more than 20 percent above a healthy body weight, but normal weight people also can be affected.

The typical age of onset for Binge Eating Disorder is during adolescence or young adulthood, but most individuals will only seek treatment in middle adulthood when they are experiencing physical symptoms related to being overweight, such as Type II diabetes, hypertension, and gastric problems. Warning signs of Binge Eating Disorder include sudden weight gain and the disappearance of large amounts of food.

If you experience episodes of emotional eating or compulsive eating, you may need treatment for Binge Eating Disorder. For long-term success, treatment must address underlying issues such as anxiety, depression, and lack of impulse control.

Emotional and behavioral signs of binge eating disorder

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
  • Appears uncomfortable eating around others 
  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
  • Fear of eating in public or with others
  • Steals or hoards food in strange places  
  • Creates lifestyle schedules or rituals to make time for binge sessions  
  • Withdraws from usual friends and activities 
  • Frequently diets  
  • Shows extreme concern with body weight and shape  
  • Frequent checking in the mirror for perceived flaws in appearance
  • Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating  
  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting
  • Developing food rituals (e.g., eating only a particular food or food group such as  condiments], excessive chewing, not allowing foods to touch).
  • Eating alone out of embarrassment at the quantity of food being eaten
  • Feelings of disgust, depression, or guilt after overeating
  • Fluctuations in weight
  • Feelings of low self-esteem

Physical signs of binge eating disorder

  • Noticeable fluctuations in weight, both up and down 
  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) 
  • Difficulties concentrating

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder (ARFID), previously known as Selective Eating Disorder (SED), is a type of eating disorder, as well as feeding disorder, where the individual limits her consumption of certain foods based on the food's appearance, smell, taste, texture, brand, presentation, or a past negative experience with the food. Women with ARFID have no significant body image distortion or fear of weight gain as with Anorexia and Bulimia. ARFID can be diagnosed in children, adolescents, and adults, and it is the second most common eating disorder in children 12 years and younger. Individuals with ARFID are at high risk for other psychiatric disorders, in particular anxiety disorders and depression.

Eating behaviors can include a lack of interest in food or poor appetite, fears about negative consequences of eating (e.g., vomiting, choking, allergic reaction), and selective or picky eating. The pattern of disordered eating is also accompanied by significant weight loss or failure to gain weight/grow as expected, nutritional deficiency (e.g., anemia), dependence on nutritional supplements or tube feeding, and impairment in psychosocial functioning.

Behavioral and psychological signs of ARFID

  • Dramatic weight loss
  • Dresses in layers to hide weight loss or stay warm
  • Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  • Consistent, vague gastrointestinal complaints (upset stomach, feels full, etc.) around mealtimes that have no known cause
  • Post-puberty loss of menstrual period
  • Dramatic restriction in types or amount of food eaten
  • Will only eat certain textures of food
  • Fears of choking or vomiting
  • Lack of appetite or interest in food
  • Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).
  • No body image disturbance or fear of weight gain

Physical signs of ARFID

Because both Anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
  • Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
  • Difficulties concentrating
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  • Dizziness
  • Fainting/syncope
  • Feeling cold all the time
  • Sleep problems
  • Dry skin
  • Dry and brittle nails
  • Fine hair on body
  • Thinning of hair on head, dry and brittle hair (lanugo)
  • Muscle weakness
  • Cold, mottled hands and feet or swelling of feet
  • Poor wound healing
  • Impaired immune functioning

Other Specified Feeding or Eating Disorders (OSFED)

OSFED is a feeding or eating disorder that causes significant impairment, but does not meet the criteria for another feeding or eating disorder. Historically, the behaviors described by OSFED were included in the diagnostic category Eating Disorder Not Otherwise Specified (EDNOS).

Examples of (EDNOS), now OSFED, include:

  • Eating behavior resulting in substantial weight loss despite normal weight status (Atypical Anorexia Nervosa)
  • Binge eating and compensatory behaviors such as purging, laxative abuse, or excessive exercising occuring less frequently than required for the diagnosis of BN (Sub-threshold Bulimia Nervosa).
  • Purging without binging (Purging Disorder)
  • Recurrent episodes of night eating, defined by excessive consumption of food after the evening meal or eating after awakening from sleep.

OSFED typically begins in adolescence or early adulthood and often has underlying causes such as a catastrophic trauma or attachment trauma. Warning signs are similar to those for related eating disorders. Without treatment, individuals with OSFED may develop other eating disorders described above.

Emotional and behavioral signs of OSFED

  • In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns 
  • Dramatic weight loss
  • Dresses in layers to hide weight loss or stay warm
  • Is preoccupied with weight, food, calories, fat grams, and dieting
  • Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
  • Makes frequent comments about feeling “fat” or overweight despite weight loss
  • Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  • Denies feeling hungry
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food  
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics 
  • Appears uncomfortable eating around others 
  • Develops food rituals (e.g. eats only a particular food or food group, excessive chewing, doesn’t allow foods to touch) 
  • Skips meals or takes small portions of food at regular meals 
  • Disappears after eating, often to the bathroom
  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
  • Fear of eating in public or with others
  • Steals or hoards food in strange places  
  • Drinks excessive amounts of water or non-caloric beverages  
  • Uses excessive amounts of mouthwash, mints, and gum  
  • Hides body with baggy clothes  
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories  
  • Shows unusual swelling of the cheeks or jaw area  
  • Has calluses on the back of the hands and knuckles from self-induced vomiting 
  • Teeth are discolored, stained  
  • Creates lifestyle schedules or rituals to make time for binge-and-purge sessions  
  • Withdraws from usual friends and activities 
  • Looks bloated from fluid retention  
  • Frequently diets  
  • Shows extreme concern with body weight and shape  
  • Frequent checking in the mirror for perceived flaws in appearance
  • Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating  
  • Purges after a binge (e.g. self-induced vomiting; abuse of laxatives, diet pills and/or diuretics; excessive exercise, fasting)  
  • Body weight is typically within the normal weight range; may be overweight
  • Extreme mood swings

Physical signs of OSFED

  • Noticeable fluctuations in weight, both up and down 
  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) 
  • Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period) 
  • Difficulties concentrating 
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 
  • Dizziness 
  • Fainting/syncope 
  • Feeling cold all the time 
  • Sleep problems 
  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)
  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity 
  • Dry skin 
  • Dry and brittle nails 
  • Swelling around area of salivary glands 
  • Fine hair on body 
  • Thinning of hair on head, dry and brittle hair (lanugo) 
  • Cavities, or discoloration of teeth, from vomiting 
  • Muscle weakness 
  • Yellow skin (in context of eating large amounts of carrots) 
  • Cold, mottled hands and feet or swelling of feet 
  • Poor wound healing 
  • Impaired immune functioning

 

Discover the Fairhaven Philosophy

Our Philosophy

What Kind of Care is Right for Me?

If you think you may be suffering from an eating disorder, you can use these assessments for more information.

Anorexia or BulimiaBinge Eating Disorder