Feeding and Eating Disorders

Avoidant/Restrictive Food Intake Disorder (ARFID)

Description

Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by limitations in the amount and/or types of food consumed. Children with ARFID do not consume enough calories to grow and develop properly; adults with ARFID do not consume enough calories to maintain weight and basic body function. Individuals with ARFID are not afraid of weight gain and are not driven to lose weight. Instead, ARFID often results from other factors, such as anxiety around eating due to food allergies or heightened sensory sensitivity and dislike of specific characteristics of food.

ARFID is more than just “picky eating;” children do not grow out of it and often become malnourished because of the limited variety of foods they will eat. ARFID is often associated with psychiatric co-morbidity such as anxious and obsessive-compulsive features. ARFID is more common in children and young adolescents and less common in late adolescence and adulthood. The prevalence of ARFID is still being studied, but preliminary estimates suggest it may affect as many as 5% of children.

Signs of ARFID can also include:

  • Significant weight loss
  • Failure to achieve expected weight gain
  • Faltering growth in children
  • Significant nutritional deficiency
  • Dependence on nutritional supplements
  • Refusal to eat anywhere outside the home
  • Constipation and abdominal pain
  • Fears of choking or vomiting

Treatment for AFRID:

Treatment for ARFID involves behavioral exposures. Your therapist will collaboratively work with you to slowly introduce you to specific sensations or foods that you currently avoid in order to help you overcome fears and aversions you might have.

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Anorexia Nervosa (AN)

Description:

Anorexia Nervosa (AN) is characterized by restricted food intake, which leads to significant and rapid weight loss or an inability to maintain a healthy weight. Individuals with AN are often afraid of gaining weight. They might also feel out of control when eating and engage in self-induced vomiting.

About .5-1% of females and 0.3% of males suffer from AN. AN has the highest death rate of any mental health condition. The longer a person has AN, the more likely they are to die from medical complications or suicide. The sooner a patient receives treatment, the more likely they are to overcome AN.

Signs of Anorexia Nervosa can also include:

  • a child or adolescent falling below their previously established growth curve
  • dieting behavior or refusal to eat certain foods
  • compulsive or excessive exercising
  • preoccupation with eating, nutrition, food preparation, body shape, and weight
  • avoiding meals with others
  • feeling anxious or irritable around meal times
  • withdrawing from family and friends
  • depression, anxiety, and difficulty concentrating
  • body checking behaviors (e.g., pinching or measuring body parts, frequently evaluating the body in the mirror)
  • frequently weighing oneself
  • feeling bloated or constipated
  • fainting or dizziness
  • very slow heart rate
  • feeling cold most of the time
  • low energy and fatigue

Treatment:

Treatment of AN can range from inpatient hospitalization to weekly outpatient therapy. A comprehensive diagnostic evaluation will determine the level of care that best meets each patient’s needs. Treatment for AN requires a collaborative, multidisciplinary teams; these often include a psychologist, medical doctor, psychiatrist, and a dietitian. We provide patients with referrals as needed and/or collaborate with providers with whom patients are already working.

The gold standard, most effective treatment for children and adolescents with AN is called the Maudsley Approach or Family-based Treatment (FBT). FBT is conducted on an outpatient basis. The psychologist teachers parents to promote weight restoration in their child or adolescent. Control of eating is slowly transferred back to the patient. Treatment also targets thoughts and behaviors that contribute to and maintain AN and body image difficulties. FBT can be appropriate for some young adults and adults, depending on the patient’s and their family’s circumstances.

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Bulimia Nervosa (BN)

Description:

Bulimia Nervosa (BN) consists of both binge eating episodes and repeated compensatory behaviors (e.g., of self-induced vomiting, laxative or diuretic use, fasting, or excessive exercise) to prevent weight gain. Binge eating episodes involve eating, in a discrete period of time (e.g., around 2 hours), an amount of food that is definitely larger than what most people would eat, along with a sense of lack of control over eating. Compensatory behaviors often follow binge episodes.

Individuals suffering from BN are very concerned with their body’s shape and weight, and they are usually at normal weight or overweight. About 1-4% of women and .5% of men suffer from BN.

Signs of Bulimia Nervosa can also include:

  • dieting behaviors and preoccupation with eating and food
  • frequently weighing oneself
  • frequent changes in weight (loss or gain)
  • spending more money than usual on food
  • hiding food and food wrappers throughout the house
  • skipping meals
  • feelings of shame, self-loathing, or guilt, particularly after eating
  • eating in private or avoiding meals with other people
  • excessive time spent exercising and/or exercising very intensely
  • frequent trips to the bathroom after eating
  • feeling bloated or constipated
  • fainting or dizziness
  • tiredness, fatigue
  • feeling bloated or constipated
  • depression, anxiety, or irritability
  • body checking behaviors (e.g., pinching, measuring body parts, evaluating oneself in the mirror)

Treatment:

The gold standard, most effective treatment for BN is Cognitive-Behavioral Therapy for Eating Disorders (CBT-E). CBT-E targets the thoughts, behaviors, and emotions that contribute to and maintain BN. Your therapist will help implement a regular pattern of eating that will prevent you from getting too hungry and then binge eating. You will learn to identify and address triggers that lead to binge eating and purging, to tolerate the urges to binge and purge without acting on them, and to manage intense emotions without binge eating and purging. You will learn to challenge thoughts and eliminate behaviors that contribute to a negative body image. If applicable, co-occurring anxiety and depressive disorders are also addressed.

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Binge Eating Disorder (BED)

Description:

Binge Eating Disorder (BED) consists of repeated binge eating episodes. Binge eating episodes consist of three or more of the following: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not physically hungry, eating alone because of feeling embarrassed by how much one is eating, feeling disgusted with oneself, depressed, or guilty afterwards. People with binge eating disorder feel distressed about binge eating.

Individuals suffering from BED can be normal weight, overweight, or obese. Binge eating disorder occurs in about 3 to 5% of women and about 2% of men. Binge eating is the most common eating disorder among men; about 40% of those suffering from BED are male. Although it can occur at any age, often individuals suffering from BED are middle-aged.

Signs of BED can also include:

  • evidence of binge-eating (e.g., disappearance or hoarding food
  • secretive behavior relating to food (e.g., hiding food and food wrappers around the house)
  • increased isolation and withdrawal from previously enjoyed activities
  • spending a lot of money on food
  • preoccupation with eating, food, and body shape and weight
  • extreme body dissatisfaction and shame about appearance
  • feeling bloated or constipated
  • feeling fatigued
  • depression, anxiety, irritability

Treatment for Binge Eating Disorder:

The gold standard, most effective treatment for BED is Cognitive-Behavioral Therapy (CBT). CBT targets the thoughts, behaviors, and emotions that contribute to and maintain binge eating. Your therapist will help you identify and address triggers that lead to binge eating. You will also learn to tolerate urges to binge without having to act on them, and to manage intense emotions in ways that don’t involve binge eating. Urges to binge become weaker over time the less you engage in them. Your therapist will also work with you to challenge thoughts and eliminate behaviors that contribute to a negative body image. If applicable, co-occurring anxiety and depressive disorders are also addressed.

For More Information:

Eating Disorder Resources

National Eating Disorders Association

NEDA is a nonprofit organization that provides support for individuals and families affected by eating disorders. It is dedicated to the prevention, treatment, and cure of eating disorders. 

https://www.nationaleatingdisorders.org/

Academy For Eating Disorders (AED)

AED is devoted to disseminating information regarding eating disorders in order to educate, prevent and assist those in need. It is involved in advocacy efforts to support individuals with eating disorders, and it supports and publicizes the latest science and research related to eating disorders.

https://www.aedweb.org/index.php