Anorexia, Bulimia & Binge Eating Disorder (BED)

Treatment for Eating Disorders

We give patients the care and support they need to overcome their eating disorder

In recent years, there has been a significant evolution in the understanding and classification of eating disorders both globally and in the United Kingdom.

These disorders are characterised by a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food, significantly impairing physical health or psychosocial functioning.

This article delves deep into the various types of eating disorders, offering a comprehensive overview of each, grounded in the latest research and expert insights.

In the following sections, we will explore the definitions, symptoms, and treatment options for a range of eating disorders including anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and many others.

Drawing from a rich pool of resources, including insights from psychiatry books and guidance from the NHS, we aim to provide a well-rounded understanding of these eating disorders.

Our aim is to identify signs of eating disorders and understand the available avenues for diagnosis and treatment.

Understanding Eating Disorders

The Psychological Aspect

The incidence of eating disorders continues to increase. The lifetime risk of any eating disorder is 8.4% in women and 2.2% in men.

Eating disorders are not merely about food; they are deeply rooted in psychological issues, often involving a distorted perception of one’s body image.

Individuals suffering from eating disorders undergo a constant battle within themselves, struggling with low self-esteem and an intense fear of gaining weight.

The Biological Aspect

Research has shown that biological factors, including genetic predisposition, can play a significant role in the development of eating disorders.

Hormonal imbalances and abnormalities in specific brain structures have also been associated with eating disorders, emphasising the need for a multi-faceted approach to understanding and treating them.

Indicators of Common Eating Disorders

Physical signs common in people with eating disorders include:

  • Low body weight (improper food rituals)
  • Experiencing amenorrhea or infertility
  • Dental issues, especially among young individuals
  • Concerns about weight, even when it’s within a normal range
  • Unsuccessful weight loss attempts in overweight or obese individuals
  • Gastrointestinal problems without another medical explanation
  • Delayed growth in children
  • Parental concerns regarding their child’s weight and eating habits
  • Erratic eating habits
  • Weight loss
  • Abdominal pain
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Common Eating Disorders

Anorexia Nervosa (AN)

Anorexia nervosa is an eating disorder that manifests in two distinct types: restricting and binging/purging.

The Restricting Type

Individuals with this type of AN engage in a severe restriction of food intake, often consuming far fewer calories than needed to maintain basic body function.

This relentless pursuit of thinness leads to a significant loss of body weight, pushing people into a dangerous zone of malnutrition and health complications.

The Binge-Eating/Purging Type

The second type of AN involves episodes of binge eating followed by compensatory behaviours such as self-induced vomiting or the use of laxatives to prevent weight gain.

This cycle of bingeing and purging not only affects physical health but also takes a toll on individuals’ mental well-being, leading to a vicious cycle of guilt and further restrictive behaviours.

Bulimia Nervosa (BN)

The Binge-Purge Cycle

Bulimia nervosa is characterised by a recurring cycle of binge eating followed by compensatory behaviours to prevent weight gain.

The binge episodes involve consuming large amounts of food in a short period, often accompanied by a feeling of loss of control. This is followed by purging behaviours, including forced vomiting and excessive exercise, to get rid of the unwanted calories.

The main thing that distinguishes BN from binge-purge-type anorexia nervosa is that a person with purge-type will also have low body weight.

The Physical and Psychological Toll

The repeated cycle of bingeing and purging has severe repercussions on both physical and psychological health. It can lead to gastrointestinal problems, dental issues, and severe dehydration.

On the psychological front, individuals often suffer from anxiety, depression, and low self-esteem, finding themselves trapped in a cycle of guilt and shame post-bingeing episodes.

Binge Eating Disorder (BED)

The Uncontrolled Episodes

Binge eating disorder is characterised by frequent episodes of uncontrolled eating, where individuals consume large amounts of food in a short period.

Eating disorders of such type are marked by feelings of distress, guilt, and loss of control, significantly affecting individuals’ mental health.

Health Risks

Unlike bulimia nervosa, BED does not involve compensatory behaviours post-binge episodes, leading to weight gain and associated health risks such as cardiovascular diseases.

It is essential to address this disorder promptly to prevent further complications and to help individuals regain control over their eating behaviours.

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Avoidant/Restrictive Food Intake Disorder (ARFID)

The Characteristics

ARFID, also known as “selective eating disorder” is an eating disorder characterised by a severe limitation in the types of food one consumes.

It is not driven by a fear of weight gain or a distorted body image but rather involves avoidance of certain textures, colours, or types of food groups, often leading to nutritional deficiencies.

The Onset and Progression

Restrictive food intake disorder often begins in infancy or early childhood and can persist into adulthood.

Eating disorders like ARFID can lead to significant health issues, including developmental delays and failure to gain weight appropriately during development, necessitating early intervention to prevent long-term complications.

Night Eating Syndrome (NES)

The Delayed Eating Pattern

Night eating syndrome is an eating disorder that involves a delay in the circadian rhythm of food intake, with individuals consuming a significant portion of their daily calories during the evening and night.

This syndrome is characterised by morning anorexia, where individuals skip breakfast, and evening hyperphagia, involving the consumption of large amounts of food later in the day.

The Associated Challenges

Individuals with NES often struggle with obesity, finding it challenging to maintain a healthy body weight due to their irregular eating patterns.

The syndrome is also associated with sleep disturbances, adding to the complexity of the disorder and requiring a comprehensive approach to treatment.

Orthorexia

The Obsession with Healthy Eating

Orthorexia, though not officially recognised as a distinct eating disorder, involves an unhealthy obsession with healthy eating.

Individuals with this disorder spend an excessive amount of time planning their diet, focusing rigidly on the quality and purity of the food they consume, often at the expense of their nutritional needs.

The Impact on Daily Life

The compulsive behaviour associated with orthorexia can significantly impact a person’s daily life, leading to social isolation as they avoid situations involving food that does not meet their stringent criteria.

The disorder can also lead to nutritional deficiencies, as individuals restrict themselves to a narrow range of foods deemed “healthy.”

Other Eating Disorders

The Lesser-Known Disorders

Apart from the well-known eating disorders discussed above, there are other lesser-known but equally serious conditions that individuals may suffer from.

These include rumination disorder, diabulimia, and pica, each with its unique characteristics and associated health risks.

Rumination Disorder

Rumination disorder is an eating disorder involving the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spat out. This disorder can occur at any age and often co-occurs with other mental health conditions, leading to a complex clinical picture that requires a multi-disciplinary approach to treatment.

The constant regurgitation of food can lead to a range of health issues, including malnutrition, weight loss, and dental problems.

It is essential to address this disorder promptly to prevent further complications and to help individuals manage their symptoms effectively.

Diabulimia

Diabulimia is a serious eating disorder where individuals with type 1 diabetes deliberately take less insulin than they need, aiming to lose weight.

This disorder is extremely dangerous, leading to severe medical complications, including diabetic ketoacidosis, a life-threatening condition that requires immediate medical intervention.

Given the severe health risks associated with diabulimia, it is crucial to identify and treat this eating disorder promptly.

It involves a comprehensive approach that includes medical management to address physical health issues and psychotherapy to help individuals cope with the psychological aspects of the disorder.

Pica

Pica involves the consumption of non-food items, such as soil, paper, and soap, among others.

This disorder is characterised by persistent eating of non-nutritive substances for a period of at least one month, often leading to serious health issues, including infections and surgical emergencies.

Early intervention is crucial in managing pica, to prevent the ingestion of harmful substances that can lead to severe health complications.

Treatment involves addressing the underlying causes of the disorder, which may include nutritional deficiencies (fat grams consumed) and mental health issues, to help individuals overcome their urges to consume non-food items.

Other Specified Feeding and Eating Disorders (OSFED)

OSFED encompasses a range of eating disorders that do not meet the full criteria for any of the other disorders discussed above.

This category includes conditions such as atypical anorexia nervosa, where individuals have all the symptoms of anorexia nervosa but are not underweight, and purging disorder, where individuals engage in purging behaviours without binge eating.

Diagnosing OSFED can be complex, given the broad range of symptoms and behaviours that fall under this category.

It requires a comprehensive assessment to understand the unique characteristics of each individual’s disorder to tailor a treatment plan that addresses their specific needs and challenges.

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Diagnosing & Treating Eating Disorders

The goal of treatment of any eating disorder is to assess the condition. For example, in AN the goal is normalising body weight and eating behaviour and overcoming the psychological problems associated with AN.

Clearly structured symptom-orientated treatment components are very important, especially at the start of treatment, as are considerations of nutrition management.

Other eating disorders such as bulimia nervosa commonly co-occur with psychological conditions like depression, anxiety, and personality disorders. These comorbidities can be quite severe. It’s important to recognise that they may require separate consideration and should be factored into the treatment approach.

Eating disorder diagnosis should assess the patient’s body mass index, preference for certain foods or food groups, whether they are skipping meals or losing weight.

Cognitive behavioural therapy (CBT) for bulimia nervosa (CBT-BN) is the most extensively studied psychotherapeutic approach with the strongest supporting evidence. Consequently, it should be recommended as the primary treatment for individuals diagnosed with bulimia nervosa.

In many cases, individuals with binge eating disorder (BED) often seek treatment with the primary goal of addressing their concurrent obesity and achieving weight loss. This desire should be a central consideration when devising a treatment plan for BED, and it should be openly and thoughtfully discussed with the patient as part of the therapeutic process.

Warning signs (such as mental disorders, weight loss, and exercising excessively) and risk factors can become life-threatening for patients with eating disorders. Such patients should seek treatment early, and improve eating habits, and eating behaviours through cognitive therapy.

Most common eating disorders not only affect the body shape (weight and muscle loss) but also become life-threatening if the patient constantly has eating concerns.

Comprehensive Assessment and Personalised Treatment

Diagnosing any eating disorder is a meticulous process that involves a detailed assessment encompassing physical examinations, laboratory tests (blood tests), and psychological evaluations.

The diagnostic process is pivotal in pinpointing the specific disorder and understanding its severity to formulate a targeted treatment strategy.

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Therapy and Support at Castle Craig

At Castle Craig rehab clinic, individuals grappling with addictive disorders alongside mild bulimia nervosa or binge-eating disorder can find a haven for recovery. The clinic integrates the management of eating disorders into its addiction treatment programme, offering a nurturing environment where patients are cared for by a skilled multidisciplinary team.

An eating disorder specialist ensures that the overall well-being of the patient is the priority.

The treatment approach for any type of eating disorder is grounded in the understanding that eating disorders are illnesses where a problematic relationship with food has developed, often accompanied by negative body image, perfectionism, impulsivity, and low self-esteem.

The clinic employs a group and community-based cognitive behavioural therapy (CBT) approach, introducing patients to the 12 Steps of Obsessive Eaters Anonymous (OEA).

Nutritional Guidance and Diet

Understanding the pivotal role of nutrition in recovery, the clinic’s chefs craft three healthy and nutritious meals daily, alongside snacks. Patients with eating disorders are encouraged and supported to foster a pattern of normal eating, with the option to seek dietary advice from a dietician. The nutritional value of foods plays a significant role in providing enough calories through food.

Addressing Co-Occurring Issues

Eating disorders often co-exist with other mental health issues such as depression and self-harm, especially in individuals with anorexia. Castle Craig addresses these intertwined issues through a range of psycho-social interventions including 1:1, group, family and complementary therapies, supplemented by anti-anxiety and antidepressant medications when necessary.

Aftercare and Continued Support

As patients approach the end of their treatment, Castle Craig prepares them for the journey ahead with a personalised continuing care plan, formulated in discussions with the medical and therapeutic team. The clinic offers a 24-week online continuing care programme post-treatment, facilitating a smooth transition back into daily life. Moreover, patients become part of a recovery club, staying connected through annual reunions, events, online workshops, and recovery newsletters, fostering a community of support and understanding.

At Castle Craig, we’re here to help you navigate the challenges that come with mental health and addiction. We offer compassionate care, understanding, and healing in times of difficulty 

Our approach addresses the interconnected nature of mental health and addiction. Through a blend of therapies, including the empowering 12-step programme, we help you find strength and healing from within.

The decision to seek help is a powerful step towards reclaiming your life. Reach out to us today to explore our comprehensive treatment options. 

References

  1. https://www.nhs.uk/conditions/eating-disorders/
  2. https://pubmed.ncbi.nlm.nih.gov/32481615/
  3. https://pubmed.ncbi.nlm.nih.gov/31051507/
  4. https://pubmed.ncbi.nlm.nih.gov/18027859/

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