Eating Disorders Diagnosis and Treatment

It is important to understand how eating disorders are diagnosed and treated. Learn more in this article.  

Table of Contents

What Is an Eating Disorder?

Eating disorders are the deadliest mental health condition a person could struggle with. There are several kinds of eating disorders, and it is not always obvious to outsiders if a person is struggling with this issue.
According to the American Psychiatric Association, “eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.”1 Normally, eating disorders begin during early adulthood or adolescence. This issue tends to be more common among young women, but it can affect people of all ages and genders.
Food disorders can have a huge impact on a person’s life, inhibiting their “physical, psychological, and social function.”1 There are multiple kinds of eating disorders, and they each have unique characteristics. The main types are bulimia nervosa, anorexia nervosa, and binge eating disorder. Many times, eating disorders will occur alongside other things such as OCD, anxiety, depression, or substance use disorder. 1

Eating Disorder Facts

There are several myths surrounding eating disorders. It is very important to make sure that, when researching them, you are focused purely on the facts and not the stereotypes. Here are a few different food disorder facts:

  • Around 5% of Americans struggle with food disorders,1 coming out to roughly 30 million people. 
  • Eating disorders affect someone’s physical and mental health. This issue is best defined as having “unhealthy relationships with food and serious disturbances in eating behaviors.” It should be taken very seriously because of this.2
  • There are multiple risk factors including stigmas around weight, trauma, dissatisfaction with one’s body image, and genetic history of mental health disorders.2
  • Approximately 71% of people who struggle with eating disorders have a co-occurring condition, normally anxiety or a mood disorder.2
  • One person dies due to an eating disorder within the United States every hour.2 As such, food disorders are the deadliest mental health disorders.
  • Sadly, research into this issue is the least funded in the United States. Anxiety research receives 500% more money and depression research receives over 1,000% more funding.2
  • Only 10% of people that suffer from an eating disorder ever seek out treatment.
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  • Around 95% of people who struggle with a food disorder are between twelve and twenty-five years old. 3
  • Malnutrition, which is a result of eating disorders, can harm vital organs within the body.3
  • Eating disorders are the result of both genetic and environmental factors. 3

Common Types of Eating Disorders

There are three primary eating disorders that people struggle with, which are anorexia nervosa, bulimia nervosa, and binge eating disorder. 

Anorexia Nervosa

When people think of eating disorders, anorexia is normally the first one that comes to mind. Anorexia nervosa tends to be more common among adolescent women.4 A person who struggles with this kind of food disorder normally has a belief that they are overweight even if they are severely underweight.

 

Anorexia normally leads to behaviors such as monitoring one’s weight frequently, restricting calories to a dangerously low level, or avoiding specific foods. Some common symptoms are denial, distorted body image, fear of weight gain, restricted calorie intake, and an unhealthy pursuit of being thin or skinny.

Bulimia Nervosa

Bulimia tends to be a back-and-forth disorder that starts with a person binge eating a lot of food that they would normally avoid. Afterward, they will “attempt to purge to compensate for the calories consumed and relieve gut discomfort.”4

 

Some common ways a person might try to compensate are by vomiting, using laxatives, fasting, or excessively exercising.4 

 

This disorder is also more common among adolescent women. An individual that struggles with bulimia nervosa might feel like they cannot control their food intake. In addition, there is typically a fear of weight gain if the person is at a healthy weight or underweight.

Binge Eating Disorder (BED)

Binge eating disorder is like bulimia in the aspect that a person feels like they do not have control over the amount of food they intake. Normally, a person with BED will eat overly large quantities of food. They might use things such as exercise or vomiting to help, but they normally do not restrict their caloric intake to compensate for their food binges.4

 

A person with a binge eating disorder will eat a lot of food in a short period, sometimes in secret, until they are uncomfortably full. People with binge eating disorders might also struggle with feeling shame or disgust over their binge eating habits. The main difference between bulimia and binge eating disorder is that the person does not use a purging technique. Someone with BED normally struggles with obesity and is at risk of heart disease and diabetes.4 

Other Types of Eating Disorder

Pica

Pica is a condition where a person eats things that are not food. A person who struggles with pica might eat things such as dirt, soap, hair, laundry detergent, or several other non-food items. People that struggle the most with pica are pregnant women, a person that struggles with a mental disability, or children.

 

Because the things being consumed are not meant to be ingested, people with pica run the risk of poisoning, malnutrition, and gut injuries. Pica can be fatal depending on what the person is consuming. Finally, a person can only be diagnosed with pica if the substance they are ingesting is not socially acceptable or a part of a culture/religion .

Rumination Disorder

A person with rumination disorder will regurgitate their food after they have chewed it or swallowed it. Afterward, they re-chew it before either swallowing it once again or spitting it out. Normally, this issue occurs within the first half-hour after someone has eaten a meal. It is a voluntary regurgitation and not something caused by reflex. 

 

This eating disorder can occur during infancy, but it normally goes away. For children and adults, behavioral therapy is often necessary to resolve the issue. A person who struggles with rumination disorder might limit how much they eat in public, leading to them losing weight or remaining underweight.

Avoidant/Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder, better known as ARFID, was formerly known as a feeding disorder that occurred during infancy or early childhood. The term changed because the condition can last into adulthood.

 

A person that has ARFID will stop eating due to either a lack of interest in eating or a strong “distaste for certain smells, tastes, colors, textures, or temperatures.” A person with ARFID will experience side effects such as not getting enough calories, struggles with eating around others, weight loss, or nutrient deficiencies.4 It is an abnormal amount of avoidance that goes further than just someone being a picky eater. 

How to Diagnose Eating Disorders?

Because eating disorders are both physical and mental health disorders, a doctor and a mental health professional will normally work together to diagnose the specific disorder. If your primary physician believes you might be struggling with a food disorder, they will normally perform some different tests and exams to find a diagnosis. 5 

Physical Exam

Doctors often begin with a physical exam. During this exam, they will rule out other causes regarding a person’s troubles with eating. After the physical exam, the doctor might run a few lab tests to also check for other side effects/factors. 

Psychological Evaluation

Doctors will also give a psychological evaluation. Depending on your provider, they may send you to a mental health professional for this part. During a psychological exam, they will ask about your eating habits, feelings, and thoughts as they pertain to food and your body image.5 A mental health professional will use the DSM-5 to see if you match the criteria regarding an eating disorder. 

Other Assessments

Doctors might also run other assessments to see if there are any complications due to the possible food disorder. They may check for malnutrition or organ damage. These tests will vary depending on the individual and what side effects or behaviors they are currently struggling with. 5 

Emotional and Behavioral ED Symptoms

There are several emotional and behavioral warning signs of an eating disorder. If you or a loved one are presenting some of these symptoms, it would be best to see a doctor for an evaluation. Some include:

  • Fear of gaining weight 
  • Extremely negative self-image or body dysphoria 
  • Phobia of eating in public 
  • Refusal to eat or restricting calories 
  • Odd food rituals 
  • Disappearing after consuming food, normally to a bathroom 
  • Withdrawal 
  • Frequent excuses for why they are not eating 
  • No concern or pride in excessive weight loss, especially when they are underweight 
  • Apathy 
  • Irritable 
  • Restless 
  • Frequent mood swings 
  • Extreme anxiety when routines are interrupted 
  • Excessive exercise 

Physical Warning Signs of Eating Disorders

People who struggle with eating disorders might present a variety of physical warning signs as well. It is important to pay close attention to these things if you fear that you or a loved one might be struggling with an eating disorder. Some side effects include:7

  • Fluctuations in weight, either gaining or losing 
  • Missing periods or irregular periods 
  • Extreme dizziness 
  • Troubles concentrating 
  • Stomach cramps 
  • Issues sleeping 
  • Cuts or calluses on finger joints 
  • Dental issues 
  • Always feeling cold 
  • Lab abnormalities 
  • Muscle weakness 
  • Wounds take longer to heal or do not heal well 
  • Weaker immune system 
  • Dry hair and skin 

Why Are Eating Disorders Often Misdiagnosed?

There are many reasons why eating disorders tend to be misdiagnosed. For one, they normally are co-occurring disorders alongside other mental health issues. Therefore, doctors might focus on things such as anxiety or mood disorders while overlooking the eating disorder. Additionally, there is shame and stigma around eating disorders. A person might not disclose if they are struggling.

 

Finally, doctors might be unfamiliar with the symptoms. Aspects such as low iron or missed menstrual cycles can be odd occurrences, which might lead a doctor to think of different conditions before looking into a person’s relationship with food.

Symptoms that Mimic Eating Disorders

Although there are risks in not properly identifying an eating disorder, there are just as many risks in falsely identifying one. For example, people that struggle with food restrictive disorders could also struggle with eating disorders. Celiac disease has similar symptoms to someone who might be struggling with anorexia.

 

A person with an illness anxiety disorder might show symptoms of eating disorders due to a preoccupation of having serious, undiagnosed health issues. Many of the symptoms of eating disorders overlap with other issues. If a doctor is not trained or well-researched, it makes sense why a misdiagnosis might occur. Factors such as body dysmorphic disorder and achalasia are not things that doctors might think of right away.

How Misdiagnosis Can Be Counterproductive To Treatment

A misdiagnosis can lead to treatment that might be counterproductive. For example, if a person has Celiac disease that is misdiagnosed as anorexia, their doctor might encourage them to eat foods that their body has a negative reaction to.

 

Moreover, by not recognizing a food disorder, a doctor could be setting their client up for further denial that they might have a problem. Because eating disorders can be fatal, it is important to make sure they are properly diagnosed in a timely manner.

Treatment for Eating Disorders

There are multiple different ways to treat eating disorders. Depending on which one a person may have or the severity of it, doctors might use a variety of treatments. 

Healthy Eating

Doctors tend to use nutrition education to teach people with eating disorders how to create healthy eating habits. They might have the patient begin to see a dietitian to create a meal plan. The patient will use these new habits to work toward a healthy weight.

During these sessions, the patient will learn about how nutrition impacts their body. Doing things such as establishing normal eating patterns helps a significant amount. Doctors will also begin to work with the patient to avoid habits such as dieting or binge eating. 8

Psychotherapy

Psychological therapy is one of the most beneficial steps in any treatment plan for a person that is struggling with an eating disorder. The person that is struggling with the food disorder will begin to see a psychologist regularly.

 

During this time, they will discuss things such as normalizing eating habits, replacing unhealthy behaviors with healthy ones and learning coping mechanisms. Because eating disorders tend to co-exist with other mood and anxiety disorders, doctors might also work on that as well.

Family-Based Therapy (FBT)

One kind of psychotherapy is family-based therapy. Because eating disorders can be caused by genetic and environmental factors, the family needs to become involved with the treatment process. Members within the family will learn ways to help the patient create healthier eating patterns and to achieve a healthy weight. It is an extremely effective method for parents of teenagers.

Cognitive-Behavioral Therapy (CBT)

Doctors might also use cognitive-behavioral therapy. CBT focuses on a person’s behaviors, thoughts, and feelings. Once they have identified them, CBT prepares them to replace their unhealthy behaviors and thoughts with healthier ones. CBT is great at helping a patient notice their distorted thoughts that led to their eating disorder in the first place, and then it gives them strategies to change those thoughts. 8  

Medications

A doctor might suggest using medications alongside psychotherapy to help a patient. Normally, doctors will prescribe an antidepressant. However, doctors might prescribe a different medication depending on the symptoms and the specific eating disorder. Sometimes, people with eating disorders might need medications to help with other health problems caused by their food disorder. 

Hospitalization

Finally, if a person has serious physical or mental health problems, doctors may suggest temporary hospitalization. Hospitalization is common among severe or life-threatening health issues that need immediate attention. The goal is to stabilize the person’s condition. Most of the treatment will take place outside of the hospital. There are day treatment programs and residential treatment programs for people that struggle with eating disorders if they need a more intense plan. 8

JFHI Concierge Approach to Diagnosis and Treatment

The goal of JFHI’s concierge approach to diagnosis and treatment is to put their client’s needs first. This approach is great for both adults with busy schedules and adolescents or children that need to program that is focused on their individual needs and problems.

Comprehensive Diagnostic Evaluations

JFHI starts with a comprehensive diagnostic evaluation to ensure that they give a clear and accurate diagnosis. The goal of a comprehensive diagnostic evaluation is to identify every need a person might have, so they can receive a treatment plan that identifies everything.9 It allows doctors to treat complex cases thoroughly and successfully.

Specialty Consults

Specialty consults are when a person’s primary physician seeks input from specialists in different areas to make sure the patient is getting the best care possible. J. Flower Health Institute’s system for comprehensive diagnostic evaluation eliminates most of the issues that come with specialty consults. 10 

Doctors Educate the Patient on Specialty Consults

During the process, the doctors at JFHI will educate the patient on the process. Doctors will talk to the patient about the different barriers they might face, the appointment process, and allow the patient to choose a specialist if they have experience with a specific one. 

J. Flowers Health Institute’s Treatment Advantages

One of the biggest advantages to J. Flowers Health Institute’s treatment is that they have a team of specialists available to help primary care physicians with treating everyone’s unique case. The goal of JFHI is to be a cohesive multidisciplinary team. If you have any questions about treating eating disorders or have questions, reach out to J. Flowers Health Institute to see what the best treatment plan will be for you.