10.1 Eating Disorders
Anorexia Nervosa
Anorexia Nervosa is characterized by weight-loss or difficulty maintaining a healthy body weight for the individual’s body type. This is a life threatening mental health issue. Generally, individuals will restrict the number of calories they eat or types of foods. A person might engage in obsessive behaviors such as frequently weighting themselves, checking the mirror, or measuring food. Here, individuals want to feel in-control of their food which sometimes coinsides with perfectionism.
Signs and Symptoms
-loss of menstral period
-rapid weight loss
-preoccupation with calories or food
-gastrointestinal issues (ex. constipation, bloating)
-food rituals (ex. chewing and spitting)
-insomnia
-dizziness
-hair thinning
-dry skin
-changes in mood
-social withdrawal
-anemia
-feeling cold
-hiding eating
-excessive or rigid exercise routine
-inflexible thinking
DSM Diagnostic Criteria
- Intense fear of gaining weight (even if they are underweight)
- Denial of the seriousness of being underweight or disturbances in how the person experiences their weight
- Persistent behaviors that interfere with being a healthy weight
Jessica is a 20 year old young lady living with anorexia nervosa. Jessica was diagnosed in her first year of university. After a break up with her boyfriend, who she thought they would get married. Jessica had a past history of adverse childhood experiences and struggled with wanting approval from others. Jessica started to create food routines and food rules. Jessica would only consume liquids during the day (ex. caffine for energy). Then would have one meal at night. Jessica would also go to the gym and run at the same time every day or else she would panic. Jessica started to weight herself everyday and if her weight did not go down, she would cut out some of her meal. Jessica’s mind started to be consumed with thoughts of her weight and food. Jessica started to feel anxious and down. Jessica also noticed she was not able to sleep or go to the washroom well.
Bulimia Nervosa
Bulimia Nervosa is when an individual has frequent and recurring episodes of eating large amounts of food and then purging. Individuals may use laxatives, over exercise, induce vomiting, fast or use diuretics. Individuals tend to feel out of control. People at any body shape or size can be struggling with Bulimia Nervosa.
May is the mother to Susie who is a 13 year old girl. May is worried about her daughter. May recently found her daughter vomiting in the bathroom after dinner. May started to pay attention to Susie’s behavior and noticed that this was happening after every meal. Susie started to hide in her room and would eat large amounts of food then go to the washroom to purge. May did not understand this behavior and was worried about her daughter and the cost of food. May reached out to her doctor who referred May to a social worker.
Signs and Symptoms
-eating a large amount of food
-going to the washroom after eating
-damaged teeth and gums
-sore throat
-bowel issues
-acid reflux
-electrolyte imbalance (dizziness)
Binge Eating Disorder
Binge eating disorder can drastically impact a person’s health. This disorder can lead to heart disease, type two diabetes, obesity, and other chronic conditions. This is where a person eats a large amount of food (past the point of full and comfort) in a short period of time and often feel out of control. These behaviors can be coupled with feelings of shame, guilt and disgust. In these cases, people do not tend to go to purging behaviors.
Case Study
Jimmy struggles with his eating. Jimmy tends to eat more when he feels sad and alone. Jimmy does not eat breakfast or lunch but will eat late at night. Jimmy finds he will have his normal dinner but then later will eat boxes of cookies, bags of chips, candy etc. Even though Jimmy feels full, Jimmy finds he cannot stop eating. Jimmy feels ashamed and upset with himself after these eating episodes happen. Jimmy will then restrict his food the next day but the same pattern happens at night.
What eating disorder is Jimmy struggling with? What do you notice about Jimmy’s experience? How can you as a social service worker support Jimmy?
Diagnostic Criteria
A person must have recurring being episodes, eat a significant amount of food in a short period of time with a feeling of lack of control (like the person is unable to stop eating). Binge episodes occur at least once per week for at least three months. A binge episode must include at least three of the following: eating faster than usual, eating way past the point of full, eating large amounts of food even though they do not feel hungry, eating alone due to feeling ashamed, having feelings of depression or guilt after an episode (NEDA, 2022).
Symptoms
-uncomfortable eating around others
-social withdrawal
-yo yo dieting
-creates schedules around binge episodes
-skipping meals during the day
-frequent body checking (ex. in the mirror)
-feeling low self-esteem, depressed, shame
-weight fluctuations and stomach cramps
Emotional Eating
Emotional eating refers to an individual eating when they are not physically hungry due to emotions. Individuals might eat in response to emotions such as loneliness, bordem, happiness, to feel safe, sadness, anxiousness, or other. In general, an individual may emotionally eat for comfort but after the episode the emotions do not usually subside.
The emotional eating cycle may look like: a situation happens that triggers an emotion, you feel the emotion and an overwhelming urge to eat, you eat past the point of hungry, which leads to more emotional feelings. What can happen is people start to feel worse and emotions can build if the cycle is not broken.
Some causes of emotional eating might be stress, not having helpful skills to manage emotions, childhood habits, or social influences.
Signs and Symptoms
-urges to eat when not hungry
-eating past the point of full
-gaining weight
-emotional disturbances (feeling depressed, guilty, ashamed)
-sneaking foods
-craving foods (ex. sugar or salty)
Activity
Take a moment to research the symptoms, diagnosis, causes and treatments of the following:
Unspecified Feeding or Eating Disorder
Other Specified Feeding or Eating Disorder
Rumination Disorder
Avoidant Restrictive Food Intake Disorder
Causes
There is not one specific cause for eating disorders. People of any age, gender, sexuality, and culture can develop an eating disorder. There is believed to be a link to having a perfectionism mindset. People being engaged in activities such as sports (ex. figure skating, dance, etc) and modelling have a higher change of developing an eating disorder. A person who has experienced adverse childhood experiences, trauma, or family conflict can be at risk.
More research is being done to see if there are brain patterns or DNA changes that can be a factor in developing eating disorders.
Treatments
Individuals may benefit from a combination of nutritional therapy, group therapy, social supports, and individual therapy. Therapy might involve using CBT to help with challenging thoughts and behaviors, trauma therapy to work through past trauma, somatic therapy to work on calming and feeling more comfortable in one’s body. Medications might include antidepressants or antipsychotics to help with stabalizing one’s mood.
Culturally Sensitive Eating Disorder Care
Eating disorders and disordered behavior can be perceived differently among cultures. People at any body type can engage in these behaviors. When looking at culturally sensitive care, it is important to look at different elements of ethnicity, beliefs, practices, economic status, sexual orientation and traditions. For example, if we look at trauma when it comes to slavery, people’s bodies were used for labor (Maharja et al, 2023). The values on body and food vary among cultures. Westernized cultures tend to place an emphasis on beauty in a thinner body type where non westernized cultures see larger bodies as beautiful. Similarly, people living in a higher socioeconomic status have been seen to view smaller body types as attractive and lower socioeconomic statues to having larger body types. This is different historically, where in the 1800s larger women were seen as attractive due to being able to survive harsher climates and rear children. Some people believe that eating disorders can be considered a culture bound syndrome. Another theory is that epigenetics can play a role in eating disorders due to the oppression, deprivation, and violence of different groups/cultures (Maharja et al. 2023). It is important to remember that a person’s body size and food habits can make them feel marginalized from society.
It is also important to look at cultural considerations when it comes to eating disorder treatment. For example, what is considered a healthy recovery might vary among cultures and societies. Another consideration is are the models used to define obesity, health, disordered eating rooted in Westernized values and beliefs? Do they take into consideration body trauma and the social determinants of health?
According to Maharja et al (2023), culturally sensitive principles include: creating a safe environment, understanding that there can be intergenerational impacts of eating disorders, understanding structural barriers to eating disorders, communicating risks and treatment appropriately, being mindful of power dynamics, creating space for conversations about culture
Reflections
- What can you as a social service worker do to support a client and their family living with an eating disorder?
- How might current societal views either perpetuate or discourage eating disorders or body image?
- What is the diet culture? How does it impact eating disorders? What can social service workers do to combat diet culture?
Resources
Maharja, A., Tam, E., Hundal, A. (2023). Let’s talk about culturally sensitive eating disorder care. NEDIC. Retrieved September 23, 2023 from https://nedic.ca/media/uploaded/NEDIC_-_Lets_Talk_About_Culturally-Sensitive_ED_Care.pdf
https://nedic.ca/culturally-sensitive-care/
National Eating Disorder Association. (2022). Binge eating disorder. Retrieved August 20, 2023 from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed
National Eating Disorder Information Center. (2023). Anorexia Nervosa. Retrieved August 5, 2023 from https://nedic.ca/eating-disorders-treatment/anorexia-nervosa/
Statistics Canada. (November 27, 2015). Section D- Eating disorders. Retrieved August 5, 2023 from https://www150.statcan.gc.ca/n1/pub/82-619-m/2012004/sections/sectiond-eng.htm
