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Eating Disorders

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Tens of millions of Americans currently struggle with eating disorders, and the problem appears to be growing. Teenage girls and young women are the most commonly affected, but eating disorders occur in both genders, and all ages and ethnic backgrounds worldwide. Many people go undiagnosed because they conceal their illness.

Many factors contribute to the development of eating disorders and they manifest in many different ways. Eating disorders are caused by “a complex interaction of genetic, biological, behavioral, psychological and social factors,” according to the National Institute of Mental Health. Major symptoms include undereating, overeating, binging, and/or purging. Though the causes and symptoms differ, most people with an eating disorder share one common problem: a negative body image.


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Body image

Body image distortions are part of the diagnostic criteria for eating disorders. The American Psychiatric Association’s 2012 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), defines body image distortions as a “disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.”

Body image distortion is not the same as body dysmorphic disorder, in which a part or parts of the body are perceived to be unacceptable and deformed when they are not. For example, a person with body dysmorphic disorder might seek amputation of a normal limb to feel “whole.” Body image distortion is a dislike of one’s own physical characteristics. No one likes everything about their body, but when thoughts become obsessive and the resulting behaviors interfere with daily activities, body image distortion becomes a problem.

A study analyzing existing scientific knowledge on the relationship between body image and eating disorders found that dissatisfaction with appearance had the most impact on body image rather than distortions in size perception. Negative body image can lead to low self-esteem and poor mental and physical health.

Symptoms of eating disorders

In addition to having negative body images, people with eating disorders experience other symptoms that help to classify specific diagnoses. The following are descriptions of the most common eating disorders, according to the DSM-5:

  • Anorexia nervosa

Anorexia nervosa is self-starvation, or the “restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.” There is an “intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.” Severity is based on calculation of the body mass index being below 15 percent of minimum expected weight for height.

Other signs and symptoms of anorexia include:

  • Elaborate food preparation and eating rituals
  • Excessive exercise
  • ­Amenorrhea (absence of menstruation)
  • Cold intolerance
  • Constipation, bloating
  • Fatigue, weakness
  • Cognitive impairment
  • Hair loss or thinning
  • Growth of lanugo (soft, fine newborn-like hair) on extremities, face and trunk
  • Bulimia nervosa

Bulimia nervosa includes both eating large amounts of food within a short period of time and feeling out of control while doing so. Bulimia is the “recurrent inappropriate compensatory behaviors 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 compensatory behaviors both occur, on average, at least once a week for 3 months.” Severity is graded by number of episodes per week.

Other symptoms of bulimia include:

  • Sore throat
  • Tooth sensitivity
  • Eroded tooth enamel
  • Gum disease
  • Calluses, abrasions, bruising on hand and thumb
  • Swollen but nontender parotid glands (large salivary glands in front of the ears)
  • Abdominal tenderness
  • Ankle swelling
  • Binge-eating disorder

Binge-eating disorder is characterized by “recurrent episodes of binge eating a large amount of food within a 2-hour period.” Those with binge-eating disorder feel a loss of self-control over what and how much they consume. During an episode, they eat “very rapidly, eating until uncomfortably full, eating when not physically hungry, and eating alone due to embarrassment over the large quantity being eaten, and feeling disgusted, depressed, or very guilty afterward. Marked distress is present. The binge eating occurs at least once a week for 3 months.” Severity is graded according to the number of binges per week.

Other symptoms of binge-eating disorder include:

  • Weight gain or fluctuations in weight
  • Depression
  • Anxiety
  • Compulsive self-harm behaviors, which may or may not be present, such as hair-pulling or skin-picking
  • Pica consists of eating nonnutritive, nonfood substances, such as soap or paper
  • Rumination disorder is the persistent regurgitation of food without any gastrointestinal disorder, and can occur at any age
  • Avoidant/restrictive food intake disorder can also occur at any age and is characterized by the avoidance or restriction of food consumption to the point at which nutritional needs are not met, but symptoms do not meet full criteria for anorexia nervosa
  • Unspecified feeding or eating disorder occurs when eating disorder symptoms are present, resulting in impaired functioning, but do not meet full criteria for any specific disorder
  • Night-eating disorder is excessive eating after the evening meal or waking up during the night to eat. Behavior occurs along with feeling a loss of control, guilt, and self-loathing

Mental and physical costs of eating disorders

Mental and physical costs of eating disorders depend on the causes, symptoms, duration, and severity of the illness. Problems not only affect the person with the disorder, but all of the people in his or her life. Some examples include:

  • Infertility
  • Tooth and gum disease
  • Gastrointestinal disorders
  • Neurological damage
  • Multisystem organ failure
  • Type 2 diabetes mellitus
  • Impaired functioning in family, school, work and social roles
  • Damaged relationships with family and friends
  • Death from heart failure, organ failure, malnutrition and suicide

Underlying disorders

Eating disorders rarely occur in the absence of other emotional disturbances or mental illnesses. The most common underlying or co-occurring disorders are as follows:

  • Depression
  • Anxiety
  • Post-traumatic stress disorder
  • Substance use disorder
  • Underlying mental illness

Treatment at Sovereign

Eating disorders are life-threatening illnesses that tend to get worse over time without intervention. Currently only 1 in 10 receives any treatment at all, and only 35 percent of those who receive treatment are managed in a specialized facility. Since eating disorders have one of the highest mortality rates of all mental health disorders, prompt diagnosis and treatment is essential.

The Sovereign Health Group currently offers treatment for eating disorders at two California locations: our flagship location at San Clemente and our teen treatment center at Rancho San Diego. At our San Clemente location, we provide residential treatment for adult women who are struggling with anorexia nervosa and bulimia nervosa. At our Rancho San Diego location, we also provide treatment for both that is specifically geared toward adolescent girls.

In both our San Clemente and Rancho San Diego facilities, we offer cognitive behavioral therapy and dialectical behavioral therapy, two forms of evidence-based treatment that have been found to reduce the symptoms associated with eating disorders. We also offer nutritional education, mindfulness/yoga, body image therapy, stress management, empowerment skills, art therapy and equine therapy. Group outings occur on a regular basis.

Our specially trained, onsite dietitian helps patients plan out their meals. These individualized meal plans are designed to help our patients understand their personal nutritional needs and accept food as a welcome part of living. Our clinicians also help patients shop for food and participate in dining excursions.

The Sovereign Health eating disorders program provides partial hospitalization and intensive outpatient levels of behavioral health service.

Sovereign Health of California treats patients with eating disorders utilizing individualized care plans tailored to their specific needs. We use state-of-the-art techniques to treat co-occurring illnesses, such as depression, anxiety and substance use disorders. Our treatment team works together with women and their families to find a solution that works for them. For more information about eating disorders or our program, please call our 24/7 helpline.

We offer weekly National Association of Anorexia Nervosa and Associated Disorders (ANAD) meetings to support individuals with eating disorders and their families. These meetings are open to the public and occur in our main office each Wednesday from 6:30 to 7:30 p.m.


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