Unraveling the Tapestry: Understanding Contemporary Eating Disorders
Imagine a scenario in which a teenager is plagued by insecurities and bombarded by images of airbrushed perfection. She starts to focus on what she eats and almost every time it is a battle for her not to count each calorie to obtain a flawless physique. But, it is not just about chasing the flawless physique, it’s about seeking control in the world that is spinning completely out of her hands. As they internalize these ideals, their self-esteem takes a hit, which pushes them into the labyrinth where there's a lot of pressure to be what they call "beautiful." But, behind this pressure hides a big problem: eating disorders. Eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions (“What are eating disorders?” n.d., pg.1). They can be very serious conditions affecting physical, psychological, and social function. Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and eating disorders. The cause of eating disorders has several reasons, such as genetics, environmental factors, psychological factors, or even epigenetics. The National Eating Disorders Association helpline has had a 40 percent jump in overall call volume since March 2020 (Damour, 2021). In navigating the complexities of eating disorders, it is evident that a multifaceted approach is necessary to address their underlying causes and provide meaningful support to those affected as these disorders are often misunderstood, stigmatized, and overlooked, despite their potentially lethal consequences. Delving deeper into this topic will reveal various solutions to these complex disorders.
The first and foremost solution for the eating disorder issue is to approach psychotherapy. Many individuals with eating disorders have underlying psychological issues such as low self-esteem, trauma, anxiety, and depression (Attachment A). Research indicates that eating disorders are one of the psychological problems least likely to be treated (Wright State University, n.d., pg. 1). People who are suffering from eating disorders do not get themselves treated because there is a factor of being hesitant and judged by society. Only an “estimated 25 percent of people with an eating disorder in the US receive treatment” (Powell 2021, pg.1). There are many reasons at play, says Cara Bohon, a psychologist at Stanford University School of Medicine, “There is a lot of denial, guilt, shame and hiding of the problem. And there is still stigma around getting treatment.” (pg.1). Psychotherapy helps in treating eating disorders by uncovering and addressing the underlying psychological issues that contribute to disordered eating behaviors.
Controlled studies have shown cognitive behavioral therapy (CBT) to be the most effective treatment for adults with bulimia and binge-eating disorder (Powell 2021, pg. 1). It is a therapy in which eating disorders are treated by targeting distorted thinking patterns, implementing behavioral strategies, and encouraging self-monitoring to identify triggers and patterns. For example, the person might be asked to monitor all events around eating — not just what they ate and when, but the location, whether it was with others, and the emotions before, during, and after (pg. 1). Another assignment might be to take notice of what activities triggered bodychecking in mirrors or negative body image thoughts (pg. 1). “That helps them to see that it’s them making changes, rather than the therapist prescribing changes,” says psychiatrist Stewart Agras of Stanford University (pg. 1). However, it's important to note that while CBT can be highly beneficial for many individuals, it might not work for everyone or may not fully resolve the disorder on its own.
Eating disorders often involve complex psychological, emotional, and social factors. While CBT addresses many of these factors, some individuals may have underlying issues that require additional or different therapeutic approaches. But, for all the evidence behind CBT, it leads to recovery in “only about 60 percent of those treated for binge-eating disorder and 40 percent of those treated for bulimia” ((Powell 2021, pg. 1). For anorexia, all treatment methods combined result in recovery for “just 20 percent to 30 percent of people” treated. “That’s clearly not good enough,” says Cynthia Bulik, “who is looking for more effective treatment possibilities by studying the genetics that underlie eating disorders” (pg. 1). It concludes that CBT does not work for all patients who are taking this therapy.
Another solution for the underlying problem of eating disorders is to take nutritional counseling. Nutrition counseling, also referred to as nutritional counseling, food counseling, or nutrition therapy, is a form of eating disorder treatment that is part of a comprehensive, multidisciplinary treatment plan (Riebl, n.d., pg.1). The dietitian/nutritionist will offer emotional support, as well as providing correct nutrition education and addressing nutrition misinformation and eating disorder beliefs (1). Nutritional therapy is often paired with CBT and Dialectical Behavioral Therapy (DBT). This helps round out an individual's healing experience, not only helping them relearn how to eat adequately but also helping them understand why they might engage in harmful eating behaviors and giving them tools to change these behaviors (1). Carolyn Costin stated that “eating disorders are not about the food, but they are about the food”, capturing the need for a multidisciplinary eating disorder treatment team consisting of medical practitioners, mental health professionals, and dietitians (Jeffery & Heruc,2020, pg.1). This makes it clear that having a proper nutritional diet plan helps individuals by developing healthier eating habits and regain control over the relationship with food by addressing nutritional imbalances.
Certainly, while nutritional therapy is recognized worldwide as a beneficial method of eating disorders, there is an argument against it that nutrition therapy might place too much emphasis on weight and food, potentially leading to approaches such as a high-calorie approach in which the patient is guided to eat to achieve a certain weight (Byrnes et al, n.d., pg. 1). Emerging evidence from studies with adult eating disorder populations details an equally dangerous “underfeeding syndrome,” characterized by the “slow achievement of nutritional goals, high rates of relapse, premature withdrawal from treatment, and even death, underscoring the need for accelerated nutrition protocols” (pg. 1). Studies have found that compared to patients without refeeding syndrome, patients with the syndrome have an “increased mortality rate and are more likely to be admitted to the intensive care unit” (Dennis,2024, pg. 1). It is important, therefore, to be aware of the signs, symptoms, and risk factors of this serious condition and to seek specialized medical care as soon as possible.
Eating disorders are complex mental health conditions that require comprehensive understanding and support. Eating disorders are complex conditions that arise from a combination of long-standing behavioral, emotional, psychological, interpersonal, and social factors. While these disorders may begin with preoccupations with food and weight, they are most often about much more than food. Eating disorders can be devastating, but with treatment and support, they can be conquered. Lastly, raising awareness about eating disorders and combating stigma are vital for promoting understanding, empathy, and access to resources for those affected.
References
Brynes, N., Tar chichi, T., McCormick, A. A., & Downey, A. (2021, July 1). Restrictive eating disorders: Accelerating treatment outcomes in the Medical Hospital. American Academy of Pediatrics. https://publications.aap.org/hospitalpediatrics/article/11/7/751/179872/Restrictive-Eating-Disorders-Accelerating?autologincheck=redirected
Damour, L. (2021, April 28). Eating disorders in teens have “exploded” in the pandemic. The New York Times. https://www.nytimes.com/2021/04/28/well/family/teens-eating- disorders.html
Dennis, K. (2024, March 4). Eating disorders and refeeding syndrome. National Eating Disorders Association. https://www.nationaleatingdisorders.org/eating-disorders-and- refeeding-syndrome/
Eating disorders: Psychotherapy’s role in effective treatment. Eating Disorders: Psychotherapy’s Role in Effective Treatment | Counseling & Wellness Services (CWS) | Wright State University. (n.d.). https://www.wright.edu/counseling-and-wellness/article/eating-disorders-psychotherapys-role-in-effective-treatment
Jeffrey, S., & Heruc, G. (2020, November 17). Balancing Nutrition Management and the role of Dietitians in eating disorder treatment. Journal of eating disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672860/
Powell, K. (2021, December 17). The search for a better treatment for eating disorders. Smithsonian.com. https://www.smithsonianmag.com/innovation/search-for-a-better- treatment-for-eating-disorders-180979255/
Riebl, S. (n.d.). Nutrition counseling for eating disorders. Nutrition Counseling for Eating Disorders. https://withinhealth.com/learn/articles/nutrition-counseling
What are eating disorders? Psychiatry.org - What are eating disorders? (n.d.-a). https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
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