Eating disorders are serious mental illnesses that can be fatal. An Eating disorder is characterized by an intense need to control one’s food intake and weight either through starving oneself or purging.
Some food disorders do not involve purging but do involve the irregular intake of food. According to the National Alliance on Mental Illness (NAMI) “most experts now believe that these disorders are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food.” Persons with these disorders often seek to achieve or maintain a very low body weight to fulfill an image they believe is desirable in society. These disorders are less about food and more about feelings of worthlessness.
What is an Eating Disorder?
According to the Journal of the American Medical Association, “1 in 7 male individuals (14.3%) and 1 in 5 female individuals (19.7%) experience a food disorder by age 40 years.” Sadly, every hour one American will die from complications from this disorder. Causes of death include heart attacks, gastrointestinal damage, and suicide.
Women are diagnosed with eating disorders more often than men, but both genders can develop a compulsive eating habit. Men often are diagnosed later than women because of the stigma of seeking treatment or under-recognition that men are affected by this disease as well.
Transgender individuals do have higher rates of eating disorders than cisgender persons. Eating disorders are more common in teens and young adults, but a growing number of middle-aged people are being diagnosed with eating disorders. There are no differences in disease onset by race or ethnicity or income.
Types of Eating Disorders
Anorexia nervosa is one type of disorder that involves an intense restriction of caloric intake through extreme dieting or exercise. Individuals with anorexia may even purge their food through induced vomiting or diarrhea. They have a distorted view of what the ideal body weight and shape should be and will do anything to achieve this ideal. There are more fatalities associated with complications from anorexia than bulimia and some estimates place mortality rates at 10% for anorexia.
Bulimia nervosa is slightly different from Anorexia nervosa in that it includes binge eating along with purging. Persons with bulimia may appear to have normal body weight, unlike those with anorexia; however, they too will seek to control their weight through induced vomiting or diarrhea, reduced caloric intake, or excessive exercise.
Binge Eating Disorder (BED), now recognized by the DSM-V, is characterized by eating large quantities of food, sometimes quite rapidly, beyond the point of feeling satiated. Purging is not a characteristic of BED but people with this disorder often feel guilty or ashamed after bingeing.
Persons with BED are more likely to be overweight but maybe underweight as well. They may not always gain substantial amounts of weight because they may cut out entire food groups or engage in dangerous forms of dieting, in addition to bingeing. There are indications that BED is more prevalent than anorexia or bulimia, and it affects males almost as frequently as females.
What is qualified as anorexia?
Anorexia is a disorder characterized by abnormally low body weight, a fear of gaining weight, and a distorted perception of body weight. People with anorexia usually severely restrict their food intake and may also exercise excessively or engage in other unhealthy weight-control behaviors, such as vomiting or abusing laxatives.
Symptoms of Food Disorders
According to the Mayo Clinic, some symptoms of anorexia include being extremely underweight, fatigued, and having low blood pressure, the erosion of tooth enamel due to vomiting, or hair loss. Individuals with binge eating disorders often exhibit a preoccupation with controlling their weight and exercising.
Those with bulimia, according to the Mayo Clinic, may exhibit “repeated episodes of eating abnormally large amounts of food in one sitting; and feeling a loss of control during bingeing” like they can’t stop eating or control what they eat.
Individuals with BED may be obsessed with their appearance, not want to eat socially, and schedule their lives around bingeing. Their weight may fluctuate a lot and they may lose their concentration because of the uneven intake of calories. BED can lead to obesity as well as kidney and heart disease due to the rapid fluctuations in weight and stress on the internal organs.
Diagnosing and Treating Eating Disorders
Social workers should use diagnostic criteria from the DSM-V to assess whether a patient has a problem and needs eating disorder treatment. They should also use diagnostic instruments such as the food Disorder Inventory, the SCOFF Questionnaire (Sick, Control, One, Fat, Food), the Eating Attitudes Test, or the Eating Disorder Examination Questionnaire (EDE-Q).
Social workers who diagnose an begin treating eating disorders should evaluate a client for other mental health issues as well. According to the Anxiety and Depression Association of America, body image disorders often co-occur with anxiety disorders, and therefore all conditions need to be diagnosed so treatment will succeed. Other conditions eating disorders often co-occur with include depression, obsessive-compulsive disorder, and substance abuse. Co-morbid mental illness is more prevalent with bulimia than anorexia. Those with OCD and do compulsive eating have been found to have more relapses and relentless symptoms. Repeatedly checking one’s weight or shape in the mirror can be obsessive-compulsive.
A Multidisciplinary Approach
A multidisciplinary approach will be needed to treat clients with these disorders. A physician or social workers should evaluate a patient’s overall physical health immediately after a behavioral health professional has diagnosed a disorder. Patients may need to be referred to specialists if there is damage to their teeth, skin, heart, or internal organs. For very serious cases, clients may need to be admitted to the hospital for intravenous fluids and emergency care.
Clinical social workers can use a range of evidence-based therapies to treat these disorders. Some clinical interventions for disorders, such as Cognitive Behavioral Therapy can also help clients with their anxiety, depression, or OCD. Evidence-based treatments for eating disorders include:
- Interpersonal Therapy,
- Dialectical Behavioral Therapy,
- Cognitive Remediation Therapy,
- Maudsley Model of Treatment for Adults with Anorexia Nervosa
- Integrative Cognitive Affective Therapy
- Maudsley Family-Based Treatment (for youth)
One problem some patients with bulimia nervosa will experience is a lack of healthcare insurance coverage for long-term behavioral treatment. This is a serious problem because a majority of patients with eating disorders do well with long-term therapy.
What qualifications do you need to help people with eating disorders?
In order to help people, you should have a minimum of a bachelor’s degree in psychology, social work, or psychiatry. You should also have specialized training, such as a certificate in eating disorder treatment or a master’s degree in clinical nutrition. In addition, you should have experience working with individuals with these disorders, ideally in a clinical setting, and a valid professional license. Some are listed here:
- Knowledge of mental health and eating disorder diagnoses
- An understanding of the underlying causes of eating disorders
- Ability to recognize signs and symptoms of eating disorders
- Ability to work with a variety of people with different levels of severity of the disorder
- Knowledge of the principles of nutrition
- Understanding of the physical and psychological effects of eating disorders
- Ability to provide supportive counseling
- Ability to help individuals develop healthier eating habits and behaviors
- Knowledge of available treatment options and resources
- Strong interpersonal, communication, and problem-solving skills
What does a nutritionist do?
A nutritionist is a health professional who advises people on what to eat in order to lead a healthy lifestyle and achieve specific health-related goals. They assess the nutritional needs of individuals and develop and implement dietary and lifestyle changes to improve their health. Nutritionists often provide advice on topics such as weight management, food allergies, diabetes management, eating disorders, and general nutrition. Listed here are ways they can help:
- Develop individualized nutrition plans
- Provide nutritional counseling
- Monitor and evaluate eating habits
- Educate clients on healthy food choices
- Make recommendations to improve diet
- Help clients reach their nutrition goals
- Create meal plans tailored to meet clients’ needs
- Monitor progress and provide feedback
- Offer advice on dietary supplements 10. Address specific health conditions with nutrition therapy
More About Social Work and Food Disorders
The National Eating Disorders Association (NEDA) and the National Association of Social Workers (NASW) are two organizations that strive to promote mental health and well-being for all individuals. The NASW is the largest professional organization of social workers in the United States and works to promote the social work profession and social justice.
NEDA and NASW have partnered together to provide support and resources to people who are struggling with disordered eating, such as binge eating, as well as those who are facing mental health issues. Social workers are a vital part of the fight against eating disorders and mental health issues, as they are trained to develop a meaningful and therapeutic relationship with their clients in order to provide effective services in both inpatient and outpatient settings.
Social workers also have a deep understanding of the social sciences and the impact of systems on a person’s inner self. As such, they are in a unique position to be able to provide support and guidance to individuals who are struggling with eating disorders and mental health issues.
In recognition of their efforts, NASW has declared March as National Social Work Month every year. This is a great opportunity to recognize and honor the hard work of social workers and to remind people about the importance of mental health and social work.
By working together, NEDA and NASW are helping to create a better and more equitable world for everyone. Through their combined efforts, they are creating a community of support and resources for people who are struggling with eating disorders, mental health issues, and any other issues they may be facing.