+
Overview of Eating Disorders
Seda Ebrahimi Ph.D.
Founder and Director of the Cambridge Eating Disorder Center
Instructor, Department of Psychiatry, Harvard University
+
THE PREVALENCE OF EATING
DISORDERS

An estimated 8 million Americans suffer from eating
disorders

7 Million Women

1 Million Men

1 in 200 women in America suffer from anorexia

2-3% of American women suffer from bulimia

Nearly 50% of all Americans know someone suffering from
an Eating Disorder

10-15% of those suffering from anorexia or bulimia are males
+ CHILDREN AND EATING
DISORDERS
 42%
of third grade girls wish to be thinner
 50%
of 11-13 girls view themselves as
“overweight”
 Obesity
rates have tripled in children ages 219 since the 1980s
 32% are overweight
 17% are obese
 Caucasian:10% boys, 15% girls
 African American: 17% boys, 23% girls
 Hispanic: 24% boys, 17% girls
+
DIFFERENT TYPES OF EATING
DISORDERS
 Anorexia
Nervosa
 Restricting type
 Binging/Purging Type
 Bulimia
Nervosa
 Binge
Eating disorder
 Other
Specified Feeding or Eating Disorder
 Unspecified
Feeding or Eating Disorder
+
ANOREXIA NERVOSA

Persistent restriction of energy intake leading to significantly
low body weight (in context of what is minimally expected
for age, sex, developmental trajectory, and physical health) .

Either an intense fear of gaining weight or of becoming fat,
or persistent behavior that interferes with weight gain (even
though significantly low weight).

Disturbance in the way one's body weight or shape is
experienced, undue influence of body shape and weight on
self-evaluation, or persistent lack of recognition of the
seriousness of the current low body weight.

Subtypes:

Restricting type

Binge-eating/purging type
+ ANOREXIA NERVOSA
(CONTINUED)

Specify if:
 In partial remission: After full criteria of anorexia nervosa were previously met,
Criterion A (low body weight) has not been met for a sustained period, but either
Criterion B or Criterion C is still met. In full remission: After full criteria of anorexia
nervosa were previously met,none of the criteria have been met for a sustained
period of time.

Specify current severity:
 The minimum level of severity is based, for adults, on current body mass index
(BMI) (see below) or, for children and adolescents, on BMI percentile.
 The ranges below are derived from World Health Organization categoriesfor
thinness in adults; for children and adolescents, corresponding BMI percentiles
should be used. The level of severity may be increased toreflect clinical symptoms,
the degree of functional disability, and the need for supervision.

Mild: BMI > 17 kg/m2

Moderate: BMI 16-16.99 kg/m2

Severe: BMI 15-15.99 kg/m2

Extreme: BMI < 15 kg/m2
+ ANOREXIA NERVOSA WARNING
SIGNS

Low Weight

Avoidance of Food

Food rituals

Excessive/compulsive exercise

Body checking

Body distortion and dissatisfaction

Calorie counting

Obsessional weighing

If binging eating/purging:




Laxative or diuretic ues
Diet pills
Binge eating
Self induced vomitting
+

BULIMIA NERVOSA
Recurrent episodes of binge eating. An episode of binge eating
is characterized by both of the following:


Eating, in a discrete period of time (e.g. within any 2-hour period), an
amount of food that is definitely larger than most people would eat
during a similar period of time and under similar circumstances.
A sense of lack of control over eating during the episode (e.g. a
feeling that one cannot stop eating or control what or how much one
is eating).

Recurrent inappropriate compensatory behavior 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 inappropriate compensatory behaviors
both occur, on average, at least once a week for three months.

Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of
Anorexia Nervosa.
+ BULIMIA NERVOSA WARNING
SIGNS

Cognitive distortions and irrational beliefs around, weight and
appearance

Body image distortions

Body loathing

May have food rituals

Hiding or sneaking food

Discomfort/avoidance of eating in public

Obsessive weighing

Body checking

Frequent/Compulsive exercise

Dieting/calorie counting
+BINGE EATING DISORDER (BED)

Recurrent episodes of binge eating. An episode of binge eating is
characterized by both of the following:
 Eating, in a discrete period of time (e.g. within any 2-hour period), an
amount of food that is definitely larger than most people would eat
during a similar period of time and under similar circumstances.
 A sense of lack of control over eating during the episode (e.g. a feeling
that one cannot stop eating or control what or how much one is eating).

The binge eating episodes are associated with three or more of the
following:
 eating much more rapidly than normal
 eating until feeling uncomfortably full
 eating large amounts of food when not feeling physically hungry
 eating alone because of feeling embarrassed by how much one is
eating
 feeling disgusted with oneself, depressed or very guilty afterward

Marked distress regarding binge eating is present

Binge eating occurs, on average, at least once a week for three months

Binge eating not associated with the recurrent use of inappropriate
compensatory behaviours as in Bulimia Nervosa and does not occur
exclusively during the course of Bulimia Nervosa, or Anorexia Nervosa
methods to compensate for overeating, such as self-induced vomiting.
+ Other Specified Feeding or
Eating Disorder (OSFED)

A diagnosis might then be allocated that specifies a specific reason why the
presentation does not meet the specifics of another disorder (e.g. Bulimia
Nervosa- low frequency). The following are further examples for OSFED:

Atypical Anorexia Nervosa: All criteria are met, except despite significant
weight loss, the individual’s weight is within or above the normal range.

Binge Eating Disorder (of low frequency and/or limited duration): All of the
criteria for BED are met, except at a lower frequency and/or for less than three
months.

Bulimia Nervosa (of low frequency and/or limited duration): All of the criteria
for Bulimia Nervosa are met, except that the binge eating and inappropriate
compensatory behavior occurs at a lower frequency and/or for less than three
months.

Purging Disorder: Recurrent purging behavior to influence weight or shape in
the absence of binge eating

Night Eating Syndrome: Recurrent episodes of night eating. Eating after
awakening from sleep, or by excessive food consumption after the evening
meal. The behavior is not better explained by environmental influences or
social norms. The behavior causes significant distress/impairment. The
behavior is not better explained by another mental health disorder (e.g. BED).
+ COMMON EATING DISORDER
WARNING SIGNS

Preoccupations with body or
weight

Obsession with calories, food or
nutrition

Constant dieting even when thin

Rapid unexplained weight loss
or weight gain

Taking laxatives or diet pills

Compulsive exercising

Making excuses to get out of
eating
+
COMMON EATING DISORDER
WARNING SIGNS (CONTINUED)

Avoiding social situations involving food

Going to the bathroom right after meals

Eating alone, at night or in secret

Hoarding high-calorie food

Fainting

Wearing many layers of clothing

Redness on backs of hands

Chipmunk cheeks

Dental problems
+
RECURRING WARNING SIGNS

Excessive talk of exercise

Lots of “food/diet talk”

“Fat Talk”

Negative body image

Low self-esteem

Self-deprecating

Complaints of constipation (laxative use)

Amenorrhea/menstrual irregularity
+
MEDICAL COMPLICATIONS

Fatigue

Anemia

Weakness

Brady Cardia

Sleep disturbances

Hypotension

Dizziness/fainting

Hypothermia

Chest pain

Chest pain

Osteoporosis/Osteoperia

Edema

Amenorrhea

Amenorrhea

Cold Intolerance

Swollen Parotid Glands

Brittle hair/nails

Dental Erosions

Abdominal pain

Knuckle scarring

Constipation/diarrhea

Electrolyte imbalance

Hair loss

Sore Throat
+ Common Comorbidities
 Depression
 Generalized
 Social
Anxiety
Anxiety
 OCD
 Alcohol/substance
 Borderline
 Trauma
abuse
Personality Disorder
History
 Self-harming
behaviors
+
Multidisciplinary Treatment
Team Approach
Medical
Stability
Medication
Nutritional
Management
Rehabilitation
Psychotherapy
+ Eating Disorders and Nutrition
Normalization
Weight
Restoration
Re-feeding
Activity
of eating
Issues
Level
+
Goals of Treatment
 Restoration
of weight
 Normalization
 Significant
of eating
changes in thoughts and
behaviors
 Relapse
prevention
+ Behavioral warning signs

Focus on low-fat or “heathy foods”

Diet drinks

Energy bars

Supplements

Counting calories and grams of fat

Becoming vegetarian/vegan

Fasting

Obsessive thinking about food

Skipping meals/refusal to eat

Avoiding food in social situations

Wearing oversized clothing

Complaining of food allergies

Excessive exercise

Reading fitness/health magazines

Checking weight several times daily

Body checking

Spending excessive amounts of time in front of the mirror
+ Psychological Signs of at-risk
Individuals

Perfectionism

Competitiveness

Overly responsible

Critical of self/others

Conformity

Approval seeking

Low self-esteem

Mood swings

Rigid “black and white” thinking

Difficulty expressing emotions

Complaining of “feeling fat”
+
SOCIAL SIGNS OF AN AT RISK
INDIVIDUAL
Isolation
Avoidance
of social/recreational
activies
Dieting schedule
Exercise regimen
+
HOW TO ADDRESS AN AT-RISK
INDIVIDUAL
 Early
intervention is crucial to recovery
 Show
support and concern
 Express
empathy and understanding
 Be
truthful in addressing denial and
resistance
 Be
aware of local resources and make
appropriate referrals for assessment and
treatment
+
TREATMENT
 Creating
the Treatment Team
 Building
the Treatment Contract
 Psycho-education
 Building
trust and rapport
 Different Therapeutic
Methods
 Cognitive Behavioral Therapy (CBT)
 Dialectical Behavior Therapy (DBT)
 Family-Based Treatment (FBT/Maudsley Method)
 Psychodynamic Therapy
+
TREATMENT LEVELS OF
CARE
 Outpatient
 Intensive
 Partial
Outpatient
Hospitalization (Day Treatment)
 Transitional
Living
 Residential
 Inpatient
(Acute Hospitalization)
+
CRITERIA FOR
INPATIENT TREATMENT

Low weight (severity, rapidity)

Alterations in vital signs (postural hypotension, Bradycardia)

Low Serum Potassium level (fatal arrhythmia)

Low Mood (Suicidal thoughts or intents)

Presence of Formal Thought Disorder

Presence and severity of associated Impulsivity Control Problems (e.g.
sexual promiscuity, shoplifting, financial difficulties, alcohol/drug abuse,
self injurious behaviors)

Level of disruption to daily functions




Job difficulties/loss of job
Withdrawal from school
Isolation
Failure of outpatient treatment
+ Treatment Contract
 Certain
amount of weight loss leading to higher
level of care
 Not
gaining weight leading to a higher level of care
 Frequency
 Activity
of weight checks, blood work, etc.
level specifications
 Frequency
of binge/purge may require a higher
level of care
 One
person is identified as the leader of the team;
generally the individual therapist
 Splitting
can be a major problem
 Frequent communication is a must
+ TREATMENT AT CAMBRIDGE
EATING DISORDER CENTER

Specialized Multidisciplinary Eating Disorder Treatment
Including:









Levels of Care include:






Individual therapy
Family therapy
Group therapy
Nutritional Support/education
CBT/DBT/FBT
Medication management
Expressive arts therapy
Yoga
Residential
Partial Hospitalization
Intensive Outpatient
Outpatient
Transitional Living
Teaching Facility:


Harvard University Psychiatry
Massachusetts General Hospital
+
Seda Ebrahimi
Director, Cambridge Eating Disorder
Center
Cambridge Eating Disorder Center
(CEDC)
3 Bow Street | Cambridge, MA 02138
617-547-2255 ext. 222
seda@cedcmail.com
www.eatingdisordercenter.org
+
Questions?