One Size Does Not Fit All:
An Overview of Eating
Disorders
Kristin Grasso, Psy.D.
Clinical Psychologist and College Liaison
1
Spectrum of Eating Disorders
Diagnosable
Disorder
Disordered
Eating
“Normative Discontent”
2
Risk Factors
Female gender
 Ethnicity
 Weight and Shape factors
 Psychiatric history
 Genetic predispositions
 Participation in activities that promote
thinness
 Certain personality traits

3
What’s the risk of dieting?

The more severely girls diet, the more likely they
are to drink frequently and heavily, as well as to use
marijuana and other illicit drugs

Adolescent girls who engage in dieting have a 324%
greater risk for obesity than those who do not diet
(Stice et al., 1999).

95% of all dieters will regain their lost weight in 15 years (Grodstein, 1996).

35% of "normal dieters" progress to pathological
dieting. Of those, 20-25% progress to partial or
full-syndrome eating disorders. (Shisslak & Crago,
1995).
Anorexia Nervosa

Refusal to maintain minimum body weight

Intense fear of gaining weight or becoming fat,
even though underweight

Disturbance in experience of weight or shape,
undue importance of weight or shape, or denial
of seriousness of problem

Amenorrhea
5
Subtypes of AN

Restricting Type:
– person does not engage in binge eating or
purge behavior

Binge Eating/Purging Type:
– person regularly engages in binge eating or
purging (self-induced vomiting or misuse of
laxatives, diuretics, or enemas)
6
Bulimia Nervosa

Recurrent episodes of binge eating
– Eating a large amount of food given the
context
– An associated sense of loss of control

Recurrent inappropriate compensatory
behavior
– E.g., purging, fasting, excessive exercise
– Diuretics and laxatives
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BN cont’d

Binge eating and compensatory behavior
occur at least twice per week for 3
months

Self-evaluation is unduly influenced by
body shape and weight

Disturbance does not occur exclusively
during episodes of anorexia nervosa
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Subtypes of BN

Purging Type:
– Regularly engages in self-induced vomiting, or
the misuse of laxatives, diuretics, or enemas

Non-Purging Type:
– Regularly engages in other inappropriate
compensatory behaviors, i.e. fasting or
excessive exercise, but has not regularly
engaged in the above stated purging behavior
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ED-NOS

Most common

Patient has clinically significant disorder,
BUT does not meet AN or BN criteria

Comparably severe in relation to AN and
BN
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Binge Eating Disorder
Recurrent episodes of binge eating
 Episodes are associated with 3 or more of
the following:

–
–
–
–
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts when not hungry
Eating alone because of embarrassment about how
much one is eating
– Feeling disgusted with self, depressed, or guilty after
overeating
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BED cont’d

Marked distress regarding binge eating

Binge eating occurs at least two days a
week for 6 months

Binge eating is not associated with regular
inappropriate compensatory behavior, and
does not occur exclusively in course of AN
or BN
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What’s the difference?

AN trumps BN

Presentation of AN vs. BN

The dieting factor

Binge Eating Disorder and obesity
13
“Drunkorexia” and other terms to
be aware of…
Prevalence

Anorexia: .5-1%

Bulimia: 1-3%

Binge Eating Disorder: .7-4%
15
Etiology

The etiology of eating disorders is multifactorial, with importance of specific
factors varying with each individual
16
Men and Eating Disorders

10% of eating disordered
individuals are male

There is a greater stigma
for males than females

Eating disorder behavior
can present differently
in males
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Beyond Food…

Eating disorders appear to be all about food…they are
not.

Simply eating more/less will not make things better
and often, when someone begins to eat, things get
harder

Issues related to control, coping with emotions, selfesteem, guilt and shame, etc will become MORE
intense as someone stabilizes
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Common Comorbid Disorders

Major Depressive Disorder or Dysthymia
– 50-75%

Anxiety Disorders
– 64%

Sexual Abuse
– 20-50%

Obsessive-Compulsive Disorder
– 25% (AN); 41% overall

Substance Abuse
– 12-18% (AN); 30-37% (BN)

Bipolar Disorder
– 4-13%
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Health Consequences
 Anorexia
– Abnormally slow heart rate & blood pressure
– Reduction of bone density
– Muscle loss, weakness
– Severe dehydration
– Anemia, Leukopenia
– Reproductive consequences
– 5-20% mortality rate
PHYSICAL SIGNS: lanugo, headaches, feeling cold,
tingling in extremities, feeling faint, dry skin, hair loss
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Health Consequences

Bulimia
– Electrolyte Imbalances
– Esophageal tears
– Ulcers
– Salivary gland enlargement
– Dental Disease
PHYSICAL SIGNS: headaches, fatigue, tingling in
extremities, feeling faint, sore throat and swollen glands,
Russell’s sign, dental problems
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Health Consequences

BED
– High blood pressure
– High cholesterol levels
– Heart disease as a result of elevated
triglyceride levels
– Secondary diabetes
– Gallbladder disease
PHYSICAL SIGNS: temperature irregularities, joint pain,
decreased endurance and fatigue
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Treatment: Anorexia

Psychopharmacoloy:
 interventions typically recommended after weight
restoration
 Medication can begin earlier with focus on
maintaining weight and normalizing eating

Psychological
 Insufficient evidence regarding psychological
interventions
 CBT, IPT, Family Therapy
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Treatment: Bulimia

Psychopharmacology
 reduce frequency of disturbed eating behaviors.
 FDA approved medication for BN: fluoxetine
(Prozac)
 Bupropion (Wellbutrin) has been associated with
seizures in purging bulimic patients and its use is
not recommended.

Psychological
 First line is CBT
 IPT and DBT
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General Treatment Issues

Require multidisciplinary approach
 Nutritional counseling and medication must not be
sole treatment

Psychotherapy will generally require at
least 1 year and most likely longer

Specialist in Eating Disorders preferred
over general practitioner
25
Levels of Care
 Inpatient
 Partial
Hospitalization
 Intensive
Outpatient
 Outpatient
26
Indicators for Hospitalization

In general:
– individual is below estimated healthy weight
– Rapid, persistent decline in oral intake or
weight and/or or uncontrollable purging
– weight at which physical instability is likely to
occur
– Serious medical abnormalities
– Comorbid psychiatric issues that warrant
increased support
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Prognosis

Anorexia
– 50% recover
– 33% improve somewhat
– 20% remain chronically ill
**mortality is 6x peers without anorexia and
is the highest of any psychiatric illness!!

Bulimia
– 50% recover
– 18-30% improve somewhat
– 20% continue to meet full criteria
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References

Deshmukh, R. & Franco, K. (2003). Eating Disorders. Retrieved December 9, 2006,
http://www.clevelandclinicmeded.com/diseasemanagement/psychiatry/eating/eating.
htm

Grodstein, F., Levine, R., Spencer, T., Colditz, G.A., Stampfer, M. J. (1996). Threeyear follow-up of participants in a commercial weight loss program: can you keep it
off? Archives of Internal Medicine. 156 (12), 1302.

National Eating Disorders Association's Information website:
www.NationalEatingDisorders.org

Practice Guideline for the Treatment of Patients with Eating Disorders (3rd Edition)

Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The spectrum of eating disturbances.
International Journal of Eating Disorders, 18 (3), 209-219.

Stice, E., Cameron, R., Killen, J. D., Hayward, C., & Taylor, C. B. (1999). Naturalistic
weight reduction efforts prospectively predict growth in relative weight and onset of
obesity among female adolescents. Journal of Consulting and Clinical Psychology, 67,
967-974.
http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=EatingDisord
ers3ePG_04-28-06
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For More Information:

http://www.nationaleatingdisorders.org
– NEDA Educator Toolkit

http://www.eatingdisorders.org
– The Center for Eating Disorders at Sheppard
Pratt
http://www.something-fishy.org
 Handbook of Treatment for Eating
Disorders: 2nd Edition by David Garner
Ph.D. and Paul E. Garfinkel, M.D.

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