Recognizing Eating Disorders and Finding Specialists

Disturbances in eating behavior can manifest through various signs. For most people, eating is a completely normal, everyday activity to satisfy hunger.

People with eating disorders, on the other hand, are constantly preoccupied with this topic. They associate eating with compulsive behaviors.

Depending on the symptoms, three main types of eating disorders can be distinguished:

• Anorexia
• Bulimia, and
• Binge-Eating Disorder

The most important characteristic of anorexia nervosa is a pathological need to lose weight. Those affected experience an almost panic-like fear of gaining weight.

As a result, they try to consume as little food as possible. They also make sure that the food they eat contains very few calories. Many patients also engage in frequent and intense physical activity to increase their energy expenditure.

Anorexia is accompanied by a body image disturbance. This leads those affected to perceive themselves as too fat even when they are extremely underweight.

Bulimia is one of the eating disorders @ Monkey Business /AdobeStock

In the case of bulimia nervosa, on the other hand, those affected are usually of normal weight but tend to experience weight fluctuations.

A key characteristic is binge eating followed by purging. In addition, patients with eating disorders often use laxatives in an uncontrolled manner.

In binge-eating disorder (episodes of uncontrolled overeating), patients suffer from recurrent binge-eating episodes. However, those with this behavioral disorder do not engage in weight-loss measures. 

They lose their sense of fullness and control over their food intake. Even if the binge-eating episodes are brief, their frequency can lead to obesity.

In addition, mixed forms of eating disorders can occur. In such cases, those affected exhibit characteristics of different clinical pictures.

The term for this is, for example:

• atypical bulimia or
• atypical anorexia

Another eating disorder is pica syndrome. It occurs in patients with developmental disorders, intellectual disabilities, or dementia. These individuals ingest non-edible substances, such as soil, paper scraps, or feces.

A recent study from the U.S. shows that 0.1 percent of 8- to 15-year-olds develop an eating disorder in a given year.

This number may seem small. However, since eating disorders are associated with significant psychological distress and serious health consequences, we must not underestimate the condition.

The doctor makes the diagnosis based on the patient’s medical history and a physical examination.

They assess underweight, overweight, and obesity based on the body mass index (BMI). The BMI indicates the ratio between a person’s body weight and height.

In the case of anorexia, body weight is at least 15% below normal weight. In girls and women, menstruation often ceases, and hair loss and dental damage may occur.

In addition, cardiovascular disorders, kidney disease, and gastrointestinal disorders are possible. For a definitive diagnosis of bulimia, the condition must have been present for at least three months and occur at least twice a week.

For binge-eating disorder, at least three of the following five criteria must be met:

• Eating without feeling hungry
• Eating excessively quickly
• Eating until feeling full
• eating alone due to feelings of guilt
• Emotions such as depression, disgust, or shame following binge episodes

The Munich-based organization ANAD e.V. Eating Disorders Care Center offers a self-assessment test for eating behavior. Please note: A self-test provides only a rough guide. It is in no way a substitute for a visit to a doctor.

The treatment of eating disorders is based on two pillars:

• psychotherapy and
• Nutritional therapy

Treatment can be provided on an outpatient or inpatient basis. In particularly severe cases, long-term treatment in therapeutic residential groups is an option.

Main goals of therapy:

• Learning normal eating behaviors
• Stabilizing body weight
• Restoring a positive body image
• Developing a normal sense of hunger and satiety
• Rediscovering joy and pleasure in eating

Psychotherapy focuses primarily on treating the symptoms of abnormal eating behavior. These include, first and foremost, starvation, purging, binge eating, and low self-esteem.

As far as possible, the therapist and patient should identify the causes of the disordered behavior and restore psychological balance.

Psychotherapy helps address psychological and social underlying factors @ WavebreakmediaMicro /AdobeStock

In addition to cognitive behavioral therapy, systemic family therapy is also used. This enables those affected to take responsibility for their own eating behavior and body weight.

Family-oriented treatment is particularly suitable for adolescents who still live at home. In this approach, it is helpful to involve the entire family in resolving the problems caused by the eating disorder.

Nutritional therapy aims to educate those affected about the symptoms and consequences of disordered eating.

In addition, experts provide guidance on:

• a structured meal plan
• optimal portion sizes, and
• healthy foods

Outpatient Therapy

Outpatient treatment takes place several times a week at a private psychotherapist’s office. 

The following conditions should be met:

• BMI is above 15
• Regular weight gain in cases of underweight
• no significant bulimic symptoms (such as severe binge eating, frequent vomiting, or heavy misuse of laxatives)
• Evidence of insight and motivation to change eating behavior
• No risk of suicide
• A stable social support system

Regional self-help groups offer additional support for those affected. Be sure to ensure that a suitable person facilitates the meetings. 

Qualified group leaders may be individuals with the condition who have worked through their illness in depth and are now stable. There are also professionally facilitated groups led by social workers or psychotherapists.

Inpatient Therapy

Inpatient treatment is indicated for very severe or particularly long-standing eating disorders and may be considered under the following conditions:

• a BMI below 15
• rapid weight loss that is also prolonged
• significant bulimic symptoms (such as severe binge eating and frequent vomiting, or heavy misuse of laxatives)
• Risk of suicide
• no stable social support network
• Unsuccessful outpatient therapy

Inpatient treatment is often necessary for patients with anorexia, as weight loss is associated with an increased risk of death.

Digital Technology in Therapy

Renowned experts from the scientific community have joined forces in the German Society for Eating Disorders (DGESS e.V.). Among other things, they are researching internet-based therapy options.

These are used, among other things, for follow-up care after an inpatient stay. You can find information on the current state of research on the association’s website.

Especially for younger patients, there is a good chance of recovery if treatment begins early. If you or a family member has an eating disorder, it is important to seek medical advice as soon as possible.

The earlier treatment begins, the better the chances are that weight will normalize and those affected will regain a normal life expectancy.

In some cases, however, eating disorders remain chronic even with treatment, or relapses occur.

The prospects for recovery decrease with:

• onset of the disorder before age 11
• a low initial weight, and
• a long duration of the eating disorder

Patients with anorexia, in particular, are at risk of dehydration or acute organ failure, which can be fatal.

Therefore, family members should recognize the signs of eating disorders as early as possible and initiate appropriate treatment.