Types of Eating Disorders and Treatments

Feeding and eating disorder affects more than 13% of men and woman coming from western countries (Reichenberg & Seligman, 2016). Out of that portion of the population, only about 40%-60% of those affected are said to be in remission from their disorder (Reichenberg & Seligman, 2016). There are many factors that come into play that contribute to the onset of such disorders including, family history, peer dieting, concepts of an ideal body, and some cultural considerations (Reichenberg & Seligman, 2016). Since the revisions of the new DSM-5, there have been some changes in this area that have occurred since the DSM-IV.

For example, all the “feeding disorders” and “eating disorders” have now been combined into “Feeding and Eating Disorders” (Reichenberg & Seligman, 2016). In the DSM-5, there are many different types of feeding and eating disorders that have different characteristics in terms of diagnosis. There are also many types of therapy that can aide in the recovery of said disorders.

Pica

Pica is when a person ingests nonfood substances, such as hair, paint, rocks, and glue (Reichenberg & Seligman, 2016). This type of disorder is typically more common in infancy and childhood, however can occur during adulthood as well. Pica is more likely to occur in children with intellectual disabilities (Reichenberg & Seligman, 2016). In infancy and preschool children, the child is more likely to consume objects such as chalk, paint, glue, hair, or cloth (Reichenberg & Seligman, 2016). Older children are more likely to eat items such as bugs, plants, pebbles, or animal droppings (Reichenberg & Seligman, 2016). When an adult is diagnosed with pica, they are more likely to consume, hair, soil, ice, and clay (Reichenberg & Seligman, 2016). The diagnosis of pica should only be made if there is a severe medical issue; for example, lead poisoning is a common medical issue found in children diagnosed with pica due to eating chips of paint (Reichenberg & Seligman, 2016).

When diagnosing a person with pica, in the DSM-5 criteria states that the person must have these behaviors lasting longer than a month, be developmentally inappropriate, and their eating habits cannot be apart of a normal cultural practice (Becker, Delaney, Eddy, Hartmann, Murray, & Thomas, 2015). The diagnosis of pica can also be made if there is another eating disorder present, however, that drive to eat nonfood items cannot be driven by another eating disorder (i.e. someone wanting to delay their hunger due to AN) (Becker, Delaney, Eddy, Hartmann, Murray, & Thomas, 2015).

Parents are taught to engage in behavior modifications of their child. Parents are encouraged to enforce positive reinforcement and monitor the child’s eating habits (Reichenberg & Seligman, 2016). Parents are also encouraged to implement a reward system, such as a behavior chart. A diet with proper vitamins and minerals has also been shown to be effective. There were studies that were conducted that showed the symptoms of pica decreasing with a daily multivitamin or iron supplement (Reichenberg & Seligman, 2016). As far as the prognosis goes, it varies. In most cases, the symptoms of pica tend to dissipate after a few months of treatment (Reichenberg & Seligman, 2016). However, concerns do show that a child with a history of pica could have a reoccurring issue of pica in their later adult life (Reichenberg & Seligman, 2016).

Rumination Disorder

This type of disorder has a typical onset age of 3-12 months; however, it is typically found in older children, adolescents and adults (Reichenberg & Seligman, 2016). This disorder is classified by the constant regurgitation and remastication of food; in other words, the person is constantly throwing their food up in their mouth, and then the person either spits it out or reswallows the food (Reichenberg & Seligman, 2016). For a DSM-5 diagnosis, the symptoms must be present for at least a month and cannot be due to a general medical condition (Reichenberg & Seligman, 2016). The difference between pica and rumination disorder is that a rumination disorder diagnosis cannot be made in the presence of another feeding and eating disorder (Becker, Delaney, Eddy, Hartmann, Murray, & Thomas, 2015). The purpose of the rumination disorder is that it serves as some sort of self-soothing or self-stimulation function (Reichenberg & Seligman, 2016). Rumination disorder is typically related to neglect, stress, or family issues (Reichenberg & Seligman, 2016). Most therapists will be using some family systems therapy approaches or CBT to help with the elimination of the symptoms. Most children who are diagnosed with rumination disorder end up getting better, however, this disorder can be particularly fatal if the child’s eating behavior is not monitored.

Avoidant/Restrictive Food Intake Disorder (ARFID)

This feeding and eating disorder is classified as a person restricting their nutritional intake, avoiding the intake of food, or the lack of interest in food (Reichenberg & Seligman, 2016). Children may avoid the intake of food due to sensory properties that are in relation to a feared consequence of eating (Murphy & Zlomke, 2016). In the DSM-5, the criteria to be met is that the person must have an eating disorder that causes them to not be able to meet the needs of the required calorie intake per day, and one of the following: does not weigh an age-appropriate wait, developed a nutritional deficiency, has to use a feeding device, or the restrictive eating habits interfere with mental functioning (Reichenberg & Seligman, 2016). This restrictive eating cannot be caused by a cultural or religious act, such as fasting (Reichenberg & Seligman, 2016). Certain disorders such as autism, ADHD, and an intellectual disability typically co-occur with ARFID (Reichenberg & Seligman, 2016). When children are diagnosed with this disorder, they typically also receive a medical condition of nonorganic failure to thrive, which is a child not eating the required amount of food to maintain the proper weight (Reichenberg & Seligman, 2016).

ARFID is unusually common for young children and about 25%-50% of toddlers experience some sort of feeding difficulty (Murphy & Zlomke, 2016). Family therapy is said to be successful. Families are provided with information about a child’s developmental and eating patterns and nutritional information (Reichenberg & Seligman, 2016). CBT and psychoeducational techniques are helpful as well. If the child refuses to eat, then behavioral techniques are to be put in place. Some behavioral techniques include positive reinforcement for eating, modeling of positive eating behaviors, the control of eating between meals, and the reductions of distractions during mealtime (Reichenberg & Seligman, 2016). Outpatient therapy is known to be the most successful. Outpatient therapy can let the parent and the clinician work closely together to help build emotional, cognitive, and behavioral skills for the child’s response to food avoidance behaviors (Murphy & Zlomke, 2016). Because this is a new diagnosis in the DSM-5, there is little information on the prognosis of this diagnosis.

Anorexia Nervosa (AN)

Anorexia nervosa is the third most common medical illness among adolescents, and it has the highest mortality rate among any other mental health disorder (Reichenberg & Seligman, 2016). When a person is diagnosed with anorexia nervosa, they have the fear of becoming fat, a troubled self-image, and they have the fear of losing control (Reichenberg & Seligman, 2016). Besides being emaciated, there are many other medical issues that the victim could potentially suffer from. The symptoms include: cold tolerance, dry skin, low blood pressure and edema (Reichenberg & Seligman, 2016). There are some changes made to the DSM-5 involving the anorexia nervosa criteria. Those changes include, the amenorrhea criterion has been taken out and the low weight criterion has been revised (Accurso, Goldschmidt, Le Grange & Vo, 2017). A study showed the increase in AN being diagnosed for a group of adolescents from 30% to 40% due to the changes in the DSM-5 criteria (Accurso, Goldschmidt, Le Grange & Vo, 2017). There are common disorders that are seen in people with anorexia nervosa, including depressive disorders, anxiety disorders, and substance abuse disorder, mainly with stimulant drugs (Reichenberg & Seligman, 2016).

This disorder is, most of the time, genetic. There are studies that show differences in the brain’s activity with people who develop anorexia nervosa. Studies show that there is a reduction in gray matter in the brain and images show that the appetite hormones have slight changes (Reichenberg & Seligman, 2016). There are also some cultural factors including people who are from higher SES income areas such as the United States, Australia, and many European countries; it is also more common in women of the European descent that are more prone to developing anorexia nervosa (Reichenberg & Seligman, 2016).

In adolescence, having a negative affect and some depressive symptoms increases the chances of developing anorexia nervosa (Reichenberg & Seligman, 2016). There is also a history of, borderline personality disorder and anxiety reported by people with anorexia nervosa (Reichenberg & Seligman, 2016). It is not uncommon for people with this disorder to have low self-esteem and issues having interpersonal relationships with others. This disorder is known to have a lifetime prevalence of 0.9% and it is 10 times more common in females than in males (Reichenberg & Seligman, 2016). However, 1 out of 4 males are known to have the disorder and they tend to over exercise where girls tend to throw up their food (Reichenberg & Seligman, 2016).

Assessing the client’s eating behaviors is the first step, along with assessing the client’s psychological damage and most importantly, referring them to a PCP. There are many assessments that are used to assess a client’s severity of their eating disorder. The assessments are, The Questionnaire on Eating and Weight Patters-Revised and the Eating Disorder Examination Questionnaire, 16th e. These assessments screen for what specific feeding and eating disorder is present, information about the frequency of the disorder, the severity of the disorder, feeding and eating behaviors, and offers insight on the client’s attitudes towards food (Reichenberg & Seligman, 2016). The severity levels are determined by using the BMIs in the DSM-5 (Reichenberg & Seligman, 2016).

Some characteristics that a therapist should hold when working with this population are empathy, having a perspective that the relationship will be long-term, have limited struggles for control, be able to challenge cognitive misrepresentations, and to be caring, however assertive as well (Reichenberg & Seligman, 2016). Early in the treatment, therapists should be willing to discuss with the patient about their expectations of improvement and encourage self-control, independence and the involvement in treatment (Reichenberg & Seligman, 2016). Therapists should also be knowledgeable of mental health disorders that are common with people who have anorexia, such a OCD, substances use disorder, personality disorders, etc.

Family-based therapy is helpful with adolescents with anorexia. Also, a multidisciplinary is extremely helpful for more severe cases. Family therapy looks at the family dynamic of the client and sees if it contributes to the development of the disorder with issues such as parentification and control (Reichenberg & Seligman, 2016). Adolescents who have mothers who are critical would benefit from separate family therapy, and adolescents with noncritical mothers may benefit from joined family therapy (Reichenberg & Seligman, 2016). Hospitalization is sometimes necessary depending on the severity of the disorder. Some issues that may indicate hospitalization would be the need for weight gain and/or a case of a suicide attempt, severe depression or anxiety, or suicide ideations (Reichenberg & Seligman, 2016).

Cognitive Behavioral Therapy (CBT) can recognize the behaviors from the eating disorder, such as binge eating and failure to maintain a healthy body weight and address any underlying emotions and faulty cognitions that contribute to that behavior (Reichenberg & Seligman, 2016). A type of CBT called Enhanced CBT (CBT-E) has shown to be successful specifically for people suffering from feeding and eating disorders. It focuses more on the behaviors shown. CBT-E focuses mainly on the dietary restraint and restriction, and is aware of the changes in mood or environmental triggers in eating behavior (Reichenberg & Seligman, 2016).

Interpersonal Psychotherapy (IPT) is a supportive treatment modality that shows to be a successful part of treatment as well. An emphasis of IPT is about helping the client to identify and change any interpersonal issues such as losses and communication problems (Reichenberg & Seligman, 2016). DBT provides treatment specific needs to people who suffer from anorexia and who show a restriction and over-control of emotions (Reichenberg & Seligman, 2016). This type of therapy offers a mindfulness approach and emphasizes a hierarchy of importance with the reduction of the participation in life-threatening behaviors such as self-injury, suicide, and starvation (Reichenberg & Seligman, 2016). In this form of therapy, clients learn to block hypervigilance to criticism and learn to become open to seeing things different and learn how to not have the need to act on their feelings (Reichenberg & Seligman, 2016).

In most inpatient facilities, medication is combined with treatment. There are many different medications that are prescribed for clients with this disorder. SSRI’s are helpful with those suffering from depression and OCD, however does not help with weight gain (Reichenberg & Seligman, 2016). The atypical antipsychotic olanzapine (Zyprexa) has been known to decrease symptoms of agitation, and increase weight gain (Reichenberg & Seligman, 2016). 

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