Eating disorders are complex health problems that can have devastating consequences for both sufferers and their families. The two main eating disorder groups are anorexia nervosa and bulimia nervosa, however many people fall into the Eating Disorder Not Otherwise Specified (EDNOS) group because their eating disorder fails to meet all the criteria for either anorexia nervosa or bulimia nervosa. Regardless, people in the EDNOS group have eating disorders that are every bit as complicated and serious as anorexia nervosa and bulimia nervosa. People who have an eating disorder should seek treatment at the earliest opportunity so they can mitigate its effects and begin the recovery process.


Why seek treatment for an eating disorder?


• Eating disorders can cause severe health consequences — even death.

The medical complications of eating disorders are significant, potentially irreversible, and life-threatening. They can involve almost all organ systems and include consequences of starvation, vomiting, laxative abuse, binge eating, and exercise (1, 2, 3). These complications are most evident during the acute phase of the eating disorder, but they also carry an increased risk for a wide range of physical and emotional disorders in future years (4).

Death rates for people who have anorexia nervosa are more than 12 times higher than from all other causes among women 15 to 24 years of age. Death rates are also about three times higher for anorexia nervosa than for other psychiatric disorders (5, 6). Although death rates for bulimia nervosa are much lower, they are not insignificant (7, 8). Psychological and physical impairment from eating disorders are common in long-term follow-up studies (9).

For these reasons, a medical evaluation is an essential part of a comprehensive assessment for an eating disorder.


• Eating disorders cloud judgment about the need for treatment.

An eating disorder usually starts when a person begins restrictive dieting to lose weight. The person's original intentions regarding the restrictive diet may be quite benign; however, its effects can lead to a progressive loss in the judgment necessary to make rational decisions about the merits of treatment.

At first, dieting is not a matter of concern — it may even lead to compliments from others. The dieter’s initial focus on weight loss or control of food intake may lead to increased self-confidence, feelings of self-control, and positive social feedback. Alternatively, it may begin to counteract certain negative feelings.

However, in time, the effects of restrictive dieting will take hold. The person will become more driven regarding the attempt to control weight while a realistic perspective about the original goals of the restrictive diet will progressively fade, as well as the ability to perceive its adverse psychological, emotional, social and physical consequences. The person’s thinking will grow more rigid and obstinate about abstaining from food as the eating disorder advances further. The person often will experience depression, anxiety, mood fluctuations, and social withdrawal. Later, the physical and social consequences may become more compromised, even though the person’s blood tests remain normal and intellectual performance remains intact.

Ultimately, depression, social isolation, and progressive physical decline will lead to the person's failure to achieve educational, employment, and social goals. However, the conviction that weight control is desirable and serves an essential purpose will become so powerful that the person rebuffs even the strongest suggestions to seek treatment.


• Mistaken Viewpoint: “You have to want to get better before you seek treatment.”

This viewpoint is a mistake because ambivalence about recovery is an eating disorder symptom. In fact, if those suffering from eating disorders wait until they “want” to get better, it may be too late. On one level, they understand that the symptoms are destructive; however, on another level, they are terrified about the implications of recovery.

Among those suffering from eating disorders, the motivations that favor and oppose recovery are usually complex. For example, eating disorder symptoms may serve a positive function of increasing the person’s self-control, self-confidence, or self-protection. And while many people suffering from eating disorders understand their symptoms’ negative consequences, they feel helpless to change in the midst of self-hatred about their physical experience. These people may also suffer from chronic social insecurity and incompetence in other areas. Moreover, most eating disorder patients know that they will probably feel worse at the beginning of treatment, so it is common for them to experience ambivalent attitudes about their disorder during treatment.

These ambivalent attitudes are well understood by eating disorder treatment professionals, who can provide patients with methods that will improve their motivation during recovery.


• Effective treatment leads to high recovery rates.

Major advancements in anorexia nervosa and bulimia nervosa treatment have emerged in recent years. Despite large variations across outcome studies, as many as 70 percent of adolescents with anorexia nervosa recover from their eating disorder if they receive proper treatment. However, the course of treatment can be difficult for these patients, with some having persistent impairment (10, 11, 12). Long-term follow-up studies of adults with anorexia nervosa indicate lower recovery rates; however follow-up studies indicate significant variations in outcome (13). Tremendous variability in treatment outcome from different treatment centers suggests that effective treatment components exist but are neither well established nor consistently applied. Finally, community studies indicate significant impairment for both anorexia nervosa (14) and bulimia nervosa (15) sufferers who never seek treatment.


To find out more information...

Fill out the short EAT-26 self-test to gather more information about whether you should consult a specialist regarding a possible eating disorder.

References:
1. Becker, Grinspoon, Klibanski, & Herzog, 1999.
2. Pomeroy & Mitchell, 2002.
3. Rome & Ammerman, 2003.
4. Johnson et al., 2002.
5. Emborg, 1999.
6. Sullivan, 1995.
7. Keel, Dorer, Eddy, Franko, Charatan, & Herzog, 2003.
8. Nielsen, 2003.
9. Keel et al., 1999.
10. Patton, Coffey, & Sawyer, 2003.
11. Steinhausen, Boyadjieva, Griogoroiu-Serbanescu, & Neumarker, 2003.
12. Strober, Freeman, & Morrell, 1997.
13. Steinhausen, 2002.
14. Wentz, Gillberg, Gillberg, & Rastam, 2001.
15. Fairburn et al., 2003.