Let’s talk about eating disorders — what they are and how they can be treated

What is your relationship with food? Do you think about it all the time? Binge once in a while, say over the holidays? Go on a crash diet when summer approaches? Have a distorted image of yourself when you look in the mirror?

While most people are able to manage their eating behaviors most of the time, it’s tougher for others. According to the National Eating Disorders Association,

“About  30 million Americans will struggle with an eating disorder at some point in their lives.

They are complex illnesses with close connections to substance abuse, trauma, obesity, and other mental health conditions, such as depression, anxiety, and obsessive-compulsive disorder (OCD).”

Dr. Patrice Lockhart is the Medical Director of New England Eating Disorders (NEED), the only comprehensive eating disorder treatment program in Maine. She says unchecked, binge eating and weight loss can set a harmful pattern for life — but there is effective treatment available.

In this interview, Catching Health associate editor Jen Boggs asked Dr. Lockhart some questions about eating disorders — what they are and how they can be treated.

CH: According to the National Institute of Mental Health, lots of folks view eating disorders as a lifestyle choice, not an illness. Can you explain what an eating disorder is?

PL: Eating disorders are serious illnesses that cause severe disturbances to a person’s eating behavior. The disorders themselves are a constellation of behaviors, and the illnesses show themselves in different ways.

CH: What are some of the most common illnesses and how do they manifest?

PL: Anorexia nervosa is when one restricts how much food she eats. Bulimia nervosa is a pattern of restricting food throughout the day and then overeating within a timeframe, and in such a way, that the person feels out of control, which is followed by some type of purging to get rid of the impact of the binge eating. Binge eating disorder is part of bulimia nervosa without the purging.

CH: What are some other signs of an eating disorder?

PL: Obsessions with food, body weight, and shape are common signals. But it’s really about the developing patterns. An eating disorder can start out by attitudes like, “I just want to eat healthy, cut down on carbs, and/or eliminate fat from my diet” — all things our culture supports, by the way. But the illness can turn apparently healthy behaviors into “I’m going to be a vegetarian,” which can turn into veganism and then severe calorie restriction, often paired with increased physical activity. This is just one example, but these kinds of behaviors add up to a malnourished body that can eventually lead to organ damage and brain malfunction.

CH: How can you tell when someone has an eating disorder?

PL: There are a lot of factors. I tend to look to parents or to patients who are self-identified if something is becoming a problem for them. The person with an eating disorder doesn’t feel in charge anymore. They’re trying to exert power that is not flexible, so there’s a rigidness that identifies as an eating disorder. Friends or family members may recognize that someone has lost (or gained) a lot of weight, but if the person is not behaving like herself anymore, that is a common sign.

CH: You keep referring to she or her as having the eating disorder. Is this a predominantly female issue?

PL: Absolutely. At NEED about 95% of our clients are girls and women.

CH: What should you do if you think you, or someone close to you, has an eating disorder?

PL: The first thing is to check in with a family doctor so they can get some objective data to support the concern. Once that has happened, that’s usually when we’d get a referral. We can assist with the appropriate level of care, or at least an assessment to see if it’s warranted.

Also, if you’re worried about yourself or someone is worried about you, increase the dialogue. One of the hallmarks of these illnesses is shame and secrecy. People can begin to isolate and withdraw from previous activities they’ve enjoyed. Anxiety and depression also increase when a person is malnourished – that can be an early identifier.

CH: How can NEED help?

PL: These disorders do not get better on their own so we offer several levels of care, depending on the severity of the illness. It doesn’t just come all it once; it builds over time, and there’s a threshold for safety. We first want to ensure that the patient is medically safe and stabilized — that there are no cardiac symptoms, dizziness, thought distortion or inability to concentrate. Malnourishment really affects every organ system in the body so it’s difficult to limit the impact.

After someone is medically cleared, we might start with a partial hospitalization program, then step down to an outpatient day program. Treatment involves intense education and support around what’s happening, along with continued medical supervision. We also involve the family and other supports. It’s one of our best tools for treatment. Eating disorders don’t just impact one person – it affects that person’s family too.

CH: Why are holidays so difficult when it comes to eating behaviors?

PL: There are many holiday gatherings where the focus is on food and eating lots of it. Add to that complicated family dynamics or spending time with a bunch of people you may or may not like — that’s a lot of stress. If you have an eating disorder, you may feel extremely out of control and it can be hard to manage. We definitely see an uptick in calls this time of year.

CH: Any parting words of advice?

PL: Pay attention. If you’re concerned, don’t minimize your concern. And don’t think: I’ll try it on my own for six months. Just do it for a week, because you’ll be able to see in a very short period of time if it’s working. If it’s not working, give us a call right away. Literature shows that when a pattern gets entrenched for more than 3-6 months, it’s harder to change. These disorders take on a life of their own, so the sooner we address it, the better.

NEED is a program of Sweetser, one of Maine’s most comprehensive behavioral health care organizations. To contact NEED, call 1-800-434-3000

You’ll find more information about eating disorders – including symptoms and medical complications – on the National Institutes of Health website and on the National Eating Disorders Association website.

Take a moment to watch this video on basic warning signs from the National Eating Disorders Association.