EATING DISORDER OVERVIEW
Eating disorders are on the rise in the majority of industrialized nations, having among the highest mortality rates of all psychiatric illnesses. There are three main types of eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder. These disorders share a common characteristics: an extreme fear of weight gain, intense disturbance with body self-perceptions, and negative relationships with food. The distinguishing factor between each disorder lies in how one copes with these neuroses; in anorexia nervosa, one engages in intense food restriction. Meanwhile, bulimia nervosa is characterized by episodes of binge eating followed by compensatory purging (i.e. self-induced vomiting, laxative abuse, fasting, and/ or excessive exercise). Binge eating disorder is characterized by recurring episodes of binging without compensatory behaviors. Binge episodes are typically used to alleviate feelings of emotional distress.
While statistics report that eating disorders affect approximately 1-3% of the population, this represents an underestimation as these studies do not account for those undiagnosed and untreated. Moreover, a large proportion of the population (the majority being women and trans folk), still suffer from eating disorder symptoms at a subclinical threshold, even if they do not fully express clinical behaviors. Full recovery rates of documented cases are dismal at approximately 50% with many patients experiencing relapse. Thus, there is certainly a pressing need for more research and rapid clinical application to better assist existing patients and subclinical persons at risk, through their recovery.
Mind-body interventions such as Hatha yoga and mindfulness meditation have been of increasing interest to mental health professionals. Both of these interventions share a common thread of their ability to aid in distress tolerance and emotion-regulation while improving body awareness– features that are impaired in those with eating disorders. For instance, recent neuroimaging studies have found that patients with eating disorders tend to have dysfunction in a brain area called the insula, which allows one to feel internal body signals such as pain, temperature, itch, tickle, muscle tension, hunger, stomach pH, and intestinal tension. Furthermore, many eating disorder patients face co-morbid affect disorders and emotion-regulation deficits such as maladaptive anxiety, depression, and intense shame.
With promise, mind-body interventions may work to combat these neural dysfunctions. Hatha yoga and mindfulness meditation have been shown to improve insula functioning, through practice of listening to internal body signals and thus re-establishing clear communication between the body and mind. Furthermore, Hatha yoga and mindfulness meditation can help tolerate and alleviate negative emotional states which can contribute to binging episodes. While studies on Hatha yoga are in their infancy, a recent array of mindfulness studies have shown promising effects for decreasing eating disorder symptoms. Mindfulness interventions that involve mindful eating components have been revealed to be the most beneficial for healing relationships with food by method of de-conditioning negative emotional responses to food consumption. Taken together, mindfulness meditation is recognized as an efficacious conjunctive treatment to eating disorders. Please see the meditation tab for a mindful body scan and mindful eating guide.
CULTIVATING A BODY POSITIVE SOCIETY
Healing our relationships with food and our bodes is an important step in fighting eating disorders. However, this fight must not be disconnected from the sociocultural systems which strategically create this suffering for monetary profit. The fashion, diet, weight loss, and some exercise industries all cooperate in creating intense fears of weight gain and toxic ideologies of how we relate to food and our bodies, just so they can sell us “cures,” that quite frankly, do not work. It’s time to take a stand against these systems of oppression. Join in the body-positivity movement, where we work to create societies free of body shame and objectification. How? Start with your own social sphere: be mindful of your speech to avoid triggering someone with an eating disorder and/ or negative past histories. Here’s a quick guide how:
- RESPECT EVERYONE’S GENDER. Use appropriate names and pronouns. Respect style and dress.
- DO NOT COMMENT ON BODIES. There is a lot more to a person beyond the body they live in. Never criticize or shame a person’s body. Do not attach positive or negative connotations to certain body features. Be aware of weight biases (the false belief that fat individuals are undisciplined and lazy). Reserve compliments to style choices rather than body features.
- AVOID DIET AND WEIGHT TALK. Do not add to the obsessive diet and weight culture. Seek other ways to bond!
- KEEP YOUR HEALTH CONCERNS TO YOURSELF. Contrary to popular belief, studies show that self- and other health concern shaming is not helpful for changing health behaviors. If you want to help someone, focus on supporting them emotionally. Lastly, acknowledge that content of food consumed primarily depends on social class and accessibility; check yourself before making any potentially classist comments.
- YOUR BODY. YOUR RULES. Respect people’s sexual orientation, relationship orientation, diet, gender, style, and dress.
Let’s work together to heal ourselves and at the same time, create a more body-positive social environment.
American Psychiatric Association (2000). Diagnostic and Statistical Manual for Mental Disorders: Fourth Edition Text Revision. Washington, DC: APA Press.
American Psychiatric Association (2006). Practice Guideline for the Treatment of Patients with Eating Disorders Third Edition. Washington, DC: APA Press.
Carei, T. R., Fyfe-Johnson, A. L., Breuner, C. C., & Brown, M. A. (2010). Randomized controlled clinical trial of yoga in the treatment of eating disorders. Journal of Adolescent Health, 46(4), 346-351.
Forbes, B. (2011). Yoga for Emotional Balance: Simple Practices to Help Relieve Anxiety and Depression. Boston, MA: Shambhala.
Kaye, W. (2008). Neurobiology of anorexia and bulimia nervosa. Physiology & Behavior, 94(1), 121-135.
Kaye, W. H., Fudge, J. L., & Paulus, M. (2009). New insights into symptoms and neurocircuit function of anorexia nervosa. Nature Reviews Neuroscience, 10(8), 573-584.
Kim, K. R., Ku, J., Lee, J. H., Lee, H., & Jung, Y. C. (2012). Functional and effective connectivity of anterior insula in anorexia nervosa and bulimia nervosa. Neuroscience Letters, 521(2), 152-157.
Kristeller, J. L., Baer, R. A., & Quillian-Wolever, R. (2006). Mindfulness-based approaches to eating disorders. Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications, 75-91.
O’Reilly, G. A., Cook, L., Spruijt‐Metz, D., & Black, D. S. (2014). Mindfulness‐based interventions for obesity‐related eating behaviours: a literature review. Obesity Reviews, 15(6), 453-461.
…And THANK YOU to all the amazing community members who participated in a series of focus groups by which I was able to create a guideline for mindful, body positive speech.