Understanding Eating Disorders
Eating disorders are a complex, serious and sometimes fatal illness that cause severe disturbances to an individual¡¯s eating behaviour, their sense of identity, self-worth, and self-esteem.
It is estimated that between two to three percent of Canadians meet the diagnostic criteria for an eating disorder.1 Of these individuals, between 10 to 20 percent will die from related complications.2
There is much to know about eating disorders, and the impact it has on one¡¯s mental and physical health. It is important to understand the potential causes and types of eating disorders, identify recognizable symptoms to be aware of, and what measures can be used to prevent an eating disorder from forming.
Factors contributing to eating disorders
There are a variety of factors that may contribute to an individual developing an eating disorder. While the factors below aren¡¯t necessarily predictive, they may contribute to the onset of disordered eating behaviours.
Biological. In some individuals, scientists believe there can be biochemical or biological predispositions which increase the odds of developing an eating disorder. Scientists have observed imbalances in certain chemicals within the brain that control appetite, digestion and hunger. These are often as a result of inherited genetics. Research has shown a significant genetic risk to the development of an eating disorder.
Psychological. There are various psychological correlations that could lead someone to develop an eating disorder. Behaviours and personal factors including low self-esteem, lack of control in life, feelings of inadequacy, anger, anxiety, depression, loneliness and stress have all been linked to eating disorders.
Societal. With cultural pressures and a bias that celebrates ¡°thinness¡± or muscularity, we collectively place value on the ¡°perfect body¡± which both women and men struggle to achieve. Often the most celebrated looks are sometimes unattainable and unhealthy for the average individual. Cultural norms have placed value on someone¡¯s physical look, with less emphasis on their inner qualities and strengths. Stresses may form due to social norms, perpetuating discrimination or prejudice onto those who suffer from eating disorders.
Interpersonal. For some, eating disorders are a result of interpersonal trauma that has been experienced in a specific instance or throughout one¡¯s life, including trauma stemming from troubled relationships or negative communications. These interactions between people can impact an individual¡¯s view of themselves. Those who may have been teased for their weight or body shape, or have experienced sexual, physical, or emotional abuse, may face an increased risk of the development of an eating disorder later in life.
Common eating disorders
Eating disorders are very complex given the various contributing factors. Many biological, behavioural, and social underpinnings cultivate this disorder. Most frequently developed in adolescence and early adulthood, these disorders can affect anyone at any point in their life and are often difficult to recognize due to the ability to hide identifying behaviours.
Anorexia nervosa. Is characterized by persistent restrictions of food intake as a result of fear of gaining weight or becoming obese. Individuals often suffer from distorted perceptions of body weight and shape, seeing themselves as perpetually overweight. Some people with anorexia nervosa will lose weight through fasting, diet, excessive exercise, taking laxatives, diuretics or enemas.
Common characteristics of anorexia are: brittle hair or nails; low blood pressure; depression; continual dieting.
Bulimia nervosa. Is considered as recurrent and frequent episodes of eating large amounts of food (binge-eating), followed by purging (vomiting, excessive use of laxatives or diuretics), fasting, and excessive exercise at least once a week for three months. Unlike those who have anorexia, people with bulimia maintain body weight at or above a minimal normal level.
Common characteristics of bulimia are: abuse of laxatives or diuretics to lose weight; purging by strict dieting, fasting, vigorous exercise, or vomiting; depression or mood swings.
Binge-eating. Is characterized by reoccurring binge-eating episodes with respect to food consumption. Often the portion size is out of the norm in comparison to what an average individual would eat in a single meal. Unlike bulimia, individuals who have binge-eating disorder do not purge, exercise, or fast after eating. This often results in individuals with binge-eating disorder being overweight or obese.
Common characteristics of binge-eating are: eating large amounts of food when not hungry; eating faster than normal; eating until feeling uncomfortably full.
Homewood Health Centre offers the largest inpatient eating disorders program in Canada. Our program helps women and men aged 16 and older to regain control over their lives. Learn more.
Q & A with Sherry Van Blyderveen, Program Director, Homewood Health Centre Eating Disorders Program
1. How does Homewood¡¯s Eating Disorders Program help patients with eating disorders and possible mental health concerns?
At Homewood, our goal is to provide high-quality, evidenced-based treatment for eating disorders, while also being sure the treatment we provide is personalized and addresses co-occurring difficulties.
2. Specifically, what does treatment look like with the Eating Disorders Program? What can patients expect?
Our program offers an environment where eating disorder symptoms can be interrupted. This includes the provision of regular and appropriately portioned meals and snacks, with supervision to help patients refrain from engaging in compensatory behaviours. It is hoped that this exposure to ¡°normalized¡± eating and increased self-care and leisure will challenge the eating disorder beliefs and fears. Greater autonomy is provided regarding meals and leisure as patients demonstrate their ability to apply the skills learned.
In order to support patients in coping with distress associated with not being able to engage in disordered eating behaviors, a variety of skills are taught. The program¡¯s approach integrates three evidence-based treatments for eating disorders; Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). The primary format of treatment is group-based, with 24-hour nursing support to help patients refine the skills they are learning in real-time. Our program schedule includes groups in both the morning and afternoon, with free time after dinner and on weekends. All groups include a teaching component where information is presented by therapists, as well as a review of homework from the previous week.
In addition to the group programming, individual therapy sessions are provided weekly with a social worker or psychologist. Sessions are also provided with our psychiatrist, dietitian, occupational therapist, and recreation therapist.
3. How does your program prepare patients for a return home? What happens after the patient completes and leaves the program?
Although we are preparing patients for a return home from the first day they are with us, we dedicate the last month of treatment to ensuring that skills they have learned are translated to the home environment. We refer to this period of time as the Community Reintegration Phase of our treatment. Emphasis is placed on exposure therapy in the community through both community outings with staff present to challenge specific goals and planned individual exposures on passes. Community outings include going to dinner with staff at a restaurant, trying a new activity like Zumba or trampolining, and body image challenges such as jean fittings.
Our treatment team supports patients in the process of securing aftercare once they leave our program. Given the nature of eating disorders, and that our treatment is only part of the recovery journey, we strongly encourage patients to plan to return to a specialized outpatient eating disorders program in their home community.
4. What makes Homewood Health¡¯s Eating Disorder Program unique?
The comprehensiveness and personalization of our care is what makes our program unique. Our program addresses eating disorder symptoms, while also addressing co-occurring conditions. In fact, we have treatment streams for individuals struggling with either substance use or trauma, and all patients receive individual therapy sessions weekly to address the issues they feel are most in the way of their personal recovery. Our community reintegration stream is also a unique feature compared to other programs.
¡°Engaging in treatment and active recovery from an eating disorder is incredibly challenging and absolutely possible.¡±
- Sherry Van Blyderveen
- National Initiative for Eating Disorders & Ontario Community Outreach Program for Eating Disorders. (2017). Canadian Research on Eating Disorders. Retrieved December 6, 2017, from http://nied.ca/wp-content/uploads/2017/11/Canadian-Research-on-Eating-Disorders-Formatted.pdf
- The National Benefit Authority. (2015, February 03). Eating Disorder Statistics in Canada. Retrieved December 06, 2017, from http://www.thenba.ca/disability-blog/eating-disorder-statistics-canada/