Understanding Eating Disorders

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By Dr. David Woo - September 23, 2024

Eating disorders (ED) are complex mental health conditions that extend far beyond food and eating habits. They often involve a challenging interplay of emotional, psychological, and physical factors. Understanding the various types of eating disorders and their connection to other mental health issues, such as anxiety, depression, and obsessive-compulsive disorder (OCD) is crucial in providing effective treatment and support for those affected.

At Madison Avenue TMS & Psychiatry, we offer a range of services, including medication management, telehealth consultations, and Transcranial Magnetic Stimulation (TMS), to help individuals with eating disorders on their journey to recovery.

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Understanding Different Types Of Eating Disorders

Eating disorders come in various forms, each with unique characteristics and challenges. The most well-known types include anorexia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID). These conditions can affect anyone, regardless of age, gender, or background, and often coexist with other mental health issues.

Anorexia Nervosa

Anorexia nervosa is perhaps the most recognized eating disorder. It is characterized by extreme food restriction, an intense fear of gaining weight, and body image distortion. Individuals with anorexia often see themselves as overweight, even when they are dangerously underweight.

The physical effects of anorexia can be severe, including:

Malnutrition
Heart problems
Bone density loss

Psychologically, anorexia is closely linked to anxiety, perfectionism, and a need for control (1, 2). Although there is a widespread perception of anorexia as a condition that primarily affects teenage girls, it can impact individuals of all ages and genders and is associated with a higher risk of mortality(3).

Binge Eating Disorder

Bing eating disorder — Binge eating disorder concept with woman eating fast food burger, fired chicken , donuts and desserts, over eating

Binge eating disorder involves consuming large amounts of food in a short period, often accompanied by feelings of shame, guilt, and a lack of control. Unlike bulimia, another eating disorder where bingeing is followed by purging, those with binge eating disorder do not typically engage in induced vomiting or use of laxatives.

This disorder can lead to significant physical health issues, such as obesity, diabetes, and heart disease, and is often associated with mood disorders such as depression and anxiety (4).

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID, meaning avoidant/restrictive food intake disorder, is a lesser-known but equally serious condition.

ARFID symptoms include:

Significant weight loss
Nutritional deficiencies
A dependence on supplements or tube feeding.

Unlike anorexia, ARFID is not driven by body image concerns but by an aversion to certain foods or eating in general. This disorder can stem from sensory sensitivities, fear of choking, or a past negative experience with food (5).

Types Of Eating Disorders Compared

Aspect	Anorexia Nervosa	Binge Eating Disorder	ARFID (Avoidant/Restrictive Food Intake Disorder)
Primary Symptoms	Severe restriction of food intake, fear of weight gain, distorted body image, and significantly low body weight.	Frequent episodes of binge eating (without purging), feelings of guilt or shame after eating.	Avoidance or restriction of food based on sensory characteristics, fear of choking, or past negative experiences with food.
Psychological Factors	Strong focus on body weight and shape, perfectionism, desire for control, often linked with anxiety and OCD.	Often linked with emotional distress, anxiety, depression, and low self-esteem.	Not typically related to body image but may be connected to sensory sensitivities, anxiety, or traumatic experiences related to food.
Physical Effects	Malnutrition, heart problems, bone density loss, organ damage, potentially life-threatening complications.	Obesity, diabetes, cardiovascular disease, gastrointestinal issues, and other health problems associated with excessive food intake.	Nutritional deficiencies, significant weight loss, growth retardation in children, dependence on nutritional supplements or tube feeding.
Prevalence	More common in females, particularly adolescents and young adults, though it can occur in people of all ages and genders.	Most common eating disorder in the US, affecting both males and females, often starting in young adulthood.	Affects both children and adults, with a higher prevalence in younger children; gender distribution is more balanced than in other eating disorders.
Treatment Approaches	Typically includes a combination of psychotherapy, nutritional counseling, and medical monitoring; in some cases, medication management and/or TMS is used to treat co-occurring mood disorders.	Psychotherapy, nutritional counseling, medication management, and TMS for co-occurring disorders like depression and anxiety.	Behavioral interventions, sensory integration therapy, nutritional counseling, and family-based therapy; medication and TMS may be considered for co-occurring anxiety or OCD.
Prognosis	Recovery is possible with early intervention and comprehensive treatment, but the risk of relapse is significant. Long-term follow-up is often necessary.	With appropriate treatment, individuals can learn to manage symptoms and achieve recovery. However, the risk of recurrence remains without ongoing support.	Prognosis varies depending on the severity and duration of the disorder; early intervention can lead to better outcomes. Ongoing support may be necessary for long-term management.
Co-occurring Disorders	Often co-occurs with anxiety disorders, depression, and OCD.	Commonly co-occurs with depression, anxiety, and other mood disorders.	May co-occur with anxiety disorders, OCD, and autism spectrum disorder.
Unique Challenges	High risk of medical complications and mortality; strong resistance to treatment due to distorted body image and denial of the seriousness of the condition.	Emotional eating as a coping mechanism can make it challenging to break the cycle of bingeing; feelings of guilt and shame can exacerbate the disorder.	Lack of body image concerns can delay diagnosis; it is difficult to distinguish ARFID from picky eating in children; and nutritional deficiencies require careful management.

The Connection Between Eating Disorders And Other Mental Health Issues

Eating disorders often do not occur in isolation. They are frequently intertwined with other mental health conditions, such as anxiety, depression, OCD, and borderline personality disorder (6). For example, the rigid control over food seen in anorexia can be a manifestation of underlying anxiety (7). At the same time, the compulsive nature of binge eating can be linked to depression and emotional distress (8). Addressing these co-occurring conditions is vital for effective treatment and long-term recovery.

Treatment Options At Madison Avenue TMS & Psychiatry

At Madison Avenue TMS & Psychiatry, we understand that treating eating disorders requires a comprehensive and compassionate approach. With extensive experience in treating patients with eating disorders, we offer several services designed to address both the eating disorder and any co-occurring mental health issues.

Medication Management

Medication can be an essential component of treating eating disorders, particularly when they are accompanied by anxiety, depression, or OCD. Our team of experienced professionals will work with you to develop a personalized medication management plan tailored to your specific needs.

Medications for mood disorders, particularly classes of antidepressants, can be notorious for causing weight gain in patients, something that can be challenging for individuals who are also struggling with eating disorders (9). Regular monitoring ensures that the treatment is effective and adjustments are made as necessary to avoid unwanted side effects.

Telehealth Consultations

We recognize that seeking treatment can be challenging, especially for those with busy schedules or limited access to in-person care in a high-pressure environment like New York. Our telehealth consultations provide a convenient and accessible way to receive the support you need from the comfort of your home.

Transcranial Magnetic Stimulation (TMS)

For individuals with treatment-resistant depression or anxiety associated with eating disorders, TMS offers a promising solution. This non-invasive therapy uses magnetic fields to stimulate nerve cells in the brain, improving mood and reducing symptoms of depression, anxiety, OCD, and related disorders.

Research into using TMS to treat eating disorders has shown promising results in reducing the psychological symptoms of EDs and improving the quality of life for patients (10, 11). As a drug-free treatment, TMS is particularly effective for those who have not responded well to traditional treatments and desirable for patients who wish to avoid the side effects, weight-related or otherwise, of medications.

Start Your Journey To Recovery

Recovering from an eating disorder is a challenging journey, but you don’t have to do it alone. At Madison Avenue TMS & Psychiatry, we are committed to providing compassionate, evidence-based care tailored to your unique needs. Whether you are dealing with anorexia nervosa, binge eating disorder, or ARFID, our team is here to support you every step of the way.

If you or a loved one is struggling with an eating disorder in the New York area, contact Madison Avenue TMS & Psychiatry at (212) 731-2033 or visit our website to schedule a consultation. Together, we can work towards a healthier, happier future.

Additional resources:

Sources:

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Coutinho BMC, Pariz CG, Krahe TE, Mograbi DC. Are you how you eat? Aspects of self-awareness in eating disorders. Personal Neurosci. 2024;May 21;7:e9. Link. Accessed August 16, 2024.
van Eeden AE, van Hoeken D, Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2021;Nov 1;34(6):515-524. Link. Accessed August 16, 2024.
Kowalewska, E., Bzowska, M., Engel, J. et al. Comorbidity of binge eating disorder and other psychiatric disorders: a systematic review. BMC Psychiatry. 2024;24, 556. Link. Accessed August 16, 2024.
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Miller, A. E., Trolio, V., Halicki-Asakawa, A., & Racine, S. E. Eating disorders and the nine symptoms of borderline personality disorder: A systematic review and series of meta-analyses. International Journal of Eating Disorders 2022;55(8), 993-1011. Link. Accessed August 16, 2024.
Dang, A. B., Kiropoulos, L., Castle, D., Jenkins, Z., Phillipou, A., Rossell, S., & Krug, I. Psychiatric comorbidity and severity in anorexia nervosa: a comparative study of the DSM-5, the ICD-11, and overvaluation of Weight/Shape severity ratings. Eating Disorders. 2024;1–17. Link. Accessed August 16, 2024.
Senra, H., Gaglianone, C. G., McPherson, S., & Unterrainer, H. Prevalence of personality disorders in adults with binge eating disorder—A systematic review and Bayesian meta-analysis. Obesity Reviews. 2024;25(3), e13669. Link. Accessed August 16, 2024.
Himmerich, H., Bentley, J. & McElroy, S.L. Pharmacological Treatment of Binge Eating Disorder and Frequent Comorbid Diseases. CNS Drugs. 2024;38, 697–718. Link. Accessed August 16, 2024.
Marcolini F, Ravaglia A, Tempia Valenta S, Bosco G, Marconi G, De Ronchi D, Atti AR. Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature. J Eat Disord. 2024;Apr 23;12(1):48. Link. Accessed August 16, 2024.
Wu, K., Lo, Y. T., Cavaleri, J., Bergosh, M., Ipe, J., Briggs, R. G., Jann, K. B., Murray, S. B., Mason, X. L., Liu, C. Y., & Lee, D. J. Neuromodulation of Eating Disorders: A Review of Underlying Neural Network Activity and Neuromodulatory Treatments. Brain Sciences. 20204;14(3), 200. Link. Accessed August 16, 2024.

Dr. David Woo

Dr. David Woo is the owner and head clinical psychiatrist at Madison Avenue TMS and Therapy in New York City. Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.

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