Eating Disorders: diagnosis, process, and healing
May 2, 2023
Eating disorders and disordered eating don’t have peak seasons. They don’t inhabit specific body types. They don’t present with the same symptoms. They don’t have the same recovery process.
Early intervention is vital. If you have concerns about your health or the health of others, please seek out a school counselor or trusted adult.
What are eating disorders? What misconceptions exist?
Even though most teens have an idea of what eating disorders are, it may be easier to find misinformation than facts. The stereotypical portrayal of a person with ED—most often, a white, wealthy, thin teenage girl—isn’t indicative of how broad and nuanced the identities of those who struggle can be.
National Eating Disorders Association defines the collected of diagnoses as “serious but treatable mental and physical illnesses.” There are a number of different types of disorders defined by mindsets, behaviors and treatment paths.
Although the difference between disordered eating and an eating disorder might sound minor, it’s distinct.
Disordered eating is includes abnormal eating patterns—eating to deal with emotions, for example, or excluding a food group from a diet—but those behaviors do not necessarily mean that that person has a diagnosable eating disorder.
One common misconception is that there are only two eating disorders: anorexia, where people heavily restrict their energy intake, and bulimia, where people binge food and then resort to “inappropriate compensatory measures” which, in most pop culture representations, means vomiting. In reality, there are many others which often slip under the radar. Binge eating disorder is actually the most common eating disorder in the U.S., yet the DSM-5, an edition of the manual that mental health professionals use to help diagnose patients, didn’t give it its own entry until 2013.
Anorexia is sometimes seen as a quieter or more attractive-looking disease than bulimia or binge eating because people who suffer from it may get thinner, and their methods aren’t overly uncomfortable for most people to visualize—they often resort to not eating and overexercising, which can be seen as just more extreme versions of behaviors that people might do anyway.
However, when people with bulimia purge food, or people with binge eating disorder feel like they’re out of control of their eating, people can be less understanding of their symptoms.
I think there can be a lot more shame that’s associated with having bulimia than with having anorexia. The shame perpetuates the eating disorder because the… disorder is some attempt to control uncomfortable, negative feelings.
— Emily Barbee
US Counselor Emily Barbee noted how infrequently people talk about overeating when discussing eating disorders.
“Anorexia can be seen in this very glorified way… but then other eating disorders, like binging… and bulimia, that’s ‘less appealing’ to talk about,” Barbee said. “I think there can be a lot more shame that’s associated with having bulimia than with having anorexia. The shame perpetuates the eating disorder because the… disorder is some attempt to control uncomfortable, negative feelings.”
Stereotypes cause harm to people who suffer from EDs that don’t fit that mold. A 2007 study by the Centers for Disease Control and Prevention showed that one-third of all people with an eating disorder are male. The weight of a person with an eating disorder has been found to be irrelevant to the psychological distress the disease causes. People may develop or suffer from eating disorders at any age, not just adolescence, and a person’s race has no bearing on whether or not they may develop an eating disorder, according to CDC research.
Ultimately, combating misinformation with facts helps kill the shame that EDs thrive on.
People with these disorders aren’t making bad lifestyle choices or are somehow weaker than others; they are living with diseases that have a vested interest in keeping their sufferers quiet. Support and understanding are some of the most valuable things that friends and family can provide.
Road to recovery requires support
Recovery from an eating disorder can take many forms. Each person’s process and support network is individualized.
For some students, the SPA counseling office is involved in the recovery process. According to US School Counselor Heidi Lohman, students typically work with outside providers, whether that’s a therapist, a pediatrician, or a treatment program such as Melrose Center or The Emily Program. However, the SPA counselors also try to support the student by contacting treatment providers and using that information to inform how the school can assist in the recovery process.
It’s very powerful to hear the stories of these patients who were in dark, dark places with their eating, with their weight, with their thoughts… and then to hear about their recovery, how thrilled they are, how optimistic. It’s just remarkable.
— Carmen Hansen, Melrose
For students who approach recovery through a clinic-based treatment, that process can bring them to a facility like Melrose Center, a HealthPartners specialty center dedicated to offering care to those struggling with disordered eating.
Carmen Hansen works as the Manager of Community Outreach and Provider Services at Melrose Center. Although Hansen holds an RN and has provided nursing care, she primarily works with the outreach department. “The more I’ve gotten into it, the more I am passionate about helping people get the life back that the eating disorder took away,” Hansen said.
Hansen also works on a podcast called “Melrose Heals,” where hearing living recovery stories helps to remind her of her passion for her work.
“It’s very powerful to hear the stories of these patients who were in dark, dark places with their eating, with their weight, with their thoughts,” she said. “And then to hear about their recovery, how thrilled they are, how optimistic. It’s just remarkable.
That’s why I do what I do.”
TREATMENT AT MELROSE CENTER
Recovery is difficult to define, and it looks different for everyone.
“When we talk about recovery, we talk about regaining the things that the eating disorder has taken away,” Hansen said.
At Melrose Center, recovery begins with an initial assessment, in which the physical characteristics and the emotional behaviors of the patient are assessed. A diagnosis is given and the recommended level of care is discussed with the patient.
“It’s very individualized,” Hansen said. “We find out what is the lowest level of care that will sufficiently help you recover.”
The majority of the patients at Melrose Center require the lowest level: outpatient care. These patients meet with a therapist and a dietitian, as well as a medical provider and a psychiatrist as needed.
For students who are in outpatient treatment and regularly attending school, support is provided during the learning day.
“Depending on what the eating disorder looks like, each student might have a different plan,” Lohman said. “We offer them access to keeping food on hand. If eating in public is something that they struggle with, we offer spaces for students to eat privately. It looks very different for every student.”
The next level of care is intensive outpatient care. While relatively similar to outpatient care, patients in this program also participate in evening meetings at Melrose, which involve group therapy and a shared meal.
Partial hospitalization is the next level of care and involves an all-day program that takes place five days a week. The regular residential program is similar, though that level involves 24/7 care.
The highest level of care offered at Melrose Center is called intensive residential care. “A patient is placed in intensive residential care when their bodies are more medically compromised and need to have close attention to restore weight and to be safe,” Hansen said. “Sometimes patients are very weak. They could pass out or lose their balance or have a heart condition because of what the eating disorder has done to their body.”
For younger patients, care can also include family-based therapy.
Director of Publications Kathryn Campbell supported her child through an anorexia diagnosis in 2014. The family worked with The Emily Program.
“Family-based therapy included one evening a month where at least a parent or supportive adult was expected to be present. There was a group session for the adults that included education. We learned about the bio-psycho-socio nature of eating disorders, what helps and impedes recovery, etc. There were times with our teens when we might do art, yoga, or meditation. In parent therapy sessions, we talked about the toll an eating disorder takes on caregivers and were offered tools to help us support our teens and take care of ourselves. The evening included a shared meal with all the families and students (and lots of conversation cards and discussion games), and often a speaker who shared their recovery story would end the night. There were occasional sibling nights, too; eating disorders impact the entire family and for family members to have a glimpse into recovery can help build empathy with siblings and give them some idea of the work their brother or sister is doing when they aren’t home.”
“The care process is not only physical, but it is also emotional,” Hansen said. “Typically, it’s not about the food. It’s about what’s going on underneath.”
Lohman believes the school could add some components to Wellness and community engagement to protect students against eating disorders. “I think that there’s a lack of education around nutrition and how it impacts your life,” she said. “I also think that there could be a better parent information component because adults at home don’t often realize how their own thinking and their own relationship with food can impact how their kids view their relationship with food.”
According to Hansen, there are a number of things one can do to protect against disordered eating.
“Stop talking about people’s bodies, about weight and shape, about how you feel in your shirt or your pants, about how someone else looks,” she said. “Throw away your scales. Eat in moderation. Enjoy your food. Don’t skip meals; don’t diet. Enjoy what your body can do for you. Get involved in activities that help your body feel good and feel whole and feel alive.”
Hansen acknowledged that recovery is often a difficult road to travel. “Treatment is hard work,” Hansen said. “But recovery is definitely possible.”
To start the recovery process, Lohman emphasized the importance of seeking support. “Recovery is not something that you can do in secret,’ she said. “I’m not saying you need to shout it from the rooftops, but there needs to be a team of trusted people, because it is an all-consuming battle to recover from an eating disorder. You’ve got to have a network.”