Welcome to the fourth and final part of our series discussing the medical complications of eating disorders (EDs), and how treatment toward recovery can help. Although we have not discussed the complications of all of the different types of recognized EDs in the DSM-5, we explored anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) as these are three of the most commonly known disorders.
Today, we’ll explore concepts around the road to recovery, and why seeking out treatment is vital to the health and wellness of everyone affected by an ED.
EDs are serious, but treatable mental health conditions. Anyone can be impacted by an ED, no matter their sex, age, sexual orientation, race, ethnicity, body size and shape, religion, socioeconomic status… but some groups are more affected by EDs than others.
Women, for example, are about 4 times more likely to develop an ED than men, with lifetime prevalence reported to be around 8.4% for women and around 2.2% for men (1). Broken down into AN, BN and BED, 1.4% of women and 0.2% of men, 1.9 % of women and 0.6% of men, and 2.8% of women and 1.0% of men are impacted by these disorders, respectively, over their lifetime (1).
Eating disorders are also more likely to impact teenagers and young adults, with young Canadians increasingly engaging in behaviours that increase their risk of developing an ED (2). For example, 12-30% of Canadian girls, and 9-25% of Canadian boys between the ages of 10 and 14 years old report engaging in dieting behaviours to lose weight (2).
LGBTQ+ youth have 3 times higher rates of EDs than straight youth (3). Lesbian and bisexual girls are 2.5 times more likely, and gay and bisexual boys are 6 times more likely to have EDs compared to straight girls and boys, respectively (3). Transgender college students are diagnosed with EDs at 4 times higher rates than cisgender students (3).
BIPOC (Black, Indigenous and People of Colour) folks experience EDs at similar rates as white folks, but are about half as likely to be diagnosed (3). Latinx folks are about half as likely to receive necessary ED treatment as white folks (3).
Less than 6% of those with EDs are medically “underweight” (3). Those in larger bodies are at highest risk of developing an ED, and research shows that the higher the body mass index (BMI), the higher the risk (3). Weight stigma in healthcare makes this evident, as those with anorexia are 14 times more likely to receive recommended ED treatment than those with atypical anorexia (a type of AN, where all of the behaviours are the same, but the person’s BMI is not considered “underweight”) (3).
These stats can show how impactful EDs can be on the lives of those who experience them, and how important it is to look out for warning signs within the population.
Despite how dangerous and serious the consequences can be, up to 4 out of 5 people with EDs do not pursue treatment (1). This is alarming, considering the high mortality rate of EDs – one death every 52 minutes, with anorexia having the highest mortality rate of any mental illness (3).
This does not mean that treatment toward recovery doesn’t work; it’s that there are so many factors that can influence one’s decision to seek treatment, such as difficulty accessing services, the cost of treatment, public and/or self-stigma of EDs, feelings of shame around consulting, and more (1). There is also the fact that many people with EDs can continue to lead “normal” lives, which can make it feel like they aren’t sick enough to need treatment.
Despite this feeling, we know (especially having read part 1-3 of this series) that anyone experiencing the effects of EDs or disordered eating will benefit from (and deserves!) treatment. The road to recovery is a challenging one and it is expected that there will be ups and downs, but most of the complications that arise from EDs can be reversed with treatment and permanent consequences can be prevented. This is especially true when EDs are caught early and treatment is started shortly after.
When it comes to AN, a main goal in beginning treatment is restoring weight back to a “safe” level (ie. helping the person gain weight back to their personal safe weight range). In focusing on and achieving weight restoration, heart health returns back to normal, one’s menstruations return and remain regular, rigidity around eating and thoughts about food/body improve, the metabolism eventually returns to normal, gastrointestinal symptoms usually completely clear up, effects of depression, anxiety, and sometimes other mental health disorders, like OCD, improve, and so much more (4). Once weight is restored, the focus of treatment moves more toward working through challenges around one’s relationship with food and their body, and creating the lives they want, without their ED.
In the case of BN and BED, emphasis is placed initially on making sure nourishment is adequate, to remove any physical vulnerabilities toward binge eating. This can mean working toward eating regularly and enough throughout the day so that intense hunger does not lead to binge eating (and then those with BN feeling the need to compensate after). Lots of work is also done around understanding other aspects of binge eating (and compensation in the case of BN) and working on developing strategies to cope with more emotional vulnerabilities without ED behaviours.
While working toward recovery is in no way an easy feat, with the help of nutritional treatment, psychological intervention, medical monitoring, social support from loved ones (and hopefully a combination of all of them), recovery is fully possible!
There are a variety of different approaches that can be taken, including individual counseling, Family-Based Treatment (the gold-standard for the treatment of AN and BN for children and teens), group counseling, and more. Treatment plans aim to address nutritional, behavioural, medical and psychological complications to stop/manage ED behaviours, and should be fully customized for each person’s unique presentation, including any co-occurring conditions or traumas.
Given that EDs impact every sphere of someone’s life, it is important to explore and recognize how the ED serves and doesn’t serve each person. Trauma-informed approaches can be especially useful for exploring the protective elements of EDs, and ways to better cope with any and all kinds of triggers. Harm reduction approaches can also be useful for working towards recovery in more realistic ways than abstinence-based approaches. For example, some people may be able to abstain from self-induced vomiting when starting treatment, while others may find this almost impossible to do. A harm reduction approach toward this could be to try to delay the purge by an hour, or to drink Gatorade afterwards to avoid any electrolyte imbalances that can harm the heart (5).
ED recovery is an incredibly personal journey for each and every person and can look completely different from one person to another. It can feel extremely challenging, and like the risk of “failing” is high, but how can we fail when there is no one right way to recover? Recovery isn’t linear and it isn’t expected that climbing the mountain will be done in one shot. In working through managing the discomfort, trusting the process, and relying on one’s support system (among many other things), recovery is possible and can happen for anyone.
At Sööma, we recognize how challenging recovery can be for everyone involved, and aim to support clients at a pace that is the most “comfortably uncomfortable” and reasonable for them. If you or someone you know is struggling with an ED or disordered eating, feel free to contact our team at (514) 437-4260 or by email at info@sooma.ca. You can also book an appointment with one of our professionals directly by clicking this link.
Written by
Registered Dietitian
