Eating Disorders

Bulimia nervosa is a cycle of uncontrolled eating, called binging, followed by purging through vomiting or the use of laxatives. Bulimics may also exercise to excess to purge calories. People with bulimia are often a normal weight, or may be slightly overweight. It usually begins as an attempt to control one's weight, but people find that they soon become out of control of the binge-purge cycle. Bulimia can range from infrequent binging and purging episodes to daily episodes that can absorb all of a person's time, emotions, and energy. Physical effects of bulimia can be quite serious, including damage to tooth enamel and the stomach and esophagus, kidney problems, and seizures. Electrolyte imbalances can result in sudden cardiac failure and even death.

Anorexia is an attempt to control one's weight and body by restricting the amount of food that he or she eats. It usually is caused by a tremendous fear of becoming overweight and tends to begin during high school or college years with a normal attempt to diet. As the person with anorexia becomes thinner and thinner, they lose their perspective and their view of their body image becomes distorted. They continue to see themselves as overweight, even if they are literally starving. Someone with anorexia may lose their menstrual periods, find themselves constantly cold, suffer from dry skin and hair, low blood pressure, and heart difficulties, but continue to deny that they are too thin. Concentration also becomes diminished, and their ability to learn becomes impaired.

Compulsive overeating is an eating disorder in which people binge on large numbers of calories at one time, but do not purge. These individuals are often somewhat overweight and may be obese. Compulsive overeaters feel out of control of their eating habits and suffer from low self-esteem and body image. They may eat when they feel stressed or may binge after attempting to eat normally for a period of time. Because of the secretive nature of their eating, compulsive overeaters often feel isolated, but they fear being ostracized if others were to find out.

Although the causes of eating disorders are not entirely known, several contributors are thought to increase the likelihood that they will develop.

• Eating disorders may arise as a secondary expression of genetically inherited depression and other mood disorders. 
• Psychological factors seem to include low self-esteem, difficulties in family of origin including families with high achievement expectations for their children, and a tendency toward perfectionism. 
• People with anorexia are often described as model children who are highly intelligent and perfectionistic. 
• It has been suggested that controlling food intake is one means for an individual with anorexia to gain control when he or she has felt out of control for much of their lives. 
• Social contributors to eating disorders include the cultural emphasis on thinness. It is a cultural value to be thin at any expense, and this message is clear in all forms of the media, including popular movies, books, and magazines. Increasingly, adolescents turn to impossibly restrictive diets to comply with these impossible standards of thinness.

Concerns related to body image and disordered eating occur on a continuum from mild to severe. Due to the complex nature and health risks related to eating disorders, thorough assessment is required to ensure an individual receives the most beneficial care for their needs. The Loyola University Counseling Center can provide assessment, support group, and short-term individual counseling for some students with body image and milder to moderate disordered eating concerns.  We can also provide referral assistance for students who require more ongoing or intensive support.  Below is a guide for possible treatment recommendations. Please note that these recommendations are based on guidance from the National Eating Disorders Association and are consistent with best practices at university counseling centers across the country. 

Symptoms/Concern	Potential Recommended Level of Care for Treatment
Student is preoccupied with worries related to body image, weight, and food These concerns mildly impact academic, social, and emotional functioning, but student continues to maintain overall healthy diet and lifestyle Student has no history of eating disorder	RIO workshop Body image/eating disorder support group Relationships group Short-term individual counseling
Student is preoccupied with worries related to body image, weight, and food Student may be beginning to mildly restrict caloric intake, exercise in an excessive manner, or engage in binging and purging episodes fewer than 1x/week Concerns may be moderately impacting academic, social, and emotional functioning Student has no history of eating disorder	RIO workshop Body image/eating disorder support group Relationships group Short-term individual counseling Referral to Health Services for physical evaluation and check-up Possible referral to community provider: therapist, nutritionist
Student is preoccupied with body image, weight, and food to the extent that they are consistently restricting caloric intake beyond a healthy limit and/or are engaging in binging/purging episodes more than 1x/week Concerns are routinely impacting academic, social, and emotional functioning Student is engaging in exercise activities in an excessive or unsafe manner Student has a history of eating disorder, with or without previous treatment, and is at risk of relapsing	Outpatient Treatment with a Community Provider(s) Referral to Health Services for physical evaluation and check-up
Presenting symptoms meet diagnostic criteria for Anorexia, Bulimia, or Binge Eating Disorder Student is medically and psychiatrically stable, but requires more intensive treatment than traditional outpatient care Student would benefit from engagement in individual and group treatment, as well as the care of a nutritionist and possibly a psychiatrist in a structured setting	Intensive Outpatient Treatment
Eating disorder impairs functioning, though without immediate medical or psychological risk Needs daily assessment of physiologic and mental status Student is unable to function in usual social, educational, or vocational situations Student engages in daily binge eating, purging, fasting or very limited food intake, or other unhealthy weight control techniques	Partial Hospitalization Program
Student is medically unstable as determined by: Unstable or depressed vital signs Laboratory findings presenting acute health risk Complications due to coexisting medical problems such as diabetes Student is psychiatrically unstable as determined by: Rapidly worsening symptoms Suicidal and unable to contract for safety	Inpatient Hospitalization

An eating disorder is disruptive for the person who suffers from it, and for their family and friends. Signs that may indicate an eating disorder include preoccupation with food and thinness, excessive exercise, refusal to eat or refusal to eat in the presence of others, noticeable and extreme loss of weight, persistent depressed mood, and/or unusual eating habits. You may also notice a strong striving for perfection, withdrawal from friends, and/or persistent low self- esteem and negative body image.

If you think a friend has an eating disorder, be frank, but supportive. Express your concern to your friend, and let them know that you are available to talk. Don't nag them about food or their eating, as this will only make them feel more self-conscious. Don't comment about their physical appearance, even if you think you are paying them a compliment. Seek consultation from the Counseling Center to help you learn how to talk to your friend about this problem, and to help him or her seek help.

These links provide information about understanding the causes of your loved one's eating problems and what your role could be in helping them improve their health.

• Tips For Families and Friends – Tips on coping with and helping a friend or family member with an eating disorder.
• What Should I Say? – Tips on how to talk to your loved one about this problem.
• Male Eating Disorders – Strategies for prevention and early intervention of male eating disorders.
• Body Image – More information about struggling with body image issues and weight management.
• National Eating Disorders Association – Lots of helpful information, resources and links.