As part of my senior internship this semester I have had the opportunity to shadow/intern at Fairhaven Treatment Center, and since this past week was National Eating Disorder Awareness Week, I have decided to share some of the experience I've had. Fairhaven has levels of care including residential, partial hospitalization, and intensive outpatient treatment program for all types of eating disorders for a wide variety of ages, races, ethnicities, and levels of care needed. Through supported meals, group therapy sessions, individual and family therapy sessions, nutrition therapy with a registered dietitian who provides a customized meal plan, outings, and the support of the staff and other clients, Fairhaven truly is a family of individuals who desire to "Reclaim the Joy," as their motto states, from their eating disorder.
Throughout my time at Fairhaven, I have learned so much about what eating disorders are and how to identify the signs and symptoms of an eating disorder in someone who may be struggling. One of the first things I think is important is establishing what are the types of eating disorders? There are currently five known and diagnosable eating disorders, but sometimes different attributes of different disorders may overlap with others, such as someone who is struggling with anorexia may also have a major binge eating session one or two times a week then purge, just to return to restricting calories the very next day. No matter what category a person is in, they are all struggling with basically the same underlying issue: a bad relationship with food and most likely a bad relationship with their body. This is the aspect the Fairhaven tries to evaluate and treat, the underlying cause. Here's a breakdown of the current 5 diagnosable eating disorders.
Anorexia Nervosa
Anorexia Nervosa is seen with excessive dietary restriction, being unable to keep an adequate body weight, and a poor/distorted body image. Individuals with Anorexia have an intense fear of gaining weight or becoming "fat", or persist in behavior that interferes with weight gain (ex. purging, laxative/diuretic abuse, use of caffeine to dull hunger, or intense overexercising). The excessive restriction typically leads to extreme amounts of weight loss in a short amount of time, loss of menstrual cycle, denies/does not recognize hunger cues, develops extremely low tolerance to cold, and extreme body image issues.
Bulimia Nervosa
Bulimia Nervosa (binge and purge) is characterized by consuming large amounts of food while feeling out of control and engaging in behaviors after eating large amounts to prevent weight gain. These behaviors may include self-induced vomiting, misuse of laxatives, diuretics, or other medication, alcohol, fasting, or excessive exercise. This disorder develops when individuals are very influenced by body shape and weight. Binges are the much larger than normal amounts amounts of food ingested in a very short time frame until extreme discomfort occurs and the guilt for being out of control triggers the compensatory behavior. Many with Bulimia appear to be a normal weight. Other struggles associated with Bulimia include suicidal thoughts, self-harm, low self-esteem, frequent mood swings, and substance abuse.
Binge Eating Disorder
Binge Eating Disorder is characterized by binge eating without the compensatory behaviors characteristic of Bulimia. Often dismissed as emotional eating or compulsive eating, only recently has the medical community recognized binge eating as a disorder. The binge-eating episode may be accompanied by eating more than normal, eating until uncomfortably full or physically sick, eating large amounts of food independent of physical hunger, eating alone because of the embarrassment about the large quantities consumed, and feeling guilty after consuming large amounts of food. These binges occur at least 2 days a week for a minimum of 6 months. Binge Eating Disorder is the most common eating disorder. Most people with Binge Eating Disorder are at a normal weight or overweight, which makes this disorder harder to identify.
Avoidant Restrictive Food Intake Disorder
Avoidant Restrictive Food Intake Disorder (ARFID), is a type of disorder, where the individual will not eat certain foods based on the food’s appearance, smell, taste, texture, brand, presentation, or a past negative experience with the food but with no significant body image distortion or fear of weight gain as with Anorexia and Bulimia. ARFID can be diagnosed in children, adolescents, and adults, and it is the second most common eating disorder in children 12 years and younger. Individuals with ARFID are at high risk for other psychiatric disorders, in particular anxiety disorders and depression. Eating behaviors can include a lack of interest in food or poor appetite, fears about negative consequences of eating (e.g., vomiting, choking, allergic reaction), and selective or picky eating. The pattern of disordered eating is also accompanied by significant weight loss or failure to gain weight/grow as expected, nutritional deficiency (e.g., anemia), dependence on nutritional supplements or tube feeding, and impairment in psychosocial functioning.
Other Specified Feeding or Eating Disorder
OSFED is a feeding or eating disorder that causes many problems, but does not meet the criteria for another disorder. The behaviors described by OSFED were at one time included in the category of Eating Disorder Not Otherwise Specified (EDNOS) which includes: Eating behavior resulting in substantial weight loss despite normal weight status (Atypical Anorexia Nervosa), Binge eating and compensatory behaviors such as purging, laxative abuse, or excessive exercising, occurring less frequently than required for the diagnosis of Bulimia (Sub-threshold Bulimia Nervosa), Purging without binging (Purging Disorder), recurrent episodes of night eating, defined by excessive consumption of food after the evening meal or eating after awakening from sleep.
My Experience
After having a basic understanding of what the eating disorders are and the type of nutritional issues the registered dietitians work with, here's a brief snapshot of what my experience has been during my Fairhaven rotation in nutrition. I spend days at either the Residential facility or the Outpatient facility, which have many similarities and many differences. Residential includes patients that need a higher level of care for their eating disorder. They are likely to attend many group sessions and one-on-one sessions with a therapist or dietitian several times a week. During the nutrition sessions, they discuss the issues they are experiencing with meals, foods that "trigger" eating disorder thoughts, and ways to slowly improve the way these thoughts influence them. Nutrition group sessions involve a class type setting with topics such as macronutrients (protein, fat, and carbohydrates), correct portion sizes, grocery store outings, or eating out at restaurants, all very challenging topics and tasks for those with an eating disorder. Outpatient is more relaxed than residential, since the clients only attend certain days/times and meals while living in transitional housing or at home. Outpatient care gives the clients a little more freedom to apply what they have learned during meal and snack times not spent at the facility and how to adjust back to a "normal" life. Outpatient also provides group therapy sessions, and one-on-one sessions usually once a week with a therapist and dietitian. Fairhaven focuses strongly on recognizing fullness and hunger cues that eating disorders typically take away. Before and after each meal, especially at residential, the clients discuss their hunger and fullness using these charts during what they call "pre and post processing." Using this chart, clients will assess where their hunger levels are before and after meal time, with an overall goal to stay in the green zone throughout the day to prevent binging or restricting from happening.
Fairhaven is a remarkable place full of caring staff members and incredibly strong clients who are working hard towards recovery one day at a time. I have learned way more than I could fit into a blog post. If you, a friend, or a family member is struggling with an eating disorder, or what you may think is an eating disorder, please reach out for help. Recovery is hard but it is possible and beyond worth leaving the eating disorder behind. Visit the Fairhaven website if you have any other questions or curiosities about their treatment options and diagnostic information. https://www.fairhaventc.com
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