By Sarah Jo Lorenz

S E R I E S C O N S U L T A N T Anne S. Walters, Ph.D. Emma Pendleton Bradley Hospital Warren Alpert Medical School of Brown University

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Foreword: Dr. Anne S. Walters, Ph.D.. ......................................... 6 Chapter 1: Introduction to Eating Disorders. ............................. 11 Chapter 2: Understanding the History of Eating Disorders. ......... 23 Chapter 3: Understanding Causes of Eating Disorders. ............... 37 Chapter 4: Treatment Options for Eating Disorders.................... 51 Chapter 5: How People Are Affected by Eating Disorders. ........... 63 Chapter 6: How Families Can Cope With Eating Disorders. .......... 77 Chapter Notes. ....................................................................... 86 Series Glossary of Key Terms. .................................................. 88 Further Reading. .................................................................... 90 Internet Resources.................................................................. 91 Organizations to Contact......................................................... 92 Index..................................................................................... 93 Author’s Biography / Credits................................................... 96 CONTENTS KEY ICONS TO LOOK FOR: Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text while building vocabulary skills. Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news coverage, moments in history, speeches, iconic sports moments, and much more! Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.


Dr. Anne S. Walters, Ph.D.

Almost one in seven children and adolescents in the United States has a diagnosable mental illness, according to the National Institute of Mental Health (NIMH), the leading federal agency for research on mental disorders. That’s more than the number of children and adolescents suffering from cancer, AIDS, and diabetes combined. NIMH

research has found that almost 50 percent of these young people will experience an episode of mental illness before the age of eighteen. The rate of mental illness is even higher among young adults between the ages of eighteen and twenty-five. This is not a uniquely American problem, however. The World Health Organization (WHO) reports that mental disorders are the leading cause of disability among young people in all regions of the world.


The most common behavioral health diagnoses in children include attention deficit hyperactivity disorder (ADHD), behavior problems, anxiety, and depression. Some of these conditions commonly occur together. For example, about three in four children (73.8 percent) between the ages of three and seventeen who have been diagnosed with depression also suffer from anxiety, and almost one in two (47.2 percent) exhibit behavioral problems, according to the Centers for Disease Control and Prevention. What do these numbers mean? To start, it means that mental illness is very common. Most of you reading this will have at least one friend or family member who either is currently struggling or has struggled in the past with a psychiatric illness. That number may even include you and may mean that you have symptoms of both anxiety and depression. In addition, mental illness is becoming more common. Suicide rates have increased in children and adolescents over the past ten years, and this is a major concern at present for professionals in the behavioral health field. No one is sure what has caused these increases, though some speculate it is related to “cultural trends.” A combination of factors such as social media and technology advances or the opioid crisis may all play contributing roles. Other professionals have wondered about how violence in our schools


might impact youth mental health, and still others have pointed to the potential effects of decreased sleep on these illnesses. Despite there being more widespread information about the prevalence of mental health issues for children and adolescents, only slightly more than half of these children receive treatment. What gets in the way? One of the barriers to seeking treatment is the fear that others will find out. Children, adolescents, and even parents fear the stigma of being identified as having a mental illness. Despite progress in the diagnosis and treatment of these illnesses, the stigma that surrounds mental illness is still very profound, even today. Parents fear that their children will experience shame. As long as this stigma exists, it affects the likelihood that children or their families will seek help. Other barriers include doctor and hospital wait lists, concern about medical expense, a shortage of available mental health providers, and lack of knowledge about treatment options. Some of the movements toward reducing stigma have been helpful in this regard. Notable examples are actress Glenn Close and her foundation aimed at reducing the stigma for those with bipolar disorder, or Olympic athlete Michael Phelps speaking out about his own depression. The good news in all of this is that in recent years, evidence-based treatment has become available. The term “evidence based” refers to treatment that has been tested via research and proven to be effective for various types of mental illness. For example,


we know that a form of treatment called “Coping Cat” utilizes a cognitive behavioral form of treatment that is effective for childhood anxiety, and that effectiveness is improved with the use of certain medications as well. Cognitive behavioral therapy (CBT) targets the way that we negatively interpret or perceive situations, and teaches us to “restructure” those thoughts, leading to different feelings and experiences. We know CBT is helpful because researchers have performed studies comparing patients who get this form of treatment with patients that receive other forms of treatment. Our readers will learn more about all these topics in the volumes ahead. We hope that having more information will help you to combat the stigma that surrounds mental illness, and therefore reduce the length of time it takes a child and family to seek treatment. Our hope is that this series will spark conversation and provide important information for children, parents, and school personnel about the various diagnoses that are most common in childhood and adolescence. With this series, we hope you will understand much more about mental illnesses, what is involved, and what to do to help those who might be suffering like family, friends, or even you.



anorexia nervosa: an eating disorder characterized by the severe restriction of calorie intake by intentional self-starvation and restriction of food and drink consumption Avoidant Restrictive Food Intake Disorder (ARFID): an eating disorder characterized by the extreme avoidance of certain types of foods or a limitation on eating certain portions or preparations of foods bulimia nervosa: an eating disorder characterized by consuming food and drink and then purging the contents of the stomach in order to avoid gaining weight from eating eating disorder: an uncommon or non-conventional habit, interest, obsession, or avoidance related to the consumption of food pica: an eating disorder characterized by the consuming desire to eat non-food items such as dirt, clay, glue, chalk, hair, cotton, and other items with little to no nutritional value rumination disorder: an eating disorder characterized by the unintentional regurgitation of food at some point after consuming food or drink


1 chapter

Introduction to Eating Disorders

Food is a big part of our lives, and along with air and water is one of the three essential components of life. Food not only keeps a human alive, it also is a big part of daily social life and interaction with others. Some people can become obsessed with food or the effects food has on the body. When this happens, an eating disorder can develop. People with eating disorders misuse food; they eat too much or too little, or eat food for the wrong reasons, such as using food to manage uncomfortable feelings such as anger or helplessness. A persistent eating disorder can put a person’s health and life at risk. Understanding the way people abuse foods and the resulting harm this abuse can create is important. Healthy eating helps people have sufficient energy, stay fit, and fight off illness. Young people and teens in particular need to eat healthy because bones are growing and organs are developing. Eating disorders tend to create a dangerous imbalance of essential nutrients, vitamins, and elements. In this chapter, several types of eating disorders are introduced.


A growing body needs nutrients for proper development and energy. Malnourishment is very common among young people suffering from eating disorders.

Anorexia Nervosa By far the most widely recognized of all the eating disorders, anorexia nervosa is a serious eating disorder that thousands of people deal with every day. Anorexia occurs when someone practices deliberate starvation with the direct and intended purpose of losing weight. Along with reducing the intake of food, someone with anorexia can over-exercise in order to burn calories more quickly. They also may use laxatives or diuretics to make weight loss occur before calories can be absorbed by the body. People with anorexia nervosa often experience a high level of disgust or dissatisfaction with their own physical appearance. Individuals with anorexia have a very distorted image of his or her body, and the fear of becoming fat usually controls


Behavioral Disorders: Eating Disorders

all of the person’s actions. Left untreated, anorexia can lead to physical and psychological damage, and even death. A person who has anorexia is often trying to lose weight to stay thin. People with anorexia think of themselves as very fat when they are actually underweight. The excessive restriction of calories by individuals who are already underweight can create a very dangerous health situation.

People with anorexia find unhealthy ways to lose weight quickly. These can include use of laxatives or excessive exercise to burn calories.


Introduction to Eating Disorders

Binge Eating Disorder Most of us have eaten too much on occasion, perhaps at a party, a favorite restaurant or a special holiday. Most of us have experienced the ‘I can’t believe I ate that much’ feeling. “To most people, binges are an occasional occurrence,” writes Noa Flynn. “But for the approximately four million Americans with binge-eating disorder (also called compulsive overeating), it’s not something that happens on

Some people eat for comfort, to relieve stress or to reward themselves. However, this emotional eating often makes them feel worse, not better.


Behavioral Disorders: Eating Disorders

special occasions. For them, binging is the norm. Binge eating is the most prevalent eating disorder in America.” 1 People who compulsively overeat generally do so alone and in private. The person is often ashamed and embarrassed by how much he or she eats or behaves. The person knows something is wrong and that these eating habits are not normal. Binge eaters keep their binging a secret and will often hide food around the house or sneak food from the refrigerator at night. They may end up telling lies or making excuses about eating behavior and weight to cover these eating habits. Bulimia Nervosa Unlike someone who is suffering from an anorexia eating disorder where food intake is restricted, the person with bulimia nervosa regularly eats much more food in a single sitting than most people normally consume. It is not unusual for individuals who are bulimic to ingest anywhere from 5,000 to 10,000 calories in a matter of minutes or hours. Afterwards, the person almost immediately purges the food from their body to prevent the calories from being absorbed and to prevent getting fat. In most cases, the person with bulimia purges by self-induced vomiting, excessive exercise, or use of laxatives, enemas, or diuretics. Bulimia is more commonly known as the binge and purge eating disorder. Bulimia is not just about food; it is also related to self-image, and for that reason can be hard to overcome. People with bulimia tend to be overly concerned or even obsessed with both food and body weight, and are often quite dissatisfied with their own physical appearances. This dissatisfaction causes the person to judge himself or herself very harshly, and leads to a vicious cycle of binge eating and purging. The person has a strong urge to overeat, which results in binging, followed by a purge to prevent weight gain.


Introduction to Eating Disorders

Avoidant Restrictive Food Intake Disorder

Avoidant Restrictive Food Intake Disorder (ARFID) describes a condition that was once called Selective Eating Disorder. The National Eating Disorders Association describes ARFID as being similar to anorexia because both disorders involve limitations in the amounts and/or types of consumed food. ARFID differs from anorexia in that with ARFID, the person does not feel any distress about body shape or size, and does not have fears of being fat. As they grow up, many children go through normal phases of picky eating. Some of these children will go on to have ARFID, and will not consume enough calories to grow and develop properly, resulting in stalled weight gain and stunted height. When ARFID persists into adulthood, people have severe weight loss and an inability to maintain basic body functions. People with ARFID sometimes have problems at school or work because they find it difficult to eat around other people and often need extended time to eat.

People with bulimia often overeat, called binge eating. Then, to lose the calories, the person performs self-induced vomiting.


Behavioral Disorders: Eating Disorders

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