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General Overview of Eating Disorders:
            Generally speaking, the term Eating Disorder applies to a range of disorders that are most easily and outwardly recognized as affecting the eating habits of an individual.  Eating Disorders may affect people in any age group, from childhood through older adulthood, regardless of gender.  Typical behaviors associated with an Eating Disorder include limiting calorie or fat intake, limiting quantity of food, binging on food, voluntary or self-induced vomiting, over exercising, and inappropriate use of diuretics, diet pills, or laxatives.  These behaviors may result in a change in weight, a change in general health, loss of concentration, and in women, loss of menstruation (amenorrhea).  Diagnoses of Eating Disorders include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Not Otherwise Specified (EDNOS). 

Anorexia Nervosa:
            Anorexia Nervosa is characterized by an intense fear of gaining weight, a refusal to maintain normal body weight, and an inaccurate perception of body weight, shape, or size by the individual.  Individuals with Anorexia Nervosa may also have a strong preoccupation with food.  Adults are likely to experience a drop in weight, while adolescents or children may ‘fall off’ their expected weight growth pattern.  Women experience either a delay in starting menstruation, or a loss of menstruation (amenorrhea).  Weight loss/control typically occurs through limiting of food intake, but may also include purging (self-induced vomiting), over-exercise, and misuse of diuretics, diet pills, or laxatives.  By definition, individuals with Anorexia Nervosa are below normal minimal weight standards.
            Anorexia Nervosa is not a ‘diet gone bad’; although the behavior may begin with a diet program, the diet itself is not responsible for the start of the Eating Disorder.  Instead, Anorexia Nervosa is a painful internal experience of fear, associated both with food and with the perception of one’s own body.  Most people who have Anorexia Nervosa will require treatment that supports both the behavioral process of increasing weight and food intake and the emotional process of targeting the negative thoughts and perceptions, to work towards recovery. 

Anorexia Nervosa, Restricting Type
            This describes individuals who have lost or controlled their weight primarily through limiting food or calorie intake or excessive exercise.

Anorexia Nervosa, Binge-Eating/Purging Type
            This describes individuals who engage in binge eating and or purging (self-induced vomiting, or the use of diuretics or laxatives) while also restricting the amount of food or calories that they eat in an effort to reduce or control weight.

Bulimia Nervosa:
            Bulimia Nervosa is characterized by individuals who binge on food and then use purging (self-induced vomiting) or other inappropriate behaviors to compensate for the binge.  Individuals who are suffering from Bulimia Nervosa often feel intense shame for their behaviors, and thus engage in them privately.  The term ‘binge’ can be described as eating a larger amount of food than most individuals would eat in a discrete period of time.  The binge may be set off by intense negative emotions, stress, or negative feelings associated with body shape, weight, or size. The binge and purge cycle may induce more positive feelings for a period of time post behavior, but shame and discomfort associated with the behavior typically follows. Individuals with Bulimia Nervosa are typically of normal or above-normal weight. 
            Individuals with Bulimia Nervosa often seek help when their behaviors become economically, socially, or personally unacceptable.  Initial treatment will focus on gaining control of the behaviors by working to limit the purge episodes and re-learning how to eat ‘normal’ amounts of binge foods.  Other very important facets of treatment include gaining mastery of emotions and feelings, and learning to communicate these effectively in your world. 

Bulimia Nervosa Purging Type:
            This describes when a person uses vomiting, or misuse of laxatives, diuretics, or enemas.

Bulimia Nervosa Non-Purging Type:
            This describes when a person uses other inappropriate compensatory behaviors such as excessive exercise or fasting.

Dia-bulimia:
            While not a currently recognized clinical diagnosis, this term refers to the use of insulin manipulation by a diabetic person as an inappropriate compensatory behavior.  Clinically, this presentation would be characterized as Non-Purging Type Bulimia Nervosa.

EDNOS (Eating Disorder Not Otherwise Specified):
            EDNOS is a diagnosis used when someone does not meet ALL the criteria required for a diagnosis of either Bulimia Nervosa or Anorexia Nervosa.  Application of this diagnosis does not imply that the eating disorder experienced by an individual is less extreme, or that an individual is less sick.  This diagnosis is most commonly used for women who meet criteria for Anorexia Nervosa except for a loss of menses, for individuals who meet criteria for Anorexia Nervosa but do not demonstrate an extreme loss in weight, for individuals who do not meet frequency criteria for Bulimia Nervosa, or for the regular use of an inappropriate compensatory behavior (such as purging) when a small amount of food has been consumed. 

Binge Eating Disorder:
            This term describes individuals who engage in repeated episodes of binging on food, but do not regularly use an inappropriate compensatory mechanism such as purging or over-exercise (see Bulimia Nervosa for a more detailed description of compensatory mechanisms).  Diagnosis of a Binge Eating Disorder will fall under EDNOS.  Individuals who suffer from Binge Eating Disorder often feel intense shame for their behaviors, and thus engage in them privately.  The binge may be set off by intense negative emotions, stress, or negative feelings associated with body shape, weight, or size. The binge may induce more positive feelings for a period of time post behavior, but shame and discomfort associated with the behavior typically follows. Individuals with Binge Eating Disorder are typically of normal or above-normal weight.  The term ‘binge’ can be described as eating a larger amount of food than most individuals would eat, in a discrete period of time.
            Individuals with Binge Eating Disorder often seek help when their behaviors become economically, socially, or personally unacceptable.  Initial treatment will focus on gaining control of the behaviors by re-learning how to eat ‘normal’ amounts of binge foods.  Other very important facets of treatment include gaining mastery of emotions and feelings, and learning to communicate these effectively in your world. 

Disordered Eating:
            This term is used to refer to eating habits that are not normalized, but are neither accompanied by the emotional and physical aspects of an eating disorder.  Disordered eating is common in our society, and includes behaviors such as dieting, food pickiness, food or food texture phobias, and overeating.  Individuals who experience Disordered Eating may be at higher risk for an Eating Disorder, but this risk is likely mediated by the existence, or lack, of a genetic predisposition for an Eating Disorder.  For individuals experiencing or recovering from an Eating Disorder, seeing Disordered Eating in their community can be a distressing event, as the behaviors themselves are not different.  Individuals working to recover from an Eating Disorder through CCED will be allowed the opportunity to develop skills to tolerate and distract from Disordered Eating they will observe.

Body Image and Body Dysmorphic Disorder:
            Body Dysmorphic Disorder is an emotionally painful experience that is not uncommon in our society.  Technically speaking, Body Dysmorphic Disorder (BDD) refers to an imagined defect in physical appearance, or if a slight physical irregularity is present, the individual’s concern is extreme.  BDD is an aspect of Anorexia Nervosa where the focus is typically on weight or body size, but can also occur independently.  BDD is often experienced as Negative Body Image.  BDD causes extreme distress in individuals, and typically results in compulsive ‘checking’ of the perceived flaw, also known as ‘Body Checking’.  Although not fully understood, there is evidence that BDD is related to differences in the neurological system, either through an atypical sensory perception process or through an organizational dysfunction that allows over-focus on minor or irrelevant things.
            Negative Body Image/BDD is a pervasive aspect of Eating Disorders, particularly Anorexia Nervosa.  Individuals seeking help at CCED will receive extensive and on-going help in learning to tolerate and distract from, and replace, these negative thoughts and perceptions. 

Co-Occurring/ Co-Morbid Disorders:
            Many individuals who are diagnosed with an Eating Disorder will also experience other additional mental health disorders.  These disorders can be either preexisting, emerge with the Eating Disorder, or emerge when an individual enters recovery from an Eating Disorder.  Many of the characteristics of the following disorders are shared by the Eating Disorder, which can complicate diagnosis until the primary disorder is effectively treated and understood.

• Depression:  Depression is characterized by a ‘low’ or sad mood for a prolonged period of time or irritability in adolescents and children, loss of interest in life activities, fatigue, sleep disturbances, diminished ability to concentrate, feelings of guilt or worthlessness, and thoughts of death or suicide.  Many individuals with an Eating Disorder will also experience Depression.  While the link between the two disorders is not well understood, it is imperative that an individual being treated for an Eating Disorder also be evaluated and treated for Depression, to best support the recovery process.
• Anxiety:  There are many Anxiety Disorders, such as panic attacks, OCD, Posttraumatic Stress Disorder, Generalized Anxiety Disorder, and Phobias.  Over half of all women diagnosed with Bulimia Nervosa will also have an Anxiety Disorder.  Likewise, there are elevated rates of Anxiety Disorders in women with Anorexia Nervosa.  As with depression, it is absolutely key that an individual seeking treatment for an Eating Disorder also be screened and treated for any existing Anxiety Disorders.
• Obsessive-Compulsive Disorder (OCD):  OCD is characterized by recurrent obsessions or compulsions that are time consuming and/or cause marked distress or impairment.  Obsessions are persistent thoughts or ideas that are experienced as intrusive.  Compulsions are repetitive behaviors.  Typically, the person will have realized at some point that the compulsions and obsessions are excessive or unreasonable.  A person diagnosed with an Eating Disorder will only be diagnosed with OCD if there are obsessions and compulsions that are not related to eating or food.  Behavioral and pharmacological treatment will typically be required to help treat OCD.
• Addictive Disorders:  Addictive disorders are characterized by tolerance, dependence, and withdrawal from a specific chemical substance(s).  Many individuals with a binge eating component of their Eating Disorder will also experience difficulty with Substance Abuse or Dependence.  Some may take this to mean that Binge Eating is actually an Addictive Disorder.  There is currently no evidence to suggest that Binge Eating and Addictive Disorders are the same thing.  It is important to note however that individuals with an Eating Disorder are at higher risk for a Substance Abuse/Dependence disorder, regardless of why this link exists.  Individuals seeking treatment at CCED will be encouraged to address any active addiction or dependence problems before beginning intensive treatment for Eating Disorders. 
• Personality Disorders:  Personality Disorders are most easily described as an ongoing pattern of behavior and internal experience that is different from what might be expected culturally which leads to distress or impairment, and is stable over time.  It is not unusual for individuals diagnosed with an Eating Disorder to also have a Personality Disorder.  Perhaps the most commonly experienced Personality Disorder among Eating Disorder patients, and specifically those with Bulimia Nervosa or Anorexia Nervosa Binge Eating/Purging Type, is Borderline Personality Disorder.  This is characterized by a pattern of instability in interpersonal relationships, self-image, mood, and impulsivity.  Our treatment program at CCED is specifically developed to address Eating Disorders and Personality Disorders simultaneously, using Dialectical Behavior Therapy (DBT) developed by Marsha Linehan. 

Eating Disorders in Children:
            Eating Disorders may manifest in children as young as 7 years old.  Anorexia Nervosa is the most common Eating Disorder seen in children, and 20-25% of children with Anorexia Nervosa will be boys.  Children who develop Anorexia Nervosa tend to be perfectionist, ‘good’ kids who have previously caused no difficulties for their parents.  As with the diagnostic criteria for Anorexia Nervosa, children with this disorder will have a fear of becoming fat, an inaccurate view of their own body shape/size, and will restrict food intake through refusal.  The food refusal behavior may be difficult to recognize initially as it tends to occur secretively.  Due to the age of the child, it is generally not feasible to look at loss or delay of menses as a diagnostic characteristic.  Children with Anorexia Nervosa will show a rapid loss in weight, or will maintain weight when instead they would be expected to gain weight through normal growth patterns.  Medically, children will typically experience a loss in bone density, possible loss of height potential, abnormal heart rhythms, and vitamin and mineral deficiencies.  The treatment program at CCED utilizes the Maudsley Method, which was developed particularly for working with children and adolescents in a family based setting and shows high levels of success.

Eating Disorders in Adolescence:
            Eating Disorders commonly present during the adolescent years, age 14-18.  As with children who develop Eating Disorders, adolescents tend to have Anorexia Nervosa, with or without binge/purging behavior.  Prior to development of the Eating Disorder, most adolescents would be described as academically rigorous, perfectionist, and generally ‘good’ kids who caused no difficulty for their parents.  Methods of controlling weight will typically include refusal of food (often secretively), use of excessive exercise either in socially acceptable means or secretively, purging, and other inappropriate forms of compensation such as diuretics or laxatives.  Adolescents with Anorexia Nervosa will show a rapid loss in weight, or will maintain weight when instead they would be expected to gain weight through normal growth patterns.  Medical complications of an Eating Disorder at this age include loss of bone density, possible loss of height potential, abnormal heart rhythms, and vitamin and mineral deficiencies, in addition to a loss or delay of menses in appropriately aged girls, which may have long term consequences.  The treatment program at CCED utilizes the Maudsley Method, which was developed particularly for working with children and adolescents in a family based setting and shows high levels of success.

Eating Disorders in Adults:
            Most commonly, Eating Disorders first manifest during childhood or adolescence, thus most of the adults in our treatment program have experienced their Eating Disorder for numerous years.  However, this does not necessarily correlate to years of awareness of the Eating Disorder; many adults may be dismayed to learn that their unusual eating habits and preoccupation with weight is actually an Eating Disorder.  On the other hand, there are adults who have been working on recovery for years.  As with children and adolescents, adults may experience a range of ways in which their Eating Disorder interferes with daily living; examples may include inability to concentrate at work or in school, need to take a leave of absence from work or education for medical or psychological reasons, increased stress on family and intimate relationships, and guilt for behaviors which are out-of-control or embarrassing.  Our program at CCED is designed to support adults, no matter what stage of the recovery process they are in.  We provide many levels of care, and have designed our program to provide tools for recovery for even the most difficult clients.

Eating Disorders in Boys and Men:
Eating Disorders are more common in boys and men than is generally known.  About 30% of all those suffering from ED are male.  Males generally have similar symptoms to females, particularly those with Anorexia.  Males with Bulimia often use running as a compensatory mechanism, but many also purge.  Binge Eating Disorder is almost as common in males as females.  The treatment for men is similar to that of women.

Eating Disorders in Athletes:
            The world of athletics, whether middle-school PE, college-level competitive, or purely recreational, can often present an increased challenge to someone who is either experiencing an Eating Disorder, or perhaps has a predisposition for an Eating Disorder.  Due to the nature of Eating Disorders, exercise is commonly abused as a means of compensatory behavior.  During an Eating Disorder, the focus of exercise moves from enjoyment of the activity towards an obsession with reducing calorie intake or re-shaping the body resulting in extreme use of exercise.  This shift in focus is often unsettling as people are frustrated that an activity that they have long enjoyed suddenly becomes an unhealthy uncontrolled obsession.  Athletes who have experienced this shift in focus should take the time to consider the cost, and to seek treatment.  Unfortunately, exercise concurrent with Eating Disorder behaviors (restricting food, purging, binging, etc) is medically dangerous, as the behaviors themselves cause injury to the heart and cardiovascular system, and the body is functioning on severely decreased or imbalanced energy, vitamin, and mineral sources. Athletes suffering from an Eating Disorder will be best served by a multi-disciplinary treatment team consisting of clinicians and medical doctors specifically trained to support healing of the mind and body.  CCED is able to offer this team to all clients.