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Why Eating Disorders Remain Socially Unaccepted as a Mental Illness

The Academy for Eating Disorders (AED) classifies anorexia nervosa, bulimia nervosa and other eating disorders as serious and viable mental illnesses requiring the same rigorous, evidence-based therapies used to treat major depression, obsessive-compulsive disorder, bipolar disorder and even schizophrenia. Unfortunately, eating disorders are not always considered a mental illness based on stereotypes characterizing individuals (especially women) who appear to be narcissistically fixated on their weight and appearance. Consequently, eating disorder treatment centers are now actively providing in-depth mental health education to patients, family members of eating disorder patients and residents of communities involved in eating disorder support.

Clinical Definitions of a Mental Illness and an Eating Disorder

The Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) defines a mental disorder as “syndromes characterized by clinically significant disturbances in a person’s behavior, emotion regulation or cognition that reflects dysfunction in the developmental, biological or psychological processes fundamental to mental functioning.” The DSM-V further defines mental illness as different from socially deviant behavior because this type of behavior emerges as a “rift” between society and the individual.

Instead of simply classifying eating disorders as a unique mental illness, the DSM-V provides criteria for each eating disorder that must be met in order for a psychologist to provide a diagnosis. For example, the DSM-V describes “unspecified eating or feeding disorders” such as selective eating disorder or pica as a disorder “causing significant impairment or distress in occupational, social or other areas important to normal functioning.” Unspecified eating disorders fail to meet criteria listed in the DSM-V but still warrant a diagnosis of an eating/feeding disorder.

Similarities Between Eating Disorders and Mental Illnesses

Psychologists and psychiatrists specializing in eating disorders do not differentiate between mental illness and anorexia, bulimia, binge-eating or unspecified eating disorders. Assessments detailing physical and psychological symptoms of patients admitted to eating disorder treatment centers include symptoms supporting a diagnosis of mental illness, such as:

  • Anxiety/panic/agitation
  • Depression, suicide ideation and feelings of hopelessness
  • Inability to control obsessing over food, weight and appearance
  • Inability to keep a job or stay in school because of an overwhelming preoccupation with their weight
  • Body dysmorphia (a distorted perception of how they appear to others and what they see in the mirror)

In severe eating disorder cases, an eating disorder therapist may need to prescribe antipsychotic medications to patients who present with delusional thinking, paranoia and/or hallucinations upon the patient entering an eating disorder recovery program. Before eating disorders can be addressed through intense psychotherapy, underlying mental health issues must be recognized and treated appropriately. Eating disorders are not a product of someone’s out-of-control vanity. It is a mental illness emerging from deep-seated psychological dilemmas rooted in genetic and biopsychosocial factors affecting patients during childhood.

The Importance of Psychiatric Services for Eating Disorders

Psychiatrists determine whether an eating disorder patient is suffering from a serious mental illness requiring immediate intervention. With their background in psychology, medicine and neurology, psychiatrists are highly qualified to differentiate a mental disorder from a temporary condition caused by malnutrition or other medical problem. Delusions, hallucinations, constant panic attacks and suicidal ideation can be caused by vitamin deficiencies, excessive or insufficient neurotransmitter levels, hyperthyroidism, hypothyroidism and many other health problems associated with long-term anorexia, bulimia or binge-eating disorder. Receiving a mental health diagnosis by a psychiatrist specializing in eating disorders is a vital component of the development of a comprehensive, efficacious treatment program.

In some cases, eating disorder treatment centers work with patients entering their center who require emergency psychiatric attention. Psychiatrists and psychologists provide immediate counseling for patients experiencing psychotic episodes, suicidal ideation and severe panic attacks. Eating disorder psychiatrists are trained to recognize when an emergency intervention is necessary for safeguarding a patient’s well-being. Once an eating disorder patient is stabilized, they are provided additional intake assessments and rapid exposure to cognitive behavioral therapy and eating disorder support therapists who help new patients adjust to their new surroundings.

Stereotypes About People with Eating Disorders

Being height-weight proportionate or slightly thinner than standards set by the U.S. Department of Health and Human Services is considered conducive to good health and may reduce your risk of chronic diseases such as diabetes, high blood pressure or heart disease. However, people who constantly diet, talk about dieting, refuse to eat when out with family or friends and spend hours looking at themselves in mirrors are often thought to be vain, self-centered and narcissistic.

The stigma surrounding adolescent girls seeking anorexia nervosa, bulimia nervosa, binge-eating or selective eating disorder treatment involves the unsound notion that eating disorders are nothing but a “girl” issue similar to a rite of passage or period of being a “control freak” as a changeable, temperamental teenager. Concerned parents may bring their teen daughter’s dieting obsession to the attention of a family physician who says “it’s just a behavioral quirk” that adolescent girls eventually outgrow. Or perhaps the parents of a teenager exhibiting signs of an eating disorder think since their child is getting good grades in school and isn’t “acting” like she is mentally ill, there is nothing wrong with her, that she is simply experiencing normal self-esteem and peer pressure issues common to girls her age.

To help combat perpetuation of the stereotype that people with eating disorders do not need treatment for their mental illness, eating disorder treatment centers are giving patients, families of patients and their local communities comprehensive, clinical information called psychoeducation that is often integrated into a patient’seating disorder recovery andeating disorder support program.

What Is Psychoeducation?

An eating disorder therapist may offer psychoeducation to patients as part of an individualized treatment plan. Information provided by psychoeducation helps eating disorder patients and their support network understand the biological causes of mental illnesses as they related to an eating disorder. Research into the benefits of psychoeducation indicates that patients who have a deeper awareness of why they are compelled to engage in eating disordered behaviors typically lead to them feeling more in control of their thoughts and behaviors. Psychoeducation also helps eating disorder patients more fully understand how vital it is to their eating disorder recovery that they attend all counseling sessions, take medications as prescribed and use cognitive behavioral therapy techniques taught to them by their therapist.

Principles of psychoeducation were originally applied to people diagnosed with schizophrenia or other serious mental disorder. Today, psychoeducation is a popular component of treatment plans developed for patients with clinical depression, anxiety disorders, personality disorders and eating disorders. Providing psychoeducation is also a way to alleviate new fears sometimes brought about by a dual diagnosis of an eating disorder and mental illness. Patients and their families gain a comprehensive understanding of what is contributing to their eating disorder in terms of genetics, brain chemical imbalances, the role of cultural and media biases and repercussions of certain life experiences.

Psychoeducation Helps Substantiate Eating Disorders as Mental Illnesses

In an attempt to provide a holistic approach to the science of what it is to be human, psychoeducation embodies principles of dynamic psychology with cognitive behavioral counseling. Eating disorder therapists talk to patients about the hopes, purpose, goals and motivations behind self-perceptions as well as how the brain acquires and learns new skills and knowledge. Additionally, aspects of developmental psychology are incorporated into psychoeducational information, such as the uniqueness of individual maturation, biological fundamentals of human development and organic factors that influence a person’s self-identity.

Psychoeducation is an excellent method for educating both patients and their communities about eating disorders as a mental illness. Psychoeducation also enhances feelings of empowerment, reduces the stigma, guilt and shame surrounding mental illness and eating disorders and improves a patient’s problem-solving strategies by increasing their awareness of relapse risk factors and how to avoid or cope with them. Moreover, quantitative and qualitative data concerning the benefits of psychoeducation has shown that eating disorder patients suffering from major depression, anxiety and mood disorders often experience a lessening of symptoms before any prescribed medication has had time to take effect.

As recipients of psychoeducation therapy, eating disorder patients come to understand their eating disorder is a mental health problem that cannot be easily managed without support, and seeking anorexia, bulimia, binge-eating, and selective eating disorder treatment should not be stigmatized. For individuals with an eating disorder who suffer from depression, panic disorder, body dysmorphic disorder and other complex mental illnesses, psychoeducation leads to a deeper comprehension of the self, the mind and their innate ability to find the motivation and strength to complete an eating disorder recovery program.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.