Eating and weight disorders are serious but treatable conditions that can affect anyone at any age and in any segment of the population.
Mount Sinai psychologists offer treatment for the following eating disorders:
- Anorexia nervosa
- Binge eating disorder
- Bulimia nervosa
- Avoidant/restrictive food intake disorder
- Other specified feeding or eating disorder
- Rumination disorder
Anorexia nervosa is characterized by body weight that is low for the patient’s age and gender due to severe restriction of food intake associated with an intense fear of gaining weight or becoming fat. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes two types of anorexia nervosa: restrictive anorexia nervosa and binge-purge anorexia nervosa.
Typically, anorexia nervosa begins in adolescence or earlier when the bodies of young people are changing, making them especially vulnerable to a distorted body image and self-esteem. Girls are nine to ten times more likely than boys are to receive a diagnosis of anorexia, though that discrepancy may be related to challenges in identifying eating disorders in males.
Anorexia patients often report experiencing associated psychological problems like depression and anxiety. They tend to withdraw from social situations and show signs of irritability, and they may experience insomnia.
In instances of anorexia nervosa, the behaviors or observable symptoms of the condition that result in maintaining a low body weight may be some or all of the following:
- Restricting food intake
- Engaging in excessive exercise
- Self-inducing vomiting
- Taking a laxative, diuretic, or diet pills
Extreme weight loss in people with anorexia nervosa can lead to dangerous health problems, including:
- Growth retardation in children
- Heart and kidney dysfunction
Anorexia nervosa is a serious psychiatric condition, and like other eating disorders, has a high mortality rate.
Effective interventions for anorexia nervosa include cognitive behavioral therapy and family-based treatment. The outcome of treatment for anorexia nervosa varies considerably. For some, a single course of treatment is effective, while other recovery paths may take longer, involving shifts from weight gain and recovery to weight loss and relapse.
Bulimia nervosa are marked by alternating cycles of food restriction and episodes of overeating or binge eating that is characterized by feeling out of control along with taking extreme measures to prevent weight gain.
Bulimia usually begins in late adolescence or early adulthood. Approximately one to three percent of adolescents and young adults develop bulimia nervosa, of whom 90 percent are female. Similar to patients with anorexia nervosa, individuals with bulimia nervosa suffer from concerns with body image; however, they are typically at a normal weight. Typically, binge eating and purging must be present at least once a week for three months to receive a full diagnosis.
Symptoms or behaviors associated with bulimia nervosa may include some or all of the following:
- Consuming large amounts of food while experiencing a sense of loss of control over eating
- Excessive exercise
- Intermittent fasting
- Laxative and diuretic misuse
- Self-induced vomiting
Bulimia nervosa includes a variety of medical complications that, although severe, are reversible with appropriate treatment, and may include:
- Cardiac abnormalities
- Dehydration and electrolyte imbalances
- Dental erosion and deterioration
- Gastrointestinal disturbances such as disorders of the esophagus like reflux
- Menstrual irregularities
- Swollen salivary glands
Many bulimia nervosa patients also suffer from a variety of psychological problems including anxiety and depression.
Effective interventions for bulimia nervosa include cognitive behavioral therapy and medication. The outcomes of treatment for bulimia nervosa vary; some individuals have the illness for a long time, while others alternate between recovery and intermittent binge eating and purging. Research, however, does show that over time symptoms appear to diminish.
Binge Eating Disorder
Binge eating disorder is marked by recurrent episodes of loss of control—or binge—eating. In contrast to bulimia nervosa, individuals with binge eating disorder do not use regular compensatory behaviors (such as self-induced vomiting). Binge eating disorder affects approximately one to four percent of the population, is as common in males and females and across the age-spectrum, and is frequently associated with obesity.
Binge-eating is associated with an array of behaviors and symptoms related to eating, such as:
- Eating alone due to shame and embarrassment
- Eating beyond the point of comfort
- Eating large amounts of food when not hungry
- Eating very rapidly
- Feeling a loss of control while eating
To receive a diagnosis, binge-eating must occur at least once a week for three months along with at least three of the above symptoms.
Binge-eating disorder can also be associated with psychological problems such as depression.
There are a variety of effective treatments for binge eating disorder, including cognitive-behavioral therapy and pharmacological treatment. These interventions help reduce or eliminate binge eating, but often, additional techniques, such as those used in diabetes prevention programs, are necessary to produce desired weight loss.
Obesity and Weight Management
Obesity is characterized by a higher than normal body mass index (BMI) that is measured as the ratio of weight in kilograms to height in meters. For adults, obesity is diagnosed as a BMI over 30. For children and adolescents, healthy BMI varies by age. In general, obesity is diagnosed in younger patients when BMI is above the 95th percentile of what is considered within a normal, healthy range for the child’s age.
The Centers for Disease Control and Prevention reports that there has been a trend in increasing rates of obesity in adults (over the age of 20) and young people.
Obesity in all ages can lead to several serious medical conditions. The Mount Sinai Eating and Weight Disorders Program provides diagnosis and treatment for the following obesity-related complications:
- Gallbladder disease
- Gastroesophageal reflux (GERD)
- Heart disease
- Hypertension (high blood pressure)
- Liver disease
- Pulmonary (breathing) problems
- Reproductive problems in women
- Sleep apnea
- Urinary stress incontinence
Our clinicians and researchers are committed to discovering new approaches. Studies show that for children and adolescents, effective treatment involves the family, particularly the parents, in the weight loss process. For adults, treatment through programs like diabetes prevention programs can help support gradual and sustainable weight loss to eliminate obesity and its health risks.
Pica is characterized by repeatedly eating substances that are not considered food (like dirt or paint). Eating non-food substances is considered inappropriate based on the age and developmental level of the patient as well as cultural norms. If pica is severe or occurs along with another mental disorder, such as autism, or during pregnancy, then diagnosis and treatment in a clinical setting is required.
Pica may be associated with or cause other health issues, such as:
- Anemia and other nutritional deficiencies
- Blockage in the digestive tract
- Poisoning, such as lead poisoning that can lead to brain damage
An essential part of treatment for pica is close observation and medical monitoring along with psychological therapies that may include counseling.
Rumination disorder is characterized by repeated expelling of partially chewed food, also known as regurgitation that occurs for at least once a month. The patient may re-chew, re-swallow, or spit out the food. This disorder often occurs in children. A diagnosis of rumination is based on psychological causes rather than digestive tract issues.
Continued regurgitation may cause a number of health-related symptoms, such as:
- Tooth decay
- Weight loss
Careful attention to eating habits and treatment interventions are required in severe cases to avoid serious medical issues.
Avoidant Restrictive Food Intake Disorder
Avoidant restrictive food intake disorder (ARFID) is characterized by continued failure to consume sufficient nutrition. Formerly referred to as selective eating disorder, this condition is not associated with body image issues such as fear of becoming fat; however, the result is significant weight loss.
ARFID can occur at any age and affects both men and women. The disorder causes significant nutritional deficiency and often requires medically supervised feeding through a tube (enteral feeding) or oral nutritional supplements to ensure necessary caloric intake. This eating disturbance is associated with abnormal psychological and social behavior, rather than a medical condition. The disorder can occur along with other medical or psychiatric conditions.
- Gastrointestinal issues like bloating that contributes to a lack of appetite
- Dizziness, fainting, and weakness
- Dry skin, brittle nails, and thinning hair
- Impaired immune functioning
Various forms of psychotherapy can be effective treatments.
Other Specified Feeding or Eating Disorder
According to the American Psychiatric Association’s DSM-5 diagnostic criteria, other specified feeding or eating disorder (OSFED) refers to eating disorders that are not otherwise categorized. These disorders cause significant food-related distress and health issues.
The following are examples of OSFED:
- Atypical anorexia nervosa: All the characteristics of anorexia nervosa, but with body weight remaining within or above the normal range
- Limited binge-eating disorder: All of the characteristics of binge-eating disorder, but with instances occurring less often or lasting for less than three months
- Low frequency bulimia nervosa: All of the characteristics of bulimia nervosa, but with binge eating and other inappropriate compensatory behaviors occurring less frequently or for less than three months
- Purging disorder: Purging to control body weight or shape, but without binge eating
- Night eating syndrome: Recurring episodes of night eating include waking to eat during sleep time, or excessive food consumption after the evening meal. The behavior causes significant distress and cannot be explained by another mental health disorder
Learn about the various treatments we offer to help address eating disorders.