What we Treat – Eating Disorders

Welcome to our Eating Disorders Treatment Track. Our multidisciplinary treatment team has specialized training to meet the needs of those struggling with an eating disorder. As the Clinical Director of the program, Dr. Federici has 20 years of clinical and research experience in the field. The team includes psychologists, a registered dietitian, social workers, and registered psychotherapists, all of whom have extensive clinical training in treating eating disorders.

What are Eating Disorders?

Eating disorders are neurologically driven, biologically-based illnesses that affect an individual’s physical, psychological, and emotional health. While there are different types of eating disorders (see below) all involve an inability to properly feed oneself. As a whole, eating disorders are characterized by disturbances in eating and body weight and specific personality traits that typically emerge well before the onset of the disorder (e.g., perfectionism, emotion regulation difficulties, risk aversion).

Eating disorders are not a choice, rather, they are the result of a complex interaction between genetics, environmental influences, and psychological factors and they require specialized treatment. At the Centre for Psychology and Emotion Regulation, we treat all types of eating disorders using evidence-based treatment models.

On an outpatient basis, our team provides comprehensive clinical care for:

• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating Disorder
• Other Specific Feeding and Eating Disorder (OSFED)
• Avoidant Restrictive Food Intake Disorder (ARFID)
• PICA
• Rumination Disorder

If a client requires a higher level of care (e.g., day treatment, inpatient) we have strong working relationships with the hospitals and programs in the province and can help you get the treatment you need. We also support individuals as they are being discharged from higher levels of care so they can maintain treatment gains when they return home. We provide treatment for those suffering with an eating disorder, those in recovery, and for families, caregivers and siblings.

Important Facts About Eating Disorders:

• Eating disorders have the highest mortality rate of any other psychiatric illness. More people will die from anorexia and bulimia this year than major depression, bipolar disorder, or schizophrenia combined.
• Rates of suicide and self-injurious behaviour are elevated in those with eating disorders. One in five with anorexia will die from suicide and up to 70% engage in self-injurious behaviours. The average length of time between the onset of the illness and the first evidence-based treatment is seven years.
• Kids as young as 6 years old are being treated for an eating disorder and rates of dieting, self-loathing, and self-injury are highly prevalent among youth.
• Many individuals with an eating disorder also struggle with other psychological illnesses including anxiety disorders, depression, trauma, and substance use disorders.
• Eating disorders typically begin during adolescence, however they can develop at any age. We are seeing an increase in diagnosis in those aged 45 and older. Eating disorders can affect anyone.
• While still commonly perceived as a “female” disorder, eating disorders are prevalent (and under-diagnosed) in men and in the LGBTQ2 community.
• Eating disorder treatment is highly specialized. Family-Based Therapy (FBT) is the gold-standard treatment for adolescents and transitional age youth. Evidence-based treatments for adults with eating disorders include:
  • Cognitive Behaviour Therapy (CBT) adapted for eating disorders
  • Enhanced CBT (CBT-E)
  • Dialectical Behaviour Therapy (DBT) adapted for eating disorders.
• Level of care matters when choosing treatment. Mild to moderate eating disorder presentations may respond to outpatient models whereas more complex and medically severe presentations typically require day treatment or inpatient hospitalization.

Webinar: Eating Disorders and Emotion Dysregulation – Helping Families Navigate

Anorexia Nervosa

Anorexia nervosa is characterized by the restriction of food or fluid intake that leads to significant weight loss and low body weight. The person suffering from this illness will also demonstrate the following symptoms:

• Intense fear of gaining weight (even if at a very low body weight), or engaging in behaviour that interferes with weight gain.
• Problems in the way one sees or experiences the body/body image distortions
• Self-worth is overly linked to body weight or shape
• Inability to recognize the seriousness of the weight loss/ low body weight.

Depending on the symptom presentation, the diagnosis is further classified as either a restricting type or a Binge Eating/purging type.

In the largest genetic study of its kind, researchers identified that anorexia (and possibly other eating disorders) is related to genetic abnormalities related to metabolic functioning. Some researchers have called for a reclassification of anorexia as genetically driven neuro-metabolic illnesses. As the field continues to evolve, the science is proving what we have known all along – that eating disorders are not choices, rather they are diseases linked to neuro-biological processes.

Bulimia Nervosa

Bulimia Nervosa is characterized by episodes of binge eating that are followed by a compensatory behaviour. A binge episode is defined as eating an objectively large amount of food in a relatively short period of time and accompanied by a sense of being out of control. Sometimes people will eat a normal amount of food (e.g., a sandwich, two cookies) and still feel out of control; in this case we refer to the behaviour as a subjective binge episode. People describe binge eating as shameful, often believing that they have “failed” their eating and weight goals. There can feel embarrassed discussing these symptoms with doctors or other healthcare practitioners.

A compensatory behaviour is anything the person does to “get rid of” the calories or food that was consumed during the binge. This may include purging, exercising, restricting food the next day, or taking laxatives. Those suffering from this illness will have disturbances in the way they view and experience their bodies, which will impact self-worth and self-esteem.

Binge Eating Disorder

Binge eating disorder (BED) is the most common eating disorder and yet, most people are not aware that they have it. It is defined by recurrent episodes of binge eating with little or no effort to compensate for the eating (as we would see in bulimia nervosa). Clinically, we define a binge as eating a large or an unusual amount of food in a shorter period of time and feeling out of control. Binges are also characterized by one or more of the following:

• eating much more rapidly than normal
• eating until feeling uncomfortably full
• eating large amounts of food when not feeling physically hungry
• eating alone because of feeling embarrassed by how much one is eating
• feeling disgusted with oneself, depressed, or very guilty afterwards

Those struggling with BED tend to experience sudden and ongoing weight gain, and are more likely to have type II diabetes, hypertension, and gastric problems. High rates of anxiety, depression, and substance use are also common.

One of the biggest barriers to treatment is that most people don’t know they have an eating disorder. When they do seek treatment, it is often at weight loss centres and bariatric clinics. This is highly problematic because dieting and surgeries will not solve the underlying problem. In fact, these approaches will exacerbate the disorder and, in some cases (e.g., bariatric surgery) can lead to life-threatening situations. It is crucial that one is evaluated for the presence of an eating disorder before pursuing permanent weight loss surgeries.

The good news is that there are well established treatments for BED. Learning to regulate emotions, integrating mindfulness practices, and working toward balanced eating and movement are key components of successful treatment.

Other Specified Feeding and Eating Disorder (OSFED)

Other Specified Feeding or Eating Disorder (OSFED) is a category used to describe and eating disorder that does not meet full diagnostic criteria for AN, BN, or BED. While this eating disorder is sometimes considered a “catch-all” diagnosis, it is just as severe and impairing as other EDs. Similar to AN, BN, and BED, individuals with OSFED typically overemphasize the importance of weight and/or shape, and therefore experience behaviours, thoughts and emotions related to the other EDs. Some examples of OSFED include:

• Atypical Anorexia Nervosa
• Binge Eating Disorder (of low frequency and/or limited duration)
• Bulimia Nervosa (of low frequency and/or limited duration)
• Purging Disorder
• Night Eating Syndrome

Treatment for OSFED follows the same basic principles used to treat other EDs, however may need to be adjusted depending on an individual’s specific needs and symptoms. Therefore, a professional can assess these symptoms to determine which treatment approach (DBT, CBT, etc.) is most appropriate.

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder (ARFID) is characterized as an eating or feeding disturbance that persistently fails to meet appropriate nutritional and/or energy needs that can lead to:

• Significant weight loss (or failure to achieve expected weight gain/growth in a child)
• Significant nutritional deficiency
• Need for oral nutritional supplements/enteral feeding
• Marked interference with psychosocial functioning

ARFID is not…

• Associated with body image issues
• The result of a lack of available food
• A culturally sanctioned practice
• Explained by another medical or mental health condition

PICA

PICA is characterized by persistent eating of non-nutritive substances/items that are not typically considered as food (eg., hair, paint chips, dirt, paper). Pica is not part of a culturally/socially normative practice and is developmentally inappropriate (this would not be diagnosed in young children that are mouthing objects to explore their senses).

Pica often occurs in the presence of other mental health disorders (eg., autism spectrum disorder, schizophrenia), or during medical conditions (eg., pregnancy, malnutrition, iron-deficiency anemia) and therefore it is recommended that a professional assess if the behaviour is severe enough to warrant independent clinical attention. Assessments should also focus on the potential toxic side effects of the substances that are being consumed (eg., lead in paint, bacteria in dirt).

Treatment for Pica typically focuses on addressing potential nutrient deficiencies that may be causing the behaviour. If these behaviours are not being caused by malnutrition, there are a variety of behavioural interventions that can be used to help individuals address these.

Rumination Disorder

RUMINATION DISORDER is characterized by repeated episodes of regurgitating food, that is not part of another ED or due to a medical condition. Regurgitated food may be re-chewed, re-swallowed, or spit out. Since Rumination Disorder is not a part of another ED, it requires specific treatment protocols.