Choosing An Eating Disorder Psychiatrist: Tips & Advice

It is estimated that as much as 9% of the U.S. population suffers from some form of eating disorder and sadly more than 10,000 people die each year from these disorders. While these statistics are alarming, the good news is that with proper treatment, one can recover from an eating disorder. It’s not easy, but with the help of a qualified eating disorder doctor, there is hope for a brighter, healthier future. 
 
Finding an eating disorder psychiatrist or therapist can be tricky, but before we provide some tips to help you find the best doctor for your needs let’s discuss some facts and myths about eating disorders in general.
 
Types Of Eating Disorders
The American Psychiatric Association recognizes several different eating disorders in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). With all of these disorders, the patient is afflicted by distressing thoughts regarding food and body image and, of course, eating behaviors also are affected severely. Here’s a quick summary of each type of eating disorder recognized in the DSM-5.
 
Anorexia Nervosa
Anorexia nervosa is a serious and potentially life-threatening eating disorder characterized by self-starvation, an intense fear of gaining weight, and a distorted body image. This disorder is characterized by the following:
 

1. Restriction of Food Intake: Persistent restriction of energy intake leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. The individual's weight is markedly below the minimum expected or, for children and adolescents, minimally expected for their age and height.
   
2. Intense Fear of Gaining Weight: Intense fear of gaining weight or becoming fat, even though underweight. This fear may persist, and the individual will continue to restrict food despite significant weight loss. 
3. Distorted Body Image: Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-worth, or persistent lack of recognition of the seriousness of the current low body weight. The individual may perceive themselves as overweight even if they are underweight.

 
Anorexia Nervosa Subtypes

• Restricting Type: Weight loss is achieved primarily through dieting, fasting, or excessive exercise. Individuals with this subtype do not engage in regular binge-eating or purging behavior.

 

• Binge-Eating/Purging Type: The individual engages in regular binge-eating or purging behaviors (i.e., self-induced vomiting or misuse of laxatives, diuretics, or enemas).

 
Physical & Psychological Complications of Anorexia:

• Cardiovascular complications, including bradycardia, hypotension, and arrhythmias.
• Osteoporosis or bone density loss.
• Gastrointestinal issues, such as constipation or gastroparesis.
• Endocrine disruptions, including amenorrhea (absence of menstruation) in females.
• Electrolyte imbalances, which can lead to severe complications, including cardiac arrest.
• Psychological issues, such as depression, anxiety, obsessive-compulsive behaviors, and social withdrawal.

 
Bulimia Nervosa
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain. This disorder is characterized by the following:
 

1. Recurrent Episodes of Binge Eating: An episode of binge eating is characterized by both of the following:​

• Eating, in a discrete period (e.g., within any 2 hours), an amount of food that is larger than most people would eat in a similar period under similar circumstances.
• A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).  
  

   2. Inappropriate Compensatory Behaviors: Recurrent inappropriate compensatory behaviors to prevent weight  gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
    3. Frequency: The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
   4. Self-Evaluation Influenced by Body Shape & Weight: Self-worth is excessively influenced by body shape and weight.
   5. Distinction from Anorexia Nervosa: The disturbance does not occur exclusively during episodes of anorexia nervosa.

Physical and Psychological Complications:

• Electrolyte imbalances – These can lead to cardiac arrhythmias and even cardiac arrest.
• Physical damage from vomiting, including tooth erosion, gum disease, and swelling of the salivary glands.
• Gastrointestinal issues, such as acid reflux or constipation.
• Psychological issues, including feelings of guilt, shame, anxiety, and depression.
• Risk of self-harm or suicidal ideation.

 
Binge Eating Disorder
While Binge Eating Disorder (BED) may seem similar to Bulimia Nervosa (BN) in that people with either disorder will engage in binge eating. However, with Binge Eating Disorder, the individual, while concerned with weight gain, does not engage in actions to restrict this weight gain, such as vomiting or using laxatives. This disorder is more common than BN and is characterized by:
 

1. Binge Eating Episodes: Just like BN, individuals with BED have recurrent episodes of binge eating where they consume a large amount of food and feel a lack of control.
   
2. No Regular Compensatory Behaviors: Unlike BN, individuals with BED do not regularly engage in inappropriate compensatory behaviors after binge eating. This is a key distinguishing feature.
3. Frequency: Binge eating episodes occur, on average, at least once a week for three months.
4. Associated Features: Binge-eating episodes are associated with at least three of the following:
   

• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts when not feeling physically hungry
• Eating alone due to embarrassment
• Feeling disgusted, depressed, or guilty afterward

     5. Physical Consequences: Individuals with BED are at increased risk for obesity and related medical conditions,  such as heart disease and type 2 diabetes. 

Avoidant Restrictive Food Intake Disorder
Avoidant Restrictive Food Intake Disorder (ARFID), previously known as Selective Eating Disorder, is a relatively new diagnosis that was introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It's characterized by restrictive eating patterns that are not associated with concerns about body shape or weight. Here are some characteristics of this disorder:

     1. Restrictive Food Intake: An eating or feeding disturbance manifested by persistent failure to meet appropriate nutritional and/or energy needs, leading to one or more of the following:​

• Significant weight loss or failure to achieve expected weight gain in children.
• Significant nutritional deficiency.
• Dependence on enteral feeding or oral nutritional supplements.
• Marked interference with psychosocial functioning.

     2. Lack of Interest or Avoidance: The disturbance is not due to a lack of available food or cultural practices. It may be associated with:

• Lack of interest in eating or food
• Avoidance based on sensory characteristics of food
• Concerns about the consequences of eating (fear of choking, etc.

     3. Absence of Body Image Disturbance: The eating disturbance is not due to concerns about body weight or  shape, and the individual does not exhibit any behaviors or symptoms consistent with anorexia nervosa or bulimia nervosa.
    4. Not Attributable to Another Medical Condition: The eating disturbance cannot be better explained by another medical condition or mental disorder. 

Associated Features:
Individuals with ARFID might have a limited range of preferred foods and may be highly sensitive to the texture, smell, or taste of certain foods. The disorder can lead to social isolation, as individuals might avoid social situations involving food or may experience anxiety around meal times. Unlike other eating disorders, individuals with ARFID do not have a distorted body image and do not engage in behaviors to lose weight.
 
Rumination Disorder
Rumination Disorder is a feeding and eating disorder characterized by the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out. This regurgitation is not due to a medical condition but is rather a repeated behavior that can be voluntary or involuntary. Here are some characteristics of this disorder:
 

1. Repeated Regurgitation: Repeated regurgitation of food for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
2. Not Attributable to a Medical Condition: The behavior is not due to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux). 
3. Not Exclusive to Anorexia, Bulimia, BED, or ARFID: The behavior does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.
   
4. Developmentally Inappropriate: If the symptoms occur in the context of another mental disorder (e.g., autism spectrum disorder, intellectual disability, another neurodevelopmental disorder) or during a neurodevelopmental period, they must be severe enough to warrant clinical attention. 

What Causes Eating Disorders?
Eating disorders are complex and there’s no single reason why a person might develop an eating disorder. In some cases, it might be genetic, and if there is a family history of an eating disorder, one may be more likely to develop an eating disorder. For others, low self-esteem or dissatisfaction with their body might be the initial trigger and social and cultural pressures can have a huge impact on the development of eating disorders.
 
Others develop eating disorders as a result of a traumatic event, abuse or bullying. Sometimes a person in a dysfunctional relationship or a dysfunctional family can develop an eating disorder. There is no single reason why these disorders develop, and for each person, determining the root cause can be beneficial for recovery.
 
Signs A Loved One Has An Eating Disorder
While we typically think of eating disorders as afflicting young women, any person can develop an eating disorder at any age and from any walk of life. As with just about any mental or physical issue, early intervention is key, but what are some signs that loved ones should watch for? Here are a few signs that a person may have some type of eating disorder:
 
Behavioral and Emotional Signs:

• Preoccupation with Food: Constantly talking about food, dieting, counting calories, or reading about nutrition.
• Change in Eating Habits: Skipping meals, avoiding social events where food is involved, or adopting strict or unusual food rituals.
• Frequent Dieting: Especially without weight loss or with continued expressions of feeling "fat."
• Fear of Gaining Weight: Even if they are underweight.
• Frequent Checking: Constantly checking their body in the mirror, weighing themselves often, or measuring body parts.
• Mood Swings: Irritability, depression, or anxiety, especially around meal times.
• Withdrawal: Avoiding friends, family, and social events, often to hide their eating habits.

 
Physical Signs:

• Rapid Weight Loss or Gain: Fluctuations in weight without a clear medical cause.
• Stomach Complaints: Consistent complaints about constipation, stomachaches, or feeling cold.
• Menstrual Irregularities: Missed periods or irregular menstrual cycles.
• Dizziness or Fainting: Due to malnutrition or dehydration.
• Signs of Vomiting: Swollen cheeks, calluses on knuckles, or discolored teeth from frequent vomiting.

 
Other Signs To Watch For:

• Wearing Baggy Clothes: To hide weight loss or body shape.
• Secretive Behavior: Hiding food, eating in secret, or frequent trips to the bathroom after meals.
• Excessive Exercise: Engaging in intense, prolonged exercise, especially outside of regular training sessions or despite adverse weather conditions or injuries.
• Sleep Problems: Insomnia or changes in sleep patterns.
• Use of Laxatives or Diet Pills: Especially in secret or in large amounts.

 
Psychological, Emotional & Social Indicators:

• Increased Sensitivity: To comments or criticism about eating, weight, or body shape.
• Low Self-Esteem: Particularly if they base their self-worth on their body shape or weight.
• Feelings of Worthlessness: Or feelings of hopelessness, often accompanied by other signs of depression.
• Perfectionism: Setting high standards and being very critical of perceived mistakes.
• Avoiding Social Situations: Especially those involving food.
• Isolation: Withdrawing from friends, family, or activities they once enjoyed.

 
Choosing An Eating Disorder Doctor
If you suffer from any of these eating disorders, finding an eating disorder psychiatrist can be a good place to start. A psychiatrist is both a medical doctor and a mental health professional, which means that this type of doctor can diagnose both your eating disorder as well as any physical conditions that might be contributing to the disorder or caused by the eating disorder.
 
Many people with eating disorders also suffer from co-occurring disorders such as anxiety or depression, and a psychiatrist can provide you with expert care and a complete diagnosis that includes all of your physical and mental health conditions. An eating disorder psychiatrist also can create a treatment plan, that may or may not include medications, but will address all of the issues you are facing, including co-occurring disorders.
 
Typically, the treatment for eating disorders is intense psychotherapy. This might include cognitive-behavioral therapy and nutritional rehabilitation. Sometimes medications such as antidepressants also can be an effective tool for patients, and an eating disorder psychiatrist is the only mental health professional who can provide you with a prescription for these medications.
 
The best approach is to find both an eating disorder psychiatrist and a psychologist or therapist who provides care for those with eating disorders. The therapist or psychologist can provide you with talk therapy and other types of therapy to help aid in your recovery.
 
Talking with a nutritionist also can be an excellent idea, especially one that specializes in the treatment of eating disorders. Sometimes joining a support group also can be beneficial. In severe cases, it can be wise to seek long-term care in an inpatient or intensive outpatient eating disorder program.
 
In some cases, patients will be limited to finding eating disorder doctors that are covered by their insurance. If this is not an issue or you can submit an out-of-network doctor bill to your insurance provider, you have a bit more flexibility. This allows you to meet with multiple doctors and find a provider that truly seems to fit your needs and comfort level.
 
If you find that a provider makes you feel uncomfortable, I highly recommend searching for a new doctor. It can take time to find the best fit, but when you have an excellent support team, your journey toward recovery will be more successful.
 
As an experienced eating disorder psychiatrist, I offer both in-person treatment and treatment via telepsychiatry. Using a virtual psychiatrist can be a great option to consider because it expands your options beyond your local area and allows you to find the best possible match.
 
An online psychiatrist or therapist also can meet with you from anywhere you have an internet connection, which means you don’t necessarily have to skip appointments if you are out of town or perhaps not feeling well enough to attend in-person meetings. I can meet with patients either virtually or in person, or a combination of the two, depending on their needs.
 
Contact Our Office Today
Eating disorders take a huge toll on your mental and physical health, but there is hope and treatment can be successful. Millions of people have courageously and successfully recovered from eating disorders and live happier, healthier lives. The path might not always be easy, but your journey to wellness can be successful. If you need an eating disorder psychiatrist, please don’t hesitate to give us a call and set up an initial consultation.