Online NewsLetter

Eating Disorders: Who Is at Risk?

With cases of eating disorders on the rise, researchers see hope in new preventive and therapeutic strategies.

About a decade ago, statistics about eating disorders reflected that as many as 10 million females and 1 million males in the U.S. were struggling with anorexia nervosa or bulimia nervosa, and many more with binge eating disorder. Based upon the rising numbers of patients evaluated each year at The Center for Eating Disorders at Sheppard Pratt, it appears that those numbers may be on the rise.

As mentioned above, there are three main types of eating disorders; anorexia nervosa, bulimia nervosa and binge eating disorder. Anorexia nervosa (AN), is an illness characterized by a refusal to maintain a body weight that is at or above normal. Individuals struggling with AN will starve themselves as a result of an intense fear of weight gain. They often experience their bodies as being much larger than they are, seeing fat where it doesn’t exist.

Bulimia nervosa (BN) is characterized by episodic intake of large amounts of food during which the individual feels a loss of control over his/her eating, followed by some type of compensatory behaviors (vomiting, use of laxatives, diuretics, fasting, excessive exercise) in order to rid the body of the food. These individuals also have extreme concerns over their body weight and shape.

Binge eating disorder (BED) is the most common eating disorder and is characterized by frequent episodes of eating large quantities of food in a short period of time. Unlike BN, there are no behaviors following the binge eating to rid the body of the food. The individual struggling with BED feels out of control with his/her eating behaviors, is ashamed of the behavior and often engages in these behaviors in secret.

Eating disorders are rarely a simple preoccupation with food and weight, rather, they are generally about much more than food. They are multifaceted illnesses borne out of behavioral, emotional, psychological, interpersonal and social factors.

People with eating disorders often use food and food related behaviors as a way to deal with emotions that they find overwhelming. In the beginning, some individuals may start with dieting and realize that taking control over their food helps the emotional pain decrease. This may perpetuate over control of eating behavior. As the disorder progresses, the behaviors may begin to erode the person’s physical and emotional health. Often, those affected will isolate themselves to maintain their eating disorder behaviors and may cease to engage in activities they once loved as these activities may interfere with the eating disorder behaviors. In essence, instead of the person being in control of the eating, the eating disorder now takes control over the person.

Eating disorders are treatable, but early identification followed by intensive treatment significantly improves the chances for recovery. For this reason, The Center for Eating Disorders at Sheppard Pratt remains committed to prevention, early identification, research and treatment of complex eating disorders. While early identification is key, preventing an eating disorder prior to its onset is critical. With this in mind, The Center is involved in a variety of prevention efforts.

 One such effort involved a recent partnership between Seventeen Magazine and The Center for Eating Disorders at Sheppard Pratt to develop an online survey that probed unhealthy eating habits among young women. A variety of eating behaviors have been seen which alone are not sufficient to meet the full diagnosis of an eating disorder, but are often evident in those suffering from the illnesses and have been identified by experts as a potential gateway to an eating disorder. Seventeen consulted with Drs. Harry Brandt and Steven Crawford, director and associate director of The Center, to refine the Seventeen questionnaire.

The results of the survey appeared in the August issue of Seventeen Magazine in an article entitled “Are You a Freaky Eater?” which revealed a tendency among a surprising number of young women to practice food rituals. Some reported purposely altering their food to make it less appetizing. Others arranged their plates so no two foods touched each other, and some ate one food completely before moving on to the next. Habits such as cutting portions into tiny bites or avoiding eating in front of other people were also disclosed.

 A goal of the survey was to encourage respondents who suspected they might have an eating disorder to seek appropriate help. Another purpose of the project was to educate parents and teenagers about the seriousness of obsessive eating behaviors and their potential relationship to serious eating disorders. Initiatives like the survey also help professionals gain a better understanding of the problem, which aids in early identification and effective treatment.

 To further develop effective treatment for eating disorders, The Center for Eating Disorders at Sheppard Pratt is participating in a multi-site international research study funded by the National Institute of Mental Health (NIMH). The main focus of the study is on family therapy and medication treatment for adolescents with anorexia nervosa (AN) to determine which therapies are most effective in treating adolescents between the ages of 12 and 18 with AN. The Center is recruiting a test group of families to participate. The study examines two types of family therapy – Behavioral Family Therapy, and Systems Family Therapy. Currently, it is unclear whether one is more effective than the other or whether they may be effective for different individuals. The study also tests the use of fluoxetine (the generic equivalent for Prozac). Fluoxetine has been chosen for this study as it is a type of medication that may be beneficial for preventing relapse, as well as for resolving mood and anxiety related symptoms associated with AN.

Behavioral Family Therapy focuses on changing the eating behavior of the child. In this form of therapy, the therapist will join the family for a meal and then work with the family for a united approach directed toward refeeding the starving child. The therapist helps the family develop the skills to return their child to physical health. Systems Family Therapy focuses on exploring the family problems which may have supported the development of the AN. The treatment deals with the family as a system, and how members of the family organize themselves in their different roles and relationships. The therapist helps the family examine communication patterns and challenge existing assumptions, working towards changing behaviors and beliefs.

In addition, the study compares the effectiveness of fluoxetine with a placebo for the treatment of AN. To date, there have been no placebo-controlled trials of fluoxetine for adolescents with AN.

To test the effectiveness of these therapies, participating families are allocated randomly to one of the family therapies and to either the fluoxetine or placebo group. Families then participate in 16, one-hour family therapy sessions, over a nine month period. Additionally, they participate in interviews and questionnaires. The study medication, fluoxetine or placebo, is given for an additional six months.

This study is a collaborative effort with five other treatment sites, looking for a total of 240 families to take part. As with all Center studies, participants’ privacy is strictly and carefully maintained. Family therapies and medication-based treatments are free, and participants are compensated for their time and contributions.

For additional information about the study, please contact Courtney DiLallo, Study Manager, at 410-427-3851 or by email at

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Last modified: Thursday, April 17, 2014

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