Mclean Hospital

The Challenges of Eating Disorders, From Bench to Bedside

March 17, 2020

Eating disorders are a difficult subject to study, treat, and diagnose—and are widespread. At least 30 million Americans of all ages and genders suffer from an eating disorder. From behaviors that can be hidden from peers to public misunderstanding that eating disorders are a choice, these illnesses are complex.

What Is an Eating Disorder?

Eating disorders happen because of severe disturbances in eating behavior. These can include reducing food intake or extreme overeating.

These patterns can be caused by distress or concern about body shape or weight, and they harm normal body composition and function. A person with an eating disorder may have started out just eating smaller or larger amounts of food than usual. At some point, the urge to eat less or more spirals out of control.

Eating disorders often develop during early adulthood. Some reports indicate onset can also occur during childhood or later in adulthood. Many adolescents can hide these behaviors from their family for months or years.

Eating disorders are not due to a failure of will or behavior. They are real, treatable medical illnesses in which certain abnormal patterns of eating take on a life of their own.

Anorexia, a form of self-starvation, is characterized by a distorted body image. This leads to restrictive behaviors that prevent a person from gaining weight. Initially identified in upper- and middle-class families, anorexia is now known to be found in all socioeconomic, ethnic, and racial groups.

Young woman sits outside and speaks with another woman
Though eating disorders are most commonly found in girls and women, they also affects males

Bulimia is characterized by uncontrolled episodes of overeating, called bingeing, followed by purging through various methods. Bingeing is eating much larger amounts of food than you would normally eat in a short period of time, usually less than 2 hours. The binge-purge cycles can happen from many times a day to several times a week. Other illnesses, such as addiction, anxiety, and mood disorders, are common in people with bulimia.

Making Strides With Research

Studying eating disorders is a field that is continuously evolving based on new discoveries and research into the compounding factors of the illnesses. Kristin Javaras, DPhil, PhD, is hoping to expand that universe to find good treatments for conditions that are far more than simple lifestyle choices.

An assistant psychologist in the Center of Excellence in Women’s Mental Health at McLean Hospital, and trained as a statistician, Javaras said her career path was focused on combining that with a fascination with psychological and psychiatric research.

Memories of a childhood friend with anorexia provided the sparks.

“I found the more I tried to talk to her, the worse I made it,” she said. That prompted her to add a degree in psychology and embark on a path to understanding eating disorders.

As with many other behavioral health conditions, eating disorders have roots in stress and potential genetic preconditions.

“In the real world, stressors or negative emotions often precipitate an increase in eating disorder symptomology,” Javaras explained. “In my own experience as a clinician, it is clear that it is difficult enough for all of us to make changes when we’re in a sort of neutral mood, but it becomes even harder to implement a different strategy when you’re upset.”

Barriers to Progress

The study of eating disorders to date is limited by the nature of the patients, she explained. Most tend to be white women with the resources to seek treatment. However, eating disorders affect all races, ethnicities, and genders.

The National Eating Disorders Association (NEDA) estimates that 10 million men will be affected by an eating disorder at some point in their lives. Self-starvation and other restrictive behaviors have been reported by more females. However, recent studies show that bingeing is comparable between males and females. The majority affected by anorexia are females (90-95%), but it is becoming more common among males. Bulimia most often affects females and starts during the teenage years, but it can also affect males.

One active duty military study reported that 5.5% of enlisted women and 4% of enlisted men had eating disorders. As the study continued, 3.3% more women and 2.6% more men developed eating disorders. In men with eating disorders, other disorders have been reportedly present, including depression and substance misuse, particularly anabolic steroids.

Another challenge is a lack of specialist care. “There’s just not that many eating disorder providers,” Javaras said. “Then there’s also the issue that many people do not recover during treatment, and even if people do experience a marked improvement, there’s a high rate of relapse. The treatments don’t work for everyone, and a number of people relapse.”

Javaras’ work is focused on how to better identify what areas of the brain are involved in an eating disorder. However, many people with eating disorders don’t seek treatment or volunteer for studies. That has made her job difficult.

“That led us to a lot of conclusions that aren’t actually about the disorder,” she said, “but about the people who are able to access treatment.”

McLean Hospital is at the forefront of eating disorder care, research, and education. We are committed to helping individuals on their pathways to recovery. Learn more about eating disorders and get access to informational resources.

March 17, 2020