Episode Transcript
Dr. Dorian Dodd (guest):
It’s just incredibly isolating and scary. Somebody with an eating disorder, they’re genuinely feeling afraid much of the time about food, about their appearance, about these things that we can’t escape. We need to live. There is also a very strong denial component, so it’s very, very hard for a person with an eating disorder to actually see the reality of what’s happening for them.
Alan Helgeson (host):
Hi, I’m Alan Helgeson with Sanford Health News. This is the “Health and Wellness” podcast series. Today our guest is Dr. Dorian Dodd, a clinical psychologist with Sanford Eating Disorders and Weight Management Center in Fargo. Welcome, Dr. Dodd.
Dr. Dorian Dodd:
Hi Alan. Thanks so much for having me here today.
Alan Helgeson:
Our topic today is disordered eating versus eating disorders. What causes eating disorders?
Dr. Dorian Dodd:
Eating disorders are a very complex illness and they’re thought of as being multifactorial. So there’s really several different causes that go into it.
So there’s genetic risk and biological risk, and then we know that so people with a family history are at higher risk. And then we know that a lot of sociocultural factors play in as well. So people are at more risk if they have other mental health issues like trauma or anxiety or depression. But the important thing to remember is that it’s both biological and genetic and sociocultural.
Alan Helgeson:
Can you talk more about some of those risk factors?
Dr. Dorian Dodd:
Absolutely. So eating disorders often start in teen and young adult years, but really anybody can get disordered eating. So being female and being in that younger age group does confer some risk, although again, anyone can get an eating disorder and people who are most at risk generally tend to have a family history of eating disorders or they have other mental health issues going on. Low self-esteem and kind of interpersonal problems are often a risk factor for eating disorders. And then histories of dieting and, and disordered eating. So a history of kind of using food to cope with emotions or things like that.
Alan Helgeson:
Is social media a concern as you look at all those things that come into play for people that may be struggling with an eating disorder?
Dr. Dorian Dodd:
Absolutely. I mean, social comparisons we know that for many young people, social media really leads to feelings of low self-esteem, low self-worth. People are going on these platforms and just comparing how they feel and how they look to all of their peers and really unfavorably tending to do so. So people pay more attention to the ways that they’re not measuring up to their peers as they see it.
And so social media really becomes a platform, especially for people who are already struggling with appearance concerns, body image, low self-esteem. It absolutely can exacerbate those issues and then increase that risk.
Alan Helgeson:
Let’s talk about eating disorders and more about what they are and help give people more of an understanding about them.
Dr. Dorian Dodd:
So the main three eating disorders – anorexia, bulimia and binge eating disorder. We also have, I think one of the lesser known eating disorders is something that we refer to as ARFID, is the abbreviation, and that stands for avoidant restrictive food intake disorder, A-R-F-I-D. And this is an eating disorder where individuals are scared to eat, they’re concerned about eating, but there is no body image component.
So somebody with anorexia, they’re refusing food because they are worried about weight in some way, or at least that’s how it started. People with ARFID are generally presenting with problems eating due to other fears, so fear of choking, fear of allergic reactions, fear that the food is going to harm them in some way. So that’s a presentation that we’re seeing in our clinic.
And then there’s also a disorder called orthorexia nervosa. This is not an official disorder yet. It’s kind of newer in our understanding and research, but this is a kind of obsession with healthy eating. So people become very rigid about, they can only eat certain types of food or food that’s been processed or not processed in a certain way. And that just becomes really problematic, the extent and the rigidity that they develop around that.
And then I would also really like to highlight atypical anorexia nervosa. So people I think might be a little more familiar with anorexia, which involves not eating to the point of being significantly underweight. However we’re seeing more and more and recognizing more and more of this presentation of atypical anorexia. So somebody who has lost a significant amount of weight, they may show up looking at a healthy weight, even looking overweight, but they have lost a significant amount of weight, so they’re not going to have that underweight criteria, but they still have that illness of anorexia.
And so it’s very important for people to understand that eating disorders don’t look any particular way. You can’t tell somebody has an eating disorder just by what they weigh or what they look like.
Alan Helgeson:
Thanks, Dr. Dodd. This really helps in identifying some various disorders. We’ll talk more about signs and symptoms to look for as well as to find help if you or a loved one may be struggling with an eating disorder. Can we shift things a little bit and talk about disordered eating? What is it? And help us to understand how it can impact a person.
Dr. Dorian Dodd:
Yes. That’s a great question, Alan. So when you talk to different people, you’re going to get some different answers on this.
So disordered eating is really any relationship with food, any way of using food other than just kind of meeting those biological needs of managing hunger and getting your nutrition in. And so disordered eating is really along a spectrum. So it’s an unhealthy relationship with food that doesn’t quite rise to the severity level of a diagnosable eating disorder.
For example, if people are kind of restricting and fasting, skipping meals, that could be disordered eating. Many experts consider dieting to be a form of disordered eating if people, especially if they’re crash dieting or yo-yo dieting, doing things that are intended to just take weight off as quickly as possible rather than like a sustainable lifestyle change to manage their health.
Certainly any kind of unhealthy, what we call compensatory behaviors. So if you feel like you have to do something to make up for eating, for example, misusing laxatives or diet pills or making yourself throw up, those would all be examples of disordered eating. Now, if those are consistent and severe enough, then they do kind of rise to that level of an eating disorder. But there are a lot of ways that people can have unhealthy relationships with food that aren’t at that eating disorder severity level.
Alan Helgeson:
So is disordered eating considered an addiction?
Dr. Dorian Dodd:
Yes. Yeah, I would say so. I mean, I think people are absolutely compelled into this behavior. It’s very hard to stop. They do kind of feel like they need to be doing this.
The interesting thing about eating disorders as an addiction or disordered eating as an addiction is that food is what I’m going to refer to as a biological imperative. So many of the other addictions, we think about alcohol or drugs or gambling, we don’t need those things. Somebody can stop those things and walk away entirely. What is very difficult about the addictive behaviors of an eating disorder is there is no abstinence approach. You have to learn how to manage it in moderation. And so that makes it very, very challenging from an addiction standpoint.
Alan Helgeson:
When it comes to eating disorders and disordered eating, can you talk about the things that people may experience as a result?
Dr. Dorian Dodd:
These disorders can cause some very serious health consequences, really impacting a lot of systems of the body. So people with eating disorders can have heart problems and can affect cardiac functioning. It can affect GI functioning, digestion. It affects the neurological system as well. So people with eating disorders tend to have problems sleeping, have a harder time regulating, you know, attention and focus. They can move into this really kind of rigid and distorted way of thinking.
And then there’s also endocrine impacts. So it impacts the endocrine system. Women with eating disorders may go on to struggle with fertility. And then there is a host of psychological and social correlates of eating disorders. So we know that people with eating disorders tend to have more mood problems, difficulty regulating their mood. They tend to isolate a little bit more and really concerningly people with eating disorders engage in self-harm.
So both non-suicidal self-injury and suicide attempts at much higher rates than their peers without eating disorders. So we know that these disorders can affect many areas of life and have really serious consequences up to and including death. And in fact, anorexia nervosa is one of the most fatal mental illnesses.
Disordered eating – you’re going to see some of those similar effects, but to a lesser scale. So it is still going to cause mood dysregulation kind of interruption in kind of healthy adaptive thought patterns. It leads to really shame and guilt and a tendency to isolate, and it can absolutely impact some of those physical health areas that I talked about. So cardiac and gastrointestinal and endocrine functioning as well.
One thing that I would like to add there is that one of the risks of disordered eating is going on to develop a full-blown eating disorder. So we know that that is a major risk factor there.
Alan Helgeson:
Are there any statistics that may show how common eating disorders are?
Dr. Dorian Dodd:
You know, it depends which eating disorder we’re talking about. Overall, there was some recent data that came out of an initiative from Harvard that shows that about 9% of Americans in their lifetime, I think it was maybe 8.5%, but in that neighborhood will develop eating disorders in their lifetime.
At any given time, maybe about 5% of the population or less would be expected to have an eating disorder. And that differs across disorders.
So we know that anorexia nervosa is much less common than binge eating disorder. So when we think of these overall prevalences, that’s across all eating disorders, whereas some of them are a little bit less common.
Alan Helgeson:
What might be signs that a loved one might be struggling with an eating disorder?
Dr. Dorian Dodd:
Yeah, absolutely. That’s a great question, Alan. If you are concerned that you have an eating disorder I think it’s very important to talk to your doctor. There’s also a screening tool online, so the National Eating Disorders Association has a screening tool that is freely available online and it will kind of walk through some of the symptoms, some of the concerns that we look for when diagnosing an eating disorder. And just give an initial sense of, yeah, this does seem like maybe a little bit of risk going on, or no, this seems kind of healthy and appropriate relationship with food.
Alan Helgeson:
Being aware of these changes, but then what should we do once we’ve recognized something, Dr. Dodd?
Dr. Dorian Dodd:
Things that I would be looking for would include not regularly eating throughout the day. So generally we’re thinking people should be eating at least three times throughout the day, at least three meals. And so anybody who is really skipping meals, fasting, going long periods without eating, using food for managing issues other than just hunger and nutrition. So either eating too much or eating too little based on someone’s mood or based on, you know, what else might be going on in their life, being really overly concerned with appearance and body image. So somebody who would become very upset if they were to gain, you know, even a pound or two. I think those are the main ones. And then of course, any significant weight loss within a short amount of time or any of those more overtly unhealthy behaviors like for example, making yourself throw up. That would be a definite risk sign and indicator.
The research is very clear that the earlier you get into an evidence-based treatment, the better your outcome is going to be. And so if you are concerned you have an eating disorder, that’s the very best thing you can do for yourself. If you’re concerned about a loved one with an eating disorder, that can be a little bit trickier. Because one feature of these disorders is often a strong sense of denial.
So somebody with an eating disorder, they might not be receptive to that feedback, they might not be receptive to that concern. So I think it’s important to, you know, consistently just express that you care, express that you’re worried or what you’re seeing that is causing you to be worried, offer support, offer to go with them to an appointment, or do they need help calling their doctor to make an appointment. So really just expressing that concern and encouraging them to get help.
Alan Helgeson:
What type of care does Sanford offer for people with eating disorders?
Dr. Dorian Dodd:
Yeah, so we have a wide range of kind of levels of care here. So we provide care across the continuum.
We have an outpatient clinic up in Fargo and we are able to see people, certainly in North Dakota, but then we are also able to offer some services to neighboring states as well through telehealth. And then we also have higher levels of care for eating disorders.
So we have partial hospital program where people come with us throughout the week, they’re with us Monday through Friday for 11 hours of the day and eating their meals with us, but then they go home at night.
And then we have a traditional inpatient hospital program as well where people are fully hospitalized and they stay with us for a period of time to get medically stable before they then step down to that more outpatient level of care.
Alan Helgeson:
For someone listening to this and looking to make that first step, what do they do, Dr. Dodd? How should they start to seek help for an eating disorder?
Dr. Dorian Dodd:
Very important first step is to see your doctor get an overall health assessment so that you can understand kind of how the eating disorder is affecting your physical health, and then make decisions about a level of care from there. Or you can always just call our clinic and we would walk you through kind of the intake questions that we would be asking to see if it makes sense to come in for in-person intake or assessment.
Cassie Alvine (announcer):
If you would like more information on eating disorders, disordered eating or weight management options, visit sanfordhealth.org. You’ve been listening to the “Health and Wellness” podcast series. For additional podcast series by Sanford Health, find us on Apple, Spotify and news.sanfordhealth.org.
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Posted In Behavioral Health, Children's, Family Medicine, Fargo, General, Nutrition, Weight Loss, Women's
