Eating Disorders, Psychoeducation, and the DSM-V

There is no debate that eating disorders pose serious health risks for the people suffering from them. But are psychiatry and psychoeducation as useful for treatment as they are for disorders like schizophrenia and OCD? 

Unequivocally, the answer is yes.

One of the leading organizations focused on eating disorders, the Academy for Eating Disorders (AED)has come to classify anorexia nervosa, bulimia nervosa, ARFID, binge eating disorder and other eating disorders as diagnosable mental illnesses. As such, they necessitate similar clinically-proven, evidence-based therapies like the ones used to treat major depression, bipolar disorder, anxiety disorder, and others. 

Unfortunately, eating disorders are not always considered a mental illness. This is due to the continuation of stereotypes about people (especially women) who worry about their weight and engage in diets – namely, that these actions are driven by narcissism.The concept that disordered eating behaviors are compulsive and not a lifestyle still persists. Consequently, eating disorder treatment centers are now working to further education about eating disorders as a type of mental health illness to clients, their families, and the general public.

How to Determine the Clinical Definition of a Mental Health Disorder

The Diagnostic and Statistical Manual of Mental Disorders V (DSM-V), the official listing of mental health disorders produced by the APA and other medical institutions defines mental illness as “syndromes characterized by clinically significant disturbances in a person’s behavior, emotion regulation or cognition that reflects a dysfunction in the developmental, biological or psychological processes fundamental to mental functioning.” Eating disorders, with their characteristic behaviors, may have been unconsciously ignored because laypeople focus on the behavior rather than the psychiatric and psychological underpinnings.

To counteract this attitude and to differentiate between each major form of eating disorder, the DSM-V provides clear criteria for each one. For example, the DSM-V has determined that “unspecified eating or feeding disorders” such as ARFD or “selective eating disorder” as a disorder “causing significant impairment or distress in occupational, social, or other areas important to normal functioning.” This codification helps psychologists and doctors who don’t specialize in eating disorders make a more correct and complete diagnosis.

Similarities and Links Between Eating Disorders and Other Mental Illnesses

Psychologists and psychiatrists who don’t specialize in eating disorders should receive at least basic training about them before receiving a degree. A non-specialist should be able to identify when a major form of mental illness is present and make a proper referral to an expert. Some of the major symptoms that indicate a client may need to attend an eating disorder treatment center include:

  • Anxiety/panic/agitation
  • Depression
  • Suicidal ideation 
  • Feelings of hopelessness
  • Obsessive thoughts about body weight and appearance
  • Social disruption (such as difficulties at work or school) because of body image and food restriction
  • Body dysmorphia (a distorted perception of how they appear to others and what they see in the mirror)

While eating disorder specialists differ in their opinions about the efficacy of psychiatric medications for treating eating disorders, they often come with another form of mental illness – rates of co-occurring disorders are high in people with diagnosed ED. Medication may be applied for symptoms of mental illness like delusional thinking, paranoia, and/or hallucinations. 

When talk therapy and other methodologies begin for eating disorder treatment, simultaneously occurring mental health issues must be recognized and treated appropriately. This must come from a place of understanding and empathy that ED is not a choice the individual is making, but a distinct mental health disorder that can be corrected.

An Eating Disorder Treatment Program Must Include a Psychiatric Component

Psychiatrists are essential to the eating disorder recovery process. As specialists with training in neurology, prescriptions, and psychology, psychiatrists are highly qualified to differentiate a long-term mental disorder from a temporary condition caused as a reaction to PTSD or another temporary trigger.

Many symptoms of mental health disorders like suicidal ideation, anxiety attacks, and delusions can be caused by vitamin deficiencies, issues with neurotransmitter levels, blood sugar, and many other health problems associated with long-term anorexia nervosa, bulimia nervosa or binge-eating disorder. On the other hand, these symptoms can also act as catalysts for eating disorder behaviors as a coping mechanism. A consultation with a psychiatrist is useful in determining a complete assessment of an individual’s eating disorder for these reasons.

In some cases, eating disorder treatment centers will be required to treat clients that need emergency psychiatric attention. They can provide immediate counseling and medication for individuals experiencing psychotic episodes or panic attacks. Eating disorder treatment centers normally keep at least one psychiatrist on staff to interpret clients’ medical needs and influence the development of a treatment plan.When the client is medically and psychiatrically stabilized after admission, they are provided additional intake assessments to determine the correct treatment plan incorporating nutrition, cognitive retraining, and psychiatric needs.

Dispelling False Beliefs About People with ED

The U.S. Department of Health and Human Services has issued guidelines about BMIs and “ideal” body fat levels that considered conducive to good health and minimize health risks like heart disease and diabetes. This may do more harm than good when it comes to people with eating disorders, though. Focusing on numbers like BMI or weight can trigger and exacerbate disordered eating behaviors and body dysmorphia. They also perpetuate diet culture, where every calorie must be counted, and which provides a socially acceptable way of masking an eating disorder. 

Because dieting is such a part of everyday life for Americans, especially girls and women, it is all too easy for parents and family members to dismiss disordered eating behavior as “just a phase” by a temperamental teenager, or even worse, might be encouraged in a misguided attempt at promoting better health. Eating disorders commonly include a sense of perfectionism that can hide disordered behavior behind a façade of achievement; the loved ones of a person hiding for example bulimia nervosa symptoms might think that because they are doing well at work, there is no sign of mental illness – and from there the disorder goes untreated.

To dissuade the stereotype that people with eating disorders do not need treatment for their mental illness, leaders in the field of eating disorder treatment are implementing psychoeducational components to their programs and assessment practices.

What Is Psychoeducation?

A central part of psychotherapy, psychoeducation is training provided that facilitates understanding of psychology. Information provided by psychoeducation helps people with ED, and their loved ones understand the biological causes of mental illnesses as they related to an eating disorder. Greater understanding of the causes of their disorder can help clients identify disordered thoughts and behavior, and gain motivation to get better. Psychoeducation stresses the importance, especially for outpatient or day treatment programs,that they attend all counseling sessions, take medications as prescribed, and employ the mindfulness and cognitive retraining exercises they learn in treatment.

These principles were originally designed for people with schizophrenia or other serious mental disorders. Now it’s commonly used across a variety of mental health treatment programs from eating disorders to clinical depression. Because of its facility on a wide application of mental health disorders, psychoeducation helps dual diagnosis patients cope with multiple disorders at once. Both the individuals getting treatment and their families gain a way to understand their eating disorder in terms of genetics, brain chemical imbalances, the role ofmediation, and social media in body image and self-esteem.

Psychoeducation Provides a Base for Recovery

Using a basis of psychoeducation to guide their clients’ understanding of ED, eating disorder therapists talk to their clients about previously hidden underlying causes, setting attainable goals, and understanding how their own perceptions may be flawed. The more understanding an individual has of the biological and developmental causes of their mental health disorders, the more likely they are to make progress on objective identification of disordered thoughts and actions. This can lead to a closer bond between therapist and client, as well.

Quantitative and qualitative data based on studies of psychoeducation has shown that people suffering from symptoms of mental health disorders like major depression, mood disorders and acute anxiety that engage in psychoeducation saw a lessening of symptoms even before psychiatric medication was applied. This makes psychoeducation a useful precursor to both further talk therapy and medication (if necessary). Psychoeducation also enhances feelings of empowerment, reduces the stigma, guilt, and shame surrounding mental illness and eating disorders and improves a patient’s problem-solving strategies by increasing their awareness of relapse risk factors and how to avoid or cope with them.

For the family and support systems for people with EDs, psychoeducation can provide a vital route to understanding their loved one’s disorder and set a foundation for providing support during and after treatment at an eating disorder facility. Family support is one of the best indicators of a successful, long-term recovery; providing psychoeducation can increase their ability to provide sound support rooted in understanding.