Emotional Eating Problems

Eating problems occur when someone:

• Overeats, or eats more than is healthy to support his body's needs.
• Under eats, or eats too little to support her body's needs.
• Has restrictive eating (eats only certain foods or only certain amounts of food).
• Purges food, including vomiting or using laxatives.

Eating problems can have emotional and physical components. Sometimes people eat for reasons other than being hungry, such as:

• Boredom.
• Stress.
• Poor impulse control.
• Emotional reactivity.
• Anxiety and worry.
• Being under the influence of substances (e.g., marijuana or alcohol).
• Depression.
• Attending special events or holidays (like potlatches, sports gatherings, or Thanksgiving).
• Seasonal patterns (e.g., eating more during the winter).
• Grief after a loss of a loved one or other important part of life, such as a job or relationship.
• Sadness or feeling bad about themselves.

Emotional eating problems such as those described here can be situational (i.e., related to a specific event or season of life) or long-term problems.

Sometimes eating problems are related the person’s physical health. For example, the following can affect eating habits and hunger:

• Medical issues (e.g., tapeworms or allergies).
• Medications.
• Pregnancy.

An eating disorder is a serious mental illness involving patterns of food restriction and/or purging that can affect people in all walks of life. Eating disorders need to be addressed with professional help. An untreated eating disorder can cause serious medical problems or even death. There are multiple kinds of eating disorders, and some people have symptoms of more than one at once or move from one type to another over time.

• Anorexia is an eating disorder involving an obsessive focus on weight loss, inadequate weight for the person's age, height, and body type, and distorted body image. Typically, people with anorexia restrict their caloric intake (how much they eat). They often also restrict what types of food they eat, and may purge (i.e., get rid of calories) through exercise, vomiting, or laxatives.
• Bulimia is an eating disorder characterized by the binge-and-purge cycle and distorted body image. Someone with bulimia will frequently eat large amounts of food, then do something to prevent weight gain such as inducing vomiting. The person will feel out of control during binge-eating episodes. People with bulimia are also at risk for self-injury (such as cutting), substance abuse, and impulsive behavior.
• Other types include Avoidant Restrictive Food Intake Disorder, Binge Eating Disorder, Pica, and more. You can learn more about the various types of eating disorders from the National Eating Disorders Association.

There are many different body types; don’t assume the person is unhealthy just because of her weight, body type, or shape.

A child’s eating patterns may be related to her family’s eating habits and the availability of nutritious food. For many people of all ages, eating habits are related to family habits, traditions, or the overall home environment. Consider working with your client or bringing the family of a minor or vulnerable adult together to:

• Identify and discuss family habits and interactions related to eating.
• Review the components of a healthy diet.
• Discuss how to have a healthy relationship with food.
• Work as a family to come up with a food plan and establish a routine around mealtimes.

Emotional eating habits can affect both males and females and people of all ages.

Restrictive eating habits may be the person's attempt to have some control in her life when she feels other parts of her life are out of control. Work with the client to develop healthy ways to express herself and develop a sense of control in different parts of her life.

Some children have a biological predisposition or temperament that makes them more likely to experience problems with emotional eating.

Some people eat things others may not consider to be food, such as dirt, Play-Doh, toothpaste, or paper. Consider the age of the client to determine whether this is likely a problem. For older children or adults, this could be a type of eating disorder.

Eating disorders are often dismissed as behavioral, but they are serious mental health conditions that require treatment. You can help to educate clients and the community about the very real and serious nature of eating disorders.

Eating disorders can involve addictive thoughts and behaviors. People with serious eating disorders will likely need residential treatment. Reassure the client or the minor's parents that needing this level of treatment is not a sign of failure.

Some children will intentionally try to gain or lose weight in response to being sexually abused.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history related to past traumas, abuse, medical conditions, medication regimens, or physical development, including menstruation cycles or use of birth control.

Treatment plan, including a history of the presenting problem and recommended course of treatment. Review the DSM-5 for criteria on Anorexia Nervosa, Bulimia Nervosa, Binge Eating, and other disorders.

Eating habits

• Refuses or avoids food
• Overeats or under-eats
• Restricts the amount or type of food he eats
• Induces vomiting after eating
• Spends excessive amounts of time in the bathroom after eating
• Has a poor appetite
• Has abnormal or inadequate food intake
• Steals, hoards, or hides food
• Uses food to control her emotions and environment
• Eats in secret (away from others)
• Has made changes in diet or nutrition
• Excessively diets

Physical health

• Has abnormal weight gain or loss, especially over a short time period
• Is short for her age
• Has experienced a rapid growth spurt
• Exercises excessively in an effort to control weight
• Uses laxatives in an attempt to control weight
• Experiences changes in menstruation, including irregular cycles or loss of menstruation
• Excessively eats followed by purging, in attempt to control weight

Emotions/moods

• Experiences anxiety and/or depression (which can increase or decrease desire for food)
• Has a preoccupation with weight and body shape or image
• Has a distorted view of his body
• Experiences tension and negative emotions around mealtimes
• Has low self-esteem
• Lacks adequate coping skills to deal with feelings

Personal history

• History of divorce
• For minors, parental divorce
• Trauma
• Social problems (e.g., being bullied)
• Significant losses (of loved ones, a job, a relationship, etc.)
• Limited sense of self-control
• Child or vulnerable adult abuse or neglect
• Partner abuse/domestic violence
• Limited food in the home
• Perfectionistic behaviors

Eating habits

• When did you last eat?
• What did you eat?
• What kind of things do you like to eat?
• Have there been any changes in your diet or nutrition lately?
• Are there times that you eat when you are not necessarily hungry?
• Are there certain times or events when you eat more or less than usual?
• Do you ever use foods to manage your emotions?
• Do mealtimes cause you stress?
• What do you do when you feel you have had too much to eat?
• Do you eat together with your family or do you prefer to eat alone?
• Do you ever vomit after eating?
• Have you ever dieted? Do you diet often?
• Have you ever used laxatives to control your diet?
• Do you steal, hide, or hoard food?
• Are your eating habits similar to or different from your family’s?
• Do you follow specific eating habits for cultural or religious reasons?

Personal history

• How do you view your body?
• Do you feel you should weigh less or more than you do?
• Are you trying to lose or gain weight for sports?
• Are you trying to gain or lose weight for the sake of your appearance?
• Have you started your menstruation? If so, is it regular?
• Is your body mass index (BMI) in the normal range for your height and age? If not, are there any factors (such as muscle mass or recent limits on your physical activity) that contribute to it?
• How much do you exercise?

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

It is important to seek guidance from your clinical supervisor or the assigned clinician regarding intervention strategies, as disordered eating is often complex and is heavily influenced by biological and psychological factors. Treatment approaches for disordered eating may differ significantly depending on the diagnosis (e.g., anorexia versus bulimia). Furthermore, people who experience disordered eating or are diagnosed with an eating disorder are often very secretive and guarded regarding their eating habits.

Individual counseling strategies may include:

• Developing a trusting and strong relationship.
• Enhancing self esteem.
• Identifying healthy activities and healthy levels of exercise; some people who experience disordered eating may exercise too much as a form of purging.
• Using acceptance strategies to become comfortable with their natural figure and body type.
• Using DBT skills in emotion regulation to develop strategies to identify, regulate, and express emotions in a healthy manner.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.