The truth about eating disorders

A sad looking woman standing by a window looking outside

It’s a debilitating illness that affects an estimated 30 million Americans each year. The disease does not discriminate, crossing all genders, socio-economic classes, cultures, races and religions. Sadly, every 62 minutes someone dies as a direct result.

“It” is an eating disorder.

And chances are, you or a loved one have been directly or indirectly affected by this mental illness. The good news is, it’s never too early or too late to get help.

HCA Healthcare operates the only eating disorder program on the East Coast to receive The Joint Commission’s disease-specific care certification, offering help and hope to adolescents, teens and adults with eating disorders. Reflections Eating Disorders Treatment Center at affiliate Dominion Hospital is a 10-bed in-patient treatment center completely dedicated to treating the disease.

Hospital patient room with two beds
Dominion Hospital patient room.

If a patient is suffering from an eating disorder, their doctor might recommend hospitalization if they are experiencing severe health issues. For example, anorexia can cause severe malnutrition. Typically, these patients are then released for follow up psychological care at an external rehabilitation center.

At Reflections, patients have access to extensive clinical support of a major hospital and expert psychological care, at the same time.

Art room with counters, stools and children's art on the walls
Dominion Hospital art room.

“Our patients receive full medical and psychological support in our program,” said Felicia Kolodner, a certified eating disorder specialist and Director of Reflections. “It’s not just about correcting their eating; it’s about dealing with the psychological features of the eating disorder as well. So, when patients aren’t in a meal support session, they are taking part in individual or group therapy.”

The Falls Church, Virginia-based Reflections program is unique for its inpatient treatment program and its outpatient day treatment program, available seven days a week, 12 hours per day. HCA Healthcare’s Parkland Medical Center in New Hampshire has an outpatient treatment program for eating disorders too.

“The problem with many eating disorders is that people can hide it well, especially the ones where there is no weight loss like bulimia or binge eating,” Kolodner explained. “It really takes a skilled clinician to ask the right questions.”

“People suffer in silence for a long time,” she added. “There’s a lot of shame around an eating disorder. Individuals are hesitant to ask for help because of the guilt around the behavior.”

Headshot of Felicia Kolodner
Felicia Kolodner, Director of Reflections at Dominion Hospital

Despite more awareness of eating disorders and celebrities like Lady Gaga and Kelly Clarkson speaking up to slash the stigma, eating disorders are still vastly misunderstood. Fighting the stigma with truth, Felicia Kolodner steps up to answer our top questions…

What classifies as an eating disorder?

The layman definition is a distorted relationship with body, body shape and size, and food. And that people utilize food, as a negative coping strategy that then becomes an impairment on their general safety, health and well-being.

Why is it considered a mental illness?

Most eating disorders usually start in the brain. The majority of people I work with have stated it starts with negative thoughts or messaging in their head, like:

  • negative thoughts about their body
  • negative thoughts about their relationship with food, and
  • obsessiveness about caloric nutrition, exercise

It becomes like a thought distortion, where people obsess and ruminate about it and then act out on those messages. They restrict or binge or use compensatory behaviors like purging over-exercising, and it’s those behaviors that then affect their physical and mental well-being.

Typically someone with an eating disorder does not have an eating disorder only.  There’s often times also anxiety, mood disorders, depression, substance abuse or non-suicidal self-injury behavior (cutting). It’s very rare that an individual would just have an eating disorder in a vacuum.

What is the most prevalent eating disorder?

The eating disorder that most people are affected by is binge eating, which only recently became an actual diagnosis in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Other disorders include anorexia, bulimia, body dysmorphic disorder – obsessed with an imaginary defect in their physical appearance – or avoidant/restrictive food intake disorder (ARFID).

Who’s most at-risk?

Individuals with a family history of eating disorders or ones with a co-occurring condition like anxiety, mood-related issues, and obsessive-compulsive thinking processes are more susceptible. Environmental factors play a role as well. In most cases, eating disorders start in childhood or early adolescence. Younger girls who have to deal with the peer pressure around body shape and size and their friends dieting to an extreme is another risk factor. However, it should be noticed that eating disorders also effect males.

What warning signs can loved ones look for?

It’s a marked change in functioning around food, body and exercise, which is usually co-occurring with changes in social functioning. Some specific warning signs include:

  • sudden change in eating behaviors
  • avoidant/restrictive food intake
  • limiting caloric intake
  • being very secretive or isolated around food
  • over exercising
  • rapid weight loss/gain
  • going to the bathroom after meals, which could be a sign that somebody might be purging or hiding food
  • changes in mood
  • isolating
  • avoiding social functions where there is food
  • wearing baggy clothes to cover the body to try and hide weight loss or body dysmorphia

When should someone seek help?

As soon as symptoms start to appear. They should seek help even if it’s not a full-blown eating disorder. It’s a progressive disorder, so it’s never too early to get support and treatment,

According to the American Psychiatric Association, here are some ways to support someone who may have an eating disorder:

  • Be empathic, but clear. List signs or behaviors you have noticed and are concerned about.
  • Help locate a treatment provider and offer to accompany them to an evaluation.
  • Be prepared that the affected individual may be uncertain about seeking treatment.

Kolodner believes people can achieve full remission and recovery from an eating disorder. She’s seen it happen.

“It has been a year since my discharge and I am so thankful for everything that you did for me,” one patient wrote in a thank you letter to Reflections.  “I have my life back!  I am thrilled to share that I have had no symptoms for some time. I am so grateful for each and every one of you.”

HCA Healthcare’s Dominion Hospital offers inpatient and outpatient treatment for eating disorders, while affiliate Parkland Medical Center, located in Salem, N.H., offers an outpatient eating disorder treatment center.  

About HCA Healthcare

HCA Healthcare, one of the nation's leading providers of healthcare services, is comprised of 183 hospitals and more than 2,300 sites of care, in 20 states and the United Kingdom. Our more than 283,000 colleagues are connected by a single purpose — to give patients healthier tomorrows.

As an enterprise, we recognize the significant responsibility we have as a leading healthcare provider within each of the communities we serve, as well as the opportunity we have to improve the lives of the patients for whom we are entrusted to care. Through the compassion, knowledge and skill of our caregivers, and our ability to leverage our scale and innovative capabilities, HCA Healthcare is in a unique position to play a leading role in the transformation of care.

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