Demystifying Disorders: The Nuances of Eating Disorders

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Navigating the complex landscape of eating disorders requires precision and clarity, especially when preparing for licensure exams or working with clients. Dr. Linton Hutchinson and Eric Twachman deliver a masterclass in distinguishing between different eating disorders, offering essential knowledge that both clarifies exam material and enhances clinical practice.

We journey through the distinct worlds of anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder, highlighting the unique diagnostic criteria for each condition. From the significant weight loss and elaborate food rituals of anorexia to the normal-weight presentation and secretive behaviors of bulimia, we illuminate the sometimes subtle differences that make each disorder unique. The conversation takes a fascinating turn when we briefly reflect on our own relationships with food, demonstrating how common some problematic eating patterns can be.

Treatment approaches receive thorough attention, with evidence-based strategies tailored to each disorder. Family-based treatment shines for adolescents with anorexia, while various forms of cognitive-behavioral therapy prove effective across multiple conditions. We explore therapeutic techniques ranging from motivational interviewing and cognitive restructuring to exposure therapy and mindful eating exercises. The episode concludes with valuable information on assessment tools like the Eating Disorder Examination and the quick-but-effective SCOFF questionnaire. Whether you're studying for your licensing exam or looking to deepen your clinical understanding, this episode provides the knowledge you need to recognize, differentiate, and effectively treat eating disorders in your practice. Subscribe to our podcast for more exam-ready content that bridges theory and clinical application!

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This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.

Episode Transcript

LINTON (00:05):
Hi everyone and welcome to today's episode.
I'm Dr Linton Hutchinson,joined by my amazing colleague,
eric Tuchman.
Together, we're looking at theworld of eating disorders,
breaking down the differenttypes and exploring their unique
nuances in a way that's clearand easy to understand.
If you're preparing for yourlicensure exam, this episode is

(00:27):
loaded with insights to help youunderstand this important topic
.
Let's get started.

ERIC (00:32):
I'll tell you, linton, those exams love throwing
curveballs, where you have totell apart disorders that seem
pretty similar at first.
So today we're here to clearthings up and give you tools to
tell the difference on your examand to help your future clients
.

LINTON (00:47):
All right, let's kick things off with anorexia nervosa
.
The DSM describes it asrestricting intake so much that
it leads to significantly lowbody weight.
There's also an intense fear ofgaining weight and a distorted
way of seeing your body.
These symptoms must occur forat least three months to
diagnose it Now bulimia nervosais a little different.

ERIC (01:10):
It's all about those binge eating episodes followed by
compensatory behaviors likevomiting, over-exercising or
misusing laxatives.
For a diagnosis, this needs tohappen at least once a week for
three months, and how clientssee themselves is heavily tied
to their weight and shape.

LINTON (01:28):
Then there's binge eating disorder.
This one involves binge eatingwithout the purging or other
compensatory stuff that you seein bulimia.
It's about quickly eating a tonof food while feeling out of
control Like the others.
It must happen at least once aweek for three months to meet
diagnostic criteria.

ERIC (01:47):
Another important disorder is avoidant restrictive food
intake disorder.
This isn't about body imageconcerns like anorexia or
bulimia.
It's more about avoidingcertain foods because of sensory
issues or fear of things likechoking.
This can lead to nutritionaldeficiencies or weight loss, but

(02:07):
the motivation behind it istotally different.

LINTON (02:10):
When it comes to what these disorders look like
clinically.
Anorexia often shows up withextreme weight loss, cold
intolerance and amenorrhea.
In females, these clients maywear loose clothes to hide their
bodies and obsessively countcalories or develop food rituals
.
These behaviors often stem froma need for control and can
cause significant distress ifinterrupted.

(02:33):
They may cut food into verysmall pieces, chew excessively,
eat only one food group at atime, arrange food meticulously
or let their food become soggyso it becomes unappealing.

ERIC (02:46):
Bulimia can be tricky because clients usually have
normal weight, but you mightnotice calluses on their
knuckles, which is also known asRussell's sign, dental erosion
from vomiting or swollen parotidglands.
They often feel ashamed andwork hard to keep their
behaviors secret.

LINTON (03:05):
Okay, so you're assuming I know what the parotid gland
is?
Give me a clue?
No, problem.

ERIC (03:12):
The parotid glands are salivary glands located on
either side of your face andextend from the cheek to below
the jawline.
If they're swollen, you mightconsider bulimia.
You also might see thatdescription in a mental status
exam, so it might be a clue tothe diagnosis.

LINTON (03:29):
Binge eating disorder, however, looks different.
Clients might be overweight orobese, but not always.
They often talk about eatinguntil they're uncomfortably full
, embarrassed about eating aloneand guilty afterward.
Unlike bulimia, there's nopurging involved.
Eric, I've been thinking abouthow we all have different
relationships with food and Iwanted to ask you something.

(03:51):
In another podcast youmentioned going to buffets and
sometimes eating until you'reuncomfortably full.
I wonder if you ever feelawkward eating so much and alone
at the buffet, or maybe evenfeel guilty afterward.

ERIC (04:07):
That's an interesting question, linton.
But now that you bring it up, Ido notice that sometimes I eat
until I'm stuffed.
Part of it is wanting to get mymoney's worth, but afterward I
do feel kind of bad, like maybeI overdid it.
And yeah, if I'm eating alone Isometimes feel a little
self-conscious, like peoplemight be watching me.
There's definitely some guiltthat comes with it too.

LINTON (04:31):
That makes sense and, honestly, you're not alone in
feeling that way.
I think it's something both ofus can work on.
Speaking of food challenges,have you ever heard of avoidant
restrictive food intake disorder?

ERIC (04:45):
Sure have Lintz Avoidant.
Restrictive food intakedisorder stands out because
there's no distress about bodyshape or weight.
Instead, clients avoid certainfoods because of sensory issues
or fears like choking.
This can cause weight loss ornutritional problems like
anorexia, but for totallydifferent reasons when it comes

(05:06):
to treatment for anorexia.

LINTON (05:08):
family-based treatment, also known as the Maudsley
approach, works really well forteens, it puts parents in charge
of refeeding.
For adults, enhanced cognitivebehavioral therapy CBT focuses
on challenging those intenseconcerns about shape and weight.

ERIC (05:29):
Bulimia responds well to CBT-E2.
It targets what keeps thedisorder going and works for
most people.
Interpersonal psychotherapy canalso help if relationship
issues are fueling thebehavior's.

LINTON (05:41):
For binge eating disorder.
Cbt is super effective in thatit helps clients figure out what
triggers their binges andteaches them healthier coping
strategies.
And don't forget thatdialectical behavior therapy can
also work well if emotionalstruggles are driving the
binging.

ERIC (06:01):
Treatment for avoidant, restrictive food intake disorder
often uses adapted CBTapproaches that gradually expose
clients to feared foods whileteaching them how to manage
anxiety around eating.
Sensory integration techniquescan also be helpful when sensory
issues are part of the problem.

LINTON (06:21):
No matter which disorder you're treating, keeping an eye
on medical stability is crucial.
Working with a physician,dietitian and sometimes a
psychiatrist as part of a teamis key, for anorexia especially.
Getting weight back up is oftenstep one before engaging in
deeper psychological work.

ERIC (06:42):
Motivational interviewing can be helpful, since recovery
ambivalence is common witheating disorders.
Instead of pushing too hardagainst resistance, roll with it
and help clients connect withvalues beyond their appearance,
across all eating disorders.

LINTON (06:58):
Cognitive restructuring is huge.
Helping clients challengedistorted thoughts like thin
equals happy by having theclient look at evidence for and
against those beliefs.

ERIC (07:10):
Exposure therapy is another approach, whether it's
eating feared foods, toleratingfullness sensations or looking
at their body in the mirror,you'll gradually guide them
through these steps, whileteaching them how to manage
anxiety.

LINTON (07:25):
Food journaling can be really eye-opening.
It helps clients track whatthey eat, along with their
thoughts and feelings, so theycan spot patterns and triggers.

ERIC (07:35):
Body image work might involve mirror exercises where
clients describe their bodyneutrally instead of critically
or questioning assumptions likemy worth depends on how I look.

LINTON (07:46):
Mindful eating exercises are great for reconnecting with
hunger and fullness, cues thatmight have been ignored for
years.
Starting with simple foods likeraisins helps them slow down
and notice textures and tasteswithout judgment For binge
eating and bulimia.

ERIC (08:04):
Especially emotion regulation skills are key,
helping clients identifyemotions, tolerate distress
without turning to food and findhealthier ways to self-soothe
when they're upset.

LINTON (08:16):
When it comes to assessments, the eating disorder
examination is indicated.
It looks at behavioral andpsychological features over the
past month and gives valuablediagnostic information.

ERIC (08:30):
The eating disorder inventory is another great tool.
It's a self-report measure thatdigs into traits like drive for
thinness or bodydissatisfaction.

LINTON (08:41):
If you need something quicker for screening purposes,
check out the SCOFFquestionnaire.
It's just five questions, butsuper effective in spotting
potential issues early on.

ERIC (08:53):
The eating attitudes test is another solid option.
It flags symptomscharacteristic of eating
disorders when scores hit acertain threshold.

LINTON (09:04):
Body checking behaviors like obsessively weighing
yourself or looking in mirrorscan keep someone stuck in a
preoccupation with their weightor shape On the flip side body
avoidance, like wearing baggyclothes or avoiding mirrors
altogether, also reinforcesthose negative thoughts tied to
eating disorders reinforcesthose negative thoughts tied to

(09:28):
eating disorders.
Well, my wonderful therapists, Iknow we've covered a lot today,
but the beauty of podcasts isthat you can listen to this
episode as many times as youneed, whether you're making
dinner, taking a shower binge,watching your favorite Korean
drama, rolling on the mat withyour jujitsu partner or driving
to your next therapy appointment.
Whatever you're up to, keepthese episodes playing in the

(09:49):
background.
Trust me, when it's time foryour licensing exam, you'll
realize it's in there.