Treating the brain for
EATING DISORDERS
INTRODUCTION
An estimated 30 million people in the U.S. will struggle with an eating disorder at some point
in their life. These are complex conditions that have been on the rise in recent years, especially
among children and teens. More than just a transient attempt to lose weight or self-soothe,
people struggling with an eating disorder will regularly engage in abnormal and unhealthy
eating behaviors that affect their consumption of food and disrupt normal digestive processes,
which can lead to potentially life-threatening consequences.
There are several different types of eating disorders and having one is not the result of a
character flaw or lifestyle choice. Rather, these conditions—which often co-occur with other
mental health disorders—are rooted in brain dysfunction that arises from a variety of causes.
As challenging as they may be, with the proper diagnosis, treatment plan, and support,
it is possible to heal from disordered eating and regain physical and mental well-being.
The different types of eating disorders described in this eBook include:
• Anorexia Nervosa
• Bulimia Nervosa
• Binge-Eating Disorder
• Orthorexia
• Other Feeding and Eating Disorders
In this eBook, you will learn more about the different types of eating disorders, some quick
facts about them, and how Amen Clinics uses a holistic brain-based approach for the
treatment of these conditions.
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ANOREXIA NERVOSA
Individuals who have anorexia intentionally and severely
limit the number of calories they consume or digest.
They have a distorted view of their body shape and irrational
concerns about gaining weight or becoming fat. Even as
they become abnormally, even dangerously thin, these
fears do not abate and may become more intense.
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COMMON SYMPTOMS IN ANOREXIA NERVOSA
• Restricted intake of food and/or bingeing and purging food to avoid
consuming calories
• Abnormally low body weight for age, gender, and developmental stage
• Distorted body image despite thinness
• Obsessive worry about weight gain or getting fat
• Inability to acknowledge or recognize the health dangers of their low body weight
5 QUICK FACTS ABOUT ANOREXIA NERVOSA
A BMI (body mass index) below 18.5 may indicate someone is suffering with
anorexia nervosa, and a BMI of 15 is the upper threshold for starvation.
Inadequate intake of nutrients can lead to serious health problems, including
anemia, infertility, menstrual irregularities, heart problems, osteoporosis,
and more.
While males comprise 25% of people who have anorexia, they are often
overlooked because this disorder is generally associated with girls/women.
Consequently, it can be more fatal for boys and men.
Other mental health conditions, including depression, anxiety, bipolar disorder,
obsessive-compulsive disorder, and addiction frequently co-occur with
anorexia nervosa.
Suicide is the second leading cause of death for those struggling with this
condition.
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BULIMIA NERVOSA
People who have bulimia engage in repetitive episodes of
consuming abnormally large quantities of food during which they
feel unable to control the urge to binge or amount of food they
are eating. Some may even experience a level of dissociation while
binge-eating. To compensate for the excessive caloric intake,
those with this condition will purge the food, usually by forcing
themselves to vomit—the most common method—or using
laxatives, diuretics, or even enemas, in some cases.
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COMMON SYMPTOMS IN BULIMIA NERVOSA
• Repetitive episodes of binge-eating large quantities of food in a single sitting
• Feeling unable to stop eating or control what food or amount of it is being eaten
• Engaging in behaviors to offset weight gain from binges, such as forced
vomiting, taking laxatives, diuretics, or other medications, fasting, doing enemas,
and exercising excessively
• Perspective of self-worth is highly dependent on weight and body shape
5 QUICK FACTS ABOUT BULIMIA NERVOSA
Enduring physical or sexual abuse during childhood can lead to the development
of bulimia, which often begins in teenage or early adult years.
Early puberty or childhood obesity also increase the risk for this condition.
Approximately 30% of people with bulimia nervosa have a co-occurring alcohol
or stimulant abuse disorder.
Most bulimic individuals hide their bingeing behavior from others and feel
shameful about their lack of control with food.
Common triggers for binge-eating episodes often include emotional distress, poor
body image, dietary restraint, interpersonal problems, or boredom.
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BINGE-EATING DISORDER
In this condition, individuals consume an inordinately large
quantity of food in a single sitting and do so at least once a week.
They experience a lack of control in resisting the compulsion to
binge as well as an inability to stop once they start eating. During
these episodes, a person might consume food at a rapid pace, eat
even though they aren’t hungry or are uncomfortably full, and feel
bad about themselves afterward. Unlike in bulimia nervosa,
people with binge-eating disorder do not purge after eating a
copious amount of food.
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COMMON SYMPTOMS IN BINGE-EATING DISORDER
• Repeated episodes of eating big quantities of food
• Binge-eating when full or not hungry
• Hiding food to eat later
• Concealing binge behaviors from others
• Eating alone because of embarrassment about quantities of food being consumed
• Feeling ashamed and distressed about food-bingeing behaviors
5 QUICK FACTS ABOUT BINGE-EATING DISORDER
Although it is commonly associated with being overweight or obese, individuals
in the healthy weight range also struggle with binge-eating disorder.
There likely is a genetic component to this condition because it tends to run in
families.
Alcohol use disorder and depression commonly co-occur with binge-eating
disorder.
Approximately 25% of people with this condition struggle with suicidal
thoughts.
Repetitive binge-eating can lead to obesity, and along with that, an increased
risk for serious medical problems including diabetes and heart disease, as well
as having a lower health-related quality of life.
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ORTHOREXIA
People who have an abnormal fixation on eating what they consider to
be “pure” foods might have what’s known as orthorexia. While eating a
healthy diet is beneficial to physical and mental wellbeing, those who
struggle with this condition take it to the extreme and become obsessed
with the quality of the food they consume. They are very fearful about the
potential consequences of eating any foods that do not meet the strict
criteria for what they believe is acceptable to eat.
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COMMON SYMPTOMS IN ORTHOREXIA
• Eating only a limited number of food groups they deem to be pure or safe
• Eliminating entire categories of food believed to be harmful (i.e. all grains, sug-
ar, or animal products)
• Obsessively reading ingredient labels to assess a product’s quality
• Becoming anxious when having to eat food prepared by someone else
• Spending hours researching ingredients, planning meals, and preparing foods
that meet their desired standard of quality
5 QUICK FACTS ABOUT ORTHOREXIA
Orthorexia is often preceded by the desire to eat better and have a healthier
lifestyle, but then spins out of control.
People with this condition are vulnerable to being hooked on blogs and social
media sites that focus on healthy lifestyle behaviors.
Despite their fixation on eating well, those who have orthorexia do not have
an accurate understanding about nutrition.
The severely limited food choices in orthorexia can lead to malnutrition.
Individuals who have this condition tend to be irrationally critical of their
friends’ and family members’ food choices.
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ADDITIONAL FEEDING
AND EATING DISORDERS
In addition to the 4 types of eating disorders described on the previous pages, there are some
other conditions that are defined by abnormal feeding and eating behaviors. They include:
AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID):
This condition is characterized by an avoidance or restriction of certain foods that an individual
finds aversive to their senses (i.e. texture or smell) or are associated with a negative experience.
It may also be due to a lack of interest in food or eating.
PICA:
This disorder involves a regular pattern of eating nonfood substances, such as pebbles, hair,
metal, soap, etc. Risks for it include neglect, developmental delays, or being unsupervised
during infancy and childhood.
RUMINATION DISORDER:
In this condition, food that has been eaten is repeatedly regurgitated and spit out or rechewed,
swallowed, and regurgitated again. Most commonly affecting infants, children, or teens, it can
adversely affect growth and other developmental markers.
OTHER SPECIFIED FEEDING OR EATING DISORDERS:
People who fall into this category have abnormal food-related behaviors, and in some
conditions, have similar symptoms but do not meet the full criteria for a specific type of
eating disorder. Examples include:
• Atypical anorexia nervosa is when a person engages in anorectic eating patterns, but
their weight is within or above the healthy range.
• Binge-eating disorder of low frequency and/or limited duration is when food
bingeing occurs less frequently than in the actual disorder.
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• Bulimia nervosa of low frequency and/or limited duration involves bingeing and
purging, but less often than that which occurs in bulimia nervosa.
• Night-eating syndrome is a condition in which there are repetitive episodes of excessive
eating after dinner or after waking up from sleep.
• Purging disorder is intentionally purging food without binge-eating beforehand.
COMMON BRAIN IMAGING
PATTERNS IN EATING DISORDERS
For more than 3 decades, Amen Clinics has utilized brain SPECT imaging to help us identify
the underlying brain dysfunction that can occur with eating disorders and other mental health
conditions. With the world’s largest database of brain scans related to behavior—more than
200,000 and growing—we have found that certain parts of the brain are associated with eat-
ing disorders. These areas include:
• Anterior cingulate gyrus (ACG): This part of the brain helps people shift their attention
from one subject to another. However, when the ACG is overactive, people tend to get
“stuck” on certain thoughts and/or behaviors.
• Basal ganglia: This area helps set the body’s “idle” and is involved in motivation and
forming habits, among other things. Too much activity in the basal ganglia is often associ-
ated with increased anxiety.
• Parietal lobes: Involved in sensory processing, abnormal activity in the parietal lobes has
been associated with eating disorders and a distorted body image, such as when people
are anorexic but view themselves as “fat.”
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A BRAIN-BASED
MODEL FOR
TREATING
EATING DISORDERS
Amen Clinics takes a brain-based holistic 1. Biological Circle is about the physical
approach to the evaluation, diagnosis, and treat- functioning of your brain and body and assess-
ment of eating disorders. We know that your brain ing for any undiagnosed medical problems or
is involved in everything you do, feel, and think, injury that could be contributing to symptoms.
as well as how you respond to the challenges you
face. We also understand that the development of 2. Psychological Circle refers to your
an eating disorder can emerge from a variety of thinking patterns, self-talk, and self-image.
causes and experiences in your life. It looks at your past experiences that influence
thoughts and beliefs, including any childhood
For this reason, we start by learning about the trauma or abuse, developmental issues, and
following 4 Circles of Health and Illness as they your upbringing.
apply to you to identify any factors that could be
contributing to your condition. 3. Social Circle is your connections to others,
the social support you have, the quality of
your relationships, and any current stressors
(i.e. friends, family, school, occupational, or
financial) that might be affecting you.
4. Spiritual Circle has to do with your connec-
tion to God/a higher power, the planet, and
past and future generations, as well as having
a sense of meaning and purpose in life.
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THE IMPORTANCE
OF LOOKING AT
THE BRAIN
Our experience using brain SPECT imaging for
more than 3 decades at Amen Clinics has taught us
the importance of looking at the brain to identify
any underlying issues that need to be addressed.
SPECT is an advanced technology that shows
activity (blood flow) patterns in the brain and tells
us 3 very important things:
• Areas of the brain that work well
• Areas of the brain that are overactive
• Areas of the brain that are underactive
SPECT is also valuable for identifying any
co-occurring mental health problems, such
as anxiety, depression, or PTSD that drive
dysfunctional eating behaviors. In addition, it
can be helpful for identifying the presence of
traumatic or toxic brain injuries or the impact
of infections like Lyme disease or COVID-19
on brain function.
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FORMULATING A COMPREHENSIVE
TREATMENT PLAN
At Amen Clinics, we don’t simply look at the results of one component of an evaluation to
formulate a diagnosis and treatment plan; rather, we look at all the information we have
been able to gather about each patient. In addition to the SPECT scans and the 4 Circles
of Health and Illness, we analyze the results of neuropsychological tests and other assess-
ments to develop a customized treatment plan that addresses a patient’s unique needs.
While each person’s comprehensive treatment plan for overcoming an eating disorder will
be different, it will likely include a number of recommendations, some of which might be:
• Getting a full medical evaluation to identify and address any physical health
problems caused by the eating disorder.
• Depending on the severity of symptoms, an inpatient, partial inpatient,
or day treatment eating disorder program might be recommended.
• Psychotherapy, such as cognitive behavior therapy, can be helpful for address-
ing negative thinking patterns that trigger disordered eating as well as cognitive
distortions about self-image and body perception.
• Family counseling for those who live at home can be beneficial for empowering
and educating parents and other household members how best to help and support
the person who is recovering from an eating disorder.
• Nutrition education is often necessary to provide accurate information about
food and dietary choices, strategies for better eating behaviors, meal planning,
and nutritional recommendations for achieving a healthy weight.
• Medications or nutraceuticals to help manage symptoms, especially if there is a
co-occurring mental health condition.
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CONCLUSION
As you have learned in this eBook, eating disorders are very complex and challenging
conditions. At Amen Clinics, we understand that having one or watching a loved one
struggle with an eating disorder is very distressing on many levels. Not only can these
conditions cause very challenging mental health problems and interfere with social,
educational, or occupational functioning, but they can also lead to very serious medical
consequences.
Furthermore, many individuals who have an eating disorder also have another
psychiatric condition, the most common of which are:
• Anxiety
• Depression
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder (PTSD)
• Substance and/or Alcohol Abuse
• Suicidal Thoughts and Behaviors
To address all these issues, Amen Clinics uses a holistic, brain-based approach for the
evaluation, diagnosis, and treatment of eating disorders and co-occurring conditions.
We use the most effective, least toxic strategies grounded in neuroscience that can
lead to recovery, healing, and the best possible outcome for each patient.
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AMEN CLINICS
IS HERE FOR YOU.
At Amen Clinics, we understand that eating disorders are complicated conditions with
many different causes. That’s why we use a comprehensive bio-psycho-social-spiritual
approach to help our patients who are struggling with any type of eating disorder. We
know that with the right diagnosis and a personalized targeted treatment plan, you
can develop a healthy relationship with food and find relief from the symptoms of any
co-existing mental health issues so that you can have a healthier, more productive, and
fulfilling life.
Founded in 1989, Amen Clinics has built the world’s largest database of functional brain
scans related to behavior—more than 200,000 scans and growing. As a world leader in
brain health diagnosis and treatment, our comprehensive evaluations include:
• Brain SPECT Imaging
• Neuropsychological testing
• Lab testing (when necessary)
• An in-depth look at the biological, psychological, social, and
spiritual factors that may be contributing to your symptoms
We offer in-clinic brain scanning and appointments, as well as mental telehealth,
remote clinical evaluations, and video therapy for adults, children, teens,
and couples.
Take the next step to start healing from your eating disorder and enhancing your brain
health by scheduling an appointment. Contact us today by visiting our website at
[Link] or click the button below to speak with one of our care coordinators to
answer your questions and help you find the best solutions for you and your loved ones.
CO N TACT U S TO DAY
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Amen Clinics is a part of Daniel Amen, MD’s united organizations dedicated to revolutionize psychiatry by teaching, training, and treating brain health.
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