Eating disorders

Eating disorders are treatable medical illnesses with complex underlying psychological and biological causes. They frequently co-occur with other psychiatric conditions such as depression, substance abuse or anxiety disorders. People with eating disorders may also suffer from numerous other physical health complications, such as heart conditions or kidney failure, which can lead to death. For this reason, treating these disorders requires specialized, multidisciplinary care in a comfortable setting.

We use a multimodal approach to your treatment, with a major focus on individual, group and family therapy. Some of the methods we use include:

• Cognitive-behavioral therapy (CBT) — As one of the most effective treatment approaches for eating disorders, we use this therapy to work with patients to change their thoughts about themselves and food.
• Dialectical behavioral therapy (DBT) — Our group therapy work incorporates DBT skills training in emotion regulation, distress tolerance, interpersonal skills and mindfulness.
• Exposure therapy — Participants in our partial hospitalization program (PHP) have the opportunity to participate in "real world" activities. With the support of members of our team, patients go to restaurants, practice grocery shopping and take part in our unique clothing shopping exposure experience.
• Expressive (alternative) therapy — We offer many types of expressive therapy such as dance or movement, art, poetry, creative writing, drama and play therapies. These build self-awareness, interpersonal skills and coping skills.
• Medical care (internal medicine) — Many patients with eating disorders have a variety of medical needs, so our programs begin with a complete physical exam. Our internist will ensure that appropriate referrals are made if a specialist is required.
• Nutritional support — Nutrition groups include education on various nutrients and why the body needs them. The groups focus on challenging negative thoughts about food and provide education on meal planning at home. We also include discussions of nutrition-related challenges and possible solutions.
• Psychiatric treatment — All program participants are assigned a psychiatrist upon admittance to the program. They will meet with you several times a week. They may also speak to you about how medication can help you in your recovery process.

Our programs offer varying levels of care for eating disorder treatment, including inpatient, partial hospitalization, intensive outpatient and routine outpatient programs. Many factors go into deciding which program is right for you, including your safety and physical health, the complexity of your illness and your outside schedule.

If you'd like more detailed information about what our Reflections Treatment Center's program is like, you can learn more in our patient handbook.

Inpatient care

In our inpatient program, we guide patients through the recovery process. Patients will work with a specialized team and an individualized treatment plan. Meal planning and dietary support are provided, ensuring patients have a plan that includes three meals and three snacks each day. Each meal is followed by a support group meeting.

Each day of inpatient care, patients participate in a range of therapeutic activities specifically geared toward their individual treatment plans. These include psychotherapy groups, nutritional groups, expressive therapy, meal planning and psychoeducational sessions. Patients meet individually with their therapists at least twice weekly and will also participate in weekly family sessions.

Inpatient program visitors

You are not expected to overcome your eating disorder alone. Your entire family plays a crucial role in the clinical treatment process, especially for adolescent patients. We strongly encourage family participation in group therapy and the nutritional education process. We also encourage your family members to visit during designated visiting hours. In addition to weekly family therapy sessions, your family can participate in certain program activities on the weekends. Together, we can help you and your family heal and thrive.

PHP treatment

Like our inpatient program, the PHP is designed to guide you through the recovery process. This daytime program is right for you if need more than an outpatient setting. We provide care if you are able to spend the night in your own home, but need a longer, more structured program during the day.

The PHP is available up to 11 hours per day, seven days per week. The program is an easy step down from our inpatient program, and we do our best to make this a smooth transition between levels of care.

Intensive outpatient program (IOP)

The IOP is designed to allow participants the freedom to customize a care plan that accommodates their regular activities, such as work and school. The program is flexible, with patients typically participating in our IOP anywhere from three to seven days a week. The schedule is built around meal times in order to accommodate a patient’s clinical and personal needs.

Outpatient care referrals

HCA Virginia has an extensive outpatient referral network, which includes psychiatrists, therapists, psychologists and registered dietitians. We use this network as a way to provide you with continuing support once you have completed inpatient or partial hospitalization treatment. We also offer outpatient access if you are not a candidate for partial hospitalization or inpatient care.

Support groups for eating disorders

The purpose of our Eating Disorders Support Group is to provide a supportive peer environment for people struggling with eating disorders. Our group meets Wednesdays from 7:00pm to 8:30pm in South Conference Room Two on the second floor of Dominion Hospital at:

2960 Sleepy Hollow Rd.
Falls Church, VA 22044

To learn more about our support group, call (703) 538-2886.

When a person experiences severe disturbances in eating behavior, it is considered an eating disorder. This may appear as an extreme reduction of food intake, extreme overeating or extreme feelings of distress about body weight or shape.

Eating disorders frequently appear during adolescence or young adulthood, but sometimes they can develop during childhood or later in adulthood. Females are much more likely than males to develop an eating disorder. Males who do have eating disorders are more likely to have a binge-eating disorder.

There are several types of eating disorders, including:

Anorexia nervosa

Anorexia is a potentially life-threatening eating disorder characterized by a relentless pursuit of thinness and an unwillingness to maintain a healthy body weight. Those with the disorder have a distortion of body image, often seeing themselves as overweight, even if starved.

Signs and symptoms

People with anorexia often have low self-esteem, anxiety and depression. They use obsessive control of their own diet and weight as a method of controlling their surroundings and their emotions.

Some signs of anorexia include:

• Absent or irregular menstrual periods
• Body weight less than 85 percent of a healthy weight (equivalent to a BMI of less than 17.5)
• Bradycardia (a heart arrhythmia in which the heart rate is less than 60 beats per minute)
• Brittle hair or nails or hair loss
• Compulsive or excessive exercise
• Distorted body image
• Dizziness or fainting after standing
• Intense fear of weight gain
• Lanugo (a fine growth of hair on the face/chest)
• Obsessive control of diet and weight
• Unusual eating behaviors, such as substituting eating with chewing gum
• Yellowish skin tone

These attitudes, symptoms and behaviors may be seen with or without purging (self-induced vomiting, laxative abuse or diuretic abuse).

When to seek help for anorexia

Reasons for inpatient hospitalization for anorexia may include:

• Active refusal to eat
• Multiple medical and behavioral concerns
• Rapid weight loss
• Requiring supervised meals and nutritional planning
• Significant impact on daily living

Reasons for partial hospitalization for anorexia may include:

• Medical and behavioral concerns
• Needing a structured treatment plan
• Preoccupation with food and weight
• Requiring supervised meals but not acute medical care

Bulimia nervosa

Bulimia is a potentially life-threatening eating disorder. It is characterized by frequent, "out-of-control" episodes of eating unusually large amounts of food followed by compensating behaviors, such as purging, fasting or excessive exercise.

As with anorexia, those with bulimia may have a distortion of body image or fear of weight gain. People with bulimia often have low self-esteem, anxiety and depression and use bingeing and purging behaviors as a way to cope with these issues.

Signs and symptoms

• Compulsive or excessive exercise
• Constipation and/or diarrhea
• Decreased ability to concentrate
• Depression or mood swings
• Gastroesophageal reflux disease (GERD)
• Irregular menstrual periods
• Mouth, teeth, gum and throat problems (such as cavities, ulcers and disease)
• Obsession with food, activities and information related to food (grocery shopping, baking, cookbooks and magazines)
• Recurrent episodes of binge eating
• Secretive behavior around food and eating
• Self-induced vomiting and laxative, diuretic or diet pill use
• Skipping some meals and overeating at others

When to seek help for bulimia

Reasons for inpatient hospitalization for bulimia may include:

• Active daily purging
• Excessive exercise that is uncontrollable
• Multiple medical and behavioral concerns
• Needs meal and bathroom monitoring
• Significant impact on daily living

Reasons for partial hospitalization for bulimia may include:

• Active purging
• Distorted body image
• Medical and behavioral concerns

Eating disorders not otherwise specified (EDNOS)

In addition to the two main types of eating disorders — anorexia and bulimia — there is also EDNOS, which includes several variations of eating disorders. Most of these disorders are similar to anorexia or bulimia but with slightly different characteristics. For example, binge-eating disorder is one type of EDNOS.