The National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports that at least 30 million people in the United States will have an eating disorder at some point in their lives. Eating Disorders can affect any age group, including children and women over age 50, according to ANAD. People of all ethnic groups, races, and sexual orientations may experience eating disorders. Environmental and social influences, genetics, and personality traits can contribute to an eating disorder. Eating disorders include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder (BED), OSFED (Other Specified Feeding or Eating Disorder), ARFID (Avoidant/Restrictive Food Intake Disorder), and Diabulimia, deliberate insulin underuse for weight loss among people with Type 1 diabetes. As many as 9 out of 10 people on the Autism Spectrum may have some symptoms of an eating disorder.

Applied behavioral analysis and cognitive behavioral therapy are used to treat eating disorders, along with related strategies such as cognitive remediation therapy (CRT), acceptance and commitment therapy, family-based treatment, and dialectical behavior therapy (DBT).

Types of Eating Disorders Applied Behavior Analysts Should Know

Eating disorders are complex and can co-occur with other disorders, including anxiety, depression, and substance abuse.

Awareness of eating disorders has grown since the 1970s, when Vivian Hanson Meehan, the founder of ANAD, was told that the reason she could find out so little about Anorexia Nervosa was that it was so rare. Vivian was overwhelmed by phone calls and letters when her story appeared in a national magazine.

Anorexia Nervosa: People with Anorexia Nervosa have a strong fear of gaining weight and often have unrealistic body images. They avoid food, purge, and overexercise, and are severely underweight. People with Anorexia often fail to recognize how thin they are and how serious their condition may be.

Bulimia Nervosa: Recurring episodes of binge eating with a lack of control over eating characterize Bulimia. People with Bulimia can try to compensate for their binge episode by vomiting, excessive exercise, fasting, laxatives, or diuretics. People with Bulimia have strong concerns about their body image and weight.

Binge Eating Disorder: Much publicity about eating disorders has focused on Anorexia and Bulimia, but Binge Eating Disorder is also a serious disorder. People with Binge Eating Disorder consume large amounts of food, similarly to those with Bulimia, but they do not purge or fast afterward. Binge eaters may eat when they are not physically hungry, or they may eat alone because they are embarrassed about how much they are eating.

Avoidant/Restrictive Food Intake Disorder (ARFID): ARFID can begin in childhood as “picky eating.” A child who will eat only hot dogs or rice has obvious nutritional deficiencies that can worsen over time. Adults who consume limited food types may also potentially have ARFID.

Other Specified Feeding or Eating Disorders (OSFED): People who do not meet every criterion for Anorexia, Bulimia, Binge Eating or ARFID may be diagnosed with other disorders. Those with Atypical Anorexia Nervosa meet all of the behavioral criteria but have normal or above-normal weight. Individuals with Night Eating Syndrome consume at least 25% of their daily calories after they go to bed.

Preparing for a Career Working With Eating Disorders as an Applied Behavior Analyst

Eating disorders can be treated in a variety of settings and encompass levels of care. The types of treatment a patient will receive depend on symptoms, health status, and risk factors. Applied Behavior Analysts will work as part of a treatment team in different clinical settings.

Outpatient Treatment: The first level of treatment is an outpatient treatment program which may be periodic or daily. Outpatient settings are suitable for eating disorder patients who don’t need daily medical monitoring and intervention and who are psychiatrically stable.

Partial Hospitalization: Eating disorder patients who have impaired functioning and require a daily assessment to prevent further physical and psychiatric consequences are treated in partial hospital circumstances, such as day treatment programs. Patients in day treatment aren’t able to go to work, school, or function in social situations without assistance, but they aren’t at immediate health risk.

Residential Treatment and Inpatient Hospitalization: Residential treatment is focused on eating disorder patients who are medically stable, but psychiatrically impaired and unresponsive to less-intensive levels of psychiatric care. Inpatient hospitalization is the highest level of medical and psychiatric care for the eating disorder patient. These patients are at imminent risk due to poor vital signs, acute health risks due to malnutrition, and potential for suicide.

How Applied Behavior Analysis Can be Used as Part of an Eating Disorder Treatment Team

Because eating disorders involve potentially fatal physical health risks and can include some co-morbid disorders such as substance abuse and clinical depression, Applied Behavior Analysts are asked to work as part of clinical treatment teams. Many ABA programs have been developed to work with children and adults on the Autism Spectrum who have co-occurring eating disorders.

Applied Behavior Analysis techniques with evidence-based practices include using surveys to discover emotional, operant, and derived behaviors when patients are eating, before they eat, or when they are refraining from eating.

Reinforcers may be introduced to support healthier eating behaviors. Using analysis techniques to understand the causes of the eating problems and functions of the eating disorder also play a role for applied behavior analysts who are working as part of an eating disorder treatment team.

An ABA may devise a behavioral treatment program for after-care and support following outpatient or residential treatment for an eating disorder. Specialized eating disorder applied behavioral analysis techniques may be used for children with eating disorders. A child is only diagnosed with a pediatric eating disorder like ARFID if the “picky eating” impacts growth and development. In the case of a child whose eating habits have reached the level of a diagnosable disorder, Applied Behavior Analysts will examine behaviors and emotions before and after mealtimes and devise interventions to moderate undesirable behavior and reward positive eating habits.

Further Reading on Applied Behavior Analysis in the Treatment of Eating Disorders

National Eating Disorder Association (NEDA) Types of Treatment for Eating Disorders.

ANAD Eating Disorder Types and Treatment Methodologies

Learn 2 Learn Eating Disorders Clinic for Autism

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