We are excited to participate in Eating Disorders Awareness Week, this February 24th-March 2nd! We are celebrating “Unifying through community and connection,” a campaign led by Collaborative of Eating Disorders Organizations (CEDO). Monte Nido aims to spread the message of understanding, support, and unity both within the eating disorder community and for those who don’t know what it’s like to live with an eating disorder.  

Raising Awareness & Breaking the Stigma

This year, we are aiming to reach as many people as possible who may not be aware of these life-threatening mental illnesses. It is important to be aware of the types of eating disorders, as well as common signs and symptoms to look out for in yourself and your loved ones. Catching an eating disorder early is key to recovery and we hope you learn something new from this information.

What is an Eating Disorder?

Eating disorders are serious mental health conditions that involve disturbances in eating behaviors, thoughts, and emotions. The most common types include binge eating disorder, anorexia nervosa, and bulimia nervosa. These disorders are multifaceted and can be influenced by a combination of factors, including biological, psychological, and sociocultural influences. Each individual’s experience with an eating disorder is unique, and there is no single cause, making these conditions complex to understand and navigate.

Eating disorders can be life-threatening, and affect individuals of all shapes, sizes, and backgrounds. It’s crucial to recognize that these disorders do not define a person. People struggling with eating disorders are much more than their condition, and recovery is always possible. These challenges, while difficult, can be overcome with the right support and treatment.

Understanding Different Types of Eating Disorders

Understanding the different types of eating disorders—whether it’s binge eating, anorexia, or bulimia—can help you identify struggles in yourself or your loved ones. Gaining this knowledge is an important first step toward recognizing the signs and seeking appropriate help. No matter the disorder, it’s important to know that support is available and recovery is within reach for everyone affected.

Anorexia Nervosa 

Anorexia nervosa comes with an intense fear of gaining weight, and involves behaviors like fasting, limiting food, or engaging in extreme exercise routines. For some, it also includes the use of diuretics or laxatives, or even vomiting after meals. A few signs and symptoms to look for in anorexia are a distorted body image, food restriction, obsessive thoughts about weight, food, and calories, and feelings of guilt or shame after eating.

Bulimia Nervosa

Bulimia nervosa is an eating disorder that often involves feelings of shame, guilt, and a lack of control around food. This disorder is characterized by periods of binge eating followed by compensatory behaviors such as purging, which can have serious physical and psychological consequences. If you or someone you care about is struggling, some common signs and symptoms are going to the bathroom right after eating, engaging in harsh exercise routines, eating in secret or hiding food, and a fear of not being able to stop eating.

Binge Eating Disorder (BED)

Binge eating disorder (BED) is characterized by recurrent episodes of consuming large amounts of food in a short period, accompanied by a lack of control over eating. Those with BED may eat rapidly, often until uncomfortably full, and may eat even when not physically hungry. They may feel embarrassed, disgusted, or guilty afterward, leading to eating alone or in secret. Unlike other eating disorders, BED does not involve compensatory behaviors like purging.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Individuals living with ARFID, or Avoidant/Restrictive Food Intake Disorder, often experience food aversions, significant anxiety around eating, or simply a lack of interest in food altogether. These restrictive eating behaviors go far beyond being a 'picky eater'—they impact both mental and physical health. ARFID involves severely limited calorie intake due to rigid and restrictive eating habits, leading to growth delays, weight loss, and malnutrition at any age. Unlike other eating disorders, ARFID is not driven by a fear of weight gain or a desire to be thin.

Other Specified Feeding or Eating Disorders (OSFED)

OSFED is an eating disorder that encompasses five types of eating disorders according to the DSM-5: atypical anorexia nervosa, sub-threshold bulimia nervosa, sub-threshold binge eating disorder, purging disorder and night eating syndrome. OSFED is a serious condition requiring treatment. Characteristics of OSFED include significant distress or impairment due to eating behaviors or negative body image, similar symptoms to atypical anorexia, purging disorder, bulimia, or binge eating disorder, and symptoms do not meet the full criteria for other eating disorders

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The Power of Community: Connecting & Unifying for Recovery

Being part of a community in eating disorder recovery helps to navigate the ups and downs of the recovery journey where having a supportive network can make all the difference. Connecting with others who share similar experiences provides a sense of understanding that is hard to find elsewhere. Whether through group therapy, support groups, or online communities, knowing you're not alone in your struggles can reduce feelings of isolation and shame. The shared experience of others fosters empathy and validation, which can be essential for healing.

Unifying in raising awareness also helps break down stigma. Eating disorders are often misunderstood or dismissed, which can prevent people from seeking the help they need. By coming together, the community can educate others, raise awareness, and advocate for better access to care. Through collective strength, those in recovery can feel empowered to not only focus on their own journey but also contribute to a larger movement that challenges societal expectations and promotes healing for everyone.

How to Seek Help for Eating Disorders & Support Resources

Seeking help for an eating disorder is a crucial step toward recovery, and there are many resources available to guide you through this journey. The first step is recognizing the need for support, which can be challenging but is essential for healing. At Monte Nido, we offer a full continuum of care, including virtual day programming, in-person day programming, and 24/7 residential and inpatient care across the country. 

Remember, recovery is possible, and seeking help is a sign of strength, not weakness. It’s important to reach out to friends, family, or support networks who can provide encouragement during the recovery process.. The key is to take that first step toward help, no matter how big or small. If you are struggling with your recovery journey, visit the link in our bio to learn about our eating disorder treatment programs.  You don't have to face an eating disorder alone.

Taking Action for Eating Disorder Awareness & Support

There are many ways to get involved this week and spread awareness. Whether in-person or online, conversations about eating disorders help break down the stigma and educate others. 

Please remember, it’s also okay if this week feels difficult or triggering for you. If you need to take a step back, unplug from social media, or lean on your support system, we encourage you to do so. Your well-being and recovery come first. If you are interested in joining an alumni support group or exploring treatment options, check out our alumni page here. If you are ready to take the first step in seeking treatment for yourself or a loved one, please reach out to us or give us a call at 888-228-1253. 

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The rise of GLP-1A culture

As the use and availability of GLP-1 receptor agonists (GLP-1RAs) continue to rise, the eating disorder community must start having conversations about how to approach this shift. While medications like Ozempic and Wegovy are approved for treating conditions like diabetes, they are increasingly being used for weight loss. With over 120 similar drugs currently in development, it's crucial to better understand how GLP-1RAs—whether prescribed for diabetes or weight management—affect eating disorder treatment, especially for binge eating disorder. As the debate over weight loss intensifies, the growing focus on weight stigma can contribute to feelings of hopelessness and lowered self-confidence in individuals in larger bodies. This desire for an “easy fix” to weight concerns is also leading to medication shortages, which impacts people who are prescribed GLP-1RAs for other medical conditions. There needs to be greater concern in the medical field about the potential effects of these medications on individuals struggling with eating disorders.

What are GLP-1As?

GLP-1RAs are approved for diabetes management in the U.S., Canada, and other countries, and are available as both pills and injections. These medications regulate blood glucose by stimulating insulin release and suppressing glucagon production.¹ They also slow stomach emptying and affect brain pathways that control appetite, which can increase feelings of fullness and reduce food intake.

While GLP-1RAs are effective, they come with side effects. These can include nausea, vomiting, abdominal pain, diarrhea, and constipation, while rarer but more serious issues can also occur. There is limited research on their long-term effects.²

GLP-1RAs are celebrated for weight loss in adults, though this loss plateaus over time and the weight can be substantially regained after stopping the medication.^{3, 4, 5, 6}  Currently, GLP-1RAs are not approved for eating disorder treatment.

In terms of short-term weight loss, GLP-1RAs show effectiveness. For example, the STEP 2 study on semaglutide with lifestyle changes showed an average weight loss of 33.7 lbs over 68 weeks, compared to just 5.7 lbs without the medication.^{4, 6} However, weight loss typically slows after this period, and some participants even gained weight, diminishing the overall effect.  

Effectiveness of binge eating disorder treatment and GLP-1As

Caloric restriction can directly conflict with the goals of eating disorder treatment, and the current studies on GLP-1RAs are insufficient to draw meaningful conclusions. More targeted research is needed, specifically examining how GLP1-RAs affect eating disorder behaviors. This includes differentiating between pathological and non-pathological restriction, tracking client outcomes over extended periods, exploring the misuse of these medications in eating disorder populations, and understanding how binge eating would likely rebound significantly once the medication’s appetite-suppressing effects wear off.⁴

As the use of GLP-1RAs increases, it's crucial for eating disorder treatment programs to prepare for a growing number of clients who are already using these medications.

Approaching this issue with empathy is essential. Understanding why a client is taking GLP-1As, particularly if it's for weight loss, helps inform the risk assessment. The potential risks need to be weighed carefully to determine if they outweigh the benefits for the client’s treatment.

Evidence-based treatments for binge eating, such as therapy and non-weight-loss prescription medications, are already available and proven as effective treatment.

In a treatment setting that emphasizes regular meals and mindful eating, medications that reduce appetite can create significant challenges. Side effects may disrupt the ability to follow a structured meal plan, leading to discomfort and potential setbacks in treatment.

Moreover, GLP-1RAs can be misused as a way to manage negative body image related to weight and weight gain. This unhealthy usage can prevent clients from reconnecting with their natural hunger and fullness cues and hinder their ability to process emotions about body size and shape.  

Navigating the intersection of eating disorder treatment and weight loss medications

When navigating the use of GLP-1As in eating disorder treatment, it’s essential to recognize that if a client meets the criteria for this medication, the decision to continue or discontinue it during treatment ultimately is theirs. However, clinicians should ensure that clients are fully informed about the potential risks and benefits of using these medications in the context of their treatment. The provider then needs to assess the overall impact on eating disorder treatment and whether or not it is feasible or too risky to do.

For clients taking GLP-1RAs in relation to binge eating disorder, it’s crucial to explain that binge eating is often a physiological response to restriction. GLP-1As, which suppress appetite, can exacerbate restriction and ultimately contribute to cycles of binge eating.⁴ Since GLP-1RAs are not approved for binge eating and there is limited research on their efficacy for this condition, it’s important to highlight other evidence-based treatments which may be more appropriate. Be transparent that if the client discontinues the medication, they may experience an increase in binge episodes.  They need to know that weight loss in itself can negatively impact their relationship with food and ultimately their success in eating disorder treatment.

Even if a client is prescribed GLP-1RAs, they may remain eligible for binge eating disorder treatment. However, clinicians should be aware that these medications may interfere with the client’s ability to adhere to a structured eating plan, which is a key component in eating disorder recovery.

The conversation about GLP-1RAs should begin with respect for the client’s autonomy in making medical decisions. It’s important to understand why the client is taking the medication and whether it’s serving the intended purpose such as diabetes treatment. If the client is using GLP-1As for weight loss, acknowledge the broader societal context of weight stigma and the pervasive influence of diet culture, which may lead them to seek weight loss solutions. Validating their feelings and offering empathy can help create a productive dialogue.  

Although the conversation surrounding GLP-1RAs in the eating disorder field can be contentious, it’s important to lead with empathy and recognize all that goes into making the decision to take weight loss medications.  

Sources:

1. Food and Drug Administration (FDA). (2022) Ozempic (semaglutide) injection precribing information, revised. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/209637Orig1s009lbl.pdf

2. Bartel, S., McElroy, S. L., Levangie, D., & Keshen, A. (2024). Use of glucagon-like peptide-1 receptor agonists in eating disorder populations. International Journal of Eating Disorders, 57(2), 286–293. https://doi.org/10.1002/eat.24109

3. Rubino, D., Abrahamsson, N., Davies, M., Hesse, D., Greenway, F. L., Jensen, C., Lingvay, I., Mosenzon, O., Rosenstock, J., Rubio, M. A., Rudofsky, G., Tadayon, S., Wadden, T. A., Dicker, D., STEP 4 Investiga- tors, Friberg, M., Sjödin, A., Dicker, D., Segal, G., ... STEP 4 Investiga- tors. (2021). Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obe- sity: The STEP 4 randomized clinical trial. JAMA, 325(14), 1414–1425. https://doi.org/10.1001/jama.2021.3224

4. Wadden, T. A., Bailey, T. S., Billings, L. K., Davies, M., Frias, J. P., Koroleva, A., Lingvay, I., O'Neil, P. M., Rubino, D. M., Skovgaard, D., Wallenstein, S. O. R., Garvey, W. T., & STEP 3 Investigators. (2021). Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: The STEP 3 randomized clinical trial. JAMA, 325(14), 1403– 1413. https://doi.org/10.1001/jama.2021.1831

5. Wilding, J. P., Batterham, R. L., Davies, M., Van Gaal, L. F., Kandler, K., Konakli, K., Lingvay, I., McGowan, B. M., Oral, T. K., Rosenstock, J., Wadden, T. A., Wharton, S., Yokote, K., Kushner, R. F., & STEP 1 Study Group. (2022). Weight regain and cardiometabolic effects after with- drawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553–1564. https://doi.org/10.1111/dom.14725

6. Davies, M., Færch, L., Jeppesen, O. K., Pakseresht, A., Pedersen, S. D., Perreault, L., ... Lingvay, I. (2021). Semaglutide 2 4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): A ran- domised, double-blind, double-dummy, placebo-controlled, phase 3 trial. The Lancet, 397(10278), 971–984. https://doi.org/10.1016/S0140-6736(21)00213-0

Two commonly confused terms, body dysmorphia and gender dysphoria, refer to distinct terms that involve dissatisfaction with one’s body. Although they may seem similar, they are pretty different, have different characteristics, and are addressed differently. Understanding these differences is key for recognizing and supporting individuals dealing with either.

What Is body dysmorphia?

Body Dysmorphic Disorder (BDD), or body dysmorphia, is a mental health condition where an individual becomes excessively preoccupied with perceived flaws in their physical appearance. These flaws are often minor or entirely imagined, yet they cause significant distress and impact daily life.

Key characteristics of body dysmorphia:

• Obsessive focus on appearance: Someone struggling with body dysphoria may fixate on specific features—such as skin, hair, nose, or body shape—that they perceive as not “normal”.
• Distorted perception: Often, someone struggling gets stuck in their thoughts. Family or friends may try to tell them nothing is wrong, but they continue to believe in their own perceptions.
• Compulsive behaviors: Body dysphoria can often lead to compulsive actions such as checking mirrors or begin to develop eating disorder behaviors to attempt to modify their body.
• Emotional distress: The preoccupation with appearance can lead to anxiety, depression, and isolation, severely impacting a person’s quality of life.

What is gender dysphoria?

Gender dysphoria, relates to the distress experienced when there is a conflict between an individual's assigned gender at birth and their true gender identity. While the term “dysphoria” simply refers to a state of dissatisfaction or unease, in this context, it’s tied specifically to gender identity.

Key characteristics of gender dysphoria:

• Incongruence with gender identity: Individuals with gender dysphoria feel that their body does not align with their true gender. This can result in discomfort with specific body parts (e.g., chest, genitals) or general unease with how others perceive their gender.
• Desire for transition: Many people with gender dysphoria experience a strong desire to transition to their true gender, whether through social changes (name, pronouns, clothing) or medical interventions (hormone therapy, surgeries).
• Emotional distress: The experience of body dysphoria can lead to significant emotional suffering, including anxiety, depression, and in severe cases, suicidal thoughts. This often stems from the difficulty of living in a body that feels incongruent with one’s gender identity and from societal stigma or lack of acceptance.

Although the terms sound similar, there is often confusion between gender dysphoria and body dysmorphia.

How dysphoria and dysmorphia relate to eating disorders

Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder, are often connected to body dysmorphia and, in some cases, gender dysphoria. Eating disorders are marked by an unhealthy relationship with food and body image, and they can arise when individuals attempt to cope with negative feelings about their bodies.

Body dysmorphia and eating disorders share a common thread: both involve an unhealthy fixation on appearance and body image. For individuals with body dysmorphia, concerns about weight or body shape may lead to disordered eating as a way to control or "fix" perceived flaws. For example, someone obsessed with their body size may engage in extreme dieting, purging, or over-exercising to achieve an unattainable body ideal.

While body dysmorphia disorder is classified as a mental health disorder by the APA and listed as such in the DSM–5 (the official listing of mental health disorders), and it can be comorbid with a variety of eating disorders, gender dysphoria is not listed as a disorder or a mental health illness.  

For transgender and gender non-conforming individuals, disordered eating may develop as a coping mechanism for dealing with body-related distress. In some cases, individuals with gender dysphoria may restrict their eating in an attempt to change the way their body looks or suppress features that feel misaligned with their gender identity. For instance, a transgender man may engage in extreme dieting to reduce the size of their chest or hips.

The incidence of eating disorders is much higher in transgender community than in the cisgender population.

In fact, 16% of college-aged transgender students surveyed in a 2015 survey had experienced or were experiencing an eating disorder. And at Monte Nido, we know from our data that 36% of all clients identify as LGBTQIA+.

Societal pressures to conform to beauty ideals, combined with the stress of living in a body that doesn’t align with one’s gender identity, can make those with gender dysphoria particularly vulnerable to developing disordered eating patterns.

Gender identity and self-image

It is still far too common for both laypeople and professionals, to conflate the body-image issues arising from a gender identity dissatisfaction with those resulting from a mental health disorder like body dysmorphia.

To put in simpler terms, a person with gender dysphoria is not mentally ill; they are dissatisfied with the gender assigned at their birth.

A person with body dysmorphia has a disorder in which they perceive their body or face as “ugly,” “fat,” or otherwise unattractive despite medical or personal reassurances.

Gender identity and self-image are inextricably linked; for a woman to look in the mirror and see a man is disorienting and distressing. Discrepancies between a person’s assigned gender and their true gender, in addition to the presence of discrimination and misunderstandings by the general public towards transgender issues, can lead to other mental health disorders, such as anxiety, depression and OCD, all of which are more prevalent in the transgender community than the non-trans community.

This all ties back to the main distinction about the difference between gender dysphoria and body dysmorphia – one involves a distorted perception of their body and the other doesn’t.

Health risks related to dysphoria and dysmorphia

Eating disorders are among the most dangerous mental health conditions, resulting in gastrointestinal, endocrine, cardiopulmonary, and neurological complications.  Without receiving anorexia treatment, there may be a mortality rate of as much as 4%.  Other eating disorders such as bulimia nervosa can result in dental problems and issues with the esophagus due to frequent vomiting. In all eating disorders, poor nutritional balance or even malnutrition are risks.

A transgender identity in and of itself carries no inherent health risks.  However, when a person decides to make the transition, they normally begin with hormone treatments, whether reassignment surgery is planned to happen or not. By introducing estrogen or testosterone, there is a slightly increased risk of cancer, and more common risks of low or high blood pressure, blood clots, dehydration, electrolyte imbalance, and liver damage. An important thing to note is that due to discrimination and societal pressure, transgender people are less likely to go through “above the board” healthcare providers, meaning the hormone treatments they receive may not be properly balanced for their body, exacerbating some of the issues raised above.

Both transgender people and people with body dysmorphia have higher than average rates of mental health and behavioral health disorders.  Prominent among these are depression and anxiety.  Both of these mental health disorders are normally caused by a combination of genetic and environmental factors, just like gender dysphoria and body dysmorphia.  In many cases, a specific trigger such as a traumatic event (i.e. abuse, a bad breakup, being in a car accident, etc.) sets off a previously hidden disorder.

In fact, our research at Monte Nido research suggests that 63% of LGBTQIA+ adults in our residential treatment programs met criteria for PTSD, compared to 45% cisgender heterosexual individuals.

The one common health risk of dysphoria and dysmorphia

Depression and anxiety are contributing factors in the one health risk that’s common to both gender dysphoria and body dysmorphia: suicide.  Rates of suicidal ideation (that is, thoughts of suicide), attempted suicide, and actual suicide are all much higher in transgender populations and in populations experiencing body dysmorphia than in the larger populace.

Body dysmorphia

• 80% of individuals have suicidal thoughts
• 24-26% have attempted suicide
• Complete suicides percentage is unknown, but thought to be very high

Transgender population

• More than 50% of transgender males have attempted suicide
• 30% of transgender females have attempted suicide
• More than 40% of non-binary adults have attempted suicide

The combination of a negative or distorted self-image and a severe mental health disorder like depression, or the combination of a mental health disorder and the societal pressures and discrimination received by transgender people, put an already at-risk group of communities even further at risk.  With the already high risk of medical complications resulting in fatalities that are associated with anorexia nervosa and other eating disorders, this creates the need for specialized, intersectional strategies for anorexia treatment in the transgender population.

A personally designed treatment plan including psychiatric treatment (if necessary) with body positivity training and behavioral therapy like Dialectical Behavior Therapy (DBT) or Cognitive Behavioral Therapy (CBT) can help people rehabilitate their body image and break out of the repeated patterns of behavior that come with both eating disorders and body dysmorphia.

While the journey to eating disorder recovery is rarely an easy one, it can be made even more difficult when added to the societal pressure and stigma associated with a transgender identity. The professional team of doctors, nurses, therapists, and psychiatrists treating a transgender individual must take into account factors beyond those which normally accompany a diagnosis of anorexia nervosa or another eating disorder. These include:

Hormone treatments

For some extreme cases of anorexia nervosa, hormone therapy is used to counteract osteoporosis and other symptoms coming from a nutritional deficiency. For transgender individuals who have begun hormone treatments to hasten their transition, medical professionals must coordinate these two types of hormone treatments to meet the client’s needs.

Body dysmorphia treatment without judgment

At the center of any effective treatment program for a trans person with an eating disorder has to be a strong understanding that gender dysphoria is not a mental health disorder.  Trans people are already at higher risk for developing body dysmorphia disorder and subsequently an eating disorder, and they face enough discrimination that they are less likely to seek medical care or psychiatric care. They need a care provider which can treat the actual disorders with sensitivity to gender dysphoria.

Gender-specific eating disorder treatment

Quite often, people seeking eating disorder treatment are more comfortable among their own gender (the distorted perceptions of “attractiveness” or past triggers of abuse are common reasons behind this), and this remains true in the trans population. The person’s true gender must be accounted for and their wishes respected during treatment.  For example, a non-binary trans person may be uncomfortable in a female-only treatment program.  For this reason, an anorexia treatment center should be flexible enough to accommodate each client’s needs in regards to gender identity.

Achieving a Full Recovery Regardless of Gender

At Monte Nido, we believe that every person deserves to find hope that their eating disorder can be treated, and full recovery can be achieved. The compassionate, empathetic staff at each of our many locations are experienced in helping people of all genders regain their lives and move on to a brighter future, free of disordered body image. If you or a loved one has received a diagnosis of an eating disorder, or simply feel you need help, contact us today to get started on the gender-affirming path to a recovered life.