UCLA's Comprehensive Approach to Eating Disorder Programs

Eating disorders are serious mental illnesses with significant, life-threatening physical and psychological complications. The UCLA Health System offers a range of programs and services designed to provide comprehensive evaluation and treatment for individuals struggling with eating disorders. These programs are tailored to address the unique needs of adolescents and young adults, using a multidisciplinary approach that integrates medical, psychological, and nutritional expertise.

Understanding Eating Disorders and Disordered Eating

Eating disorders are a group of mental illnesses that involve abnormal and unhealthy eating behaviors, thoughts, and emotions. These disorders can have serious physical and psychological consequences, including malnutrition, electrolyte imbalances, organ damage, anxiety, depression, and even death in severe cases. The National Eating Disorder Association (NEDA) estimates that 28.8 million Americans will be affected by an eating disorder during their lifetime. Eating disorders do not discriminate and can afflict patients of all ages, races, religions, ethnicities, genders, sexual orientations, body shapes, and weights.

Disordered eating refers to a wide range of abnormal eating behaviors that do not meet the criteria for a specific eating disorder. Disordered eating may be occasional or frequent and can be caused by various factors, such as stress, poor body image, or a desire to control one's weight. Disordered eating behaviors can include skipping meals, fasting, bingeing, purging, and restrictive eating patterns. While disordered eating may not meet the diagnostic criteria for a specific eating disorder, it can still have negative physical and psychological consequences and can contribute to the development of an eating disorder if it isn't addressed.

Dr. Michael Strober, a faculty member in the UCLA Department of Psychiatry and Biobehavioral Sciences since 1975, notes that individuals with disordered eating may exhibit erratic eating patterns and preoccupations similar to those seen in classic eating disorders, but without the full clinical syndrome.

Types of Eating Disorders

There are several recognized eating disorders, each with its own set of characteristics:

Anorexia Nervosa: Characterized by a fear of gaining weight, a distorted body image, and extreme food restriction.
Bulimia Nervosa: Characterized by binge eating followed by purging behaviors, such as self-induced vomiting, fasting, or excessive exercise.
Binge Eating Disorder: Characterized by repeated episodes of binge eating, during which an individual consumes large amounts of food in a short period of time and feels a lack of control over their eating.
Pica: Characterized by the persistent eating of non-food items, such as hair, dirt, or chalk.
Rumination Disorder: Characterized by the repetitive regurgitation and rechewing of food after eating.
Avoidant/Restrictive Food Intake Disorder (ARFID): Characterized by a selective avoidance of certain foods or food groups, which can lead to malnutrition or weight loss.
Other Specified Feeding or Eating Disorder (OSFED): Includes eating disorder symptoms that do not fully meet the criteria for any of the above disorders.

It's worth noting that the criteria for these disorders are continually evolving, and new eating disorder types and categories may be recognized in the future as more research is done in the field. For instance, more and more specialists are starting to research Orthorexia, an unhealthy obsession with healthy eating or a fixation on "clean" or "pure" foods, though it has not been formally recognized in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).

Factors Contributing to Eating Disorders

Research suggests that several factors contribute to the development of eating disorders, including:

Genetics: Studies suggest that eating disorders can run in families, and that certain genetic factors may increase the risk of developing an eating disorder.
Environmental Factors: Certain environmental factors, such as stress, traumatic life events, and cultural pressure to conform to a certain body type, can trigger or worsen eating disorder symptoms. High-stress and high-conflict environments, as well as a history of parental obesity or alcoholism, may also play a role.
Psychological Factors: Patients with eating disorders often have co-occurring mental health conditions, such as anxiety, depression, and obsessive-compulsive disorder. Trauma, low self-esteem, and difficulty regulating emotions may also contribute to the development of an eating disorder.
Biological Factors: Research suggests that imbalances in certain brain chemicals and hormones may play a role in the development of eating disorders.

Dr. Strober emphasizes the role of early life anxiety, particularly in anorexia nervosa, stating, "I have never in 48 years seen a person with anorexia nervosa who did not have early life anxiety." He also notes that higher-than-average body weight may predispose individuals to weight loss, which can then trigger periods of binge eating in bulimia nervosa.

Signs and Symptoms of Eating Disorders

Eating disorders can cause a wide range of physical and psychological symptoms, including:

Extreme changes in weight: Rapid weight loss or weight gain.
Distorted body image: Feeling excessively overweight even if underweight, or having a negative self-image.
Preoccupation with food: Constant thoughts about food, calories, and nutrition.
Abnormal eating patterns: Skipping meals, eating alone, hoarding or hiding food.
Rigid food rules and rituals: Such as only eating certain foods, or in a specific order.
Obsessive calorie counting and portion control: Weighing food, cutting it into small pieces, or pushing food around on a plate instead of eating.
Purging behaviors: Such as self-induced vomiting, overuse of laxatives or diuretics.
Excessive exercise: Engaging in intense or excessive physical activity, even when injured or ill.
Irregular menstrual periods: Changes in menstrual cycle or loss of periods in women.
Social withdrawal: Avoiding social situations, especially those involving food.

UCLA Eating Disorder Programs and Services

UCLA Health offers a variety of programs and services for individuals struggling with eating disorders, including both inpatient and outpatient options. These programs are designed to provide personalized, multispecialty treatment that addresses the unique needs of each patient.

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Inpatient Programs

The Eating Disorders Program at the Stewart and Lynda Resnick UCLA Health Neuropsychiatric Hospital is internationally recognized for providing exceptional inpatient eating disorder treatment. At UCLA Health Santa Monica Hospital, a team of physicians, psychologists, dietitians, and nurses oversees medical recovery for malnourished adolescents and young adults.

When patients arrive, they are automatically placed on ward restriction (AL1) and no sharps for a 24-hour evaluation period and need to be reassessed to determine if activity level may be changed. As a precautionary measure, they may also be placed on “day room” and “bathroom observation” status for safety and evaluation of symptoms and their level of control of their symptoms. Statuses need to be regularly reviewed at treatment planning and/or rounds.

Patients admitted with eating disorders are often medically compromised and are at risk for refeeding syndrome. They usually require daily vitals and frequent lab draws. Phosphorus and magnesium are commonly low during refeeding and require special attention.

The inpatient program includes various levels of observation and support:

AL3: May leave unit with staff as part of a patient group, may not leave the hospital building. Exception is if patient is in off-unit activity such as OT. Off unit staff is responsible for patient.
1:1 Patients: 1 patient, 1 staff ratio.
SO (Suicide Observation): Used for patients who are imminently suicidal, requiring the patient to be within arm's length of staff at all times.
Dayroom Status: Patients are limited to the dayroom during free time, with staff accompaniment required to return to their room (limited to two trips per shift).
Bathroom Observations: Patients must be accompanied to the bathroom, with the door open for staff to observe the patient's face/mouth at all times.

Mealtime support is also tailored to the patient's needs:

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When patients are admitted they get assigned a meal status which begins with sitting at the monitored table.
Patients progress to “self-monitored meals” status after demonstrated ability to control behaviors.
1:1 Meals: Patients who struggle with eating behaviors in the dayroom may be placed on 1:1 meal status in the Multipurpose Room for closer support and feedback.
Self-Select Snacks: Patients with the self-select option will come to the Dining Room 5 minutes before snack period begins to select their snack. Patients on self-select may request to bring in food from home for their snacks, and this request must go through Dietitian.
Exposure Meals: Patients may have Relapse Prevention Pass to practice meals/snacks in the cafeteria with family (with MD order). Eating tray with family on the unit while the family brings in food for themselves to eat at this shared mealtime. May have visiting off unit while seated (no snacks or meals at this time). Eating meal with family on unit.

Every patient in the inpatient or partial hospitalization eating disorders program meets with his or her psychotherapist three times per week. The focus of individual therapy is identifying and exploring psychosocial issues that influence the patient's sense of self and in turn impact levels of functioning at home or school, and in interpersonal relationships. The psychotherapy process group provides an opportunity for patients to collectively explore issues that are meaningful to the group. This group focuses on the relationships between issues of daily living and eating disorder symptoms and behaviors. Recreation therapy focuses on developing leisure and interpersonal skills in a group setting.

Outpatient Programs

At UCLA Health Mattel Children’s Hospital, specialists provide outpatient support for those age 26 and under. An initial consultation is offered, first with a comprehensive eating disorder focused medical assessment, followed by a consultation with our psychologist and dietician.

UCLA Health also offers the following outpatient programs:

UCLA Health Nourished for Life Outpatient Program: Provides interdisciplinary assessment and treatment recommendations, including medical assessment and consultation, psychotherapy, and nutritional counseling.
CAPS Eating Disorder Services: The CAPS (Counseling and Psychological Services) Eating Disorder Team is comprised of clinicians with experience and interest in the complexities of eating disorders. They coordinate care closely with medical providers and dieticians at UCLA Ashe Center or with outside treatment providers. Services include:
- Clinical assessment and treatment recommendations
- Short term individual therapy
- Psychiatry
- Group therapy (Disordered Eating I & II)
- Case management/treatment planning to help students connect with outside services.

Additional Support

There are many support groups available for individuals with eating disorders, both on and off campus.

Recovery from Eating Disorders

Recovering from an eating disorder can be a long and challenging process, but it is possible with the right support and resources. Here are some steps that can help patients with the recovery process:

Focus on nourishing the body: Eating a balanced diet, drinking enough water, and engaging in physical activity in a healthy way can help support a patient's physical recovery process.
Challenge negative thoughts: It is important for patients to challenge and replace negative and distorted thoughts and beliefs about food, weight, and body image with more positive and realistic ones.
Lean on supportive people: Patients should spend time with friends, family, and other people who will support and encourage the recovery process.
Set achievable goals: Setting small, achievable goals can help build confidence and a sense of accomplishment in patients, which can be important in the recovery process.
Practice self-care: Patients should engage in activities that bring joy and relaxation, such as meditation, yoga, or spending time in nature.
Be patient: Recovery from an eating disorder is a journey, not a destination. It is important to be patient and celebrate small victories along the way.

Dr. Strober defines recovery as the absence of symptoms for a sufficiently long period of time, emphasizing that many patients can develop an eating disorder, recover from it, and live the rest of their adult life without a return of the disorder. He notes that relapses are often tied to life stress, but that long-term recovery is achievable.

Addressing Misconceptions

There are many misconceptions about disordered eating and eating disorders. It's important to acknowledge that disordered eating is a complex issue, and these misconceptions can be harmful for those who are struggling. Here are some common misconceptions:

Disordered eating is a choice: Disordered eating is often a manifestation of underlying psychological, emotional, or cultural issues.
Only thin people struggle with disordered eating: Disordered eating can affect people of all sizes, shapes, and body types.
Disordered eating is a phase: Disordered eating is a serious and complex issue that requires proper treatment and support.
Disordered eating is all about food: It can also be associated with low self-esteem, a lack of control in other areas of life, and emotional distress.
People can't have disordered eating and be healthy: Recovery and a healthy relationship with food and their body is possible.

Dr. Strober also addresses misconceptions within the field, such as the belief that someone recovering from anorexia nervosa is automatically at risk for a relapse if they are less than the average weight for their age and height, or that a patient who was a heavy child must maintain an equivalent weight as an adolescent or an adult to protect their recovery. He emphasizes the importance of understanding the evolutionary traits that predispose individuals with anorexia nervosa to believe that weight loss represents a "safe space."

National Eating Disorder Awareness Week

National Eating Disorder Awareness Week takes place annually, usually sometime in February or March. This week-long event is designed to spotlight the lived experiences of those who have eating disorders and promote education about disordered eating in order to advocate for better understanding as well as real, impactful change across all communities.

Self-Care for College Students

College life can be exhilarating but also demanding, making self-care essential for maintaining physical and mental well-being. Here are some self-care tips for college students:

Prioritize Sleep: Aim for 7-9 hours of quality sleep each night.
Healthy Eating: Fuel your body with balanced meals that include fruits, vegetables, lean proteins, and whole grains.
Regular Exercise: Incorporate physical activity into your routine.
Time Management: Create schedules that include study time, leisure, and self-care.
Seek Support: Don’t hesitate to reach out to friends, family, or counseling services when you need support.
Set Realistic Goals: Establish achievable academic and personal goals.
Social Connection: Cultivate relationships with peers who share your interests.
Me-Time: Dedicate time to activities you enjoy, whether it’s reading, art, music, or simply relaxing.

Self-care is not a luxury but a necessity, especially during the demanding college years.

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