Eating Disorders

An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder (BED).

Eating disorders tend to develop during the teenage and young adult years, and they are much more common in girls and women. No one knows the precise cause of eating disorders, but they seem to coexist with psychological and medical issues such as low self-esteem, depression, anxiety, trouble coping with emotions, and substance abuse.

For some people, a preoccupation with food becomes a way to gain control over one aspect of their lives. Although it may start out as simply eating a bit more or less than usual, the behavior can spiral out of control and take over the person’s life. Eating disorders are a serious medical problem that can have long-term health consequences if left untreated.

It is common for people with eating disorders to hide their unhealthy behaviors, so it can be difficult to recognize the signs of an eating disorder, especially early on.

Each eating disorder has distinct signs and symptoms, and they may include physical and psychological components.

The physical symptoms associated with anorexia nervosa are related to starvation and malnutrition, but anorexia also comprises many emotional and behavioral issues.

Physical signs and symptoms of anorexia include:

• Extreme weight loss (15% or more below the normal weight)
• Thin appearance
• Abnormal blood counts
• Fatigue
• Insomnia
• Dizziness or fainting
• Bluish discoloration of the fingers
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation
• Dry or yellowish skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Osteoporosis or loss of bone strength
• Swelling of arms or legs
• Confused or slow thinking, along with poor memory or judgment
• Dry mouth
• Wasting away of muscle and loss of body fat

Emotional and behavioral symptoms of anorexia include:

• Preoccupation with food
• Refusal to eat
• Denial of hunger
• Fear of gaining weight
• Lying about how much food has been eaten
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Reduced interest in sex
• Depressed mood
• Thoughts of suicide

Signs and symptoms of bulimia may include:

• Being preoccupied with body shape and weight
• Living in fear of gaining weight
• Feeling that you cannot control your eating behavior
• Eating until the point of discomfort or pain
• Eating much more food in a binge episode than in a normal meal or snack
• Forcing yourself to vomit or exercise too much to keep from gaining weight after binge eating
• Misusing laxatives, diuretics or enemas after eating
• Restricting calories or avoiding certain foods between binges
• Using dietary supplements or herbal products excessively for weight loss
• Compulsive exercise
• Suddenly eating large amounts of food or buying large amounts of food that disappear right away
• Regularly going to the bathroom right after meals
• Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
• Broken blood vessels in the eyes (from the strain of vomiting)
• Dry mouth
• Pouch-like look to the cheeks
• Rashes and pimples
• Staining or discoloration of the teeth
• Cuts and calluses on the hands and fingers from inducing vomiting

BED is a vicious cycle of recurrent binging without purging and people with the disorder experience feelings of despair, disgust, and a sense of loss of control. Emotional and physical distress can become so severe that work, school, and social relationships are impaired.

People with BED display:

• Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
• Secretive food behaviors, including eating secretly (e.g., eating alone or in the car, hiding wrappers) and stealing, hiding, or hoarding food.
• Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting; and developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, not allowing foods to touch).
• Extreme restrictions and rigidity with food and periodic dieting and/or fasting.
• Periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling uncomfortably full, but does not purge.
• Lifestyle schedules or rituals to make time for binge sessions.
• Feelings of anger, anxiety, worthlessness, or shame preceding binges.
• Co-occurring conditions such as depression may be present.
• Feelings of disgust about body size.
• Certain thought patterns and personality types are associated with BED, including:
• Rigid and inflexible “all or nothing” thinking
• A strong need to be in control
• Difficulty expressing feelings and needs
• Perfectionistic tendencies
• Working hard to please others

In BED, body weight varies from normal to mild, moderate, or severe obesity. Weight gain may or may not be associated with BED. There is a correlation between BED and weight gain, but not everyone who is overweight binges or has BED.

Eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors.

Researchers are studying questions about behavior, genetics, and brain function to better understand risk factors, identify biological markers, and develop specific psychotherapies and medications that can target areas in the brain that control eating behavior. Neuroimaging and genetic studies may provide clues for how each person may respond to specific treatments for these medical illnesses.

Eating disorders are real, treatable medical illnesses. They frequently occur with other illnesses such as depression, substance abuse, or anxiety disorders. Some symptoms can become life-threatening if a person does not receive treatment.

To be diagnosed with an eating disorder, you must meet criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Eating disorders are serious conditions that can be life-threatening.

Support groups are available to ease the stress of eating disorders for the patient and the family. If you are receiving treatment for an eating disorder, be sure to stick to your treatment plan. Do not skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable. Talk to your doctor about appropriate vitamin and mineral supplements to make sure your body is getting all of the nutrients it needs. Do not isolate yourself from family members and friends who want to see you get healthy. Resist urges to weigh yourself or check yourself in the mirror frequently. These fuel your drive to maintain unhealthy habits.

Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment. Specific forms of psychotherapy, or talk therapy, and medication are effective for many eating disorders. However, in more chronic cases, specific treatments have not yet been identified. Treatment plans often are tailored to individual needs and may include one or more of the following:

• Individual, group, and/or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications

Some patients may also need to be hospitalized to treat problems caused by malnutrition or to ensure they eat enough if they are very underweight.