Eating Disorders

What Are Eating Disorders?

Eating disorders – such as anorexia, bulimia, and binge eating disorders – stem from extreme emotions, attitudes, and behaviors regarding weight and food.These disorders are serious emotional and physical problems that can have life-threatening consequences for both females and males. While the onset of eating disorders typically occurs during pre-adolescence or adolescence, they can affect people of all ages. Given the serious medical complications that may result from these disorders, it is imperative to identify, diagnose and treat them as early as possible. With a proper diagnosis and treatment, recovery is likely.

The Data Around Adolescent Eating Disorders Is Alarming:

95% of those with eating disorders are between the ages of 12 and 25
40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming overweight. This concern endures through life.
44% of females and 15% of males attempt to lose weight in high school.
35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders.
Over 50% of teenage girls and nearly 33% of teenage boys use unhealthy weight control behaviors (ex, skipping meals, fasting, smoking cigarettes, purging)

Causes of Eating Disorders

There is no consensus regarding the root cause of eating disorders, as it can vary from person to person. The general belief is that eating disorders result from one or more biological, behavioral, or social factors; potential causes include genetics, unpleasant experiences/trauma, peer pressure, teasing, family members with eating disorders, etc.

Types of Eating Disorders

Anorexia Nervosa

Anorexia Nervosa is an eating disorder characterized by inadequate food intake to lose weight. Anorectics often have intense fears of gaining weight, yet they often do not understand the severity of their situation.

Warning Signs:

Social withdrawal
Hiding or discarding food
Obsessively counting calories and/or grams of fat in the diet
Frequent comments about feeling “fat” or overweight despite weight loss.
Consistent excuses to avoid mealtimes or situations involving food.
Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate, cutting food into tiny pieces).
Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury--to burn off calories taken in.
Pronounced emotional changes, such as irritability, depression and anxiety

Physical signs of anorexia include rapid or excessive weight loss, feeling cold, tired and weak, thinning hair, absence of menstrual cycles in females, and dizziness or fainting.

Bulimia Nervosa

Like Anorexia, Bulimia is also characterized by an obsession with body appearance and controlling weight. Bulimics try to maintain body weight through cycles of binging (eating an excessive amount of junk food) and purging (self-induced vomiting, use of laxatives, enemas, or other means to rid the stomach of food). During the binge period of the cycle, a bulimic cannot stop eating, even after the stomach is full. After binging, bulimics often feel guilt and embarrassment about what they have consumed. They will then use any possible method to purge, or rid themselves of everything they just ate.

Bulimia can also include cycles of binging and fasting, as well as excessive exercise. Often, a person with bulimia will deny the seriousness of their condition, but will continue to binge in secret.

Typically, a clinician would diagnose a patient with bulimia if they binge and purge an average of once a week for at least three consecutive months.

Warning Signs:

Eating unusually large amounts of food with no apparent change in weight
Frequent trips to the bathroom after meals
Inappropriate use of laxatives, diuretics, or other cathartics
Hiding food or discarded food containers and wrappers
Excessive exercise or fasting
Peculiar eating habits or rituals
Frequently clogged showers or toilets

Physical signs of bulimia include discolored teeth, odor on the breath, stomach pain, calluses/scarring on the hands caused by self-inducing vomiting, irregular or absent menstrual periods, and weakness or fatigue.

Binge-Eating Disorder

Binge-Eating Disorder is characterized by a person regularly eating a large amount of food in a quick amount of time, with no control over stopping, as well as eating without regarding hunger. A person with Binge-Eating Disorder becomes obsessed with food and often experiences extreme feelings of embarrassment or guilt because of what they ate. This produces “cycle” effect--the person will feel some slight relief from binging, then will feel shame, which urges them to eat more, in order to improve their mood.

Like Bulimia, Binge-Eating Disorder is commonly diagnosed if a patient binges on average once a week for at least three consecutive months.

Warning Signs:

Eating unusually large amounts of food in a certain period of time (within 2 hours)
Hiding food or discarded food containers and wrappers
Eating in secret because of shame about how much they are eating
Eating when stressed or when unsure how to cope with emotional issues
Lack of control over how much is consumed and then feelings of disgust after
Experimentation with different diets

Most of the physical signs and symptoms associated with binge eating disorder are long-term; these include weight gain (often leading to obesity), high blood pressure, diabetes, irregular menstrual cycle, skin disorders and heart disease.

Consequences of Eating Disorders

Psychosocial

Eating disorders have a profound negative impact on an individual's quality of life. Self-image, interpersonal relationships, financial status, and job performance are often negatively affected.

Eating disorders are also associated with high rates of other co-existing psychiatric disorders, particularly mood disorders and anxiety disorders. Bulimia nervosa may also be associated with alcohol and/or drug abuse problems.

Medical

Semi-starvation in Anorexia Nervosa can affect organ systems. Physical signs and symptoms (in addition to the lack of menstrual periods in women) can include constipation, cold intolerance, abnormally low heart rate, abdominal distress, dryness of skin, hypotension, and fine body hair (lanugo). Anorexia Nervosa causes anemia, kidney dysfunction, cardiovascular problems, changes in brain structure, and osteoporosis (i.e., inadequate bone calcium).

Self-induced vomiting seen in both Anorexia Nervosa and Bulimia Nervosa can lead to swelling of salivary glands, electrolyte and mineral disturbances, and dental enamel erosion. Use of Ipecac to induce vomiting can lead to extreme muscle weakness, including weakness of the heart muscle. Laxative abuse can lead to long-lasting disruptions of normal bowel functioning. Rare complications include tearing of the esophagus, rupturing of the stomach, and abnormal heart rhythms.

Treatment Options

Patients with eating disorders typically require a treatment team consisting of a primary care physician, dietitian, and a mental health professional knowledgeable about eating disorders.

Most individuals with eating disorders are treated on an outpatient basis after a comprehensive evaluation. Individuals with medical complications may require hospitalization. Other individuals, for whom outpatient therapy has not been effective, may benefit from day-hospital treatment, hospitalization, or residential placement.

Acute inpatient hospitalization is necessary when a patient is medically or psychiatrically unstable. Once a patient is medically stable, he/she is discharged from a hospital, and ongoing care is typically delivered at a subacute care residential treatment facility. The level of care in such a facility can be full-time inpatient, partial inpatient, intensive outpatient by day or evening, and outpatient. There are also facilities that operate solely as outpatient facilities. Outpatient psychotherapy and medical follow-up may also be delivered in a private office setting. Learn more.

Initial Assessment. The initial assessment of individuals with eating disorders involves a thorough review of the patient's history, current symptoms, physical status, weight control measures, and other psychiatric issues or disorders such as depression, anxiety, substance abuse, or personality issues. Consultation with a physician and a registered dietitian is often recommended. The initial assessment is the first step in establishing a diagnosis and treatment plan.

Therapy. Teen eating disorder treatment needs to first address the physical condition by helping the person return to healthy eating habits and practices, regardless of what their comforts and urges are. Because this can be such a difficult transition for a person with an eating disorder, this is often most successfully carried out in a therapeutic setting where the person can be closely monitored and guided through the process. Depending on the specific disorder, a person will be monitored in different ways, geared toward their current misconceptions and unhealthy eating habits. In addition to diet, therapy also addresses any current habits or practices related to exercise and help modify them to be healthy. These foundational steps, crucial to a person’s physical well being, can then help lay the groundwork for a person to address the underlying causes and beliefs related to their eating disorder.

Outpatient Treatment. This type of treatment is the least restrictive level of care. Men and women participating in outpatient programs may see a nutritionist, therapist and other recovery professionals approximately 2-3 times per week. This treatment is well-suited to those who need to continue working or attending school.

Intensive Outpatient Treatment. Programs at this level usually meet at individualized times for the participant, ranging from 2-5 days a week. Treatment options typically include individualized therapy, personalized nutrition consultation, topic focused groups, and/or family support groups.

Inpatient Treatment. Inpatient treatment occurs 24 hours a day in a hospital setting. The goal of inpatient treatment is to medically stabilize the patient and disrupt extreme weight loss. Once the individual is stabilized, he/she is often discharged to a residential treatment center for ongoing care.

Residential Eating Disorders Treatment. At treatment centers, patients are provided with 24-hour treatment at a live-in facility. Constant medical supervision is placed over every participant, which makes it effective in monitoring health conditions. These treatment programs are usually very structured, offering a setting that allows a the patient to focus solely on physical and psychological healing.

Nutritional Counseling. Regular contact with a registered dietitian can be an effective source of support and information for patients who are re-gaining weight or who are trying to normalize their eating behavior.

Role of Supporters

Parents, siblings and close friends play a significant role in guiding and supporting their loved ones. In many cases, individuals with eating disorders are unable to recognize a need for help within themselves, and it takes a strong, caring individual to reach out.

First and foremost, you should know that there is always hope. Recovery can be difficult — but it is possible. The information in this section is specific to family members and friends, but you’ll also find a host of terms and topics under General Information. We recommend you start there and then augment your learning with the subjects covered here.

Our Parent Toolkit has a wealth of information for parents, friends and loved ones who are supporting someone through an eating disorder.

In addition, more support is available for parents, friends and loved ones of a person with an eating disorder in the Find Help and Support section of our website.

If you are worried about your friend’s eating behaviors or attitudes, it is important to express your concerns in a loving and supportive way. It is also necessary to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders. Learn more.

Common Eating Disorder Myths

You can tell is someone has an eating disorder just by looking at them.

Individuals with eating disorders come in all shapes and sizes; many individuals with Anorexia may not ever appear dangerously underweight. Even athletes who appear fit and “healthy” might be struggling with an eating disorder. You cannot define someone’s health by how much they weigh and you cannot determine whether they have an eating disorder just by looking at them.

Eating disorders are a result of over-controlling parents and dysfunctional families.

Parents are often unfairly blamed for an individual’s eating disorder. While genetic factors and family relationships can contribute to the development of an eating disorder, we also know that parents and families play an integral role in helping a loved one recover. For this reason, family therapy is a primary therapeutic modality used for adolescents and is also strongly encouraged for adults.

Eating disorders are a lifestyle choice.

Eating disorders are serious illnesses with mental and physical consequences. No one ‘chooses’ to have this illness. In fact, recovering from an eating disorder requires a lot of hard work and involves more than simply deciding to not act on symptoms. In most cases, the eating disorder has become a person’s primary way of coping with intense emotions and difficult life events.

Eating disorders are benign.

Eating disorders are serious psychological conditions and can lead to very serious medical problems. They have the highest mortality rate of any mental illness and are also associated with an increased risk of suicide.

Eating disorders are just a teen phase and will go away if you ignore them.

While eating disorders generally begin during teen years they are not a normal part of growing up. Puberty is a time of great biological, physical and psychological change. Teenagers are often vulnerable to societal pressures and can feel insecure and self-conscious, which are factors that increase the risk of engaging in extreme dieting behavior. Ignoring signs of adolescent eating disorders can have serious lifelong medical and psychological repercussions.

Recovery from eating disorders is rare.

Recovery, though challenging, is absolutely possible. Recovery can take months or years, but with proper treatment, many people do eventually recover and go on to live a life free from their eating disorder.