CONDITIONS

What Is Eating Disorder

These are serious conditions that involve extreme changes in eating behavior and weight regulation. Eating disorders are more common in industrialized societies where there is an abundance of food–and where being thin, especially for women, is considered attractive. Eating disorders are most common in the United States, Canada, Europe, Australia, New Zealand, and South Africa. However, the prevalence in non-Western countries is growing.

The main types of eating disorders are:  

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • Otherwise Specified Feeding or Eating Disorder

All of these eating disorders are associated with serious and wide-ranging psychological, physical, and social consequences. Characterized by severe concern about body weight or shape, extreme efforts to manage weight or eating habits; eating disorders are serious conditions that can have far-reaching ramifications.

These conditions often go hand-in-hand with other illnesses, like:

  • Depression
  • Substance abuse
  • Anxiety disorders

Eating disorders are real, treatable medical conditions—but left untreated, symptoms can become life threatening, possibly leading to complications, like organ failure or death. Anorexia has the highest mortality rate of any psychiatric disorder. But with a timely diagnosis, you can receive necessary treatment and live a long, healthy life.

While these disorders affect both genders, rates among women and girls are 2.5 times higher than those for men and boys. Often emerging during puberty or young adulthood, but can in some cases develop in childhood, or later in life.

In the United States alone, 20 million women and 10 million men suffer from eating disorders at some point in their life, according to the National Eating Disorders Association, or NEDA.


Anorexia nervosa

Most people that have anorexia nervosa view themselves as overweight, even when it is apparent to the outside world that that they are actually underweight. For those that suffer from anorexia, food and weight control become obsessive fixations, and can become the center of daily life. Behavior associated with anorexia can include very careful portioning of food, eating only small quantities of specific types of food, and repeatedly weighing oneself. For some, there are bouts of binge eating that are followed by excessive exercise, extreme dieting, overuse of laxatives and/or diuretics, enemas, and self-induced vomiting.

 Symptoms of anorexia nervosa may include:

  • Dangerously low body weight
  • Strict food restriction
  • Persistent, unrelenting pursuit of thinness
  • Refusal to maintain a healthy, normal weight
  • Deep fear of gaining weight
  • Deeply skewed perception of body image
  • Low self-esteem, which is heavily impacted by misperceptions of body weight and shape
  • Denial of the seriousness of low body weight
  • Lack of menstruation among girls and women

The earlier treatment begins, the better the odds of recovery. Some recover with minimal treatment, while others may suffer several relapses. And some may have a more chronic form of anorexia, in which their health declines as they battle the illness.

Listed below are other possible medical complications and symptoms associated with anorexia, that may develop over time:

  • Brittle hair and nails
  • Dry and yellowish skin
  • Growth of fine hair all over the body, known as lanugo
  • Mild anemia, muscle wasting, and weakness
  • Osteopenia or osteoporosis (thinning of the bones)
  • Drop in internal body temperature, causing a person to feel cold all the time
  • Lethargy, sluggishness, and feeling tired all the time
  • Severe constipation
  • Infertility
  • Low blood pressure, or slowed breathing and pulse rates
  • Damage to the structure and function of the heart
  • Brain damage
  • Multi-organ failure

Bulimia nervosa

Bulimia nervosa, or bulimia, is characterized by frequent and recurring episodes of bing eating, followed by some compensatory behavior for the overeating like self-induced vomiting, excessive use of laxatives or diuretics, excessive exercise (sometimes referred to as hypergymnasia), fasting, or a combination of these behaviors.

People that have bulimia often maintain a healthy, normal body weight; some are even slightly overweight. Similar to anorexia, there is often an intense fear of gaining weight, a strong desire to lose weight, and an intense unhappiness with body shape and size. Bulimic behavior is often done in secret as it is connected to feelings of disgust or shame. The binge eating and purging cycle can happen anywhere from several times a week to many times a day.

Other symptoms of bulimia may include:

  • Chronically swollen and sore throat
  • Inflamed salivary glands in the neck and jaw area
  • Worn down tooth enamel, along with increasingly sensitive and decaying teeth, due to repeated exposure to stomach acid from vomiting
  • Acid reflux disorder and other gastrointestinal problems
  • Intestinal pain, discomfort, and possible chronic irritation from laxative abuse
  • Dehydration from purging of fluids
  • Electrolyte imbalance—too low or too high levels of minerals like potassium, sodium, calcium, which can—if severe enough—lead to a heart attack or stroke.

Binge eating disorder

Binge eating disorder is characterized by a loss of control over eating habits. Unlike with bulimia, periods of binge eating are not followed by purging, excessive exercise, fasting, or laxative/diuretic use—and perhaps as a result, those with binge eating disorder are often overweight, or even obese. Those with binge eating disorder have a higher risk of developing high blood pressure and other metabolic or cardiovascular diseases. There is a cyclical aspect to binge eating disorder because the guilt and shame that sufferers feel about their binge eating often leads to more binge eating as a means to make themselves feel better.

The key features of binge eating disorder are:

  • Frequent episodes of uncontrollable binge eating.
  • Feeling extremely distressed or upset during or after bingeing.
  • Unlike bulimia, there are no regular attempts to “make up” for the binges through vomiting, fasting, or over-exercising.

Other Specified Feeding or Eating Disorder

Formerly described at Eating Disorders Not Otherwise Specified (EDNOS) in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, the main reference guide used by medical and mental health providers to diagnose psychiatric disorders), this type of eating disorder is now known as Other Specified Feeding or Eating Disorder (OSFED) in the new DSM-V.  OSFED is an eating disorder that causes significant distress or impairment, but does not meet the criteria for another eating disorder. A person with OSFED may present with many of the symptoms of other eating disorders such as anorexia, bulimia, or binge eating disorder, but does not meet the full criteria for diagnosis for any one of these particular disorders. It is important to state that this does not mean this is a less serious type of eating disorder. In fact, approximately 30% of people who seek treatment for an eating disorder have OSFED.

The following are some examples of condition presentations, which would be given a diagnosis of OSFED:

  • Atypical Anorexia nervosa. Anorexic behaviors are present, but without the low body weight
  • Bulimia nervosa of lower frequency than typically required to meet diagnostic criteria of bulimia nervosa
  • Binge eating disorder of lower frequency than typically required to meet diagnostic criteria of binge eating disorder
  • Purging disorder. Unlike with bulimia, sufferers purge without bingeing
  • Night eating syndrome. Characterized by eating abnormally little food during the day, but then overeating at night

What Causes Eating Disorder

Eating disorders arise from a combination of long-standing psychological, emotional, behavioral, biological, interpersonal and social factors. While there is some knowledge into some of the general issues than contribute to the development of these complex conditions, scientists are still investigating the underlying physical and psychological causes of these conditions.

 

Risk Factors For Eating Disorder

Eating disorders may seem to be solely about food, body image, and weight fixations, but those that suffer from these conditions are often using food and the control of food to cope with emotions and feelings that seem overwhelming. Dieting, bingeing, purging and more may start as way to deal with painful feelings, and act as a means of control over seemingly uncontrollable events. These behaviors, however, will eventually damage a person’s health and wellbeing, and may lead to very serious health consequences if left untreated.


Psychological Factors that Can Contribute to Eating Disorders:

  • Low self-esteem
  • Feelings of inadequacy
  • Feelings of lack of control in one’s life
  • Depression, anxiety, anger, stress or loneliness

Interpersonal Factors that Can Contribute to Eating Disorders:

  • Troubled personal relationships
  • Difficulty expressing emotions and feelings
  • History of being made fun of based on size or weight
  • History of physical or sexual abuse

Social Factors that Can Contribute to Eating Disorders:

  • Cultural norms that place value on obtaining the “perfect body”
  • Media imagery that support beauty ideals that include only women and men of specific body weights and shapes
  • Perceived societal value on basis of physical appearance over that of personality, inner qualities, and strengths

Biological Factors that Can Contribute to Eating Disorders:

  • Research is being done into possible biological and/or biochemical causes of eating disorders. Studies have shown that in some individuals with eating disorders, there is evidence that certain brain chemicals, which govern hunger, appetite, and digestion, are unbalanced. Chronically swollen and sore throat
  • Research indicates that there is a genetic component to eating disorders, and it has been observed that these conditions often run in families

There are many possible causes that may be responsible for the development of an eating disorder.  And once one has taken root, a challenging cycle of physical and emotional destructive behavior can continue to perpetuate itself, leading to an eating disorder that can continue to worsen with time. Successful treatment of eating disorders is possible however, though most often requires professional help.

Left untreated, eating disorders can cause a number of serious health complications, some of them life-threatening. The longer the eating disorder continues, the more likely that significant complications may occur, like:

  • Depression and anxiety
  • Substance use disorders
  • Social and relationship problems
  • Work and school problems
  • Problems with growth and development, which can lead to easily broken bones, loss of hair, and even infertility
  • Suicidal thoughts or behavior
  • Death

The earlier treatment is sought—the better the outcome. If you suspect you may be suffering from an eating disorder, or that a loved one is struggling with this complex condition, please speak with a health care professional.

Diagnosing Eating Disorder

Eating disorders can affect anyone; and often begin in the teen or young adult years when there may be more preoccupation with self-image. These conditions, however, can also begin as early as childhood, or start much later in life.  Females are more likely than males to have this illness, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). In fact, only an estimated 10 to 15 percent of people with anorexia or bulimia are males.

The exact cause of eating disorders is unknown, but several factors can contribute to the disease—and doctors pay attention to these factors when making a diagnosis:

  • Family history of eating disorders
  • History of depression
  • History of obsessive-compulsive disorders
  • History of other emotional disorders

Because eating disorders can have serious, life-threatening complications, it’s important to get help for these conditions. But before a doctor can treat anorexia, bulimia, or binge eating, they have to diagnose the condition.

There are various components that go into diagnosing an eating disorder. If you or your doctor suspects that you may have an eating disorder, he or she will likely perform a physical and psychological exam, and run some lab tests to come to a diagnosis. You may see both a physician and mental health specialist to get to a definitive diagnosis.


Exams and tests generally include:

Physical exam. Your doctor will likely give you a physical exam and run lab tests to rule out other medical causes for your eating issues. During your physical, your doctor will check your weight, height, vital signs, check your skin and hair for dryness, inspect your teeth for signs of decay, examine your abdomen, check your nails for brittleness—all possible signs of eating disorders. High or low blood pressure, slow breathing and pulse rates can also be indications of an eating disorder—so it is important for your doctor to carefully listen to your lungs and heart.  You will likely be asked about other medical problems, like gastrointestinal issues, or sore throat—which can be signs of bulimia.

Lab tests. Eating disorders can lead to complications with vital organs; lab tests can include kidney, thyroid, liver function tests, urinalysis, and a complete blood work up. X-rays may be taken to check for possible fractures that can occur due to bones loss from anorexia or bulimia. Heart irregularities sometimes occur due to eating disorders—your physician can check for this by performing an electrocardiogram (EKG or ECG).

Psychological evaluation. Eating disorders are not diagnosed solely based on a physical exam—a psychological evaluation by a mental health professional is a crucial part of determining a diagnosis. You will likely be asked questions relating to your eating habits, your thoughts and feelings about body image, food, and meals. These questions will delve into your personal inner thoughts and feelings—which can be difficult for certain individuals. You will likely discuss your dieting, bingeing, purging, extreme exercise habits, use of diuretics, diet pills, laxatives, and more. Even if these questions are hard for you to answer—it’s imperative that you respond honestly so that your doctor can accurately diagnose your condition, and get you on the path to recovery if necessary.

Diagnostic criteria. Criteria for eating disorders is listed in the DSM-5, or Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association—and is the standard manual used to diagnose all mental conditions. Insurance companies require a specific diagnosis as stipulated by the DSM-5 in order to reimburse for treatment. Each specific eating disorder has its own set of diagnostic criteria—which ultimately guides the diagnosis your mental health provider will provide. While some individuals may not meet all criteria for a particular eating disorder, but exhibit a number of key symptoms, professional help and treatment may still be prescribed.

 

Symptoms of Eating Disorder

Listed below are key symptoms of the three main types of eating disorders. The symptoms of OSFED are an amalgamation of the below.


Key symptoms of anorexia nervosa include:

  • Dangerously low body weight and very thin or skinny appearance
  • Strict food restriction
  • Insomnia
  • Exhaustion, extreme fatigue
  • Dizziness or fainting spells
  • Brittle hair and nails
  • Severe constipation
  • Dry skin
  • Irregular heart and pulse rates
  • Low blood pressure
  • Lack of menstruation among girls and women
  • Deep fear of gaining weight
  • Persistent, unrelenting pursuit of thinness
  • Refusal to maintain a healthy, normal weight
  • Deeply skewed perception of body image
  • Low self-esteem, which is heavily impacted by misperceptions of body weight and shape
  • Denial of the seriousness of low body weight

Key symptoms of bulimia include:

  • Fear of gaining weight
  • Self-induced vomiting
  • Excessive use of laxatives or diuretics
  • Extreme exercising (sometimes referred to as hypergymnasia)
  • Fasting
  • A combination of these behaviors

Key symptoms of binge eating disorder include:

  • Depression and anxiety
  • Constantly dieting but not losing any weight
  • Frequent episodes of uncontrollable binge eating
  • Feeling extremely distressed or upset during or after bingeing
  • Unlike bulimia, there usually no attempts to “compensate” for the binges through vomiting, fasting, or over-exercising

Prognosis

Treatment outcomes improve greatly with early intervention. If fact, seeking treatment within the first one to three years of illness can significantly impact recovery. One study of patients with bulimia found that those who received treatment within the first five years of developing the condition had a recovery rate of 80%. Patients who waited more than 15 years from the start of their illness, however, experienced recovery rates closer to 20%.

It is important to note, however, that regardless of when treatment begins, each person’s road to recovery is different and will be affected by a variety of personal and environmental factors. Recovery is rarely a quick or easy process, and most often unfolds over an extended period of time.

Relapse is not uncommon, and is estimated to occur 10% to 42% of the time. The greatest risk for relapse is during the first year following initial treatment.  A strong support system can help get you back on track if relapse does occur.

The majority of people who receive treatment for their eating disorders, however, do recover, and go on to fulfill healthy, meaningful lives.

Living With Eating Disorder

Making sure to take care of yourself can help you feel better during and after treatment for an eating disorder, and can be very important for helping to maintain your overall wellbeing and health.

  • Stick to your treatment plan. Do not skip therapy sessions and work to stay on target with your meal plans
  • Take your vitamin and mineral supplements recommended by your doctor every day
  • Don’t cut yourself off from friends and family, especially when you are feeling down
  • Follow the recommended exercise plan set forth by your healthcare team
  • Don’t weigh yourself—this may fuel your desire to revert back to unhealthy habits

 

Prevention

Although there’s no sure way to prevent eating disorders, but if you notice a family member or friend with low self-esteem, who has begun to diet in an extreme manner, or has been having bouts of overeating, who has expressed dissatisfaction with appearance—consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, reaching out with compassion may encourage the person to seek treatment.

 

Medication And Treatment

Treatment goals for eating disorders include:

  • Restoring adequate nutrition
  • Bringing weight to a healthy level
  • Reducing excessive exercise
  • Stopping bingeing and purging behaviors

Typically a team approach is used for treating eating disorders, which typically include a doctor, mental health provider, social worker, dietitian, nutritional consultant, and complementary medicine practitioner—ideally all who have extensive experience with treating eating disorders. Consistency in the treatment plan and rewarding behavior changes has been shown to be effective—and should be considered as part of a successful treatment regimen.

Specific treatment depends on your specific type of eating disorder—but generally includes:

  • Medication
  • Psychotherapy
  • Nutritional education
  • Group therapy
  • Possible hospitalization if your condition is grave

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

All these various components of treatment are critical for a successful outcome.


Psychotherapy

Psychotherapy, or therapy, can help replace unhealthy thinking and behavior with healthier habits. Cognitive behavioral therapy, interpersonal therapy and family therapy have all been tried and are found to be effective. However, cognitive behavior therapy has the most evidence available.

Psychotherapy may allow for improved relationships and mood.

There are many types of therapy, but in treatment of eating disorders, the most commonly employed include:

  • Cognitive behavioral therapy (CBT). CBT is one of the few forms of therapy that has been scientifically tested and found to be effective in clinical trials for the treatment of many different conditions. With respect to eating disorders, CBT is often used to treat bulimia and binge-eating disorder. This is a very focused type of therapy that is more centered on the present, and seeks to achieve results in a shorter timeframe than other forms of therapy. The goal is to help you develop better problem-solving skills, that will help you better monitor your eating and moods, and explore healthy ways to cope with stressful situations. Specific skills that help identify distorted thinking, modifying disruptive thinking and beliefs, are all key to helping change behavior.
  • Group cognitive behavioral therapy. CBT in a group atmosphere, led by a therapist, can help by encouraging sharing or thoughts, feelings, and experiences with others who are going through recovery as well. The community aspect can be helpful for increasing connection and lessening risk of isolation.
  • Family-based therapy (FBT). FBT is a therapeutic modality often employed in the treatment of children and teens with eating disorders; and involves the family to make sure that an environment is created that can support healthy eating habits. Weight normalization and nutrition education

Weight Regulation

If you’re underweight due to an eating disorder, the first step is to get you to a healthy weight. Your medical team will help your establish a healthy diet and create an eating plan that you can adhere to maintain a healthier and more well body.


Hospitalization

In some cases, where an eating disorder, especially anorexia, has resulted in extremely low body weight and malnutrition, your doctor may recommend that you be hospitalized. There are specialized programs that exist that specifically treat people that have eating disorders—some are in-patient programs, some outpatient—and typically offer more intensive treatment.

 


Medications

Certain medications can be very helpful in the treatment of eating disorders. Some help control urges to purge or binge, or help allay anxiety around body image, and others can help manage obsessive ideation about food, diet, portion size, and more. Anti-depressant and anti-anxiety medications also help with depression and generalized anxiety, often associated with eating disorders.

Commonly utilized anti-depressants include fluoxetine, which is a selective serotonin reuptake inhibitor (SSRI) that acts to increase the amount of serotonin in the brain. Another class of antidepressants, known as tricyclic antidepressants, or TCAs, is commonly used in this patient population. Examples of TCAs include imipramine and amitriptyline, which also act to increase the level of certain neurotransmitters in the brain.

In addition to antidepressants, medications known as orexigenics can also be used. These are specific medications utilized to stimulate appetite. An example of an orexigenic is dronabinol, which is a cannabinoid (the active ingredient in marijuana that stimulates appetite).

Complementary and Alternative Treatment

Complementary treatments may help reduce anxiety in people with eating disorders. Such treatments may help people with eating disorders by reducing stress, promoting relaxation and increasing a sense of wellbeing.

Examples of anxiety-reducing complementary treatments include:

  • Acupuncture
  • Massage
  • Yoga
  • Meditation

The Importance of Adherence to Treatment

As a general guideline, it appears that one third of patients that suffer from eating disorders fully recover, one third retain some symptoms—though not enough to fully qualify as having a “full-blown” disorder, and one third maintain a chronic eating disorder. Sadly, mortality from anorexia nervosa in particular remains a great concern. The most effective way to manage the dangers inherent with long-term eating disorders is consistency in the treatment plan. Rewarding behavior changes has been shown to be particularly effective—and should be included as part of the treatment regimen. Relapses can occur—and it is important to note that mortality from anorexia nervosa in particular remains a great concern. A supportive environment that encourages adherence to the treat plan is key to success.

 

When To Contact A Doctor

If you have already received a diagnosis of anorexia, and feel dizzy, call your doctor immediately.

If you find that you have symptoms of eating disorders, signs of anorexia, are overly concerned about your appearance, find yourself eating very little, purging, abusing laxatives or diuretics, experiencing rapid weight loss, you may want to call your doctor or healthcare professional.

 

Questions For Your Doctor

Your medical team may consist of several healthcare professionals, such as a doctor that specializes in eating disorders, psychotherapist, dietitian, nutritional consultant, and more. The National Eating Disorder Association (NEDA) has a comprehensive list of care providers:

 

Questions For A Doctor

If you have made the decision to see a doctor or health care professional about a possible eating disorder, here is some information to help you prepare for your appointment.

Prior to your appointment, make a list of:

  • Symptoms that you are having. Include any that may seem unrelated to the reason for your appointment
  • Important personal information.  Include any major stresses or recent life changes
  • All medications, vitamins or other supplements that you are taking, and their doses
  • Questions to ask your doctor so that you know you are ready to cover everything you want to discuss

It is a good idea to ask a family member or friend to come with you to your appointment. Having someone with you can help you remember something that you missed or forgot, and this person may also be able to provide your doctor with outside context about what is going on with you.

Here are some possible questions you may want to ask your doctor or health care provider:

  • How do you determine if I have an eating disorder?
  • What kinds of tests will diagnosis require? Will any of these tests necessitate any special preparation?
  • If I have an eating disorder, is it short-lived or long lasting?
  • What treatments are available, and which do you recommend?
  • How will treatment affect my weight?
  • What other resources or material do you recommend I read to learn more? What websites do you    recommend?

Your doctor will likely ask you some questions, like:

  • Do you often think about food?
  • Do you worry about your weight?
  • How long have you been worried about your weight?
  • What weight loss regimens have you tried?
  • Have you found any other ways to lose weight?
  • How often do you exercise? How long?
  • Have you ever vomited because you were uncomfortably full?
  • Have people in your life expressed concern about your weight or weight loss?
  • Do you ever eat in secret?
  • Has anyone in your family even been diagnosed with an eating disorder?

 

Resources

The National Eating Disorder Association: Provides support, information, access to treatment, and community for those suffering from eating disorders.

The National Association of Anorexia Nervosa and Associated Disorders: Provides support, information and access to support groups across the USA