Eating disorders

What are eating disorders?
Eating disorders are illnesses with a biological basis modified and influenced by emotional and cultural factors. The stigma associated with eating disorders has long kept individuals suffering in silence, inhibited funding for crucial research and created barriers to treatment. Because of insufficient information, the public and professionals fail to recognize the dangerous consequences of eating disorders. While eating disorders are serious, potentially life threatening illnesses, there is help available and recovery is possible.

Anorexia nervosa
Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.

Anorexia nervosa has four primary symptoms:
• Resistance to maintaining body weight at or above a minimally normal weight for age and height
• Intense fear of weight gain or being “fat” even though underweight.
• Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight.
• Loss of menstrual periods in girls and women post-puberty.

Eating disorders experts have found that prompt intensive treatment significantly improves the chances of recovery. Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.

Warning signs of anorexia nervosa:
• Dramatic weight loss.
• Preoccupation with weight, food, calories, fat grams, and dieting.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
• Frequent comments about feeling “fat” or overweight despite weight loss.
• Anxiety about gaining weight or being “fat.”
• Denial of hunger.
• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
• Consistent excuses to avoid mealtimes or situations involving food.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury--the need to “burn off” calories taken in.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health consequences of anorexia nervosa:
Anorexia nervosa involves self-starvation. The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences

• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower.
• Reduction of bone density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin, hair loss is common.
• Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

About anorexia nervosa:
• Approximately 90-95% of anorexia nervosa sufferers are girls and women
• Between 0.5-1% of American women suffer from anorexia nervosa.
• Anorexia nervosa is one of the most common psychiatric diagnoses in young women
• Between 5-20% of individuals struggling with anorexia nervosa will die. The probabilities of death increases within that range depending on the length of the condition
• Anorexia nervosa has one of the highest death rates of any mental health condition.
• Anorexia nervosa typically appears in early to mid-adolescence.

Bulimia nervosa
Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Bulimia nervosa has three primary symptoms:
• Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
• Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.
• Extreme concern with body weight and shape.

The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

Warning signs of bulimia nervosa:
• Evidence of binge-eating, including disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food.
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury--the need to “burn off” calories taken in.
• Unusual swelling of the cheeks or jaw area.
• Calluses on the back of the hands and knuckles from self-induced vomiting.
• Discoloration or staining of the teeth.
• Creation of complex lifestyle schedules or rituals to make time for binge-and-purge sessions.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health consequences of bulimia nervosa:
Bulimia nervosa can be extremely harmful to the body. The recurrent binge-and-purge cycles can impact the entire digestive system and purge behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the health consequences of bulimia nervosa include:

• Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
• Inflammation and possible rupture of the esophagus from frequent vomiting.
• Tooth decay and staining from stomach acids released during frequent vomiting.
• Chronic irregular bowel movements and constipation as a result of laxative abuse.
• Gastric rupture is an uncommon but possible side effect of binge eating.

About bulimia nervosa:
• Bulimia nervosa affects 1-2% of adolescent and young adult women.
• Approximately 80% of bulimia nervosa patients are female
• People struggling with bulimia nervosa will often appear to be of average body weight.
• Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.
• Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment
• Risk of death from suicide or medical complications is markedly increased for eating disorders

Binge eating disorder
Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

Binge eating disorder is characterized by:
• Frequent episodes of eating large quantities of food in short periods of time.
• Feeling out of control over eating behavior.
• Feeling depressed, guilty, or disgusted by the behavior.
• There are also several behavioral indicators of BED including eating when not hungry and eating alone because of embarrassment over quantities consumed, eating until uncomfortably full.

Health consequences of binge eating disorder:
The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:
• High blood pressure
• High cholesterol levels
• Heart disease
• Diabetes mellitus
• Gallbladder disease
• Musculoskeletal problems

About binge eating disorder:
• The prevalence of BED is estimated to be approximately 1-5% of the general population
• Binge eating disorder affects women slightly more often than men--estimates indicate that about 60% of people struggling with binge eating disorder are female, 40% are male
• People who struggle with binge eating disorder can be of normal or heavier than average weight
• BED is often associated with symptoms of depression
• People struggling with BED often express distress, shame, and guilt over their eating behaviors
• People with binge eating disorder report a lower quality fo life than non-binge eating disorder

Psychological factors that can contribute to eating disorders:
• Low self-esteem
• Feelings of inadequacy or lack of control in life
• Depression, anxiety, anger, or loneliness

Interpersonal factors that can contribute to eating disorders:
• Troubled personal relationships
• Difficulty expressing emotions and feelings
• History of being teased or ridiculed based on size or weight
• History of physical or sexual abuse

Social factors that can contribute to eating disorders:
• Cultural pressures that glorify "thinness"or muscularity and place value on obtaining the "perfect body"
• Narrow definitions of beauty that include only women and men of specific body weights and shapes
• Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths
• Stress related to racial, ethnic, size/weight-related or other forms of discrimination or prejudice

Other factors that can contribute to eating disorders:
• Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be imbalanced. The exact meaning and implications of these imbalances remains under investigation.
• Eating disorders often run in families. Current research is indicates that there are significant genetic contributions to eating disorders.

Eating disorders are complex conditions that can arise from a variety of potential causes. Once started, however, they can create a self-perpetuating cycle of physical and emotional destruction. All eating disorders require professional help.

Health consequences of eating disorders
Health consequences of anorexia nervosa:
In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.

• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.
• Reduction of bone density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin, hair loss is common.
• Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

Health consequences of bulimia nervosa:
The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the health consequences of bulimia nervosa include:

• Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors
• Potential for gastric rupture during periods of bingeing
• Inflammation and possible rupture of the esophagus from frequent vomiting
• Tooth decay and staining from stomach acids released during frequent vomiting
• Chronic irregular bowel movements and constipation as a result of laxative abuse
• Peptic ulcers and pancreatitis

Health consequences of binge eating disorder:
Binge eating disorder often results in many of the same health risks associated with clinical obesity. some of the potential health consequences of binge eating disorder include:

• High blood pressure
• High cholesterol levels
• Heart disease as a result of elevated triglyceride levels
• Type II diabetes
• Gallbladder disease

Eating disorders prevention
Prevention is any systematic attempt to change the circumstances that promote, initiate, sustain, or intensify problems like eating disorders. This may involve reducing negative risk factors (such as body dissatisfaction, depression or basing self-esteem on appearance) or increasing protective factors (such as a non-appearance oriented self-definition, and replacing dieting and body snarking with intuitive eating and appreciation for the body’s functionality). Prevention is important to reduce the suffering associated with eating disorders. Treatment is often expensive and difficult to obtain, which makes prevention even more important.

At least two types of audiences may be the target of eating disorders prevention:
• Universal prevention is aimed at the general public, i.e., people without any symptoms of eating disorders. In fact, the audience typically does not even show any particular risk of developing eating disorders. This type of prevention aims to promote healthy development, understanding of the many complex issues that cause eating disordersand to stop eating disorders before they begin.
• Targeted prevention targets people who are beginning to show indications of eating disorders. So, for example, they may have unusually high levels of body dissatisfaction. The audience does not yet have eating disorders. The goal is to stop the development of a serious problem.

Does eating disorders prevention work?
There are now dozens of studies evaluating a variety of eating disorders and disordered eating prevention programs. Some of the major findings are:

• Prevention programs can alter knowledge, attitudes, and behaviors associated with eating disorders and disordered eating.
• Both targeted and universal prevention programs have enjoyed some success, though there may be more success with the targeted programs.
• There is particularly good evidence that targeted programs using a cognitive dissonance approach is effective with adolescents and young adult women from various ethnic groups. This approach encourages girls and women to question the media and cultural messages by asking them to present information on eating disorders prevention to others. The conflict between what they say to others and what they do themselves creates dissonance that leads to change so that their behaviors are more consistent.
• Programs that adopt an ecological approach – involving not only individual change but also changing the environment of teacher and peer behavior – have also shown some success. So have media literacy programs. Programs that emphasize a healthy weight have also led to change.
• Various programs have successfully discouraged the development of eating problems in children, adolescents, and young adults.
• Obesity and eating disorders programs can be combined.
•Much more research is needed concerning prevention. We are particularly lacking information about prevention programs that work with children, with males, and with people from a variety of ethnic groups.

Suggested readings
Cash, T., & Smolak, L. (2011). Body image: A handbook of science, practice, and prevention (2nd ed.). NY: Guilford.
Levine, M.P., & Smolak, L. (2006). The prevention of eating problems and eating disorders: Theory, research,and practice. Mahwah, NJ: Lawrence Erlbaum.
Neumark-Sztainer D. (2005). Can we simultaneously work toward the prevention of obesity and eating disorders in children and adolescents? International Journal of Eating Disorders, 38, 220-227.
Smolak, L., & Thompson, J.K. (2009). Body image, eating disorders, and obesity in youth: Assessment, prevention, and treatment (2nd edition). Washington, DC: American Psychological Association.
Stice, E., Shaw, H., & Marti, C. N. (2007). A meta-analytic review of eating disorder prevention programs: progress at last. Annual Review of Clinical Psychology, 3, 233-57

This information was developed by National Eating Disorders Association herewith used with permission.

National Eating Disorders Association. General Information Index. Available at: https://www.nationaleatingdisorders.org/learn. Last accessed September 6, 2018.

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