Background on Eating Disorders

An eating disorder is marked by extremes, whether it is reduction of food intake, extreme overeating, or feelings of extreme distress or concern about body weight or shape.

Eating disorders frequently appear during adolescence or young adulthood, but they can develop during childhood or later in adulthood. Women and girls are much more likely than males to develop an eating disorder, but men and boys account for an estimated 5% to 15% of patients with anorexia or bulimia and an estimated 35% of those with binge-eating disorder.

Eating disorders are real, treatable medical illnesses with complex underlying psychological and biological causes. Often, other psychiatric disorders such as depression, substance abuse, or anxiety disorders

The three most common eating disorders are Anorexia Nervosa (self-starvation), Bulimia Nervosa (binge-purge), and Binge Eating Disorder (bingeing). Eating Disorders Not Otherwise Specified (EDNOS) have recently emerged because many people may have other eating problems.

Anorexia Nervosa is characterized by self-starvation and excessive weight loss.

Symptoms include:

• Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level
• Intense fear of weight gain or being “fat”
• Feeling “fat” or overweight despite dramatic weight loss
• Loss of menstrual periods
• Extreme concern with body weight and shape

Effects of Anorexia:

• Abnormally slow heart rate and low blood pressure, which indicate an increased risk of heart failure.
• Reduction of bone density (and possible 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.

Bulimia Nervosa is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food--more than most people would eat in one meal--in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising.

Symptoms include:

• Repeated episodes of bingeing and purging
• Feeling out of control during a binge and eating beyond the point of comfortable fullness
• Purging after a binge, (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting)
• Frequent dieting
• Extreme concern with body weight and shape

Effects of Bulimia:

• Electrolyte imbalances, caused by dehydration and loss of potassium, sodium and chloride, that can lead to irregular heartbeats and possibly heart failure and death.
• 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.

Binge Eating Disorder (also known as compulsive overeating) is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge. People who overeat compulsively may struggle with anxiety, depression, and loneliness. Body weight may vary from normal to mild, moderate, or severe obesity.

Effects of Binge eating:

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

Eating Disorders Not Otherwise Specified (EDNOS) can include some combination of the signs and symptoms of anorexia, bulimia, and/or binge eating disorder. While these behaviors may not be clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining.

Criteria for EDNOS includes the following symptoms:

• For females, all of the symptoms of anorexia nervosa except that the individual has a regular menstrual cycle.
• For males and females, all of the symptoms of anorexia nervosa except that, despite significant weight loss, the individual's current weight still maintains a normal range according to BMI (Body Mass Index) classification.
• For males and females, the regular use of inappropriate compensatory behaviors by an individual of normal weight after eating small amounts of food. For example: self-induced vomiting after the consumption of two cookies.
• For males and females, repeatedly chewing and spitting out, but not swallowing, most of ones potential daily consumption.

EDNOS is still a disorder. Despite the lack of specific classification, the presence of EDNOS symptoms is serious and it may turn into a full-blown eating disorder. Even if a person does not eventually exhibit symptoms of a more specifically classified eating disorder, the results can still be severe and even deadly. Any person exhibiting any of the symptoms should immediately consult a trained medical professional or psychiatrist for treatment.

Contributing Factors:

People with eating disorders often use food in an attempt to compensate for feelings and emotions that may otherwise seem overwhelming. For some, dieting, bingeing, and purging may begin as a way to cope with painful emotions and to feel in control of one’s life, but ultimately, these behaviors will damage a person’s physical and emotional health, self-esteem, and sense of competence and control.

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 family and 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" 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

Other Factors That Can Contribute to Eating Disorders:

• There may be undiscovered biochemical or biological causes of eating disorders. In some individuals with eating disorders, scientists have found certain chemicals in the brain that control hunger, appetite, and digestion to be imbalanced.
• Eating disorders often run in families. This indicates that there may be significant genetic contributions to eating disorders.

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