Eating Disorders

In the United States, nearly 29 million people suffer from an eating disorder at some time in their life.

The prevalence of eating disorders is similar across most races and ethnicities.

Eating disorders carry a significantly elevated death rate. People with anorexia nervosa and bulimia have a mortality risk that is at least five times higher than the general population. Reasons for death include starvation, substance abuse, and suicide.

Disordered eating and dangerous weight loss behaviors have become normalized in our culture. But dieting, "clean eating," and compulsive exercise can be signs of an eating disorder. Eating disorder symptoms do not need to be severe to seek professional help. It is important to remember is that most complications can be reversed or improved with adequate and timely treatment.

Anorexia nervosa often shows up as self-starvation and excessive weight loss. Symptoms may include:

• Inadequate food intake or extreme food restriction leading to significant weight loss.
• Intense fear of weight gain
• Obsession with size
• Over-exercising to burn calories
• Dehydration
• Dizzy spells and faintness
• Feeling cold (due to poor circulation)
• Extreme tiredness.
• Disturbance in self-image
• Denial of the seriousness of the condition

People with anorexia nervosa may be more at risk for health challenges like heart failure, osteoporosis and muscle loss. They may also experience malnutrition, low blood pressure, severe dehydration, and growth of lanugo (fine hair) all over the body.

Bulimia nervosa often shows up as a cycle of binge eating followed by offsetting behaviors. Self-induced vomiting is a common offsetting behavior. Symptoms include:

• Regular intake of large amounts of food. This is accompanied by a sense of loss of control over eating behavior
• Use of inappropriate offsetting behaviors. Examples include: vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise
• Extreme concern with body weight and shape.

Health consequences include heart failure, gastrointestinal symptoms, tooth decay, chronically inflamed and sore throat, and severe dehydration.

Binge eating disorder often shows up as recurrent binge eating without the use of offsetting behaviors. Symptoms include:

• Frequent episodes of eating large quantities of food in short periods of time
• Feeling out of control during the binge
• Eating even when full or not hungry
• Frequently eating alone or in secret
• Experiencing shame, guilt, and distress after the binge.

Health consequences include heart disease, type II diabetes, gastrointestinal symptoms, and sleep challenges.

Other specified feeding or eating disorder (OSFED) is a feeding or eating disorder that causes significant distress or impairment but does not meet the criteria for another feeding or eating disorder. Examples of OSFED include:

• Atypical anorexia nervosa (weight is not below normal)
• Bulimia nervosa (with less frequent behaviors)
• Binge eating disorder (with less frequent occurrences)
• Purging disorder (purging without binge eating)
• Night eating syndrome (excessive nighttime food consumption)

Eating disorders come in many different forms. OSFED can be equally as severe as the other eating disorder diagnoses.

As with most mental health conditions, eating disorders are not caused by one factor. They are caused by a combination of sociocultural, psychological, and biological factors.

Sociocultural and psychological factors:

• Low self-esteem
• Pressures to be thin (i.e., pressure to lose weight from family and friends)
• Cultural norms of attractiveness, as promoted by popular culture and in media
• Use of food as way of coping with negative emotions
• Rigid thinking (e.g., “being fat is bad” and “being thin is good”) 
• Over-controlling parents who do not allow expression of emotion
• History of sexual abuse

Biological factors:

• Genetic predisposition to eating disorders, depression, and anxiety
• Certain personality styles, for example, obsessive-compulsive personality type
• High or low levels of certain brain chemicals called neurotransmitters

Co-occurring mental health conditions are common in people with an eating disorder. One study found that a majority of people with an eating disorder were also diagnosed with at least one mental health condition. The most common co-occurring disorders were mood and substance use disorders and anxiety disorders. Additionally, around two-thirds of people with an eating disorder reported experiencing a traumatic event. It is important for providers to be aware of co-occurring conditions when working with a person with an eating disorder so they can receive effective treatment.

Eating disorders are treatable. Early diagnosis and intervention often leads to better outcomes. The most effective treatment for an eating disorder is some form of counseling, coupled with careful attention to medical and nutritional needs. Treatment should be tailored to the individual's specific needs and strengths.

Treatment must address the eating disorder symptoms and medical consequences. It must also address the psychological, biological, interpersonal, and cultural forces that contribute to the eating disorder.

It is recommended that care is provided by a team of health care professionals with expertise in dealing with eating disorders. This may include a therapist (e.g., psychologist, counselor, or social worker), dietician, psychiatrist, and/or primary care physician.

Many people with eating disorders respond to outpatient therapy, including individual, group, or family therapy, and medical management by their primary care provider. Support groups, nutrition counseling, and psychiatric medications administered under careful medical supervision have also proven helpful for some individuals. Family-based treatment is a well-established method for families with adolescents.

Inpatient care is necessary when an eating disorder has led to physical problems that may be life-threatening. It is also necessary when an eating disorder is causing severe psychological, social, or behavioral problems. This type of care can include hospitalization and/or residential care in an eating disorders specialty unit or facility.

Inpatient stays typically require a period of outpatient aftercare. This includes individual, group, or family therapy, and medical management by a primary care provider. Support groups and nutrition counseling have proven helpful for some individuals. Psychiatric medications administered under careful medical supervision can also be supportive. For families with adolescents, family-based treatment is a well-established treatment method.

The exact treatment needs of each person will vary. It is important for individuals struggling with an eating disorder to find a health professional they trust to help coordinate and oversee their care.

• Find resources and support from Alliance for Eating Disorders.
• Learn about the importance of prioritizing health and well-being at WithAll.
• Find parent resources and courses surrounding food and body love at Parent Guidance.
• Learn more about the common misconceptions about eating disorders at Project HEAL.
• Read about body positivity for kids at The Kids Mental Health Foundation.

National Association of Anorexia Nervosa & Associated Disorders, Inc. (ANAD)
Helpline: (630) 577-1330
Email: anadhelp@anad.org
www.anad.org

The National Association of Anorexia Nervosa and Associated Disorders, Inc. is a nonprofit 501(c)3 corporation that seeks to prevent and alleviate the problems of eating disorders, especially including anorexia nervosa, bulimia nervosa, and binge eating disorder. ANAD advocates for the development of healthy attitudes, bodies, and behaviors. ANAD promotes eating disorder awareness, prevention, and recovery through supporting, educating, and connecting individuals, families, and professionals.

Eating Disorder Hope
www.eatingdisorderhope.com

Eating Disorder Hope offers education, support, and inspiration to those with eating disorders, their loved ones, and eating disorder treatment providers. Eating Disorder Hope resources include articles on eating disorder treatment options, support groups, recovery tools, and more.

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