Eating Disorders

Disordered eating and dangerous weight loss behaviors have unfortunately become normalized in our culture. Dieting, "clean eating," and compulsive exercise are often behaviors that come before diagnosable eating disorders. There is a common misconception that eating disorder symptoms must be severe in order to seek professional help, but any symptom is cause for concern, and it is best to take action early. When disordered eating has a negative impact on quality of life, it's time to seek help.

Eating disorders—such as anorexia, bulimia, and binge eating—include extreme emotions, attitudes, and behaviors surrounding weight and food. Eating disorders are conditions affecting both emotional and physical health that can lead to life-threatening consequences. Anyone can develop an eating disorder regardless of their gender, age, race, ethnicity, culture, size, socioeconomic status, or sexual orientation.

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

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

Anorexia nervosa is characterized primarily by self-starvation and excessive weight loss. Symptoms may include:

• Inadequate food intake leading to significant weight loss.
• Intense fear of weight gain, obsession with size, and persistent behavior to prevent weight gain (over-exercising to burn calories or extreme food restriction).
• Dehydration, dizzy spells and faintness, feeling cold (due to poor circulation), and extreme tiredness.
• Disturbance in self-image.
• Denial of the seriousness of illness.

Health consequences include heart failure, osteoporosis, muscle loss, malnutrition, low blood pressure, severe dehydration, and growth of lanugo (fine hair) all over the body.

Bulimia nervosa is characterized primarily by a cycle of binge eating followed by offsetting behaviors, such as self-induced vomiting, in an attempt to counteract the effects of binge eating. Symptoms include:

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

Health consequences include heart failure, gastric rupture, tooth decay, rupture of the esophagus, and pancreatitis.

Binge eating disorder is characterized primarily by recurrent binge eating without the regular use of compensatory measures. 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 you're full or not hungry.
• Eating until you're uncomfortably full. 
• Frequently eating alone or in secret.
• Experiencing shame, guilt, and distress after the binge.

Health consequences include heart disease, type II diabetes mellitus, gastric rupture, and gallbladder disease.

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, and OSFED can be equally as severe as the other eating disorder diagnoses.

As with most mental illnesses, eating disorders are not caused by just one factor but 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

Eating disorders can impact relationships with family members, friends, and coworkers, as well as functioning in academic settings and the workplace. The health consequences of eating disorders—including, but not limited to, heart disease, osteoporosis, and tooth decay—can have long-lasting negative effects.

Aside from the medical complications associated with eating disorders, they carry a significantly elevated death rate. In one study, people with anorexia nervosa had a six-fold increase in mortality compared to the general population. Reasons for death include starvation, substance abuse, and suicide. Importantly, the authors found an increased rate of death from “natural” causes, such as cancer. A second study found that the elevated mortality risks for bulimia nervosa and OSFED were similar to those for anorexia nervosa.

An important thing to remember is that most complications can be reversed or improved with adequate and timely treatment.

Eating disorders are treatable, and early diagnosis and intervention often leads to better outcomes. The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Ideally, whatever treatment is offered should be tailored to the individual; this will vary according to both the severity of the disorder and the patient's individual problems, needs, and strengths.

Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder.

Recommended care is provided by a multidisciplinary team, which may include a therapist (e.g., psychologist, counselor, or social worker), dietician, psychiatrist, and/or primary care physician. Care should be coordinated and provided by health professionals with expertise and experience in dealing with eating disorders.

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 (including hospitalization and/or residential care in an eating disorders specialty unit or facility) is necessary when an eating disorder has led to physical problems that may be life-threatening, or when an eating disorder is causing severe psychological, social, or behavioral problems. Inpatient stays typically require a period of outpatient follow-up and aftercare to address underlying issues associated with the individual's eating disorder.

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.

For assistance assessing options for yourself or a loved one who may be struggling with an eating disorder, you can find help at the National Eating Disorder Association.

• Read stories from people living with eating disorders on The Mighty.
• Get additional Information about eating disorders at Psych Central.
• Learn more about WithAll's Recovery for All Support Program and see if you or a loved one qualifies for care.
• Find parent resources and courses surrounding food and body love at Parent Guidance.

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. Whether an individual struggles with bulimia, anorexia, body image distortion, or binge-eating disorders, Eating Disorder Hope can help.

National Alliance for Eating Disorders
https://www.allianceforeatingdisorders.com/

National Alliance for Eating Disorders is a national nonprofit dedicated to outreach, education, early intervention, and advocacy for all eating disorders.

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