Eating Disorders

Anorexia nervos is a serious, occasionally chronic, and potentially life-threatening eating disorder defined by a refusal to maintain minimal body weight within 15 percent of an individual's normal weight.  Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, denial of the seriousness of the illness, and amenorrhea (absence of at least three consecutive menstrual cycles when they are otherwise expected to occur).

There are two subtypes of anorexia nervosa.  In the restricting type, people maintain their low body weight purely by restricting their food intake and possibly by excessive exercise.  Individuals with the binge eating/purging type also restrict their food intake, but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas.  Many people move back and forth between subtypes during the course of their illness.  Starvation, weight loss, and related medical complications are quite serious and can result in death.  People who have ongoing preoccupation with food and weight even when they are thin would benefit from exploring their thoughts and relationships with a therapist.  The term anorexia literally means loss of appetite, but this is a misnomer.  In fact, people with anorexia nervosa often ignore hunger signals and thus control their desire to eat.  Often they may cook for others and be preoccupied with food and recipes, yet they will not eat themselves.  Obesessive exercises that may accompany the starving behavior can cause others to assume falsely that the person must be healthy.

Like all eating disorders, anorexia nervosa tends to occur in pre-or post-puberty, but can develop at any time throughout the lifespan.  It predominately affects adolescent girls and young adult women, although it also occurs in boys, men, older women, and younger girls.  One reason younger women are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an "ideal" figure.  This obsessive dieting behavior reflects today's societal pressure to be thin, which is seen in advertising and the media.  Others especially at risk for eating disorders include athletes, actors, dancers, models, and TV personalities for whom thinness has become a professional requirement.  People with anorexia nervosa will often mention that the sense of control they develop over eating and weight helps them feel as if other aspects of their life are under control.  The presence of depression and anxiety disorders may increase the risk of developing anorexia nervosa.

Conservative estimates suggest that one-half to one percent of females in the U.S. develop anorexia nervosa.  Because more than 90 percent of all those who are affected are adolescent and young women, the disorder has been characterized as primarily a woman's illness.  It should be noted, however, that males and children as young as seven years old have been diagnosed; and women 50, 60, 70, and even 80 years of age have fit the diagnosis.  Some of these individuals will have struggled with eating or weight in the past but new onset cases can also occur.  Eating disorders also tend to run in families, with the heritability of anorexia nervosa estimated at over 50%.

The medical complications  of anorexia nervosa are vast.  Damage to vital organs such as the heart, kidneys, and brain can occur.  Pulse rate and blood pressure drop, and people may experience irregular heart rhythms or heart failure.  Nutritional deprivation along with purging causes electrolyte abnormalities such as low potassium and low sodium; calcium loss from bones; and decreased brain volume. Anorexia nervosa has the highest mortality rate of any psychiatric illness.  The most frequent causes of death are suicide and complications of the malnutrition associated with the disorder.

Recovery from anorexia nervosa is possible.  In long term follow-up studies, about half of individuals fully recover from the illness, a small percentage continued to suffer from anorexia, and the remainder continue to have other eating disorders.  For some, anorexia can be relatively short-lived, whereas for others it can become a chronic and debilitating illness.  Most physical complications experienced by persons with anorexia nervosa are reversible when they restore their weight and nutrition. Eating disorders are most successfully treated when diagnosed early.  Some patients can be treated as outpatients, but some may need hospitalization to stabilize their dangerously low weight. Many of these people will require a coordinated team of professionals from many disciploines to maximize their chance of recovery.

Bulimia nervosa is an eating disorder marked by a destructive pattern of binge-eating and recurrent inappropriate compensatory behaviors to control one's weight.  It can occur together with other psychiatric disorders such as depression, obsessive-compulsive disorder, substance dependence, or self-injurious behavior. Bulimia nervosa is an invisible eating disorder, because patients are of normal weight or overweight.  Bing eating is the rapid consumption of an unusually large amount of food in a short period of time. The binge usually occurs in secret. Unlike simple overeating, the hallmark feature of a binge is feeling out of control.  This means that one cannot stop the urge to binge once it has begun or that one has difficulty ending the eating episode even when far past being full.  The inappropriate behaviors used to control one's weight may include purging behaviors such as self-induced vomiting, abuse of laxatives, diuretics, or enemas; or non-purging behaviors such as fasting or excessive exercise. 

The typical age of onset for bulimia nervosa is late adolescence or early adulthood, but onset can and does occur at any time throughout the lifespan.  Bulimia nervosa primarily affects females, although 10 to 15 percent are male. An estimated two to three percent of yoiung women develop bulimia nervosa, compared with the one-half to one percent that is estimated to suffer from anorexia.  Studies indicate that about 50 percent of those who have anorexia nervosa later develop bulimia nervosa.

People with bulimia nervosa are overly concerned with body shape and weight.  Weight fluctuations are common because of alternating binges and fasts.  Unlike people with anorexix, people with bulimia are usually within a normal weight range.  Common signs of bulimia are erosion of dental enamel due to the acid in vomit, and scarring on the backs of hands, due to repeatedly pushing fingers down the throat to induce vomiting.  A small percentage of people with bulimia show swelling of the glands near the cheeks or experience irregular menstrual periods, depressed mood, sore throats and abdominal pain. Despite these signs, bulimia nervosa is difficult to catch early. Medical complications of bulimia include electrolyte imbalance, dehydration, cardiac complications, and occasionally, sudden death.

 The precise causes of bulimia are unknown, but there is some evidence that obesity in adolescence or familial tendency toward obesity predisposes an individual to the development of the disorder. People with bulimia are often impulsive and may abuse alcohol, drugs, and engage in self-injurious behavior.

Most people with bulimia nervosa can be treated through outpatient therapy; however, admission to an eating disorders treatment program may help if the binge purge cycle is completely out of control.  Fluoxetine (Prozac) is the only FDA approved medication for bulimia nervosa, showing 50-60% reduction in binge eating and purging; however these behaviors often return when the drug is discontinued.  Treatment should be adjusted to meet the needs of the individual concerned, but usually a comprehensive treatment plan involving a variety of experts and approaches is best.

Individuals with binge eating disorder (BED) engage in binge eating, but in contrast to people with bulimia nervosa, they do not regularly use inappropriate compensatory weight control behaviors such as fasting or purging.  Binge eating is defined as the rapid consumption of a large amount of food and experiencing the eating as out of control.

When the binge is over, the person often feels disgusted, guilty, and depressed about overeating.  For some, BED can occur together with other psychiatric disorders such as depression, substance abuse, anxiety disorders, or self-injurious behavior. The person suffering from BED often feels caught up in a vicious cycle of negative mood followed by binge eating, followed by more negative mood.  Over time, individuals with BED tend to gain weight dur to overeating; therefore, BED is often, but not always, associated with overweight and obesity. Previous terms used to describe this problem included compulsive overeating, emotional eating, and food addiction.

BED is the most commonly diagnosed disorder among individuals seeking professional help for an eating disorder.  Recent statistics indicate that in the U.S., BED affects an estimated three and one-half percent of females and two percent of males at some point in their lifetime.  The average age of onset for BED is in young adulthood (early 20's) and slightly later in life compared to anorexia and bulimia.  However, recognition of binge eating in children is increasing.  Since most people who suffer from BED tend to do so in secret, it is not always easy to identify. 

The most common medical complications associated with BED are related to the weight gain and other metabolic disturbances that occur.  In some cases, individuals become obese and develop nutritional problems and type II diabetes.  In rare instances, binge eating can cause the stomach to rupture. 

BED has been shown to run in families, and it is believed to be influenced by both genetic and environmental factors.  There also appear to be some common triggers, such as increased depressed and/or anxious mood prior to bingeing; cravings for sweets and simple carbohydrates; and high reactivity to food cues such as sight and smell in the environment.

Treatment for binge eating disorder targets both the elimination of binge eating and the development and maintenance of a healthy weight. Most people with BED can benefit from psychotherapy based on cognitive-behavioral principles and/or medication.  Usually hospitalization is not required, but admission to an eating disorders program could be helpful in interrupting severe binge eating cycles. Consultation with a dietician is a valuable component of treatment to help establish a healthy eating plan and appreciation of appropriate portion sizes.

For more information regarding eating disorders, go to http://www.nationaleatingdisorders.org/