More Information about Eating Disorders

What is an eating disorder?

Eating disorders are defined as severe disturbances in attitudes and behaviors around eating, weight, shape, and body image.  They are often accompanied by problems of self-image, mood, and interpersonal functioning. Many people with eating disorders suffer from medical complications, and in some cases these medical problems can lead to hospitalization and can be life threatening.

Dieting and weight loss can sometimes lead to the development of an eating disorder. Eating disorders, however, differ from dieting and occasional changes in eating patterns, in that they are associated with a preoccupation with body weight and shape, maladaptive eating patterns, and emotional and medical problems.

Eating disorders rarely go away on their own and often require professional attention. Fortunately, there are many treatments available for people suffering from eating disorders.

There are several different types of eating disorders:

Anorexia Nervosa 
Bulimia Nervosa 
Binge Eating Disorder 
Other eating disorders

Anorexia Nervosa

Anorexia Nervosa involves a relentless pursuit of thinness and an unwillingness to maintain a normal body weight.  People who suffer from Anorexia Nervosa are preoccupied with body weight, body shape, dieting, food, fat, or calories. Despite their emaciation, Anorexia Nervosa sufferers have an extreme fear of gaining weight and becoming fat, and these fears do not usually subside even after weight loss. They also have distortion in the way they perceive the shape or size of their bodies.  Females with Anorexia will also stop menstruating or fail to begin. In order to maintain a low body weight people with Anorexia Nervosa will often severely restrict their diets, either by consuming only small quantities of food, eliminating “high-calorie” foods from their diets, or fasting.  Some sufferers will try to keep weight low by self-inducing vomiting; abusing laxatives, diuretics, and enemas; or exercising excessively. A subgroup of people with Anorexia Nervosa has periods when they lose control over eating and consume unusually large amounts of food (binge eating).

Common Physical Complications Associated with Anorexia Nervosa

Anorexia Nervosa has the highest mortality rate of any psychiatric disorder and is associated with numerous medical complications. Many of these complications, however, are reversible with proper nutrition and discontinued use of laxatives, diuretics, and enemas, and cessation of self-induced vomiting.

The medical complications include:

  1. Electrolyte imbalances (which can lead to heart attack and kidney failure)
  2. Cardiac irregularities
  3. Kidney dysfunction
  4. Cerebral atrophy
  5. Swollen salivary glands
  6. Gastrointestinal disturbances
  7. Dental deterioration
  8. Finger clubbing or swelling
  9. Edema and dehydration
  10. Loss of menstrual periods and infertility
  11. Bone abnormalities (bone mineral loss and osteoporosis)
  12. Dry skin and hair loss
  13. Lanugo (fine hair growth on face and body)

Bulimia Nervosa

Bulimia Nervosa is a severe eating disturbance involving recurrent episodes of uncontrolled overeating that are referred to as binge episodes. These binge episodes are followed by compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, laxative or diuretic abuse, fasting, or intense exercising. The disorder also involves a preoccupation with shape and weight that influences self-evaluation. People with Bulimia Nervosa are able to maintain a body weight at or above a minimally normal level.

Common Physical Complications Associated with Bulimia Nervosa

Bulimia Nervosa is associated with numerous medical complications that can be very dangerous. Many of these complications, however, are reversible with discontinued use of laxatives, diuretics, and enemas, and cessation of self-induced vomiting.

The medical complications include:

  1. Electrolyte imbalances (which can lead to heart attack and kidney failure)
  2. Cardiac irregularities
  3. Swollen salivary glands
  4. Gastrointestinal disturbances
  5. Dental deterioration
  6. Finger clubbing or swelling
  7. Edema and dehydration
  8. Loss of menstrual periods and menstrual irregularities

Binge Eating Disorder

Binge Eating Disorder involves recurrent episodes of uncontrolled overeating that are referred to as binge episodes. Unlike Bulimia Nervosa, Binge Eating Disorder does not involve compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, laxative or diuretic abuse, fasting, or intense exercising. Binge eating is associated with much distress.

Common Physical Complications Associated with Binge Eating

Severe binge eating is associated several medical complications including the following:

  1. Obesity (which has been associated with high cholesterol, high blood pressure, gall bladder disease, diabetes, heart disease, and certain types of cancer)
  2. Swollen Salivary Glands
  3. Abdominal discomfort

Common Psychological Consequences of Binge Eating Disorder

There is often tremendous guilt, shame, anger, and depressed mood associated with bingeing.

Other Eating Disorders

At least half of the patients seen at the Eating Disorders Program at the University of Chicago Hospitals do not meet full diagnostic criteria either Anorexia Nervosa or Bulimia Nervosa.  These individuals can suffer from a variety of eating disorder symptoms, such as severely restricting their food intake; engaging in binge eating, self-induced vomiting, or misuse of laxatives, diuretics, or enemas; or they may be repeatedly chewing and spitting (not swallowing) large amounts of food. Depending of their symptoms, these people may suffer from various psychological or medical problems, which are similar to those seen in the other eating disorders.

How many people have eating disorders?

  • 0.05%-1.0% of females in late adolescence and early adulthood have Anorexia Nervosa, and rates for males are unknown (APA, 1994).
  • 1-3% of females in late adolescence and early adulthood have bulimia nervosa, and the rate in males in 0.1%-0.03% (APA, 1994).
  • It is expected that the prevalence rates are much higher for those who have eating disturbances but do not meet full criteria for an eating disorder (APA, 1994).

At what age do people develop eating disorders?

Anorexia Nervosa typically develops at age 17 and rarely past the age of 40, while Bulimia Nervosa typically develops in late adolescence or early adulthood (APA, 1994).

What are the causes of eating disorders?

Research suggests that there is not one specific cause of eating disorders, but rather that they are caused by combination of factors including biological/genetic, social/cultural, and psychological.

Do people overcome eating disorders?

It is very rare for people to overcome eating disorders without treatment, and the mortality rate for individuals with Anorexia Nervosa is 6-15% (Steinhausen et al., 1991, 1993), making treatment extremely important for eating disorders.

While research suggests that some treatments are more effective than others for certain subgroups, in general about half of people with Anorexia Nervosa who seek treatment fully recover, show very good outcomes, approximately one fourth show moderate outcomes, and slightly less than one fourth do not show much improvement in symptoms (Loewe et al., 2001; Ratnasuriya et al., 1991; Smith et al., 1993; Steinhausen et al., 1991, 1993; van der-ham et al., 1994; Walford & McCune, 1991).

A 10-year follow-up of patients who underwent treatment for Bulimia Nervosa found that 52% patients fully recovered, 39% had improved but had some symptoms, and 9% still had the full disorder (Collings & King, 1994).

What can friends and family do to help?

While it might feel awkward and be difficult to approach a friend or loved one about their eating behaviors, the worse thing to do is nothing.

Some suggestions:

  • Before approaching a loved one about eating, you should try to get information about resources and treatments that are available for eating disorders in your community.
  • Once you have done some research on eating disorders and treatment, approach the person privately, when you think you will not be interrupted, and allow for enough time to discuss your concerns.
  • Start by telling the person how much you care about him/her, and then tell the person that you are worried about him/her.  Offer specific observations about his/her behavior that concerns you.
  • Encourage the person to express his/her feelings, and listen carefully.
  • If the person agrees to seek help, present the person with the information you gathered on eating disorders, and offer to take the person to his/her appointment. Even if the person refuses to seek help, you can give him/her a written list of resources in the community that they can contact.  Many people with eating disorders are embarrassed about their symptoms and may contact a resource you provide privately.
  • People with eating disorders often deny their symptoms, so expect that the person might be angry when you confront him/her.  It is important to stay calm, and not argue with the person as to whether or not they have an eating disorder.  Instead explain that you are concerned and worried. You might suggest that he/she meet with a mental health professional for a consultation, and that he/she does not have to commit to treatment right away.  It might take several attempts before the person admits that he/she has a problem and gets help. If the person refuses help, allow some time to pass and then voice your concerns again. Even if the person refuses to get help, knowing that he/she has someone who cares and is concerned, can help that person to admit they have a problem and seek help in the future.
  • If there is concern that the eating disorder is life-threatening or has created serious medical complications, or if the person seems suicidal or in dangercontact a mental health professional immediately.

Further reading for parents

Help Your Teenager Beat an Eating Disorder by James Lock & Daniel Le Grange. Published by Guilford Press, 2005.

Pediatric Eating Disorders Links