An Education on Eating Disorders

The American Psychiatric Association defines eating disorders as “behavioral conditions characterized by severe and persistent disturbances in eating behaviors and associated distressing thoughts and emotions.” National Eating Disorders Awareness Week, which just ended (February 21-27), serves as a time to learn more about these disorders and actively support those affected by them.

Eating disorders are serious illnesses that can lead to nutritional deficiencies and dangerous medical complications, even death. They are associated with an intense preoccupation with weight, body shape and food, which leads to dangerous behaviors. These behaviors include restrictive eating, binge eating, purging by vomiting or misusing laxatives and compulsive exercising.

Eating disorders are prevalent in the US, affecting approximately 30 million Americans. Most eating disorders develop during adolescence and young adulthood but can occur at any age. They are more common in young girls and women, but men can have eating disorders as well. Often, eating disorders co-occur with mental health conditions such as depression, anxiety and substance abuse disorder.

The most common eating disorders are anorexia nervosa, bulimia nervosa and binge eating disorder.

People with anorexia nervosa typically see themselves as “fat” even though they are underweight. There are two subtypes: the restrictor type, in which people limit their food intake to the point of starvation, and the binging and purging type, where people eat a lot of food (binge) and then make themselves throw up the food they’ve eaten (purge).

Anorexia is very harmful to the body. It can lead to serious health issues including heart problems such as arrythmias, heartbeats that are too fast, too slow or irregular, and heart failure, the inability of the heart to pump enough blood to meet the body’s needs. Other serious consequences include anemia, low blood pressure, kidney problems, bone loss and death.

Bulimia nervosa is characterized by eating large amounts of food and then trying to get rid of the calories consumed by vomiting, fasting, using laxatives or compulsively exercising. People with bulimia often weigh withing the normal limits for their age and height but intensely fear gaining weight. And they are usually very dissatisfied with their body shape.  

Repeated exposure to stomach acids from purging can erode the enamel on the teeth and lead to cavities and gum disease. Other complications associated with bulimia include stomach ulcers, ruptures of the stomach or esophagus, dehydration, irregular heartbeat, low sex drive and gastroparesis, a condition in which the stomach takes too long to digest food. In addition, people with severe bulimia have a higher risk for heart attack.

People with binge eating disorder eat a lot of food in a short amount of time, even if they’re not hungry, and feel intense distress or guilt afterward. But unlike bulimia, people with binge eating disorder don’t purge after eating. An episode of binge eating can be triggered by stress, negative feelings about weight or body shape, availability of food or even boredom. People with this disorder may eat in secret so others can’t see how much they’re eating.

Many people with binge eating disorder are overweight or obese, which increases the risk for heart disease, stroke, Type 2 diabetes and many types of cancer. These people may also experience sleep problems, chronic pain, asthma, irritable bowel syndrome and fertility problems. Pregnant women with binge eating disorder tend to have more complications during their pregnancy.

Eating disorders also increase the risk for suicide.

Each eating disorder has its own symptoms, but there are some red flags to look out for. These include skipping meals or following an overly restrictive diet, leaving during meals to use the bathroom, eating more food during a meal than considered normal, frequently using laxatives for weight loss, exercising excessively and frequently talking about weight or dieting.

There are multiple factors that contribute to the development of an eating disorder, including genetic, biologic, psychological and emotional factors. Your risk is increased if you have a family history of eating disorders, have another mental health disorder and have a lot of stress in your life. Eating disorders are more common in those that engage in activities that stress weight, such as gymnastics, wrestling, dancing and modeling. Peer pressure is also a factor.

If your doctor suspects an eating disorder based on your history and physical examination, he or she may refer you to a mental health professional, who uses special interviewing and assessment tools to make the diagnosis and determine which type of eating disorder you have. They follow the guidelines set down by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM).

Treatment for eating disorders depends on the type of disorder but usually involves psychotherapy, medication, nutritional counseling and weight monitoring. In severe cases, hospitalization or a stay in an inpatient treatment facility is required. Family support is essential in helping people with eating disorders cope and recover.