Elevating Awareness Of 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. This year, National Eating Disorders Awareness Week is February 20-26. The observance serves as a time to learn more about these disorders and to support the people who suffer from 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. That includes 20 million females and 10 million males. Most eating disorders develop during adolescence and young adulthood but can occur at any age. Often, eating disorders 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.  

Anorexia nervosa is characterized by self-starvation and weight loss resulting in low weight for height and age. People with anorexia nervosa often see themselves as “fat” even though they are underweight.

There are two subtypes:

• Restrictor: people limit their food intake to the point of starvation.
• Binging and purging: people eat a lot (binge) and make themselves regurgitate (purge).

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

Anorexia nervosa has an extremely high mortality rate compared with other mental disorders. People with anorexia are at high risk of dying from complications related to starvation. Suicide is the second leading cause of death for people who have anorexia nervosa. 

People with bulimia nervosa typically eat large amounts of food and follow the binging with “compensatory behaviors,” such as vomiting, fasting, misusing laxatives or compulsively exercising. Those with bulimia nervosa often weigh within the normal limits for their age and height but intensely fear gaining weight. 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 experience a loss of control over their eating. They typically eat a lot of food in a short amount of time, even if they are not hungry, and feel intense distress or guilt afterward. But unlike bulimia, people with binge eating disorder do not 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 cannot see how much they are 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. 

Each 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. 

The cause of eating disorders is a combination of several complex factors, including genetics, brain biology, personality, cultural and social ideals, and mental health issues. Your risk is increased if you have a family history of eating disorders, another mental health disorder and a lot of stress.  

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, you may be referred to a mental health professional, who use special interviewing and assessment tools to make the diagnosis and determine the type of eating disorder. They follow the guidelines set down by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).  

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.