With all the recent news about movie stars and alleged eating disorders, it’s easy to think this is a disease of the rich and famous.
But that would be woefully inaccurate. It’s not just celebrities and there is nothing glamorous about this serious mental illness. In fact, if left untreated, eating disorders – anorexia nervosa, bulimia nervosa or another unspecified eating disorder – can be fatal.
Consider these sobering statistics from the American Journal of Psychiatry (2009) and the National Disorders Eating Association:
- Up to 24 million people in the U.S., all ages and genders, have an eating disorder
- Eating disorders have the highest mortality rate of any mental illness.
— The combined mortality rate from all causes among persons with anorexia nervosa, bulimia nervosa and other eating disorders is 70% greater than the national rate for comparable age, sex and year of occurrence.
— As a group, the suicide rate among persons with eating disorders is more than 5 times the national rate for the same age, sex and year.
- Anorexia is the single leading cause of death for women between the ages of 15 – 24, and the third most common chronic illness among adolescents
- Eating disorders do not only affect women. An estimated 10-15% of people with anorexia or bulimia are male.
- Athletes are more prone to developing an eating disorder than the rest of the population, with significantly higher rates among elite athletes.
- Eating disorders can cause depression and other mental illnesses. Lack of food and proper nutrition reduces serotonin and endorphins in the brain.
Eating disorders can be found across the socioeconomic spectrum and are colorblind. They involve self-critical, negative thoughts and feelings about body image. Eating habits then become unhealthy and affect physical and emotional well-being. Onset often begins with adolescence, but can it can start even younger. The way media and culture glorify the very thin is absolutely part of the problem.
More than one-third of persons with an eating disorder begin with normal dieting and progress to pathological behavior. Indeed, over one-half of teenage girls and nearly one-third of teenage boys use some form of unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (although not necessarily to the point of becoming an eating disorder). And while eating disorders are a global epidemic, they are more prevalent in the U.S.
What is an Eating Disorder?
Eating disorders are characterized by a persistent pattern of dysfunctional eating or dieting behavior. These patterns of eating behavior are associated with significant emotional, physical, and interpersonal distress.It can be difficult to delineate between normal differences in eating patterns and actual eating disorders. The links on this page provide a basic overview of eating disorders, their treatment and associated issues.Please note that although most individuals with eating disorders are female, the criteria and descriptions also apply to the 5-10 percent of individuals with these disorders who are male. (Academy for Eating Disorders)
Individuals with anorexia nervosa are unable or unwilling to maintain a body weight that is normal or expected for their age and height. There is no precise boundary dividing “normal” from “too low”, but most clinicians use 85% of normal weight as a reasonable guide.
Individuals with anorexia nervosa usually display a pronounced fear of weight gain and a dread of becoming fat even though they are markedly underweight. Concerns about their weight and about how they believe they look have a powerful influence on the individual’s self-evaluation. The seriousness of the weight loss and its health implications is usually minimized, if not denied, by the individual.
The diagnosis of anorexia nervosa includes two subtypes of the disorder that describe two behavioral patterns. Individuals with the restricting type maintain their low body weight purely by restricting food intake and, possibly, by exercise. Individuals with the binge-eating/purging type usually restrict their food intake as well, but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics or enemas.
Available data indicate that the binge-eating/purging type of anorexia nervosa is more frequently associated with other impulsive behaviors, substance use disorders and mood lability. The longer a person has anorexia nervosa, the more likely they are to binge and purge. (Academy for Eating Disorders–Anorexia Nervosa)
Individuals with bulimia nervosa regularly engage in discrete periods of overeating, which are followed by attempts to compensate for overeating and to avoid weight gain. There can be considerable variation in the nature of the overeating but the typical episode of overeating involves the consumption of an amount of food that would be considered excessive in normal circumstances. The individual’s subjective experience is dominated by a sense of a lack of control over the eating.
Binge eating is followed by attempts to “undo” the consequences of eating too much though behaviors such as self-induced vomiting, misuse of laxatives, enemas, diuretics, severe caloric restriction, or excessive exercising. Profound concerns about weight and shape are also characteristic of individuals with bulimia nervosa. Self-evaluation is centered on the individual’s perceptions of her body image. (Academy for Eating Disorders–Bulimia Nervosa)
Diagnosing Bulimia Nervosa
The formal diagnosis of bulimia nervosa requires that the individual not simultaneously meet criteria for anorexia nervosa. In other words, if an individual simultaneously meets criteria for both anorexia nervosa and bulimia nervosa, only the diagnosis of anorexia nervosa, binge-eating/purging type is given.
The bulimia nervosa diagnostic criteria also specify minimum frequency and duration cut-offs for the diagnosis: individuals must binge eat and engage in inappropriate compensatory behavior at least twice weekly for at least three months.
As with anorexia nervosa, there are two subtypes of bulimia nervosa. The purging type describes individuals who regularly compensate for the binge eating with self-induced vomiting or through the use of laxatives, diuretics, or enemas. The non-purging type is used to describe individuals who compensate through excessive exercising or dietary fasting. (Academy for Eating Disorders–Diagnosing Bulimia Nervosa)
Binge Eating Disorder
The term, binge eating disorder, was officially introduced in 1992 to describe individuals who binge eat but do not regularly use inappropriate compensatory weight control behaviors such as fasting or purging to lose weight.
The binge eating may involve rapid consumption of food with a sense of loss of control, uncomfortable fullness after eating, and eating large amounts of food when not hungry. Feelings of shame and embarrassment are prominent. (Academy for Eating Disorders–Binge Eating Disorder)
Binge Eating and Obesity
Binge eating disorder is often associated with obesity. In the past these individuals were often referred to as compulsive overeaters, emotional overeaters, or food addicts. Available research suggests that approximately one fifth of the people who seek professional treatment for obesity meet the criteria for binge eating disorder.
In the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM- IV-TR), binge eating disorder is not an officially recognized eating disorder, but is included in the category titled Eating Disorder Not Otherwise Specified (EDNOS). (Academy for Eating Disorders–Binge Eating and Obesity)
Other Eating Disorders
There are numerous variants of disordered eating in addition to binge eating disorder that do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa, but nevertheless are eating disorders requiring treatment. Individuals with eating disordered behaviors that resemble anorexia nervosa or bulimia nervosa but whose eating behaviors do not meet one or more essential diagnostic criteria may be diagnosed with EDNOS.
Examples of EDNOS include individuals who regularly purge but do not binge eat, individuals who meet criteria for anorexia nervosa but continue to menstruate, and individuals who meet criteria for bulimia nervosa, but binge eat less than twice weekly. (Academy for Eating Disorders–Other Eating Disorders)
Risk Factors of Eating Disorders
A wide variety of factors have been considered important in the onset of eating disorders. Scientific studies of many of these factors have been inconclusive in verifying that they do indeed increase the risk of eating disorders.
Gender and Ethnicity
However, recently there have been some careful reviews of this literature and several risk factors have in fact been identified. One of the most potent risk factors is female gender, particularly adolescent or young adult females. Also, members of certain ethnic groups such as Asians, Native Americans, and African Americans appear less likely to have eating disorders than other ethnic groups.
Weight and Shape
Several factors focusing on weight or shape have been found to increase risk for eating disorders, including higher body mass index, concerns about weight, and a history of dieting. Also, a history of psychiatric problems, such as depression, anxiety, or substance use may increase the risk of eating disorders, as well as certain problems in childhood such as childhood eating difficulties or sexual abuse.
Recently there has been considerable interest in both genetic and biological factors which may contribute to the onset of eating disorders. For both anorexia nervosa and bulimia nervosa, behavioral genetic studies using twin designs have indicated that there is a substantial genetic effect for the liability for each of these disorders.
Researchers are now examining genetic influences by searching for genes, and some gene candidates have been found to be associated with anorexia nervosa and bulimia nervosa, although this research remains relatively inconclusive in terms of genetic effects. There are also numerous studies indicating that certain brain chemicals, such as serotonin, may be abnormal in eating disordered individuals.
Continued research on the genetics and biological function of people with eating disorders may reveal additional factors which increase the risk for these conditions.(Academy for Eating Disorders–Risk Factors)
Consequences of Eating Disorders
Eating disorders can have a profoundly negative impact on an individual’s quality of life. Self-image, interpersonal relationships, financial status, and job performance are often negatively affected. The extent to which these problems are an inherent part of the disorders or are secondary to it is unclear. The range of the negative effects does, however, highlight the critical importance of treatment.Eating disorders are also associated with high rates of other co-existing psychiatric disorders, particularly mood disorders, and anxiety disorders. Bulimia nervosa may be particularly associated with alcohol and/or drug abuse problems.
Semi-starvation in anorexia nervosa can affect most organ systems. Physical signs and symptoms (in addition to the lack of menstrual periods in women) can include constipation, cold intolerance, abnormally low heart rate, abdominal distress, dryness of skin, hypotension, and fine body hair (lanugo). Anorexia nervosa causes anemia, kidney dysfunction, cardiovascular problems, changes in brain structure, and osteoporosis (i.e., inadequate bone calcium).
Self-induced vomiting seen in both anorexia nervosa and bulimia nervosa can lead to swelling of salivary glands, electrolyte and mineral disturbances, and dental enamel erosion. Use of ipecac to induce vomiting can lead to extreme muscle weakness, including heart muscle weakness. Laxative abuse can lead to long lasting disruptions of normal bowel functioning. Rarer complications are tearing the esophagus, rupturing of the stomach, and life-threatening irregularities of the heart rhythm.
For more information about Eating Disorders, please visit the Academy of Eating Disorders.
Warning Signs of Anorexia and Anorexia With BulimiaYour son or daughter is clearly loosing weight but will look in the mirror and see themselves as fat. Their brain is sending distorted messages. Here are red flags that you can watch for:
- Skipping breakfast saying they will eat at school (where you can’t see what they eat)
- Coming home and saying they are not hungry because they ate at school
- Hiding their body behind baggy clothing so you cannot see how they look
- Wearing seasonally inappropriate clothing to hide their body
- Developing rituals around eating
— Not wanting foods on the plate to touch each other
— Cutting food into tiny pieces so it looks like they are eating a lot– Playing with food on the plate to appear to be eating
- Choosing only “safe foods” to eat like fruit and vegetables
— Becoming vegan or vegetarian to avoid what everyone else is eating
— Claiming to be lactose or gluten intolerant to avoid foods
- Messing up the kitchen so it looks like they ate
- Hiding food in napkins or pockets
- Wanting to eat upstairs in the bedroom or in any room away from you
- Over-exercising or developing an exercise obsession to stay thin
- Drinking excessive amounts of water, particularly before being weighed
- Swollen or “chipmunk cheeks” from throwing up (the parotid gland becomes inflamed)
- Frequent trips to the bathroom to purge
- Showering after meals to hide vomit
Prevention and Management Tips – Eat Meals TogetherThe best way to prevent an eating disorder, or spot one that is developing, is to engage with your child. A strong relationship affirms their positive self-image and lets them know you care. Take the time for any issues to unfold in a natural, unhurried way.Having meals together is a good way to start.Sit with them at breakfast and talk about the day ahead. Dinner together is the best way to cap the day. Turn off the TV. Actively listen. It doesn’t really matter what you talk about, as long as you interact. Tell them about your day and how you have handled any issues. Let them see you eat normally.Eating regular dinners together will also allow you to spot any warning signs or destructive eating patterns. Are they cutting food into tiny pieces or running to the bathroom? When you clear the table, is food in the napkins? Do they eat incredibly fast, shoving food into their mouth?If you suspect your child has an eating disorder, seek help immediately. Talk to their pediatrician. Ask for a referral to a therapist or psychiatrist. No matter how much you may want to, do not put your child on a scale or discuss their weight with them. They will shutdown. Leave the weight discussion to professional therapists.
Many parents are in denial, but the stakes are too high. More information, including toolkits for parents, teachers and coaches can be found one the website for the National Disorders Eating Association. A list of books about eating disorders from our Patient Library is also available on the Silver Hill Hospital Facebook page.
(Source: Kathy Fitzgerald, Licensed Professional Counselor, Eating Disorder Therapist, Silver Hill Hospital)