Eating Disorders: Symptoms, Types and Treatment
Disabled World: Revised/Updated: 2019/05/24
Synopsis: Information on eating disorders including anorexia nervosa, bulimia nervosa, binge eating, eating disorder not otherwise specified (EDNOS), and purging. It is estimated 50% of anorexics will develop bulimia nervosa and 30-40% of bulimics will develop anorexia nervosa. Many times it is difficult to differentiate between anorexia nervosa and bulimia nervosa.
What are Eating Disorders?
An eating disorder is defined as a continual disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food, significantly impairing physical health or psychological and social functioning.
Eating disorders are psychological illnesses defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa and anorexia nervosa are the most common specific forms of eating disorders. Other types of eating disorders include binge eating disorder and Other Specified Feeding or Eating Disorder (OSFED). Eating disorders are often long-term problems, which can cause immeasurable suffering for victims and their families.
Types of Eating Disorders
1. Anorexia Nervosa (AN)
Anorexia Nervosa means "loss of appetite." In reality, the person has not actually lost their appetite, but chooses to deny the hunger because of an unreasonable fear of becoming fat. If left untreated, anorexia nervosa can be fatal, with an estimated fatality rate of 6% in serious cases.
a) Restrictive Type:
Individuals with this specific type of anorexia nervosa limit the amount of food they eat, typically eliminating foods that contain fat. These individuals also tend to exercise excessively to assist in weight loss.
b) Binge Eating/Purging Type:
These individuals are first diagnosed with the restrictive type of anorexia nervosa and then begin to regularly engage in the binge eating and purging behaviors that are more commonly linked with bulimia nervosa.
Individuals with anorexia nervosa can be further categorized based on their eating behaviors.
2. Bulimia Nervosa (BN)
Bulimia Nervosa eating disorder is described by repeated episodes of binge eating, during which large amounts of food are consumed in a short period of time (sometimes as many as 20,000 calories). To be diagnosed with bulimia nervosa, binge eating needs to occur at least twice every week for a 3-month period. As a result of the repeated binge eating, the person often feels depressed and guilty.
a) Purging Type:
Individuals with this specific type of bulimia nervosa will have an episode of binge eating followed by self-induced vomiting, abuse of laxatives and/or diuretics (water-pills) to avoid gaining weight from the binge.
b) Non-Purging Type:
Individuals with this specific type of bulimia nervosa will have an episode of binge eating and then use other behaviors to offset the behavior, such as fasting or excessive exercise. Individuals with this type of bulimia nervosa do not regularly engage in self-induced vomiting or the misuse of laxatives and/or diuretics.
Individuals with bulimia nervosa can be further categorized based on their purging behaviors.
Many times it is difficult to differentiate between anorexia nervosa and bulimia nervosa. Every individual who resorts to binge eating and purging may not be classified as bulimic because of the subgroup of patients diagnosed with anorexia nervosa who may also display these behaviors. Furthermore, a large percentage of individuals may have both eating disorders at the same time. It has been estimated that 50% of anorexics will develop bulimia nervosa and that 30% to 40% of bulimics will develop anorexia nervosa.
3. Binge Eating Disorder (BED)
This eating disorder is characterized by recurrent consumption of large amounts of food without purging, fasting, or excessive exercise. The difference between binge eating disorder and non-purging type bulimia nervosa is the behavior that takes place after binge eating.
In non-purging type bulimia nervosa after binge eating the individual will try to offset their calorie consumption by fasting or excessive exercise.
In binge eating disorder the individual does nothing to offset the calorie consumption.
EDNOS, Eating disorder not otherwise specified, is described as a category disorders of eating that do not meet the criteria for any specific eating disorder.
People diagnosed with EDNOS may frequently switch between different eating patterns, or may with time fit all diagnostic criteria for anorexia or bulimia.
People who eat a normal amount of food, but become exceedingly obsessed with healthy eating, or strictly categorize normal foods or entire food groups as "safe" and "off-limits", may be referred to as having orthorexia. However, this diagnosis is not formally accepted by the psychiatric community.
What Causes Eating Disorders?
The exact cause of eating disorders is unknown; however, physical, psychological, personal, and social issues have been associated with triggering eating disorders.
The social pressure to be thin affects everyone to some extent. Society is flooded with messages on TV, in the movies, in magazines, on billboards, and on the Internet that thinness brings beauty, success, and happiness. These messages can also come from an individual's family structure, culture, and way of life. Social and cultural pressures along with a low self-esteem are thought to be the major causes for the development of anorexia nervosa and bulimia nervosa.
No one factor causes an eating disorder, but a few or a combination of factors may increase the risk.
Common psychological factors that may contribute to developing eating disorders:
A plate with 2 small sticks of celery in front of a girl hiding her face in her hands.
- fear of growing up
- inability to separate from the family
- need to please or be liked
- need to control
- need for attention
- lack of self esteem
- high family expectations
- parental dieting
- family discord
- temperament - often described as the "perfect child"
- teasing about weight and body shape
- difficulty regulating mood
- more impulsive - sometimes with shoplifting, substance abuse, etc.
- sexual abuse
family dysfunction - If individuals are at risk of developing an eating disorder, sometimes all it takes to put the ball in motion is a trigger event that the individual does not know how to handle. A trigger could be something as seemingly harmless as teasing or as devastating as rape.
Who has Eating Disorders?
Currently, it is estimated that 7 million women and 1 million men suffer from an eating disorder. Eating disorders have reached epidemic levels in America in all segments of society; however, eating disorders are most common in individuals who have a higher social or economic background. This may be due to the fact that these individuals are continually striving to achieve the social standards of thinness in order to be accepted into their chosen career or lifestyle.
Almost all (86%) anorexics and bulimics begin their eating disorder related behaviors by the age of 20; however, reports that eating disorders are occurring in children 8 to 11 years of age are on the rise. Also, adults are not immune to eating disorders. A significant number of newly diagnosed anorexics and bulimics are in their upper 20s, 30s, and 40s.
It is estimated that about 6% of persons with serious cases of eating disorders die and only 50% report being cured. Therefore, it is a debilitating disease that has consequences if it is not realized (by the individual or people around them) and treated correctly.
Risk factors are characteristics that can make you more likely to develop a condition. The risks associated with developing an eating disorder are related to the following:
- Family history of anorexia nervosa or bulimia nervosa
- Less than 20 years of age
- Female gender
- Participating in activities that focus on weight, appearance, and lean body mass (for example, ballet, modeling, gymnastics, acting, figure skating, running, diving)
- Existing psychiatric illness such as obsessive-compulsive disorder (a type of anxiety distinguished by patterns of repetitive thoughts and behaviors) or depression.
- Presence of personality traits such as being a perfectionist (having the best or expecting the best at all times) and low self-esteem.
Symptoms of Eating Disorders
- The main symptom of anorexia nervosa is self-induced starvation.
- The main symptom of bulimia nervosa is binge eating with purging.
- The main symptom of binge eating is out of control eating without purging.
These disorders may become a compulsive addiction such as alcoholism. Most patients with anorexia nervosa, bulimia nervosa, and binge eating disorder report psychological impairments (mainly depression), shame, guilt, and withdrawal from social events.
Because many people are concerned about their weight, most people diet at least once in a while; however, it may be difficult to distinguish between normal dieting behaviors and abnormal dieting behaviors that could develop into a serious eating disorder. Not every individual will show all of the characteristics listed below for anorexia nervosa and bulimia nervosa, but people with eating disorders may clearly show several of them.
Signs of Anorexia Nervosa
- Intentional self-starvation associated with weight loss
- Intense, persistent fear of gaining weight
- Refusal to eat, except tiny portions
- Pretending to eat and trying to hide that you are not eating from others
- Continuous dieting
- Excessive facial/body hair due to inadequate protein in diet (malnutrition)
- Abnormal, rapid weight loss
- Hair loss - mainly on the head
- Dry, cracked, or discolored skin
- Sensitivity to cold temperatures
- Absent or irregular menstruation.
Signs of Bulimia Nervosa
- Constantly thinking about food
- Binge eating, usually in secret
- Vomiting after binging
- Abuse of laxatives, diuretics, diet pills
- Denial of hunger
- Denial of induced vomiting
- Swollen salivary glands
Anorexia nervosa and bulimia nervosa are closely related and several characteristics of the two eating disorders often overlap.
Signs Associated with Both Anorexia Nervosa and Bulimia Nervosa
- Poor body image (constant thoughts of thinness)
- Lethargy (sluggish, inactive, or slow moving)
- Decreased concentration
- Abdominal pain
- Compulsive exercise (a person feels compelled to exercise and struggles with guilt and anxiety if she or he doesn't exercise)
If continued, the starving, binge eating, and purging can lead to irreversible physical damage and even death. Eating disorders can affect every cell, tissue, and organ in the body. The following is a list of some of the physical and medical dangers associated with anorexia nervosa and bulimia nervosa.
- Malnutrition (can lead to loss of muscle and bone density [osteoporosis] resulting in dry, brittle bones)
- Severe dehydration, which can result in kidney failure and chemical imbalances (can lead to seizures, irregular heartbeats and possibly heart failure and death)
- Tearing of the esophagus from excessive vomiting
- Chronic irregular bowel movements and constipation as a result of laxative abuse
- Potential for a ruptured stomach during periods of binge eating
- Tooth decay and gum erosion from stomach acids released during frequent vomiting
- Irregular menses or absence of menstruation
- Abnormally low blood pressure.
How are Eating Disorders Treated:
There are many factors that contribute to the development of an eating disorder, and because each individual's situation is different, the "best treatment" must be tailored for that individual. The process begins with an evaluation by a physician or psychiatrist. From there, a variety of approaches are used to treat individuals with anorexia nervosa and bulimia nervosa.
a) Nutritional Therapy:
A professional nutritionist or dietitian can help patients learn how to manage their weight effectively. Individualized guidance and a meal plan that provides a framework for meals and food choices (but not a rigid diet) are helpful for most individuals. Nutritionists can also help individuals better understand how their eating disorders can create serious medical problems.
b) Drug Therapy:
Drug therapy in the treatment of anorexia nervosa and bulimia nervosa should be used in combination with psychotherapy and nutritional therapy.
For anorexia nervosa, medications are used most frequently after weight and normal eating behaviors have been restored. Medications including certain antidepressants, anti-psychotics, and gastrointestinal stimulants are used to treat psychiatric and gastrointestinal symptoms that may coincide with eating disorders. Also calcium plus vitamin D supplementation is recommended for people with low bone mineral density (BMD) because of their high risk of developing bone loss and/or osteoporosis.
Eating Disorder Facts and Statistics
- Anorexia has the highest fatality rate of any mental illness.
- Nearly half of all Americans personally know someone with an eating disorder.
- Almost 50% of people with eating disorders meet the criteria for depression.
- It is estimated that 4% of anorexic individuals die from complications of the disease.
- It is estimated that 1.0% to 4.2% of women have suffered from anorexia in their lifetime.
- Eating disorders result in about 7,000 deaths a year as of 2010, making them the mental illnesses with the highest mortality rate.
- Up to 24 million people of all ages and genders suffer from an eating disorder (anorexia, bulimia and binge eating disorder) in the U.S.
- Only 1 in 10 men and women with eating disorders receive treatment. Only 35% of people that receive treatment for eating disorders get treatment at a specialized facility for eating disorders.
- It is estimated that up to 4% of females in the United States will have bulimia during their lifetime. 3.9% of these bulimic individuals will die. Of those practicing bulimia, only 6% obtain treatment.
- Although eating disorders are increasing all over the world among both men and women, there is evidence to suggest that it is women in the Western world who are at the highest risk of developing them and the degree of westernization increases the risk.
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