Eating Disorders

Anorexia | Bulimia | Binge Eating

For someone with an eating disorder, food can become a deadly obsession. In fact, according to the National Institute of Mental Health (NIMH), eating disorders have one of the highest mortality rates of all mental disorders. (Read about "Mental Health") Although there are several kinds of eating disorders, such as anorexia, bulimia and binge eating, people with such disorders tend to share some of the same personality traits. NIMH says that these include:

• low self-esteem
• feelings of helplessness
• fear of becoming fat

These feelings create anxiety. Eating and/or dieting can become the way to cope with this anxiety, as well as other daily stresses. (Read about "Anxiety" "Stress" "Job Stress") Eating disorders can also be triggered by comments about a person's weight, for example, a coach who remarks about an athlete's weight. The American College of Sports Medicine says that while eating disorders are more common in women, they can also occur in men. Eating disoders can start at an early age (Read about "Childhood Weight Issues"), or they can begin later in life.

Anorexia

Anorexia or anorexia nervosa is self-imposed starvation, with an obsessive desire to be thin. This desire is often accompanied by a highly distorted body image. In other words, dieting and exercising continue even as the anorexic's weight drops well below the norm. NIMH says anorexics frequently think they are fat despite all evidence to the contrary. Warning signs include:

• dramatic weight loss
• efforts to hide the weight loss from friends or family
• preoccupation with food in spite of the anorexic's refusal to eat
• excessive exercise to burn calories
• irregular or stopped menstrual periods (Read about "Menstrual Disorders")
• mood swings

The American Academy of Family Physicians (AAFP) says no one knows why anorexia develops. Often, according to AAFP, anorexics are high achievers. If they're in school, they're often good students, involved in multiple school activities. They tend to be perfectionists.

Although excessive thinness is the most outstanding characteristic of anorexia, AAFP says the disorder is about more than food or weight; it's about control. The anorexic is using food and weight as a way of coping with emotional issues and gaining a sense of control in at least one aspect of their lives. Treatment therefore needs to address both the physical and psychological needs of the person, and may require a team of medical, nutritional and mental health professionals. Depending on the duration of the disorder and the amount of weight lost, hospitalization may be required as well.

See treatment options below.

Binge Eating

Binge eating disorder is probably the most common eating disorder, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), affecting as many as 4 million Americans. Most people with this problem are either overweight or obese (Read about "Obesity"), but normal-weight people also can have the disorder. Binge eaters eat huge quantities of food; as a result, their weight often rises quickly. This can be followed by periods of strict dieting, leading to repeated up-and-down weight changes (so-called yo-yo syndrome) that are very stressful to the body.

No one knows for sure what causes binge eating disorder. Binge eaters may turn to food in response to anxiety. (Read about "Anxiety") NIDDK says as many as half of all people with binge eating disorder have also been depressed in the past. (Read about "Depressive Illnesses") Whether depression causes binge eating disorder or whether binge eating disorder causes depression is not known.

When binge eating leads to obesity, serious health problems can result, including diabetes, heart disease, hypertension, high cholesterol and gallbladder disease. (Read about "Diabetes" "Coronary Heart Disease" "Hypertension: High Blood Pressure" "Cholesterol" "Gallstones") Although losing weight can reduce the risk of these health problems, NIDDK says people with binge eating disorder may find it hard to stay in a weight-loss program and may need treatment for their eating disorder before they try to lose weight.

See treatment options below.

Bulimia

Bulimia or bulimia nervosa refers to binge eating that is followed by attempts to rid the body of the excess calories. This can be done through fasting and/or strenuous exercise. It can also be done through purging, which includes using laxatives or vomiting. The National Women's Health Information Center (NWHIC) says the cycle of overeating and purging can quickly become an addictive behavior. (Read about "Addiction")

According to the American Anorexic Bulimia Association (AABA), bulimics are often a normal weight. Like the anorexic, however, they can have a distorted body image and may see themselves as fat. During an episode in which they binge, they may eat huge quantities of food, for example cartons of ice cream or an entire loaf of bread. The binge eating is often done in secret. It is usually then followed by a trip to the bathroom to throw up or take large amounts of laxatives, or the person may fast for a day or longer, or they may exercise for an hour or more.

NWHIC says warning signs of bulimia can include:

• the disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food
• frequent trips to the bathroom after meals
• excessive, rigid exercise regimen
• calluses on the back of the hands and knuckles from self-induced vomiting
• withdrawal from friends and activities

The repeated episodes of vomiting and laxative use often associated with bulimia can also cause severe throat and stomach irritation, bowel disorders (Read about "Digestive System"), swollen salivary glands in the cheeks, tooth enamel erosion (Read about "Oral Health") and breaks in the small blood vessels around the eyes. (Read about "The Eye")

The treatment of bulimia needs to address both the physical and psychological needs of the person, and is often undertaken by a team of medical, nutritional and mental health professionals.

See treatment options below.

Treatment Options

AABA says eating disorders can have grave consequences. As an anorexic's weight drops to dangerously low levels, complications can include electrolyte imbalance, as well as damage to the heart and kidneys, and heart irregularities. (Read about "Arrhythmia") In bulimics, the repeated use of laxatives and/or vomiting also creates severe complications, such as tooth decay (Read about "Oral Health") and damage to the esophagus and/or digestive tract. (Read about "Digestive System") In binge eaters, the constant weight gain and loss is highly stressful to the body. Even if there are no apparent weight concerns, an untreated eating disorder can get worse over time.

Because of the potential dangers, NIDDK says it's essential that someone with an eating disorder get help, either from a health professional such as a psychiatrist or psychologist, or a clinical social worker. Although getting help is essential, often someone with an eating disorder is in denial about the problem. In such cases, family members or friends may need to intervene.

According to the American Psychological Association (APA), a psychologist can help a patient replace destructive thoughts and behaviors with more positive ones, focusing on health, for example, rather than weight. A patient must also explore the psychological issues underlying their eating disorder. Sometimes a combination of therapies is needed.

• Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations.
• Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas.
• Dialectical behavior therapy combines different forms of therapy, to help people deal with underlying emotions, stress and relationship issues that may contribute to their eating disorder.

Family or marital therapy may be needed. Group therapy may be helpful.

Medications may also be needed. NIDDK says drug therapy, such as antidepressants, may be useful for some people. APA says that some patients, especially those with bulimia, may benefit from medication if it's used in combination with psychotherapy, not as a replacement for it. Types of medications include:

• Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be helpful for some people. Make sure you talk with your doctor about potential side effects of medications for depression. (Read about "Depressive Illnesses")
• Anti-anxiety medications may help people whose eating disorder is tied to anxiety issues. (Read about "Anxiety")
• Medications that control seizures may be used in some cases of binge eating. (Read about "Seizures")
• Anti-obesity drugs may be used if a binge eater is also obese and needs to lose weight. A medically supervised weight loss program may also help in such cases.

Make sure you talk to your doctor about what to expect with any medication, and learn about possible complications and side effects (Read about "Medicine Safety")

Whatever form of treatment is used, APA says the chances for success are highest if started early, before the eating disorder becomes a deeply ingrained way of life. If you or someone you know has this type of disorder, contact a healthcare professional as soon as possible.