For many people, eating is a positive experience. People go out to restaurants with family members and friends to celebrate special occasions, they try new foods to experience different cultures, and they eat their favorite foods after a long day to reward themselves and relax. However, for people with eating disorders, eating is anything but a positive experience. Instead, eating is an obsession, a time of crisis, and a battle where food is the enemy.

Eating disorders are a group of illnesses characterized by an unhealthy relationship with food and one’s weight. These diseases, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder, lead to extreme behaviors regarding food and weight that affect one’s well-being. As many as 10 million females and one million males in the United States struggle with anorexia nervosa or bulimia nervosa, while millions more fight binge-eating disorder. Eating disorders can affect people of all ages, but most frequently, they affect teenagers and young adults. In fact, 86 percent of people with eating disorders report that they developed their conditions by the time they were 20 years old.

Although millions of people suffer from eating disorders, doctors do not fully understand the causes of these diseases. Fortunately, eating disorders can be treated. However, it is not always easy to know when a person has an eating disorder, so it is important to look for the warning signs.

Eating Disorders: An Overview

Eating disorders are mental health problems that can lead to serious physical problems as well. People with eating disorders often have negative feelings about their bodies and intense emotions regarding food. As a result of these feelings, people develop extreme eating habits and other habits that disrupt their normal daily activities and the normal functioning of their bodies.

People with eating disorders may have a distorted sense of reality (for example, they think that they are fat when in actuality they are very thin) and may become obsessed with their bodies and food to that point that they lose the ability to control their thoughts and behaviors. They may stop eating, exercise to the point of exhaustion, intentionally throw up after eating (purge), or overeat compulsively even when they are uncomfortably full. Because these behaviors prevent people from getting proper nutrition, they jeopardize people’s physical health and can cause problems including heart disease, digestive problems, kidney damage, and even death.

Both men and women are at risk for developing eating disorders, but these conditions are more likely to be diagnosed in women than in men for several possible reasons. For example, more women than men may seek treatment for eating disorders. Additionally, while there are several acceptable body types for men, women may be under more societal pressures to be thin. Men may also cope with their body issues in ways that are harder to detect than women’s coping methods. For instance, instead of intentionally throwing up, men may try to avoid weight gain by exercising excessively, and others may perceive them as being in good shape instead of as having an eating disorder.

Eating disorders are most likely to develop in teenagers and young adults, but they can develop in children as young as eight or in older adults as well. Teenagers are particularly vulnerable to eating disorders because as they go through puberty, their bodies change, and they may gain weight. This can be a stressful, confusing, and emotional time for teens, and some may cope with these changes by developing unhealthy eating behaviors. Also, as teens grow older, they gain more independence, and it is easier for them to make more of their own decisions regarding eating. Finally, during their teenage years, people often become very aware of societal pressure to be thin and are more easily influenced by peer pressure and their peers’ perceptions of them as well.

The characteristics, signs, and symptoms of eating disorders vary depending on the type of eating disorder. Anorexia nervosa, bulimia nervosa, and binge-eating disorder are the main types of eating disorders.

         Anorexia nervosa. People with anorexia nervosa (frequently just called anorexia) are obsessed with a desire to be thin and have an extreme fear of gaining weight. Typically, people with anorexia also have a distorted view of their body size and shape, meaning that even though they are actually very thin, they believe that they are fat.

In order to be thin and avoid gaining weight, people with anorexia use a variety of strategies, including extreme dieting, fasting, calorie counting, excessively exercising to the point of exhaustion, and taking diet pills, laxatives (drugs that induce bowel movements), or diuretics (drugs that increase the rate and frequency of urination). Their fixation on their weight also causes them to obsess over what little food they do eat. Other signs and symptoms of anorexia can include:

o   A lack of emotion

o   Social withdrawal

o   Dizziness or fainting

o   Soft, downy hair present all over the body (called lanugo)

o   Menstrual irregularities or loss of menstruation (amenorrhea) in females

o   Constipation

o   Abdominal pain

o   Dry skin

o   Frequently being cold

o   Irregular heart rhythms

o   Low blood pressure

o   Dehydration

         Bulimia nervosa. While people with anorexia are usually very thin, people with bulimia nervosa (frequently just called bulimia) are usually an average weight or even a little bit overweight. However, like people with anorexia, people with bulimia are obsessed with being thinner, fear gaining weight, and have distorted views of their bodies.

Bulimia is characterized by episodes of bingeing and purging. During a binge, a person will eat a large amount of food (often high-fat or sweet foods) in a short period of time. Then he or she will try to purge the extra calories by throwing up or taking laxatives or diuretics. People with bulimia may also exercise excessively to try to prevent any weight gain. Typically, people with bulimia will try to hide their bingeing and purging behaviors from others because they are ashamed or disgusted with themselves. People with bulimia may repeat this bingeing and purging cycle several times a week. 

People with bulimia often have several physical problems as a result of their purging behaviors, including the following:

o   Damaged teeth and gums (from stomach acid)

o   Abnormal bowel functioning

o   Sores in their throats and mouths

o   Sores or scars on their knuckles or hands

o   Chronically inflamed and sore throats

o   Electrolyte imbalances

o   Digestive problems

o   Intestinal distress and irritation from laxative abuse

o   Kidney problems from diuretic abuse

o   Severe dehydration

Other signs and symptoms of bulimia may also include the following:

o   Frequently going to the bathroom after or during meals

o   Irregular heartbeat

o   Feelings that one cannot control his or her eating behaviors

o   Menstrual irregularities or loss of menstruation (amenorrhea) in females

         Binge-eating disorder. Like people with bulimia, people with binge-eating disorder also lose control of their eating and regularly eat excessive amounts of food (binge) even when they are not hungry. Also like people with bulimia, people with binge-eating disorder may be ashamed of their eating habits. They may eat normal-sized meals when they are around others and then binge when they are alone. However, unlike people with bulimia, people with binge-eating disorder do not purge after they binge. While people with binge-eating disorder can be normal weight, they are more likely to be overweight or obese than people with bulimia.

Other signs and symptoms of binge-eating disorder can include:

o   Feeling that one’s eating behavior is out of control

o   Feeling depressed, disgusted, or upset over the amount of food eaten

Although doctors do not understand the exact causes of eating disorders, they have identified several factors that can influence a person’s likelihood to develop these conditions. These factors include:

Genetics: People with parents or siblings who have eating disorders may be more likely to develop eating disorders themselves. This leads researchers to believe that certain genes may make people more vulnerable to developing eating disorders. (Genes are pieces of DNA that are passed from mothers and fathers to their children. Genes determine a person’s traits, such as their eye and hair color and how susceptible they are to certain diseases, for example.)

Emotional Disorders: People with emotional disorders including depression, anxiety disorders, and obsessive-compulsive disorder (OCD) are more likely to have eating disorders than people who do not have these emotional disorders. There is likely a complex relationship between emotional disorders and eating disorders, and doctors have several theories regarding this relationship.

One theory is that having depression may make a person more likely to develop an eating disorder because irregular levels of serotonin (a neurotransmitter, or a chemical messenger in the brain) may cause depression, and serotonin levels also play a role in regulating appetite and signs of hunger.

Additionally, OCD may make people more likely to develop eating disorders because people with OCD develop rituals and routines based on rigid beliefs, and some of these rituals and routines may become about food and people’s bodies.

Other Psychological Issues: Other psychological issues, such as low self-esteem, perfectionism, a distorted perception of themselves, and no sense of control over their lives, may also make people more likely to develop eating disorders. These issues may result from having family members, friends, or peers who are overly-critical and tease them about their appearances, for example. When people do not feel good about themselves, want to be perfect, and/or do not see their bodies as they really are, they may go to extremes to try to improve their bodies. Also, if people lack a sense of control over their lives, they may start controlling their food intake and their exercise routines to the extreme to feel a sense of power. 

Societal Influences: Additionally, Western culture may play a part in causing eating disorders. Many models, popular movie and TV stars, athletes, and other icons are very thin. This sends the message that being thin is beautiful and may make children and teens equate being thin with being successful as well. When people do diet to lose weight, they also receive positive reinforcement for doing so. The get compliments from others about how good they look, and this may cause some people to continue dieting to an extreme.

Peer pressure and pressure from coaches and instructors can push children and teens in certain activities to develop extreme eating behaviors as well. For example, dancers, gymnasts, ice skaters, cheerleaders, and wrestlers are pressured to weigh certain amounts and to look certain ways. Trying to achieve a certain body could cause a child or teen to develop an eating disorder.

Complications

While it is healthy to watch what one eats and to exercise, people with eating disorders take these behaviors to the extreme so that they become unhealthy. The mental and emotional distress involved with constantly obsessing over food and weight can lead people with eating disorders to develop emotional problems, including depression and suicidal thoughts. However, people with eating disorders also put their bodies at risk for several physical complications.

While some of the complications of eating disorders are common among several diseases, other complications depend on the specific eating disorder a person has.

Anorexia Nervosa Complications: Anorexia causes the body to go into starvation mode. Also, because they are not consuming the proper nutrition, anorexics can experience the following physical problems as well:

o   A drop in blood pressure, pulse, and breathing rate

o   Anemia (a condition where there are not enough healthy red blood cells to carry adequate levels of oxygen to the body’s tissues)

o   Swollen joints and brittle bones

o   Bone loss

o   Dehydration

o   Stomach problems

o   Heart problems

o   Stunted growth

o   Absence of menstruation (amenorrhea)

o   Death

Bulimia Nervosa Complications: The purging behaviors and loss of nutrients associated with bulimia can cause several health problems. These complications of bulimia can include:

o   Damaged teeth and gums

o   Abnormal bowel functioning

o   Electrolyte imbalances

o   Digestive problems and damage to the stomach

o   Intestinal problems

o   Kidney problems

o   Heart problems

o   Absence of menstruation (amenorrhea)

o   Severe dehydration

o   Death

Binge-Eating Disorder Complications: Since people with binge-eating disorder consume a lot of food in a short period of time, they can face the following complications:

o   Heart disease

o   High blood pressure

o   Type 2 diabetes

o   Obesity

o   High blood cholesterol

o   Death

Fortunately, eating disorders can be treated. Individual treatment plans can be slightly different depending on which type of eating disorder a patient has, but eating disorder treatments may include the following components:

Weight Restoration and Nutrition Education: If a patient with an eating disorder is underweight or overweight, the first goal of the treatment program will be to get that person back to a healthy weight. Also, no matter what a patient’s weight, dietitians and other health care providers can help teach that patient how to have normal eating habits and how to eat a healthy, balanced diet.

Psychotherapy: There are several types of psychotherapy that may help people with eating disorders, including individual psychotherapy, group psychotherapy, and family-based therapy. Individual psychotherapy and group psychotherapy can help people with eating disorders learn how to replace their unhealthy eating and exercise habits with healthy ones. Also in individual and group psychotherapy, patients learn new ways of thinking about food and weight, develop problem-solving skills, learn healthy ways to cope with stressful situations, and learn to change their distorted perceptions of their bodies.

Family-based therapy can be helpful for children and teens with eating disorders. During this type of therapy, the entire family becomes involved in helping the child or teen follow healthy-eating guidelines and attain a healthy weight. Also, family-based therapy can help families resolve conflicts and figure out the best ways to encourage and support the person with the eating disorder.

Hospitalization: If a patient is severely malnourished, refuses to eat, or has a severe, underlying medical issue (such as heart problems, for example), doctors may recommend hospitalization. Hospitalization programs can range from day programs to intensive, long-term treatment depending on a patient’s condition.

Medications: Although medications cannot cure an eating disorder, they can help people control their urges to binge or purge and manage their obsessive thoughts about food and weight. Doctors may also prescribe medications like antidepressants and anti-anxiety drugs to help with depression or anxiety symptoms or with underlying emotional disorders.

Treatment for an eating disorder is typically more successful when the disease is less advanced. It may be difficult to know when someone has an eating disorder because he or she will likely try to hide it. Also, it may be difficult to tell when a child or teen has an eating disorder because children and teens can be picky eaters and can compare their bodies to others without having eating disorders.

Being aware of the warning signs may help someone identify an eating disorder sooner rather than later. Knowing the warning signs may also help parents and family members tell the difference between an eating disorder and normal childhood and adolescent behavior.

Having an unnatural concern about body weight or being very unhappy with one’s body (even if the person is a normal weight or is thin)

Having an obsession with eating, food, and weight control

Having an extreme fear of gaining weight

Buying or using any medications, such as diet pills, laxatives, or diuretics, to keep from gaining weight

Counting or portioning food carefully

Becoming very thin or emaciated

Weighing oneself repeatedly

Exercising excessively

Refusing to eat or lying about how much one ate

Withdrawing from social activities, particularly those where food is involved

Being depressed, lacking energy, and feeling cold a lot

Throwing up after meals or continually going straight to the bathroom after meals

Not having periods (if female)

Having calluses or scars on the knuckles (from forced throwing up)

Denying that there is anything wrong when others know that there is

Summary

Eating disorders are complex diseases that affect people emotionally and physically. There are several different types of eating disorders, but anorexia nervosa, bulimia nervosa, and binge-eating disorder are the main types.

Doctors do not know exactly what causes an eating disorder, but they believe that a variety of factors influence their development including genetics, emotional disorders and psychological issues, and societal messages and values. If eating disorders are not treated, they can cause severe complications ranging from depression to damage of the internal organs (ex. kidneys, heart, stomach, and intestines) to death. As with other diseases, seeking treatment earlier rather than later improves one’s changes for a successful recovery.

If someone feels that he or she may have an eating disorder, talk to a doctor. If family members or friends believe that a loved one has an eating disorder, it may be difficult to convince him or her that there is anything wrong. Approaching a person with a suspected eating disorder in a supportive and non-threatening way can help. If that does not work, talk to a doctor or a mental health care professional for suggestions of other approaches to use.