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What You Need to Know About Eating Disorders

Eating Disorder, a publication of the National Institute of Mental Health, recognizes that the condition is marked by extremes. An eating disorder is present when a person experiences severe disturbances in eating behavior, such as extreme reduction of food intake, extreme overeating or feelings of extreme distress or concern about body weight or shape.

Someone with an eating disorder may have started out just eating smaller or larger amounts of food than usual, but at some point, the urge to eat less or more spirals out of control. Eating disorders are very complex and, despite scientific research to understand them, the biological, behavioral and social underpinnings of these illnesses remain elusive.

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Primary Eating Disorders

The types of eating disorders people are most familiar with are anorexia nervosa, bulimia nervosa and binge-eating disorder, which has received increasing research, media attention and, as of 2013, its own diagnosis. Another category is “eating disorders not otherwise specified (EDNOS),” which includes several variations similar to anorexia or bulimia but with slightly different characteristics.

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The Diagnostic and Statistics Manual of Mental Disorders 5th Edition (DSM V) brought some welcome changes to the section describing eating disorders. Recognizing the large number of people struggling with symptoms that did not fit into the criteria for anorexia, bulimia or binge eating disorder, the DSM V strives to be more inclusive to ensure that more people are able to receive the treatment they need and deserve.

The DSM V added Avoidant Restrictive Feeding and Eating Disorder (ARFID), PICA, Rumination Disorder, Other Specified Feeding or Eating Disorder (OSFED) (for example: purging disorder, low intensity bulimia, atypical anorexia) and Unspecified Feeding or Eating Disorder (UFED).

Who’s Likely to Have an Eating Disorder?

Eating disorders frequently appear during adolescence or young adulthood, but some reports indicate they can develop during childhood or even much later in adulthood. Women and girls are much more likely than males to develop an eating disorder. Men and boys account for an estimated 5 to 15 percent of patients with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder.

Treatment Helps

Eating disorders are real, treatable medical illnesses with complex underlying psychological and biological causes. They frequently co-exist with other psychiatric disorders such as depression, substance abuse or anxiety disorders. People with eating disorders also may display many other physical health complications, including heart conditions or kidney failure, which can lead to death.

Anorexia Nervosa is a potentially life-threatening eating disorder characterized by a relentless pursuit of thinness and an unwillingness to maintain a healthy body weight. Those with the disorder have a distorted body image, often seeing themselves as overweight, even if starved. Main features of the disease are:

  • Inability to maintain a normal body weight
  • Intense fear of gaining weight
  • Obsession with food
  • Distorted view of one’s own body

These attitudes and behaviors can be seen with or without purging behaviors (self-induced vomiting, laxative abuse, diuretic abuse or over-exercising). With both physical and psychological consequences, anorexia nervosa is best treated by a multispecialty medical team.

People with anorexia often have low self-esteem, anxiety and depression, and use an obsessive control of their own diet and weight as a method of controlling their surroundings and their emotions.

Signs and Symptoms of Anorexia Nervosa

  • Intense fear of weight gain
  • Intense preoccupation with food and weight
  • Constipation
  • Intolerance to cold
  • Distorted body image
  • Unusual eating behaviors, such as slow pace, or substitutive behaviors to replace eating (gum chewing)
  • Compulsive or excessive exercise
  • Lanugo—a fine growth of hair on the face/chest
  • Brittle hair or nails or hair loss
  • Yellow skin color
  • Bradycardia—slow heart rate (less than 60 beats per minute)
  • Dizziness or fainting after standing
  • Depression and/or social isolation

Bulimia Nervosa is a potentially life-threatening eating disorder characterized by frequent episodes of eating unusually large amounts of food and feeling a lack of control around eating, followed by behaviors that compensate for the binge, such as purging, fasting or excessive exercise.

Like anorexia, those with bulimia may have a distorted body image or fear of weight gain. With both physical and psychological consequences, bulimia nervosa is best treated by a multispecialty treatment team.

People with bulimia often have low self-esteem, anxiety and depression and use binging and purging behaviors as a way to cope with these issues.

Signs and Symptoms of Bulimia Nervosa

  • Recurrent episodes of binge eating
  • Self-induced vomiting, laxative, diuretic or diet pill use
  • Skipping some meals and overeating at others
  • Secretive behavior around food and eating
  • Compulsive or excessive exercise
  • Obsession with food and activities and information related to food (grocery shopping, baking, cookbooks, food magazines)
  • Mouth, teeth, gum and throat problems (cavities, ulcers, disease)
  • GERD (acid reflux)
  • Constipation/diarrhea
  • Irregular menstrual periods
  • Decreased ability to focus or concentrate
  • Depression or mood swings