An eating disorder is marked by extremes. It is present when a person experiences severe disturbances in eating behavior, such as extreme reduction of food intake or extreme overeating, or feelings of extreme distress or concern about body weight or shape. A person with an eating disorder may have started 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.
Eating disorders frequently appear during adolescence or young adulthood, but some reports indicate that they can develop during childhood or later in adulthood.
Eating disorders affect cisgender women and girls, boys and men as well as genderqueer and transgender individuals. One in four preadolescent cases of anorexia occurs in cisgender boys, and binge-eating disorder affects females and males about equally. Genderqueer individuals experience a higher incidence of eating concerns relative to cisgender men and women and transgender individuals are four times as likely to experience an eating disorder.
Cisgender women and girls are much more likely than cisgender males to develop an eating disorder however, all individuals who have eating disorders experience a warped sense of body image. Boys and men in particular often have muscle dysmorphia, a type of disorder that is characterized by an extreme concern with becoming more muscular. Boys who think they are too small are at a greater risk for using steroids or other dangerous drugs to increase muscle mass. Among college age transgender individuals, approximately 14% report using diet pills and 16% report being diagnosed with an eating disorder.
Eating disorders are real, treatable medical illnesses with complex underlying psychological and biological causes. They frequently coexist with other psychiatric disorders such as depression, substance abuse, or anxiety disorders. People with eating disorders can also suffer from numerous other physical health complications, such as heart conditions or kidney failure, which can lead to death.
Anorexia Nervosa
Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense fear of gaining weight, a lack of menstruation among girls and women, and extremely disturbed eating behavior. Some people with anorexia lose weight by dieting and exercising excessively; others lose weight by self-induced vomiting, or misusing laxatives, diuretics, or enemas.
Many people with anorexia see themselves as overweight, even when they are starved or are clearly malnourished. Eating, food, and weight control become obsessions. A person with anorexia typically measures their weight repeatedly, portions food carefully, and eats only very small quantities of only certain foods.
Some who have anorexia recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic form of anorexia, in which their health deteriorates over many years as they battle the illness. According to some studies, people with anorexia are up to 10 times more likely to die as a result of their illness compared to those without the disorder. The most common complications that lead to death are cardiac arrest, and electrolyte and fluid imbalances. Suicide also can result.
Other symptoms may develop over time, including:
- thinning of the bones (osteopenia or osteoporosis)
- brittle hair and nails
- dry and yellowish skin
- growth of fine hair over body (e.g., lanugo)
- mild anemia, and muscle weakness and loss
- severe constipation
- low blood pressure, slowed breathing and pulse
- drop in internal body temperature, causing a person to feel cold all the time
- lethargy
Treating anorexia involves three components:
- Restoring the person to a healthy weight.
- Treating the psychological issues related to the eating disorder.
- Reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse.
Bulimia Nervosa
Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (i.e., binge-eating), and feeling a lack of control over the eating. This binge-eating is followed by a type of behavior that compensates for the binge, such as purging (e.g., vomiting, excessive use of laxatives or diuretics), fasting and/or excessive exercise.
Unlike anorexia, people with bulimia can fall within the normal range for their age and weight. But like people with anorexia, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly, because it is often accompanied by feelings of disgust or shame. The binging and purging cycle usually repeats several times a week.
Similar to anorexia, people with bulimia often have coexisting psychological illnesses, such as depression, anxiety and/or substance abuse problems. Many physical conditions result from the purging aspect of the illness, including electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems.
Other symptoms include:
- chronically inflamed and sore throat
- swollen glands in the neck and below the jaw
- worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids
- gastroesophageal reflux disorder
- intestinal distress and irritation from laxative abuse
- kidney problems from diuretic abuse
- severe dehydration from purging of fluids
Binge-Eating Disorder
Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over his or her eating. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise or fasting. As a result, people with binge-eating disorder often are overweight or obese. They also experience guilt, shame and/or distress about the binge eating, which can lead to more binge-eating. Obese people with binge-eating disorder often have coexisting psychological illnesses including anxiety, depression, and personality disorders. In addition, links between obesity and cardiovascular disease and hypertension are well documented.
Treatment
Psychological and medicinal treatments are effective for many eating disorders. However, in chronic cases, specific treatments have not yet been identified. In these cases, treatments are often tailored to the patient's individual needs and may include medical care and monitoring; medications; nutritional counseling; and individual, group, and/or family psychotherapy. Some patients may also need to be hospitalized to treat malnutrition or to gain weight, or for other reasons.