Eating Disorders: Anorexia, Bulimia and Binge-Eating Disorder

Eating DisordersWhat is an Eating Disorder?

An eating disorder is a serious illness that can have devastating and life-threatening consequences. Eating disorders are characterized by a poor relationship with food and negative self-image. They are associated with unhealthy harmful behaviors. Having an eating disorder can significantly interfere with daily functioning. As symptoms progress, they can translate into difficulties in interpersonal relationships, school settings, or professional performance.

There are three categories of eating disorders:

Anorexia Nervosa

People with anorexia have a body weight that is below the normal level. This is achieved through a dramatically reduced caloric intake. Nutritional levels are drastically restricted in an effort to lose weight. Anorexia is accompanied by an often severely distorted body image. Individuals who suffer with anorexia often believe they are morbidly obese despite being dangerously thin. Anorexia Nervosa has the highest mortality rate of any psychiatric disorder.

Bulimia Nervosa

Bulimia is defined by frequent and recurrent episodes of consuming large quantities of food followed by “purging,” or unhealthy compensatory behaviors. These can include behaviors such as vomiting or using laxatives. Individuals with bulimia typically feel a lack of control over these episodes. People with bulimia usually maintain a normal body weight, and may even be slightly overweight. Similar to those with anorexia, people with bulimia have an unhealthy self-image. They desperately want to lose weight and are extremely unhappy with the size and shape of their bodies.

Binge-Eating Disorder

Like bulimia, binge-eating disorder is indicated by episodes of eating large amounts of food. Unlike bulimia, however, no episodes of purging follow the binging. As a result, individuals are typically overweight or obese. People who binge-eat do not feel like they have control over these episodes and feel a great amount of distress related to their behavior. Shame and guilt play an important role in this and other eating disorders.

Who Can Develop an Eating Disorder?

Studies show, in the the United States, about 20 million women and 10 million men suffer from a clinically diagnosable eating disorder at some point in their lives. The actual numbers are likely to be higher because, for various reasons, many cases go unreported.

About 3% of American 13-18 year olds struggle with an eating disorder during their lifetimes. Estimates also indicate that 0.1% of 8-15 year olds deal with eating disorders. Among adolescents, eating disorders are often linked to impaired functionality and suicidal ideation. Surprisingly, in the adolescent population, there is not a significantly higher percentage of girls than boys with an eating disorder.

The prevalence of eating disorders in the United States is the same among Non-Hispanic Whites, African-Americans, Hispanics, and Asians, except for anorexia nervosa which is more common in Non-Hispanic Whites.

Body dissatisfaction is often cited as the prominent contributor in the development of eating disorders, particularly anorexia nervosa and bulimia nervosa. Individuals with eating disorders often experience co-occurring psychiatric conditions that may make treatment a more difficult process. Alcohol and other substance-abuse disorders are 4 times more common in those who suffer from an eating disorder than in the general population. Depression and anxiety also present quite frequently.

What are the Symptoms of an Eating Disorder?

Anorexia Nervosa

Caloric restriction resulting in significantly low body weight Excessive fear of gaining weight, becoming fat, or the presence of behaviors that persistently prevent weight gain, despite being at a significantly low body weight Unhealthy self-perception related to one’s body-weight or shape Unjustified influence of body-weight and shape on self-concept/evaluation Continuous lack of recognition of the seriousness of current low body weight

There are two subtypes of Anorexia Nervosa:

1. Restricting Type: The current episode of anorexia is considered restricting if the individual has not regularly engaged in binge-eating or purging behavior.

2. Binge-Eating/Purging Type: The current episode of anorexia is considered the binge-eating/purging type if the individual has engaged in these behaviors.

Bulimia Nervosa

Recurring episodes of binge-eating that are characterized by both: Eating a significantly larger amount of food than most people would in any given period of time A sense of lack of control over these episodes of eating Recurrent inappropriate compensatory behavior, commonly referred to as “purging,” such as self-induced vomiting, improper use of laxatives, diuretics, or other medications, fasting, or excessive exercise Binge-eating and compensatory behaviors both occur, on average, at least once a week for 3 months Unjustified influence of body-weight and shape on self-concept/evaluation These conditions do not occur exclusively during episodes of Anorexia Nervosa

Binge-Eating Disorder

Recurring episodes of binge-eating that are characterized by both: Eating a significantly larger amount of food than most people would in any given period of time A sense of a lack of control over these episodes: feeling like you cannot stop eating or control what or how much you are eating These binge-eating episodes are associated with at least three of the following: Eating more rapidly than usual Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of embarrassment of quantity of food Feeling disgusted with oneself, depressed, shame, or guilt after overeating Experiencing significant distress about binge-eating behavior No inappropriate compensatory behavior follow an episode of binge-eating These episodes occur, on average, at least 2 days a week for 6 months

Eating Disorders and Health Concerns

As these cycles of significant under-eating and over-eating progress, they tend to take their physical toll on the body. Each eating disorder can result in its own set of health consequences.

Anorexia Nervosa

With Anorexia Nervosa, the body does not receive essential nutrients needed for proper functioning. To conserve energy, the body begins to slow down its processes. Resulting effects include:

Osteoporosis (reduced bone density): dry, brittle bones Slower heart rate/lowered blood-pressure: as these levels decrease, the risk for heart failure increases Dry skin and hair, hair loss Muscle loss and weakness Severe dehydration Kidney failure In women, amenorrhea or disturbances in menstrual cycle

Bulimia Nervosa

The entire digestive system is significantly affected by the recurrent binge-and-purge cycle that is prevalent in bulimia nervosa. The can also lead to:

Imbalances in electrolyte levels that can lead to an irregular heartbeat, and potentially to heart failure and death Binge episodes may lead to gastric rupture Frequent vomiting may result in inflammation and/or rupture of the esophagus Tooth decay/staining Irregular bowel movements/constipation Pancreatitis Peptic ulcers

Binge-Eating Disorder

The recurring episodes of excessive over-eating that characterize binge-eating disorder can result in significant health concerns including:

  1. Heart disease
  2. Elevated blood pressure
  3. High cholesterol levels
  4. Diabetes Gallbladder complications
  5. Treatment for Eating Disorders

Recovering from eating disorders is possible, particularly with early intervention. The cornerstone of treatment includes adequate nutrition, ceasing excessive exercise, and stopping binge-and-purge behaviors. Psychotherapy and medication have been shown to be effective in treating eating disorders.

Treatment for Anorexia Nervosa

Many of the complications that occur with anorexia nervosa can be reversible with proper treatment that focuses on restoring individuals to a healthy weight. Hospitlization may be necessary for those who are severely malnourished.

Different forms of psychotherapy including Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) can be implemented to challenge and ultimately change associated harmful thoughts and behaviors. Psychotherapy is also effective in treating related psychological issues. Antidepressants, mood stabilizers, and antipsychotics have been shown to be modestly effective in treating anorexia nervosa. Using psychotherapy and medication in conjunction has shown to be the most effective treatment,

Treatment for Bulimia Nervosa

Treatment for Bulimia Nervosa is similar to that of Anorexia Nervosa in that a combination of options is ideal. Treatment plans are usually individualized based on an individual’s history and patterns of behavior. Nutritional psycho-education and psychotherapy (individual or group-based) are commonly used to help change negative attitudes and beliefs. Medications, particularly antidepressants, can be effective in treating depression and anxiety that often co-occurs with bulimia nervosa.

Treatment for Binge-Eating Behavior

Treating Binge-Eating Disorder follows a similar plan for that of Bulimia Nervosa. Psychotherapy, particularly individualized CBT, has been shown to be effective in treating thoughts and behaviors related to binge-eating. Therapy is available for individuals and groups. Antidepressants may decrease binge-eating behavior and possibly reduce associated depression and anxiety.


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