Eating disorders

Signs and symptoms

Causes

Risk factors

Medical advice

Diagnosis

Complications

Treatment

Prevention

Selfcare

Coping skills

Eating disorders are a broad group of serious conditions in which you’re so preoccupied with food and weight that you can often focus on little else. The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder, and there are also many subtypes.

Most people with eating disorders are females, but males also have eating disorders. The exception is binge-eating disorder, which appears to affect almost as many males as females.

Treatments for eating disorders usually involve psychotherapy, nutrition education, family counseling, medications and hospitalization.

Signs and symptoms

The signs and symptoms of eating disorders vary with the particular type of eating disorder.

Anorexia nervosa

When you have anorexia nervosa (an-o-REK-se-uh nur-VOH-suh), you’re obsessed with food and being thin, sometimes to the point of deadly self-starvation. You may exercise excessively or simply not eat enough calories.

Anorexia symptoms may include:

  • Thin appearance
  • Abnormal blood counts
  • Fatigue
  • Dizziness or fainting
  • Brittle nails
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Menstrual irregularities or loss of menstruation (amenorrhea)
  • Constipation
  • Dry skin
  • Frequently being cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Bone loss

Emotional and behavioral symptoms of anorexia may include:

  • Refusal to eat
  • Denial of hunger
  • Excessive exercise
  • Flat mood or lack of emotion
  • Difficulty concentrating
  • Preoccupation with food

Red flags that family and friends may notice include:

  • Skipping meals
  • Making excuses for not eating
  • Eating only a few certain “safe” foods, usually those low in fat and calories
  • Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
  • Weighing food
  • Cooking elaborate meals for others but refusing to eat them themselves
  • Repeated weighing of themselves
  • Frequent checking in the mirror for perceived flaws
  • Wearing baggy or layered clothing
  • Complaining about being fat

Bulimia nervosa

When you have bulimia, you have episodes of bingeing and purging. During these episodes, you typically eat a large amount of food in a short amount of time and then try to rid yourself of the extra calories by vomiting or excessive exercise. In between these binge-purge episodes, you may eat very little or skip meals altogether. You may be a normal weight or even a bit overweight.

Bulimia symptoms may include:

  • Abnormal bowel functioning
  • Damaged teeth and gums
  • Swollen salivary glands in the cheeks
  • Sores in the throat and mouth
  • Bloating
  • Dehydration
  • Fatigue
  • Dry skin
  • Irregular heartbeat
  • Sores, scars or calluses on the knuckles or hands
  • Menstrual irregularities or loss of menstruation (amenorrhea)

Emotional and behavioral symptoms of bulimia may include:

  • Constant dieting
  • Feeling that you can’t control your eating behavior
  • Eating until the point of discomfort or pain
  • Self-induced vomiting
  • Laxative use
  • Excessive exercise
  • Unhealthy focus on body shape and weight
  • Having a distorted, excessively negative body image
  • Going to the bathroom after eating or during meals
  • Hoarding food
  • Depression or anxiety

Binge-eating disorder

When you have binge-eating disorder, you regularly eat excessive amounts of food (binge), sometimes for hours on end. You may eat when you’re not hungry and continue eating even long after you’re uncomfortably full. After a binge, you may try to diet or eat normal meals, triggering a new round of bingeing. You may be a normal weight, overweight or obese.

Emotional and behavioral symptoms of binge-eating disorder may include:

  • Eating to the point of discomfort or pain
  • Eating much more food during a binge episode than during a normal meal or snack
  • Eating faster during binge episodes
  • Feeling that your eating behavior is out of control
  • Frequent dieting without weight loss
  • Frequently eating alone
  • Hoarding food
  • Hiding empty food containers
  • Feeling depressed, disgusted or upset over the amount eaten
  • Depression or anxiety

Eating disorders in youngsters

Eating disorders can affect people of any age. In children, it’s sometimes hard to tell what’s an eating disorder and what’s simply a whim, a new fad, or experimentation with a vegetarian diet or other eating styles. In addition, many girls and sometimes boys go on diets to lose weight, but stop dieting after a short time. If you’re a parent or guardian, be careful not to mistake occasional dieting with an eating disorder. On the other hand, be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders.

Causes

It’s not known with certainty what causes eating disorders. As with other mental illnesses, the possible causes are complex and may result from an interaction of biological, psychological, family, genetic, environmental and social factors. Possible causes of eating disorders include:

  • Biology. Some people may be genetically vulnerable to developing eating disorders. Some studies show that people with biological siblings or parents with an eating disorder may develop one too, suggesting a possible genetic link. In addition, there’s some evidence that serotonin, a naturally occurring brain chemical, may influence eating behaviors because of its connection to the regulation of food intake.
  • Psychological and emotional health. People with eating disorders may have psychological and emotional characteristics that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior, anger management difficulties, family conflicts and troubled relationships, for instance.
  • Sociocultural issues. The modern Western cultural environment often cultivates and reinforces a desire for thinness. Success and worth are often equated with being thin. The media and entertainment industries often focus on appearance and body shape. Peer pressure may fuel this desire to be thin, particularly among young girls.

Risk factors

Certain situations and events might increase the risk of developing an eating disorder. These risk factors may include:

  • Gender. Teenage girls and young women are more likely than teenage boys and young men to have eating disorders.
  • Age. Although eating disorders can occur across a broad age range — from preadolescents to older adults — they are much more common during the teens and early 20s.
  • Family influences. People who feel less secure in their families, whose parents and siblings may be overly critical, or whose families tease them about their appearance are at higher risk of eating disorders.
  • Emotional disorders. People with depression, anxiety disorders and obsessive-compulsive disorder are more likely to have an eating disorder.
  • Dieting. People who lose weight are often reinforced by positive comments from others and by their changing appearance. This dieting may be taken too far and lead to an eating disorder.
  • Transitions. Whether it’s heading off to college, moving, landing a new job or a relationship breakup, change can bring emotional distress. One way to cope, especially in situations that may be out of someone’s control, is to latch on to something that they can control, such as their eating patterns, which can eventually lead to an eating disorder if taken to an extreme.
  • Sports, work and artistic activities. Athletes, actors and television personalities, dancers, and models are at higher risk of eating disorders. Eating disorders are particularly common among ballerinas, gymnasts, runners and wrestlers. Coaches and parents may unwittingly contribute to eating disorders by encouraging young athletes to lose weight.
  • Media and society. The media, such as television and fashion magazines, frequently focus on body shape and size. Exposure to these images may lead some people to believe that thinness equates to success and popularity.

Seek medical advice

Because of its powerful pull, an eating disorder can be difficult to manage or overcome by yourself. Eating disorders can virtually take over your life. You may think about food all the time, spend hours agonizing over options in the grocery store, and exercise to exhaustion. You also may have a host of physical problems because of your eating disorder, such as irregular heartbeats, fatigue, bowel troubles and dizziness. You may feel ashamed, sad, hopeless, drained, irritable and anxious.

If you’re experiencing any of these problems, or if you think you may have an eating disorder, you’d probably benefit from a medical evaluation. Remind yourself that you’re not actually in control anymore — the eating disorder is. When everything revolves around what you eat and how you look, it’s difficult to take part in normal activities and live life to its fullest. You may not even be able to enjoy a simple meal with family and friends.

Unfortunately, many people with eating disorders resist treatment. If you have a loved one you’re worried about, urge him or her to talk to a doctor. But unless you have legal authority to do so, you can’t force loved ones to get treatment. If you think your child may have an eating disorder, talk to him or her. Your child may not be ready to acknowledge having an issue about food, but you may be able to open the door by expressing concern and a desire to listen. You may also want to consider contacting your child’s doctor about your concerns. You can get a referral to qualified mental health providers for treatment.

Screening and diagnosis

Eating disorders are diagnosed based on signs, symptoms and eating habits. When doctors suspect someone has an eating disorder, they typically run a battery of tests and exams. These can help pinpoint a diagnosis and also check for related complications. You may see both a medical doctor and a mental health provider for a diagnosis.

Physical evaluations

These exams and tests generally include:

  • Physical exam. This may include such things as measuring height and weight; assessing body mass index; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin for dryness or other problems; listening to the heart and lungs; and examining your abdomen.
  • Laboratory tests. These may include a complete blood count (CBC), as well as more specialized blood tests to check electrolytes and protein, as well as liver, kidney and thyroid function. A urinalysis also may be done.
  • Other studies. X-rays may be taken to check for broken bones, pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. You may also have a bone density test.

Psychological evaluations

In addition to a physical exam, you’ll have a thorough psychological evaluation. Your doctor or mental health provider may ask you a number of questions about your eating habits, beliefs and behavior. The questions may focus on your history of dieting, bingeing, purging and exercise. You’ll explore how you perceive your body image and how you think others perceive your body image. You may also fill out psychological self-assessments and questionnaires.

Diagnostic criteria

To be diagnosed with an eating disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Each eating disorder has its own set of diagnostic criteria. Your mental health provider will review your signs and symptoms to see if you meet the necessary diagnostic criteria for a particular eating disorder. Some people may not meet all of the criteria but still have an eating disorder and need professional help to overcome or manage it.

Complications

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely you are to experience serious complications. Complications may include:

  • Death
  • Heart disease
  • Depression
  • Suicidal thoughts or behavior
  • Absence of menstruation (amenorrhea)
  • Bone loss
  • Stunted growth
  • Nerve damage
  • Seizures
  • Digestive problems
  • Bowel irregularities
  • Tooth decay
  • Ruptured esophagus
  • High blood pressure
  • Type 2 diabetes
  • Gallbladder disease

Treatment

Eating disorder treatment depends on your specific type of eating disorder. But in general, it typically includes psychotherapy, nutrition education and medication. If your life is at risk, you may need immediate hospitalization to stabilize your health. You may have a treatment team of medical doctors, mental health providers and dietitians.

Psychotherapy

Individual psychotherapy can help you learn how to exchange unhealthy habits for healthy ones. You learn how to monitor your eating and your moods, develop problem-solving skills, and explore healthy ways to cope with stressful situations. Psychotherapy can also help improve your relationships and your mood. A type of psychotherapy called cognitive behavioral therapy is commonly used in eating disorder treatment. Family therapy and group therapy also may be helpful for some people.

Nutrition education

Dietitians and other health care providers can offer information about a healthy diet and help design an eating plan to achieve a healthy weight and healthy-eating habits. If you have binge-eating disorder, you may benefit from medically supervised weight-loss programs.

Hospitalization

If you have serious health problems or if you have anorexia and refuse to eat or gain weight, your doctor may recommend hospitalization. Hospitalization may be on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.

Medications

Medication can’t cure an eating disorder. However, medications may help you control urges to binge or purge or to manage excessive preoccupations with food and diet. Medications such as antidepressants and anti-anxiety medications may also help with symptoms of depression or anxiety, which are frequently associated with eating disorders.

Prevention

Although there’s no sure way to prevent eating disorders, some steps may help. Pediatricians may be in a good position to identify early indicators of an eating disorder and prevent the development of full-blown illness. They can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance. Make sure children attend well-child doctor visits. These visits should include checks of body mass index and weight percentiles. Those checks can provide an early warning about overeating or undereating.

Family dining habits may also influence the relationships children develop with food. Try to eat at least some meals together as a family. Teach children about the pitfalls of dieting, and encourage healthy eating. If your child has symptoms of anxiety, depression or other mood disorders, seek medical care.

Parents and other adults also can cultivate and reinforce a healthy body image in children of any shape or size. Talk to children about their self-image and offer reassurance that body shapes can vary. Don’t allow children to be teased about their appearance. And encourage your own children or family members to refrain from joking about other children or adults who are overweight or have a large body frame. These messages of acceptance and respect can help build healthy self-esteem and resilience that will carry children through the rocky periods of adolescence.

In addition, if you notice a family member or friend with low self-esteem, severe dieting, frequent overeating, hoarding of food or dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, reaching out with compassion may encourage him or her to seek treatment.

Self-care

When you have an eating disorder, taking care of your health needs often isn’t one of your priorities. But proper self-care can help you feel better during and after treatment and help maintain your overall health.

Try to make these steps a part of your routine. But don’t beat yourself up if you aren’t able to do so every day:

  • Stick to your treatment plan. Don’t skip therapy sessions and try not to stray from meal plans.
  • Talk to your doctor about appropriate vitamin and mineral supplements to make sure you’re getting all the essential nutrients.
  • Don’t isolate yourself from caring family members and friends who want to see you get healthy and have your best interests at heart.
  • Talk to your health care providers about what kind of exercise, if any, is appropriate for you.
  • Read self-help books that offer sound, practical advice. Consider discussing the books with your health care providers.
  • Resist urges to weigh yourself or check yourself in the mirror frequently. Otherwise, you may simply fuel your drive to maintain unhealthy habits.

Coping skills

In addition to getting professional treatment for your eating disorder, you can also follow these coping skills:

  • Boost your self-esteem. Get involved in activities that interest you and that are personally rewarding. These may include learning a new skill, developing a hobby or participating in a social group in your church or community.
  • Be realistic. Don’t accept what some of the media portray about what’s a normal weight and what’s an ideal body image.
  • Resist the urge to diet or skip meals. Dieting actually triggers unhealthy eating and makes it difficult to cope with stress.
  • Remind yourself what a healthy weight is for your body, especially at times when you see images that may trigger your desire to binge and purge.
  • Don’t visit Web sites that advocate or glorify eating disorders. These sites can encourage you to maintain dangerous habits and can trigger relapses.
  • Identify situations that are likely to trigger thoughts or behavior that may contribute to your eating disorder so that you can develop a plan to deal with them.
  • Look for positive role models, even if they’re not easy to find. Remind yourself that the ultrathin models or actresses showcased in popular magazines often don’t represent healthy bodies.
  • Acknowledge that you may not be the best judge of whether your eating habits and weight are healthy.
  • Consider journaling about your feelings and behaviors. Journaling can make you more aware of your feelings and actions, and how they’re connected.