An eating disorder is an unhealthy relationship with food and weight that interferes with many areas of a person’s life. One’s thoughts become preoccupied with food, weight or exercise. A person who struggles with an eating disorder can have unrealistic self-critical thoughts about body image, and his or her eating habits may begin to disrupt normal body functions and affect daily activities. Eating disorders are not just about food and weight. People begin to use food as a coping mechanism to deal with uncomfortable or painful emotions or to help them feel more in control when feelings or situations seem over-whelming. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and OSFED (Other Specified Feeding or Eating Disorder).
Anorexia Nervosa – A person with anorexia may have an intense fear of gaining weight or becoming fat. Someone with anorexia may practice unhealthy behaviors such as: restricting calories, only eating specific foods or skipping meals frequently.
Bulimia Nervosa – A person with bulimia may also be intensely afraid of becoming fat or gaining weight. Someone with bulimia may eat large amounts of food in a short period of time (binge) and then eliminate the food and calories (purge). One may induce vomiting, exercise excessively, or use laxatives, diuretics, or diet pills to purge weight or calories.
Binge Eating Disorder – This disorder involves eating very large amounts of food rapidly (to the point of feeling sick or uncomfortable). These episodes of bingeing occur frequently. When binge eating, a person feels like they cannot stop eating or control what or how much is eaten.
OSFED (Other Specified Feeding or Eating Disorder) – OSFED is a feeding or eating disorder that causes significant distres or impairment, but does not meet the criteria for another feeding or eating disorder.
There isn’t one conclusive cause of eating disorders. Multiple factors are involved, such as genetics and metabolism; psychological issues – such as control, coping skills, trauma, personality factors, family issues; and social issues, such as a culture that promotes thinness and media that transmits this message.
Thomas Insel, MD, Director of NIMH, discusses eating disorder causes and treatment.
The role of genetics on eating disorders is of particular interest to researchers. Our knowledge at this point indicates that genes load the gun and the environment pulls the trigger. We are far from knowing specific genes that cause eating disorders. There are a number of genes that work with environmental triggers. Dieting and loss of weight may influence the development of anorexia by turning on a gene that may influence an eating disorder. There are many cases of transgenerational eating disorder and twin studies which make this connection. There is probably a 5-6 greater chance of developing an eating disorder if an immediate relative has an eating disorder.
Depression and Anxiety
Looking at depression and anxiety disorders as psychiatric illnesses which are biological in nature, we see that they commonly co-exist in the eating disorder patient and their families.
Thought: Did you know that rats who were put on a restrictive diet spent increasing amounts of time running on their activity wheel? They lost a great deal of weight. If the researchers had let them continue to do this, the animal would have died.
Although every case is different, clinicians have noticed patterns in psychological issues with patients who have eating disorders.
– fear of growing up
– inability to separate from the family
– need to please or be liked
– need to control
– need for attention
– lack of self esteem
– high family expectations
– parental dieting
– family discord
– temperament – often described as the “perfect child”
– teasing about weight and body shape
– difficulty regulating mood
– more impulsive – sometimes with shoplifting, substance abuse, etc.
– sexual abuse
– family dysfunction
-emphasis on thinness as the ideal for beauty
-availability and indulgence of food
-role of the media
-obesity and reaction to the larger body size
Thought: If we took an average 5′ 2” woman, age 22 and normal weight of 125 lbs. and expected her to fit the Barbie image, she would have to be 7′ 2” tall.
It’s estimated that eating disorders affect over 30 million people in the U.S. Of those who are struggling with Anorexia or Bulimia, at least 10-15% are male1. Eating disorders can have significant and sustained impact on one’s health and are statistically the deadliest of all mental illnesses2.
Signs and Symptoms
There are physical and psychological indicators of eating disorders. Depending on the disorder, some include: • Preoccupation with food, weight, and body • Unrelenting fear of gaining weight • Refusal to eat except for tiny portions • Dehydration • Compulsive exercise • Excessive fine hair on face and body • Distorted body image • Abnormal weight loss • Sensitivity to cold • Absent menstruation • Rapid consumption of a large amount of food • Eating alone or in secret • Abuse of laxatives, diuretics, diet pills, or emetics • Depression • Shame and guilt • Withdrawal
-Difficulty concentrating or focusing
-Difficulty regulating mood
-Associated mental disorders: depression, anxiety disorders, obsessive-compulsive disorder, substance abuse
-Slow irregular, pulse
-Low blood pressure
-Dizziness or faintness
-Shortness of breath
-Decreased potassium levels may result in life-threatening cardiac arrhythmias or arrest
-Electrolyte imbalances may lead to life-threatening cardiac arrhythmias or arrest
Muscular Skeletal (Bones):
-Stunted growth in children
-Stress fractures and broken bones more likely
-Loss of teeth
-“Chipmunk cheeks”- swollen salivary glands from vomiting
-Sore throat because of induced vomiting
-Painful burning in throat or chest
-May vomit blood from small tear(s) in esophagus
-Rupture of the esophagus, may lead to circulatory collapse and death
-Low energy or fatigue
-Low body temperature
-Hair becomes thin and may fall out
-Development of fine body hair as the body’s attempt to keep warm
-Stomach may swell following eating or binging (causes discomfort and bloating)
-Gastric rupture due to severe binge eating (gastric rupture has an 80% fatality rate)
-Vomiting causes severe electrolyte imbalance which can lead to sudden cardiac arrest.
-Normal movement in intestinal tract often slows down with very restricted eating and severe weight loss
-Chronic irregular bowel movements
Complications Associated with Laxative Abuse:
-“Cathartic colon,” refers to the colon’s inability to function normally without the use of large doses of laxatives due to the destruction of the nerves in the colon that control elimination
-Dependence on laxatives
1. Sullivan, P.F. 1995. Mortality in anorexia nervosa. The American Journal of Psychiatry 152 (7): 1073–4.
2. Carlat, DJ, C.A. Camargo Jr. 1991. Review of bulimia nervosa in males. The American Journal of Psychiatry 148 (7): 831–43.