Learn About Eating Disorders

Anorexia nervosa is a serious, occasionally chronic, potentially life-threatening eating disorder defined by a refusal to maintain minimal body weight within 15% of an individual's normal weight. Other characteristics include an intense fear of gaining weight, a distorted body image, denial of the seriousness of the illness, and for women, amenorrhea (absence of at least three consecutive menstrual cycles otherwise expected to occur).

There are two subtypes of anorexia nervosa. In the “restricting” subtype, low body weight is maintained purely by restricted food intake and, possibly, excessive exercise. Anorexics with the “binge eating/purging” subtype restrict food intake but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. It’s common to move back and forth between subtypes during the course of the illness.

Anorexia often appears during adolescence, with 76% reporting onset of the disorder between the ages of 11 and 20. It is about ten times more likely in females than males. The mortality rate for diagnosed anorexics is between 5–20%—the highest of any mental illness—with roughly half of those due to suicide. The probability of death increases within that range in conjunction with the illness’ duration.

Anorexics harbor a distorted self-image. Even when extremely thin, they see themselves as too fat. Anorexics are often perfectionists, driven to succeed, yet they set unattainable standards of performance for themselves. When they fail to meet these standards, they use food and weight to regain a sense of control in their lives. Low self-esteem and constant self-criticism fuel an ongoing fear of losing control, and eating even a small amount can be seen as a loss of control.

Warning Signs:

• Preoccupation with food, calories, and nutrition
• Denial of hunger
• Excessive dieting and/or exercising
• Frequent weighing
• Claiming to “feel” fat while continuing to lose weight
• Distorted body image
• Feeling bloated or nauseated after eating normal or less than normal amounts of food
• Hair loss
• Feeling cold even though the temperature is normal
• Interruption of menstrual cycle (for women)

Bulimia nervosa is a cyclical and recurring pattern of binge eating (uncontrolled bursts of overeating) followed by guilt, self-recrimination, and overcompensatory behavior such as crash dieting, overexercising, and purging to compensate for the excessive caloric intake.

Bulimics often have “binge foods”— the foods they typically consume during binges. Some describe their binge episodes as feeling a physical high, numbing out, going on auto-pilot, losing control, etc. The specific reasoning or triggers differ from person to person. Bingeing leads to feelings of guilt, shame, embarrassment, and failure. Trying to regain control and make up for their mistake, they then purge the food (either by self-induced vomiting or using a laxative). This leads to feeling famished and empty again and, therefore, another binge, followed by feeling powerless, and the vicious cycle continues.

Compulsive, excessive exercising is a type of bulimia nervosa also known as anorexia athletica or exercise bulimia. Anxious and guilty until exercising, these individuals force themselves to work out even when sick or injured. They’ll often “exercise off” the calories they’ve consumed, leaving them depleted of energy. Being praised for looking good only spurs them on. Often developed as a way to gain control, this disorder is more common in women. Measuring self-worth through performance, they tend to take out their emotions—depression, frustration, anger—on their bodies.

The extreme eating and exercising habits of bulimics are often echoed in other harmful behaviors, such as sexual promiscuity, pathological lying, and shoplifting. Bulimia nervosa often appears during late adolescence or early adulthood. 90% of bulimics are women. The good news: roughly 70% of bulimics eventually recover.

Warning Signs:

• Excessive concern about weight
• Strict dieting followed by periods of binge eating
• Reacting to emotional stress by overeating
• Expressing guilt or shame about eating
• Depressive moods
• Feeling out of control in situations involving food
• Possible weight fluctuations
• Vomiting after eating
• Excessive use of laxative or diuretics
• Obsessive exercising

The most prevalent eating disorder in the U.S., binge eating disorder (also known as obsessive compulsive overeating) is linked with Obsessive Compulsive Disorder (OCD). It involves the consumption of very large amounts of food in a short period of time. About 2% of American adults struggle with binge eating disorder. Though this particular disorder can develop at any age, it is seen most in young adults. In contrast to other eating disorders, one-third to one-fourth of all patients with binge eating disorder are men. Preliminary studies also show that the condition occurs equally among African-Americans and Caucasians.

Binge eating can be triggered by certain emotions (boredom, anger, sadness, etc.). The binge eater’s feelings of disgust and guilt often lead to depression. Studies find that obese binge eaters have much higher levels of depression than other obese individuals. Binge eaters are likely to have problems with impulsive behavior and alcohol. They feel they can’t control themselves, are typically not close with their community, and have trouble discussing their problems and feelings. Binge eaters have more health issues—joint pain, muscle pain, stress, headaches, menstrual problems, difficulty sleeping and digesting food—and often have suicidal thoughts. Ashamed, they excel at hiding their disorder, even from close friends and family.

Not often diagnosed, binge eating can be more difficult to recognize than other eating disorders. Because it is not commonly taught or discussed, many don't realize the disorder exists or that there may be a psychological reason behind it. Random eating patterns can help diagnose binge eating: healthy foods for a few days, followed by dieting, followed by a relapse into binge eating. A common misconception is that binge eaters don’t have healthy eating habits or simply “don't know better.” What makes this an eating disorder is the addiction to eating large amounts of food and repeated relapsing while trying to return to healthy eating.

Warning Signs:

• Eating in the absence of hunger
• Feeling out of control when eating
• Feeling guilty about eating
• Eating during stressful times to feel better