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Eating Disorders

 

Eating disorders are characterized by a persistent pattern of dysfunctional eating or dieting behavior. About 10 percent of women report symptoms of an eating disorder and any given time. Sometimes, it can be difficult to distinguish between normal differences in eating patterns and actual eating disorders. Here, we provide a basic overview of eating disorders, their treatment and associated issues.

Binge Eating Disorder

What it is

People with binge eating disorder often eat an unusually large amount of food and feel out of control during the binges. People with binge eating disorder also may:

    * eat more quickly than usual during binge episodes

    * eat until they are uncomfortably full

    * eat when they are not hungry

    * eat alone because of embarrassment

    * feel disgusted, depressed, or guilty after overeating

Causes

No one knows for sure what causes binge eating disorder. Researchers are looking at the following factors that may affect binge eating:

  • Depression. As many as half of all people with binge eating disorder are depressed or have been depressed in the past.
  • Dieting. Some people binge after skipping meals, not eating enough food each day, or avoiding certain kinds of food.
  • Coping skills. Studies suggest that people with binge eating may have trouble handling some of their emotions. Many people who are binge eaters say that being angry, sad, bored, worried, or stressed can cause them to binge eat.
  • Biology. Researchers are looking into how brain chemicals and metabolism (the way the body uses calories) affect binge eating disorder. Research also suggests that genes may be involved in binge eating, since the disorder often occurs in several members of the same family.

 

Certain behaviors and emotional problems are more common in people with binge eating disorder. These include abusing alcohol, acting quickly without thinking (impulsive behavior), and not feeling in charge of themselves.

Complications of binge eating

People with binge eating disorder are usually very upset by their binge eating and may become depressed. Research has shown that people with binge eating disorder report more health problems, stress, trouble sleeping, and suicidal thoughts than people without an eating disorder. They also often feel badly about themselves and may miss work, school, or social activities to binge eat.

People with binge eating disorder may gain weight. Weight gain can lead to obesity, and obesity raises the risk for these health problems:

    * type 2 diabetes

    * high blood pressure

    * high cholesterol

    * gallbladder disease

    * heart disease

    * certain types of cancer

Treatment

There are several different ways to treat binge eating disorder:

    * Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It teaches them how to cope with stressful situations. It also helps them feel better about their body shape and weight.

    * Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas.

    * Drug therapy, such as antidepressants, may be helpful for some people.

Other treatments include dialectical behavior therapy, which helps people regulate their emotions; drug therapy with the anti-seizure medication topiramate; exercise in combination with cognitive-behavioral therapy; and support groups.

Many people with binge eating disorder also have a problem with obesity. There are treatments for obesity, like weight loss surgery (gastrointestinal surgery), but these treatments will not treat the underlying problem of binge eating disorder.

Anorexia Nervosa

What it is

A person with anorexia nervosa, often called anorexia, has an intense fear of gaining weight. Someone with anorexia thinks about food a lot and limits the food she eats, even though she is too thin. Anorexia is more than just a problem with food. It's a way of using food or starving oneself to feel more in control of life and to ease tension, anger, and anxiety. Most people with anorexia are female. An anorexic:

    * has a low body weight for her height

    * resists keeping a normal body weight

    * has an intense fear of gaining weight

    * thinks she is fat even when very thin

    * misses three (menstrual) periods in a row

Who is at risk?

While anorexia mostly affects girls and women (90-95 percent), it can also affect boys and men. It was once thought that women of color were shielded from eating disorders by their cultures, which tend to be more accepting of different body sizes. Sadly, research shows that as African American, Latina, Asian/Pacific Islander, and American Indian and Alaska Native women are more exposed to images of thin women, they also become more likely to develop eating disorders.

Causes

There is no single known cause of anorexia. But some factors may play a part:

  • Culture. Women in the U.S. are under constant pressure to fit a certain ideal of beauty. Seeing images of flawless, thin females everywhere makes it hard for women to feel good about their bodies. More and more, men are also feeling pressure to have a perfect body.
  • Families. If you have a mother or sister with anorexia, you are more likely to develop the disorder. Parents who think looks are important, diet themselves, or criticize their children's bodies are more likely to have a child with anorexia.
  • Life changes or stressful events. Traumatic events like rape as well as stressful things like starting a new job, can lead to the onset of anorexia.
  • Personality traits. Someone with anorexia may not like herself, hate the way she looks, or feel hopeless. She often sets hard-to-reach goals and tries to be perfect in every way.
  • Biology. Genes, hormones, and chemicals in the brain may be factors in developing anorexia.

 

Symptoms

Someone with anorexia may look very thin. She may use extreme measures to lose weight by:

    * making herelf throw up

    * taking pills to urinate or have a bowel movement

    * taking diet pills

    * not eating or eating very little

    * exercising a lot, even in bad weather or when hurt or tired

    * weighing food and counting calories

    * moving food around the plate instead of eating it

Someone with anorexia may also have a distorted body image, thinking she is fat, wearing baggy clothes, weighing herself many times a day, and fearing weight gain.

People with anorexia often don't act like themselves--talking about weight and food all the time, not eating in front of others, being moody or sad, or not wanting to go out with friends.

Complications of anorexia

With anorexia, your body doesn't get the energy from foods that it needs, so it slows down. Anorexia affects your whole body:

  • Brain and nerves—can't think right, fear of gaining weight, sad, moody, irritable, bad memory, fainting, changes in brain chemistry
  • Hair—thins and gets brittle
  • Heart— low blood pressure, slow heart rate, palpitations, heart failure
  • Blood— anemia and other blood problems
  • Muscles, joints, and bones— weak muscles, swollen joints, bone loss, fractures, osteoporosis
  • Kidneys— kidney stones, kidney failure
  • Body fluids— low potassium, magnesium, and sodium
  • Intestines— constipation, bloating
  • Hormones— periods stop, trouble getting pregnant; if pregnant, higher risk for miscarriage, having a C-section, baby with low birthweight, post partum depression
  • Skin— bruise easily, dry skin, growth of fine hair all over body, get cold easily, yellow skin, nails get brittle

Women who have recovered from anorexia and are at a healthy weight have a better chance of getting pregnant. If you're having a hard time conceiving, see your doctor.

Treatment

Treatment generally requires a health care team of doctors, nutritionists, and therapists to help the patient learn healthy eating patterns, cope with thoughts and feelings, and gain weight. Some patients may need "partial hospitalization." This means that the person goes to the hospital during the day for treatment, but lives at home.

Individual counseling can also help someone with anorexia. If the patient is young, counseling may involve the whole family, too. Support groups may also be a part of treatment. In support groups, patients and families meet and share what they've been through.

Often, eating disorders occur along with mental health problems such as depression and anxiety. These problems are treated along with the anorexia. Treatment may include medications that repair hormone imbalances that play a role in these disorders.

Bulimia Nervosa

What it is

Bulimia nervosa is a type of eating disorder. It is often called just bulimia. A person with bulimia binges—eating a lot of food in a short amount of time. The person may fear gaining weight after a binge. Binging also can cause feelings of shame and guilt. So, the person tries to "undo" the binge by getting rid of the food. This is called purging. Purging might be done by:

    * making yourself throw up

    * taking laxatives

    * exercising a lot

    * eating very little or not at all

    * taking water pills to urinate

Who is at risk?

Nine out of 10 people with bulimia are women. But bulimia can affect anyone: Men, older women, and women of color can become bulimic. It was once thought that women of color were protected from eating disorders by their cultures. These cultures tend to be more accepting of all body sizes. But research shows that as women of color are more exposed to images of thin women, they are more likely to get eating disorders.

Causes

Bulimia is more than just a problem with food. A binge can be set off by dieting or stress. Painful emotions, like anger or sadness, also can bring on binging. Purging is how people with bulimia try to gain control and to ease stress and anxiety. There is no single known cause of bulimia. But these factors might play a role:

  • Culture. Women in the U.S. are under constant pressure to be very thin. This "ideal" is not realistic for most women. But seeing images of flawless, thin females everywhere can make it hard for women to feel good about their bodies. More and more, men are also feeling pressure to have a perfect body.
  • Families. It is likely that bulimia runs in families. Many people with bulimia have sisters or mothers with bulimia. Parents who think looks are important, diet themselves, or judge their children's bodies are more likely to have a child with bulimia.
  • Life changes or stressful events. Traumatic events like rape can lead to bulimia. So can stressful events like being teased about body size.
  • Psychology. Having low self-esteem is common in people with bulimia. People with bulimia have higher rates of depression. They may have problems expressing anger and feelings. They might be moody or feel like they can't control impulsive behaviors.
  • Biology. Genes, hormones, and chemicals in the brain may be factors in getting bulimia.

 

Symptoms

A person with bulimia may be thin, overweight, or normal weight. This makes it hard to know if someone has bulimia. But there are warning signs to look out for. Someone with bulimia may do extreme things to lose weight, such as:

    * using diet pills, or taking pills to urinate or have a bowel movement

    * going to the bathroom all the time after eating (to throw up)

    * exercising too much, even when hurt or tired

Someone with bulimia may show signs of throwing up, such as:

    * swollen cheeks or jaw area

    * rough skin on knuckles (if using fingers to make one throw up)

    * teeth that look clear

    * broken blood vessels in the eyes

Someone with bulimia often thinks she or he is fat, even if this is not true. The person might hate his or her body. Or worry a lot about gaining weight. Bulimia can cause someone to not seem like herself. The person might be moody or sad. Someone with bulimia might not want to go out with friends.

Complications of bulimia

Bulimia can hurt your body, affecting every part of it:

  • Brain— depression, fear of gaining weight, anxiety, dizziness, shame, low self-esteem
  • Cheeks— swelling, soreness
  • Mouth— cavities, tooth enamel erosion, gum disease, teeth sensitivity to hot and cold
  • Throat and esophagus— sore, irritated, can tear and rupture, blood in vomit
  • Muscles— fatigue
  • Stomach— ulcers, pain, can rupture, delayed emptying
  • Skin— abrasion of knuckles, dry skin
  • Blood— anemia
  • Heart— irregular heartbeat, heart muscle weakened, heart failure, low pulse and blood pressure
  • Body fluids— dehydration, low potassium, magnesium, and sodium
  • Intestines— constipation, irregular bowel movements, bloating, diarrhea, abdominal cramping
  • Hormones— irregular or absent period

If a woman with active bulimia gets pregnant, these problems may result:

    * miscarriage

    * high blood pressure in the mother

    * baby isn't born alive

    * baby tries to come out with feet or bottom first

    * birth by C-section

    * baby is born early

    * low birth weight

    * birth defects, such as blindness or mental retardation

    * problems breastfeeding

    * depression in the mother after the baby is born.

Women who have recovered from bulimia have a better chance of getting pregnant once their monthly cycle is normal. If you're having a hard time getting pregnant, see your doctor.

Treatment

Someone with bulimia can get better with the help of a health care team. A doctor will provide medical care. A nutritionist can teach healthy eating patterns. A therapist can help the patient learn new ways to cope with thoughts and feelings.

Therapy is an important part of any treatment plan. It might be alone, with family members, or in a group. Medications can help some people with bulimia. These include drugs used to treat depression.

Chances of getting better are greatest when bulimia is spotted and treated early.

 

Source: The National Women's Health Information Center (www.womenshealth.gov)