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Eating disorders are characterized by a preoccupation with weight that results in severe disturbances in eating and other behaviors. These disorders include anorexia nervosa, bulimia nervosa and binge eating disorder.

Anorexia nervosa. Essentially self-starvation, this disorder involves a refusal to maintain a minimally normal body weight. In severe cases, anorexia can be life-threatening.
Bulimia nervosa. This involves repeated episodes of binge eating, followed by ways of trying to purge the body of the food or of expected weight gain. People can have this condition and be of normal weight.
Binge eating disorder. This is characterized by frequent episodes of overeating without purging.
Other variations of eating disorders occur, such as purging without bingeing, chewing and spitting without purging, and anorexic behavior with less severe weight loss.

Most Americans with eating disorders are females between the ages of 12 and 25. Males can develop eating disorders, but generally less frequently. The exception is binge eating disorder, which appears to affect almost as many males as females.

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



Women's Health


Mental Health

Signs and symptoms

Anorexia
The signs and symptoms of anorexia include:

Weight loss, sometimes achieved by self-induced vomiting, abuse of laxatives, use of diuretics or exercise
Refusal to maintain normal body weight, sometimes maintaining a weight 15 percent or more below normal body weight
Intense fear of gaining weight
Negatively altered body image
In females, menstrual changes or the absence of menstruation
Anxious or ritualistic behavior at mealtimes
Fatigue
Depression
Irregular heart rate
Lightheadedness
Mild anemia
Brittle nails and hair
Bulimia
Signs and symptoms of bulimia include:

Recurrent episodes of binge eating
Feeling that you can't control your eating behavior
Eating much more food in a binge episode than in a normal meal or snack
Following a binge with efforts to prevent weight gain — such as self-induced vomiting, using laxatives or other medications, fasting or excessive exercise
Unhealthy focus on your body shape and weight
Dehydration
Fatigue
Weakness
Depression
Irritability
Dry, sometimes yellowed skin
Damaged teeth and gums from gastric acid contained in vomit
Swollen cheeks from regular vomiting
Irregular heartbeat
Binge eating disorder
Signs and symptoms of binge eating disorder include:

Recurrent — at least two a week — episodes of compulsive overeating not followed by purging
No control over eating behavior
Feelings of shame or guilt
Fatigue
Joint pain
Gallbladder disease
Increased blood pressure and cholesterol levels
It's often hard to distinguish between an eating disorder and the whims and fads of adolescence. Binge eating, dieting and experimenting with vomiting to get rid of food aren't uncommon behavior among teenage girls. These behaviors also occur, although not as frequently, among teenage boys. As a parent, be alert to sustained changes in dietary habits, not the occasional quirks that are part of growing up.

Most teenage girls, and some teenage boys, go on diets to lose weight and stop dieting after a few weeks. As a parent, be careful not to mistake occasional dieting with an eating disorder. The problem occurs when your child stops gaining weight during preadolescent years, when your child should be gaining as much as 10 pounds a year during an active growth spurt.

Other behaviors that may indicate your child has a potential eating disorder:

Not wanting to eat meals with the family
Frequent, long visits to the bathroom during or just after meals — your teenage child may run water to obscure the sound of induced vomiting
Excessive exercise or preoccupation with weight
Wanting to be alone


Depression


Amenorrhea

Causes

Doctors aren't sure of the exact causes of eating disorders. It appears that a variety of factors are involved, including genetics, family behavior and culture. In some instances, the biological systems in the brain that govern mood and appetite develop abnormalities.

Part of the explanation may also be the messages that the media in modern, economically developed nations send to young people, particularly females. These messages are that excessive thinness is attractive. To be as thin as some teen idols and models requires some people to achieve and maintain a weight that's not healthy. Although it's possible for some idols and models to be both thin and healthy, the trouble arises when some young people aren't able to sustain those body shapes without an unhealthy — for them — amount of weight suppression.

For some young people, the media message of thinness contributes to a distorted body image. A bright, high-achieving 14-year-old who is rational in every other way may come to believe that 90 pounds is the ideal weight for her 5-foot-4-inch frame, when 110 pounds is actually the average weight for a girl that age. Gradually, she may begin skipping meals, denying herself the fuel her body needs to develop normally. She may get thinner and thinner, but still believe she is fat. Eventually, she may become so undernourished that she needs to be admitted to the hospital for anorexia.


Risk factors

These factors may increase the risk of an eating disorder:

Gender. Teenage girls and young women are more likely than teenage boys and young men to develop eating disorders, though eating disorders do occur in teenage boys and young men.
Age. Although eating disorders can occur in midlife, they are much more common during the teens and 20s.
Family influences. People who feel less secure in their families, whose parents and siblings may be overly critical, are at higher risk of eating disorders.
Heredity. Eating disorders may be more common in people who have close family members with eating disorders.
Emotional disorders. People with depression, anxiety disorders and obsessive-compulsive disorder are more likely to have an eating disorder. People with anorexia tend to have perfectionist traits. Some with bulimia have problems with impulse control.
Excessive exercise. People who participate in highly competitive athletic activities are at greater risk of developing an eating disorder. At particular risk of anorexia are females in sports such as gymnastics, figure skating and track.


Obsessive-compulsive disorder


Eating disorders at midlife: An interview with a Mayo Clinic specialist

When to seek medical advice

If you have severe weight loss or if you find yourself alternating between binge eating and strict dieting, talk to your doctor to see if you have an eating disorder. Because denial often is a part of eating disorders, seeking medical advice may come only at the insistence of a family member or friend. If you notice the signs and symptoms of eating disorders in a family member or friend, urge that person to talk to a doctor.


Screening and diagnosis

Your doctor likely will perform a physical examination and ask you a number of questions about your eating habits and medical history. The questions your doctor asks may include your history of dieting and binge eating, whether you self-induce vomiting or use laxatives, your exercise routine, how you perceive your body image, and how you think others perceive your body image. Doctors diagnose eating disorders based on symptoms and eating habits.

Besides recording your weight, a physical exam will help determine if you're suffering from any of the side effects of an eating disorder. These complications may include problems with your gums or teeth, bloating, unusual heart rhythms, loss of bone density, anemia and changes in your menstrual cycle. Your doctor may order these tests:

Complete blood count (CBC). This test can signal the presence of a wide variety of health problems, including anemia. One substance measured by this blood test is hemoglobin. Hemoglobin is the red, iron-rich substance that binds to oxygen to carry it throughout your bloodstream.
Electrocardiogram. This procedure measures the pattern of electrical impulses generated in your heart. The test can help identify heart damage and irregular heart rhythms. The procedure involves attaching electrodes to your skin on your chest. The electrodes detect electrical impulses, and the impulses are recorded on a graph.
Chest X-ray. An image of your heart generated by an X-ray may reveal whether anorexia has damaged your heart muscles by reducing the size of your heart.
Other imaging tests. Tests such as a computerized tomography (CT) scan may reveal damage to your brain or digestive tract.
Bone density test. Your doctor uses a device called a sonometer to pass painless sound waves through your bones to measure bone density.
Tests of the function of various organs. Your doctor may order more extensive blood tests to detect your blood levels of hormones, enzymes, proteins, electrolytes, vitamins and other substances to gauge the performance of various organs, such as your liver, kidney, thyroid, pituitary gland and ovaries.


Complete blood count (CBC)


X-ray


Computerized tomography


Bone density testing: Measure your risk of broken bones

Complications

People with anorexia have a greater variety of health complications and a greater risk of death than do people with bulimia. However, both eating disorders can result in serious health problems.

Anorexia
The most serious health risk from anorexia is death, either because of the effects of severe weight loss or by suicide. Other problems include:

Heart disease. Anorexia can cause irregular heart rhythms and result in smaller heart muscles. Heart disease is a common cause of death for people with anorexia.
Hormonal changes. Changes in reproductive hormones and in thyroid hormones can cause absence of menstruation (amenorrhea), infertility, bone loss and retarded growth.
Imbalance of minerals and electrolytes. Your body needs adequate levels of minerals, particularly calcium and potassium, in order to maintain the electric currents that keep your heart beating. Disruption of your body's levels of fluids and minerals creates an electrolyte imbalance. Unless restored, this imbalance can be life-threatening.
Nerve damage. Anorexia may cause brain and nerve damage, seizures and loss of feeling.
Blood disorders. Lack of nutrition can reduce your body's levels of vitamin B-12, causing anemia and affecting your body's ability to produce enough red blood cells.
Digestive problems. Anorexia can cause constipation and bloating.
Bulimia
The related health problems aren't as severe for bulimia, partly because most people with bulimia maintain a normal weight. Complications may include:

Teeth and gum problems. The presence of gastric acid in your mouth from regular vomiting may cause damage to your teeth and gums.
Low potassium levels. The purging process tends to make your body dehydrated and to lower the level of potassium in your blood. This can cause weakness and irregular heart rhythms.
Digestive problems. Purging may cause irritation of the walls of your esophagus and rectum. Repeated purging may also cause constipation.
Behavioral and emotional problems. Bulimia may lead to depression and can be associated with a variety of impulsive behaviors such as sexual promiscuity, stealing, alcohol abuse and drug abuse.
Abuse of medications. The variety of over-the-counter drugs you may use during purge cycles may cause a drug dependency. These include laxatives, diuretics, appetite suppressants and ipecac, a drug that induces vomiting.
Binge eating disorder
This eating disorder can cause a variety of complications, including:

High blood pressure
Elevated cholesterol levels
Heart disease
Type 2 diabetes
Gallbladder disease


Anemia


Alcoholism


Drug addiction

Treatment

Severe cases of anorexia may require immediate hospitalization in order to rehydrate your body and restore your electrolyte balance.

For anorexia, your doctor or a nutritionist will want to set you on a course to gradually gain weight. To treat either anorexia or bulimia, your doctor likely will recommend nutrition education, psychotherapy and family counseling. Your doctor may also prescribe medications to reduce bingeing, vomiting and preoccupation with food or to treat the depression and anxiety that may be associated with eating disorders.

Nutrition education. Your doctor or nutritionist may discuss with you the establishment of a routine for meals and the importance of a healthy diet.
Psychotherapy. Your therapist may suggest cognitive behavior therapy. This approach is based on a belief that emotional problems stem from distorted attitudes and ways of thinking. Your therapist helps you to revise negative or erroneous perceptions.
Family counseling. This counseling can help address feelings of guilt and anxiety within a family that may have led to a child's eating disorder.
Medications. Doctors sometimes prescribe antidepressant medications to treat eating disorders. Commonly, doctors prescribe selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Luvox). Other antidepressant medications may include venlafaxine (Effexor) and tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin). If you're experiencing depression and anxiety, which commonly accompany eating disorders, antidepressant medications will benefit these conditions as well.


Selecting an antidepressant


Digestive

Self-care

Making these steps a part of your routine can help you stay healthy if you've experienced anorexia or bulimia:

Follow a regular schedule of meals.
Stop eating when you're full, not stuffed.
Eat healthy, well-balanced meals.
Take vitamin and mineral supplements.
Exercise regularly, but in moderation.


Food & Nutrition


Fitness & Sports Medicine

Coping skills

If you or your child has been prone to eating disorders, these steps may help you stay away from the self-destructive behaviors of anorexia and bulimia:

See your doctor regularly. Discuss with your doctor any concerns you have about proper weight and proper nutrition.
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.
Improve your family's dynamics. Work to improve the atmosphere of acceptance and inclusion in your family. Often, low self-esteem can lead a child into anorexic or bulimic behaviors. Show your child your love and find ways to say good things about your child.
Be realistic. Don't accept what some of the media portray about what's a normal weight and what's an ideal body image.

Favorite Links

miirage web documentary

Anorexia Files