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Understanding Eating Disorders:
Most of us want to trim off a few unwanted pounds at some point in our lives. And when we shed them, we are satisfied. But for some people, losing weight or keeping weight off
becomes an obsession that can lead to irreversible health damage, such as stunted
growth, thinning bones, infertility, injury to teeth and internal organs, and even to death.
This fact sheet addresses two of the most common eating disorders—anorexia nervosa
and bulimia nervosa. It is by no means exhaustive, nor does it include the full range of
symptoms and treatments. Keep in mind that new research can yield rapid and dramatic
changes in our understanding of, and approaches to, mental disorders.
Eating disorders often are chronic in nature and, as a result, may require long-term
treatment. The medical consequences of anorexia, which include death in about 10
percent of the cases, usually are more severe than bulimia. The earlier these disorders
are diagnosed and treated, the better the prospects are for full recovery.
Statistics show 95 percent of those who have eating disorders are women between the
ages of 12 and 25. However, the incidence of eating disorders among people who are
older and men may be increasing. Studies have found that women who have bulimia
nervosa are often impulsive and are at high risk for other disorders such as substance abuse. Many people with eating disorders also appear to have co-occurring depression.
If you believe you or a loved one has an eating disorder, seek competent, professional
help from someone who has been trained specifically to recognize and treat eating
disorders.
Symptoms:
Anorexia nervosa—People who have this disorder often develop elaborate rituals around
food, continue to lose weight, and can literally starve themselves to death. They also
may exercise excessively.
Bulimia nervosa—Those who have bulimia gorge themselves, then almost immediately
make themselves vomit or use laxatives or diuretics to purge their bodies of food. This
often is referred to as the “binge/purge” cycle. Preoccupation with weight is a primary
trait of both disorders.
Medical Complications:
Anorexia nervosa—Breathing, pulse, and blood pressure rates drop and thyroid function
slows. Hair and nails may grow brittle. Similarly, skin may dry, yellow, and develop a
covering of soft hair called lanugo. Mild anemia, swollen joints, reduced muscle mass,
and light-headedness also commonly occur. Severe cases also lead to brittle bones that easily break as a result of calcium loss. Heart failure is a risk for those who use drugs to
stimulate vomiting, bowel movements, or urination. Starvation can also damage the heart
and brain.
Bulimia nervosa—Acid in vomit can wear down the outer layer of the teeth, inflame the
esophagus, and enlarge the glands near the cheeks. Binge eating can also cause the
stomach to rupture, and purging can result in heart failure as a result of the loss of vital
minerals, such as potassium.
Formal Diagnosis:
Anorexia—Body weight that is at least 15 percent below normal for age and height;
distorted body image; fear of gaining weight; and, in women, absence of at least three
consecutive menstrual cycles.
Bulimia—A minimum average of two binge eating episodes a week for at least 3 months;
self-induced purging; and feeling a lack of control over eating behavior.
Treatment:
Anorexia nervosa—Assuring physical health, including restoring weight, is the first goal
of treatment. This may require hospitalization. After a person’s physical condition has
been stabilized, treatment usually involves individual psychotherapy that may include
psychoanalytic approaches, family therapy, and, later, supportive group therapy. Self-help groups in communities may provide ongoing support. Cognitive behavioral
therapy has been effective for helping people who have anorexia nervosa maintain healthy
eating habits. Psychoactive medication may be combined with psychotherapy for people
who have problems with underlying anxiety, depression, or who spend inordinate amounts of time involved in elaborate food rituals.
Bulimia nervosa—Unless malnutrition is severe, any co-occurring substance abuse
problems should be treated first. Cognitive behavioral therapy helps most people who
have this disorder to reduce symptoms. Psychotherapies—such as cognitive, psychodynamic, or psychoanalytic
approaches—have proven effective in helping prevent relapse and in addressing
underlying interpersonal issues. As with anorexia, family therapy is recommended.
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