Eating disorders are mental health disorders that result in irrational and abnormal eating patterns that have a negative effect on health.
Diane, a 13-year-old seventh grader, was at a healthy weight, but soon after starting junior high school, she became convinced that she was fat. She began dieting and switched her lunch from a sandwich and a cookie to a salad. She lost a few pounds but still felt fat. Soon she reduced the salad at lunch to a carrot and a small piece of cheese. Diane trimmed her dinner as well, lying to her parents that she had eaten a big lunch and was not hungry. Before long, Diane had lost 20 pounds. She still felt fat and became obsessed with the calorie count of different foods. She started skipping lunch completely. At dinner she ate only a few bites and then claimed she was full. She also increased the amount she exercised.
Diane felt exhausted all the time. She was unhappy, depressed, and irritable. She told herself that if she could just lose a little more weight, she would be happy. Activities Diane used to enjoy no longer interested her. She spent a lot of time in her room on her computer visiting chat rooms about extreme dieting. Diane's parents recognized that she had changed, but they thought the changes were temporary and had to do with starting junior high. When Diane complained of pains in her stomach, her parents took her to the doctor, thinking that she might have a digestive problem. After much testing, the doctor said that Diane had developed anorexia nervosa (an-or-REX-e-uh ner-VO-sa) and referred the family to a psychiatrist who specialized in eating disorders.
Eating disorders are psychiatric illnesses that create irrational patterns of eating too little or too much in an out-of-control manner. They are much more than unhealthy eating habits, ordinary overeating, or healthy, structured dieting. Eating disorders cause a variety of sometimes life-threatening physical and emotional problems.
Various eating disorders are described in the DSM-5 *
Eating disorders are found in all developed countries in the world and in the developing countries of India and China. They occur in all races and ethnicities. They are ten times more common in women than in men, although the rate of eating disorders among homosexual and bisexual men is much higher than in heterosexual men. Certain eating disorders such as pica, rumination disorder, and ARFID often begin in childhood, but the majority of eating disorders appear during adolescence or early adulthood, often at a time of social change and stress such as beginning a new school or a new job, moving, or a major disruption in the family.
Eating disorders that start in childhood or adolescence can continue into adulthood. Because they are irrational, eating disorders often occur along with other mental health problems that complicate treatment of the eating disorder. People with eating disorders often experience relapses, even when treatment appears to be working. Eating disorders can have severe health consequences including death.
Most often simply called anorexia, this disorder involves a distortion in body image. People with anorexia (called anorectics) irrationally believe that they are fat even when they are underweight. No matter how much weight a person with anorexia loses and no matter how badly their health is affected, an anorectic is desperate to lose more weight. She (most anorectics are female) will always have an excuse for why she does not want to eat; will lie, saying she has eaten; will eat, then force herself to vomit or abuse laxatives * or diuretics * to make food pass through her system before nutrients can be absorbed.
People with anorexia often have other mental health disorders, most often major depression, anxiety disorders, and obsessive-compulsive disorder. Anorectics often have perfectionist traits, whereas some with bulimia are overly impulsive.
Sometimes referred to as the binge-purge disorder, the major feature of this disorder is consuming large amounts of food in a short time (bingeing), then following this binge by self-induced vomiting, laxative, enema *
Binge eating disorder was added to the DSM-5 as a psychiatric disorder in 2013. In binge eating disorder, individuals rapidly gobble significantly more food in a limited time (usually one to two hours) than most people typically would eat. Often they consume between 3,000 and 10,000 calories in one sitting, far more than the recommended calorie intake for an entire day. While they are eating, people with binge eating disorder feel out of control and unable to stop. They will continue to eat until they feel uncomfortably full, and later feel ashamed and guilty about their eating behavior. This behavior occurs repeatedly, usually several times each week and often in private. Most people with binge eating disorder recognize that their behavior is not normal or healthy but they cannot control the urge to binge.
Eating disorders are serious problems and can cause a variety of medical complications. In anorexia, rapid weight loss can lead to blood chemistry imbalances, failure to menstruate * , slow pulse, low blood pressure, and heart damage. Damage to vital organs can be serious enough to cause death. The death rate for people with anorexia is 10 to 20 percent, and only 50 percent of anorectics recover completely.
The frequent vomiting associated with bulimia can cause throat tears or sores, damaged tooth enamel, broken blood vessels in the eyes, and puffy cheeks from swollen salivary glands. With both anorexia and bulimia, bowel and intestinal problems can occur and major vitamin and mineral deficiencies can cause serious and long-lasting problems.
Although binge eating is not the cause of most obesity, the disorder often results in obesity, which can lead to other health problems. People who are obese are at greater risk of developing diabetes * , heart disease, high blood pressure, and other health problems. In addition, many people with eating disorders have other mental health disorders that can affect physical health and complicate diagnosis and treatment of the eating disorder.
People with anorexia, bulimia, and binge eating disorder often try to hide the problem, so formal diagnosis can be delayed or difficult. Even when caring friends or family members ask about the weight loss or other symptoms, most people with eating disorders are ashamed or embarrassed, especially by the purging that accompanies bulimia, and will lie about their eating habits. Because of distorted body image, those with anorexia often cannot recognize the seriousness of their extreme weight loss. Unbearable fear of being fat may cause people with anorexia to actively resist attempts to help them gain weight.
If an eating disorder is suspected, or if the individual complains of digestive or other symptoms, blood or other laboratory tests can help determine if a person's nutritional needs are being met and if their general body chemistry is balanced. Other tests are done to rule out another disease or disorder as the cause of rapid weight loss (e.g., cancer) and to evaluate damage to vital organs.
A careful interview and health history may reveal concerns about body image or distorted opinions about body appearance. A questionnaire exists to help diagnose an eating disorder, but to be effective, the individual must answer honestly, which often does not happen. Obesity can be easily diagnosed, but most obesity is not caused by binge eating disorder.
The first step in treating any eating disorder is to stabilize an individual whose physical health has degenerated to the point of being life threatening. This requires hospitalization and carefully regulated re-nutrition. People who have an eating disorder but whose physical health is not life threatening are treated with a combination of psychotherapies * either in an in-patient or outpatient program. Attendance at these programs may continue for months.
Overcoming an eating disorder takes a long time and a lot of commitment from both the individual and the family. Almost all people with eating disorders have relapses, even with intensive therapy, support groups, nutritional counseling, and family counseling. Although there are no medications specifically to treat eating disorders, drugs may be used to treat accompanying mental and physical disorders.
Citrome. L. “A Primer on Binge Eating Disorder Diagnosis and Management.” CNS Spectrum 20 suppl. S1 (December 20, 2015): 41–51.
Lock, James, and Daniel LaGrange. Helping Your Teenager Beat an Eating Disorder, 2nd ed. New York: Guilford Press, 2015.
“Eating Disorders.” National Institute of Mental Health http://www.nimh.nih.gov/health/topics/eating-disorders (accessed March 28, 2016).
MedlinePlus “Eating Disorders.” U. S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/eatingdisorders.html (accessed March 28, 2016).
American Psychiatric Association. 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209-3901. Telephone: 703-907-7300. Toll-free: 888-357-7924. Website: http://www.psych.org (accessed March 28, 2016).
National Association of Anorexia Nervosa and Associated Disorders (ANAD). 750 E. Diehl Rd., #127, Naperville, IL 60563. Telephone: 630-577-1333. Help Line: 630-577-1330. Website: http://www.anad.org (accessed March 28, 2016).
National Eating Disorders Association, 165 W. 46th Street, Suite. 402, New York, NY 10036. Telephone: 212-575-6200. Helpline: 800-931-2237. Website: https://www.nationaleatingdisorders.org (accessed March 28, 2016)
See also Anorexia Nervosa • Anxiety and Anxiety Disorders: Overview • Body Image • Bulimia Nervosa and Binge Eating Disorder • Depressive Disorders: Overview • Metabolic Disease • Obesity
* DSM -5 is the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, published by the American Psychiatric Association. This book is used by physicians in the United States to classify and diagnose mental conditions.
* laxatives (LAX-ah-tivs) are drugs that stimulate the movement of material through the intestines. Used correctly, they can prevent constipation. When abused, they cause food and waste material to move through the intestines before the food can be absorbed into the body.
* diuretics (dye-yoor-EH-tiks), sometimes called “water pills,” are drugs that help eliminate excess water from the body by increasing urine production.
* enema (EH-nuh-muh) consists of a procedure in which liquid is injected through the anus into the intestine, to force the intestines to empty.
* menstruate (MEN-stroo-ate) to have a monthly period when non-pregnant females who are physically mature enough to bear children discharge the blood-enriched lining of the uterus.
* diabetes (dye-uh-BEE-teez) is a condition in which the body's pancreas does not produce enough insulin or the body cannot use the insulin it makes effectively. This results in increased levels of sugar in the blood and can lead to increased urination, dehydration, weight loss, weakness, and a number of other symptoms and complications related to chemical imbalances within the body.
* psychotherapies (sy-ko-THERa-peas) sometimes called talk therapies, are treatments of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personal understanding and growth in order to change destructive behaviors.