Eating disorders are not a fad. They’re not a phase or even a lifestyle choice. They are serious and complex illnesses that affect both physical and mental health, and they’re potentially life-threatening.
According to the National Eating Disorders Association (NEDA), 20 million women suffer from an eating disorder, generally stemming from body dissatisfaction.1 NEDA points out that up to 60 percent of girls between the ages of six and 12 are concerned about their weight or worried about becoming too fat, and 46 percent of girls aged nine to 11 are “sometimes” or “very often” on a diet. Of elementary school girls who read magazines, 69 percent say that the pictures of models influence their idea of the ideal body, and 47 percent say that the pictures make them want to lose weight.
While the average American woman is 5’4” tall and weighs 165 pounds, the average American model is 5’11” and weighs 117 pounds. The U.S. Department of Health and Human Services’ Office on Women’s Health points out that society associates being “thin” with beauty and self-discipline, while being “fat” is associated with laziness, ugliness and weakness.2
While the average American woman is 5’4” tall and weighs 165 pounds, the average American model is 5’11” and weighs 117 pounds.
The Office on Women’s Health also points out that eating disorders are about more than just food. Women with eating disorders often use food to feel in control of overwhelming feelings and emotions. Starving or purging may help a woman feel more in control of her life and ease anxiety, stress, tension or anger.
While eating disorders most commonly develop during adolescence and early adulthood, they can occur in childhood and later in life. Anorexia nervosa, bulimia nervosa and binge eating disorder are the three most common eating disorders among women, although a number of other eating disorders are classified under the umbrella of OSFED, or “other specified feeding or eating disorder.”
Anorexia nervosa is characterized by extreme fear of weight gain and severe self-induced weight loss driven by starving yourself, exercising too much or both. People with anorexia nervosa believe they weigh too much even though they may be dangerously thin.
People with anorexia nervosa believe they weigh too much even though they may be dangerously thin.
According to the University of Maryland Medical Center, anorexia is an emotional disorder that focuses on food as an attempt to gain control and deal with a high level of perfectionism.3 Many women with anorexia believe their self-worth is tied to their body weight.
There are two types of anorexia. People with restricting anorexia achieve weight loss by severely restricting their caloric intake, while people with purging anorexia achieve it by vomiting or using diuretics or laxatives.
Anorexia affects as many as three percent of teenage girls, and one in 200 adult women suffers from the disorder.4
While researchers don’t know exactly what causes anorexia, experts agree that a number of factors are typically involved in its development. These may include:
Excessive weight loss is the primary sign of anorexia nervosa. Other physical signs and symptoms of anorexia may include:
Insisting you’re fat when in reality you’re very thin is the primary behavioral sign of anorexia. Other behavioral signs and symptoms of anorexia may include:
Anorexia can have dire health consequences, including death from heart failure, starvation, electrolyte imbalance or suicide. Hospitalization is commonly needed for those suffering from anorexia, particularly in cases where a patient exhibits an irregular heartbeat, severe depression, low blood pressure or low potassium levels.
Bulimia nervosa is characterized by episodes of eating a large amount of food, or bingeing, followed by vomiting or using laxatives to purge in order to avoid weight gain. Many people who have anorexia nervosa also have bulimia nervosa.
Binges lead to self-disgust, which leads to purging to prevent weight gain, often leaving you feeling a great sense of relief. While most people with bulimia believe they’re overweight, the majority maintain a normal weight.
While most people with bulimia believe they’re overweight, the majority maintain a normal weight.
Bulimia most often begins in the late teens or early adulthood, but women of all ages can develop the condition. According to the Alliance for Eating Disorders Awareness, up to 4.2 percent of American women will suffer from bulimia in their lifetime.5
Psychological and emotional problems are typically at the heart of bulimia. These may include low self-esteem or an anxiety disorder. Triggers for bingeing may include a poor body self-image, boredom, a high level of stress, a restricted diet or food itself. Other underlying factors that may contribute to bulimia include:
Signs and symptoms of bulimia include:
Like anorexia, bulimia can lead to dangerous or life-threatening complications. Some of the health problems associated with bulimia include:
Binge eating disorder is characterized by a loss of control over your eating. Unlike bulimia, binges associated with this disorder aren’t followed by a period of purging, and people who suffer from it may therefore be overweight or obese.
Binge eating disorder affects about two percent of all adults in the U.S., affecting women slightly more often than men.
Like all eating disorders, binge eating disorder may involve abnormal activity in various parts of the brain. Researchers believe that a number of factors may contribute to binge eating disorder, including:
Signs and symptoms of binge eating disorder include:
People with binge eating disorder may develop depression as a result of feeling out of control of their eating. People who binge eat report having more stress, sleep problems, health conditions and suicidal thoughts than people without binge eating disorder.6
Since binge eating disorder typically leads to being overweight or obese, health problems associated with this disorder are those associated with obesity, including:
Mental health problems commonly associated with binge eating disorder include anxiety, depression and personality disorders.
Research shows that around half of all people with an eating disorder also suffer from a substance use disorder, a rate that’s five times that of people without an eating disorder.7 Eating disorders and substance use disorders are both influenced by genetic, environmental, biological and psychological factors, many of which may overlap, leaving people with an eating disorder more susceptible to developing a substance use disorder and vice versa.
Around half of all people with an eating disorder also suffer from a substance use disorder, a rate that’s five times that of people without an eating disorder.
In many cases, a person with an eating disorder will abuse psychoactive substances in order to facilitate purging or suppress the appetite. In addition to street drugs and alcohol, people with eating disorders may abuse prescription medications like steroids, insulin, thyroid medications and psychostimulants like Adderall or Ritalin. Over-the-counter medications like diet pills, diuretics, laxatives and syrup of ipecac are also commonly abused.
Treatment for a co-occurring eating disorder and substance use disorder should ideally involve a specialized treatment program that combines substance abuse treatment and treatment for the eating disorder. Most such programs work with clients who have an eating disorder and abuse over-the-counter diet pills, diuretics, emetics and laxatives, but few are equipped to offer medical detox from opiates, stimulants, depressants or alcohol. However, a high-quality dual diagnosis drug treatment program will offer medical detox and also ensure that you get the help you need to recover from both the eating disorder and the substance use disorder.
Both eating disorders and substance abuse are correlated with suicide rates that are higher than those of the general population. The National Institutes of Health points out that anorexia has the highest mortality rate of any mental disorder, and many of the deaths associated with this disorder are by suicide, particularly among women.8
An article published in the journal Eating Disorders Review cites suicide as the second leading cause of death—after cardiac disease—in people with anorexia nervosa.9 It’s also a major cause of death among people with other eating disorders.
One study cited in the article found that 8.65 percent of participants with restrictive anorexia nervosa had attempted suicide at least once, while a staggering 25 percent of those in the purging anorexia group had attempted suicide. By comparison, a non-anorexia control group in the study had a zero percent prevalence of suicide attempts. The study’s authors noted that these numbers may indicate more serious psychiatric problems in those with purging anorexia as well as a higher rate of impulsiveness.
People with bulimia nervosa are also at a higher risk of suicide, although the suicide rate for bulimia is considerably lower than that for anorexia. But bulimia and anorexia share a number of risk factors for suicide, including depression, substance abuse and childhood trauma.
The Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, is published by the American Psychiatric Association and contains the criteria for diagnosing the wide spectrum of mental disorders, including eating disorders.
Each eating disorder has its own set of criteria used by mental health and medical professionals for diagnosis. In a medical setting, a variety of tests may be used to help identify any complications resulting from the eating disorder. A psychological evaluation will uncover your thoughts, attitudes and feelings about food and eating.
Once an eating disorder has been diagnosed, a treatment plan will be developed as a cooperative effort among the treatment team and the individual with an eating disorder.
A high-quality treatment program that specializes in eating disorders or dual diagnosis offers the best chances for long-term successful recovery. Although the exact treatment will depend on the eating disorder and the person, psychotherapy, medication and nutrition education will be part of the treatment plan.
Also known as talk therapy, psychotherapy helps you identify self-destructive patterns of thought and behavior and replace them with healthier ways of thinking and behaving. Through cognitive-behavioral therapy, you’ll delve into the complex issues underlying an eating disorder and learn how to assess and shift your mood and monitor your eating. You’ll also develop an arsenal of skills, techniques and strategies for coping with triggers like stress. Family therapy may also be used to address dysfunction in the family system and educate family members about eating disorders and the best way to support a loved one in recovery.
Psychotherapy helps you identify self-destructive patterns of thought and behavior and replace them with healthier ways of thinking and behaving.
Repairing the damage done by an eating disorder and maintaining a healthy weight is one of the primary goals of recovery. To that end, nutrition education by dietitians and other health care professionals will design an eating plan to help you achieve and maintain a healthy weight and develop normal eating habits.
While no medication can cure an eating disorder, some medicines may help curb cravings for food and control urges to binge or purge. If a mental illness like anxiety or depression underlies the eating disorder, medication will likely be prescribed to help get it under control.
In cases of severe malnutrition or other serious health problems related to an eating disorder, hospitalization may be required. An inpatient treatment program will help restore your health and will include intensive therapy to address the complex issues behind the disorder and address any mental health problems that may have contributed to it.