Eating Disorders Among Women

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."

What are the Symptoms of Anorexia Nervosa?

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

Contributing Factors for Anorexia Nervosa

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:

  • Emotional stress or severe trauma during prepuberty or puberty, such as the loss of a loved one or sexual abuse
  • Abnormalities in brain chemistry related to the neurotransmitter serotonin, which is a brain chemical involved in depression
  • An environment that puts a great deal of value on being thin
  • Perfectionism and a desire to always be regarded as good, and the belief that perfection is the key to being loved
  • Fear of being humiliated or ridiculed
  • Difficulty dealing with stress
  • A family history of anorexia. Twenty percent of people with anorexia have a relative with an eating disorder
  • Having anxiety, depression or obsessive-compulsive disorder

Signs & Symptoms of Anorexia

Excessive weight loss is the primary sign of anorexia nervosa. Other physical signs and symptoms of anorexia may include:

  • Abnormal menstruation
  • Thinning hair, dry skin and brittle nails
  • Bloating
  • Downy hair covering the body
  • Fatigue
  • Low blood pressure
  • Abnormal heart rhythms

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:

  • Neglecting to eat
  • Refusing to eat in public
  • Constantly checking body weight
  • Ritualistically cutting food into tiny pieces
  • Compulsive exercising
  • Memory problems
  • Denial about the seriousness of the condition
  • Depression

How Anorexia Affects Your Heath

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

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

Contributing Factors for Bulimia Nervosa

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:

  • Media portrayals of thin women as successful and popular
  • Engaging in acting, dancing, modeling or participating in a sport that puts an emphasis on maintaining a low weight and restricting your diet for a higher level of performance
  • Having a sibling, parent or child with an eating disorder, which may put you at a higher risk of developing one
  • A deficiency in serotonin
  • Being overweight as a child or teen

Signs & Symptoms of Bulimia

Signs and symptoms of bulimia include:

  • Preoccupation with body shape and weight
  • Extreme fear of gaining weight
  • A loss of control over eating behaviors
  • Eating to the point of pain or discomfort
  • Eating an extremely large amount of food
  • Forcing yourself to purge after eating, either by vomiting, taking laxatives or using an enema
  • Excessive exercising in an attempt to prevent weight gain
  • Dramatically restricting calories between binges
  • Excessive use of supplements or herbal remedies for weight loss
  • Sores, scars or calluses on the hands due to forcing yourself to vomit
  • Damaged teeth and gums from repeated exposure to stomach acids

How Bulimia Affects Your Health

Like anorexia, bulimia can lead to dangerous or life-threatening complications. Some of the health problems associated with bulimia include:

  • Dehydration and kidney failure
  • Irregular heartbeat
  • Severe gum disease and tooth decay
  • Abnormal menstrual periods
  • Digestive problems, including needing laxatives in order to have a bowel movement or chronic acid reflux
  • Substance abuse
  • Electrolyte imbalance, which can cause stroke or heart attack
  • Infertility
  • Brain damage

Binge Eating Disorder

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.

Contributing Factors for Binge Eating Disorder

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:

  • Depression. Up to half of all people with binge eating disorder have a history of depression
  • Dieting. After skipping meals or otherwise restricting your diet, you may be more likely to binge
  • Emotional distress. Research shows that people with binge eating disorder may have problems handling emotions like anger, boredom, sadness, worry or stress, and binge eating may provide some comfort
  • Impulsiveness
  • Feeling out of control of your life
  • Feeling apart from your community

Signs & Symptoms of Binge Eating Disorder

Signs and symptoms of binge eating disorder include:

  • Eating faster than usual during binges
  • Eating to the point of pain or discomfort
  • Eating when you're not hungry
  • Eating alone because you're embarrassed
  • Feelings of self-hatred, guilt or depression after a binge
  • Missing work, school or social activities to binge eat

How Binge Eating Affects Your Health

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:

  • Type 2 diabetes
  • High cholesterol and high blood pressure
  • Heart disease
  • Gallbladder disease
  • Certain types of cancer
  • Excessive alcohol consumption, which leads to a number of health problems

Mental health problems commonly associated with binge eating disorder include anxiety, depression and personality disorders.

Other Specified Feeding and Eating Disorders (OSFED)

Eating disorders that don't meet the criteria for anorexia, bulimia or binge eating disorder but cause a significant amount of personal distress are known as "other specified feeding and eating disorders," or OSFED. These include:
  • Atypical anorexia nervosa, in which your weight is normal
  • Bulimia nervosa with less frequent bingeing and purging behaviors
  • Binge eating disorders with less frequent bingeing episodes
  • Purging disorder, in which you purge without binge eating
  • Night eating syndrome, which is characterized by excessive eating at night
  • Avoidant or restrictive food intake disorder, in which you fail to eat enough food but you don't suffer from psychological problems
  • Pica, which involves eating substances that aren't food and don't have nutritional value
  • Rumination disorder, which is characterized by regurgitating food that you've already swallowed and re-swallowing it or spitting it out

Eating Disorders and Substance Abuse

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.

Eating Disorders and Suicide

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.

Diagnosing Eating Disorders

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.

Eating Disorders Are Treatable

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.

Psychotherapy

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.

Nutrition Education

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.

Medication

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.

Hospitalization

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.

There is Hope

Hope is the foundation of recovery from an eating disorder. Hope is the belief that a better future is possible and that you can overcome the challenges of recovery with your inherent skills and talents and enjoy a healthy lifestyle that fosters a keen sense of well-being. If you or someone you love has an eating disorder, treatment through a high-quality, holistic program can lead to lifelong recovery and a far higher quality of life.

Sources

  1. Get the Facts on Eating Disorders. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/get-facts-eating-disorders
  2. Body Image: Eating Disorders. (2010, September 22). Retrieved from http://www.womenshealth.gov/body-image/eating-disorders/
  3. Anorexia Nervosa. (2015, April 23). Retrieved from http://umm.edu/health/medical/altmed/condition/anorexia-nervosa
  4. Eating Disorder Statistics. (n.d.). Retrieved from http://www.state.sc.us/dmh/anorexia/statistics.htm
  5. Eating Disorder Statistics. (n.d.). Retrieved from https://www.ndsu.edu/fileadmin/counseling/Eating_Disorder_Statistics.pdf
  6. Binge Eating Disorder Fact Sheet. (2012, July 16). Retrieved from http://www.womenshealth.gov/publications/our-publications/fact-sheet/binge-eating-disorder.html
  7. Dennis, A. B., & Helfman, B. (n.d.). Substance Abuse and Eating Disorders. Retrieved from https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders
  8. Eating Disorders. (2016, February). Retrieved from http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
  9. Suicide Risk Among Eating Disorders Patients. (2011, July/August). Eating Disorders Review, 22(4). Retrieved from http://eatingdisordersreview.com/nl/nl_edr_22_4_4.html
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