Eating Disorders

Eating Disorders can be seen on a continuum. There are many types of problematic eating but the common component is that an individual has a problematic relationship with food that affects their life in an unhealthy way. The most common eating disorders are anorexia nervosa, bulimia, binge eating disorder and eating disorder NOS. Below are some of the symptoms associated with each. The source for the information below comes from Edreferal.com and the Mayo Clinic.

Anorexia Nervosa:

The following definition of Anorexia Nervosa is used to assist mental health professionals in making a clinical diagnosis. The clinical criteria is not always representative of what one living with anorexia feels. Please note, you can still suffer from Anorexia even if one of the below signs is not present. One cannot simply read the criteria and think “I don’t have one of the symptoms, so I am not anorexic.” or “I don’t have a problem with food.”

The physical signs and symptoms of anorexia nervosa are related to starvation, but the disorder also includes emotional and behavioral issues related to an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

Physical Symptom:

• • Extreme weight loss
  • Thin appearance
  • Abnormal blood counts
  • Fatigue
  • Insomnia
  • Dizziness or fainting
  • Bluish discoloration of the fingers
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Absence of menstruation
  • Constipation
  • Dry or yellowish skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Osteoporosis
  • Swelling of arms or legs

Behavioral Symptoms

Attempts to lose weight by either:

• • Severely restricting food intake through dieting or fasting and may include excessive exercise
  • Bingeing and self-induced vomiting to get rid of the food and may include use of laxatives, enemas, diet aids or herbal products

Emotional and Other Behavioral Signs & Symptoms

• • Preoccupation with food
  • Refusal to eat
  • Denial of hunger
  • Fear of gaining weight
  • Lying about how much food has been eaten
  • Flat mood (lack of emotion)
  • Social withdrawal
  • Irritability
  • Reduced interest in sex
  • Depressed mood
  • Thoughts of suicide

Bulimia Nervosa:

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

There are two common types of bulimia nervosa, which are as follows:

• • Bulimia Nervosa Purging type -This type of bulimia nervosa accounts for the majority of cases of those suffering from this eating disorder.  In this form, individuals will regularly engage in self-induced vomiting or abuse of laxatives, diuretics, or enemas after a period of bingeing.
  • Bulimia Nervosa nonpurging type -In this form of bulimia nervosa, the individual will use other inappropriate methods of compensation for binge episodes, such as excessive exercising or fasting.  In these cases, the typical forms of purging, such as self-induced vomiting, are not regularly utilized.

Following is the diagnostic criteria for Bulimia Nervosa:

• • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.

Binge Eating Disorder:

Binge eating disorder (BED) is an eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. Binge eating disorder is a severe, life-threatening and treatable eating disorder. Common aspects of BED include functional impairment, suicide risk and a high frequency of co-occurring psychiatric disorders. Binge eating disorder is the most common eating disorder in the United States, affecting 3.5% of women, 2% of men,1 and up to 1.6% of adolescents.

To the right is the diagnostic criteria for BED:

Diagnostic Criteria

• • Recurrent episodes of binge eating. An episode is characterized by
    • Eating a larger amount of food than normal during a short period of time (within any two-hour period)
    • Lack of control over eating during the binge episode (i.e. the feeling that one cannot stop eating).
  • Binge eating episodes are associated with three or more of the following:
    • Eating until feeling uncomfortably full
    • Eating large amounts of food when not physically hungry
    • Eating much more rapidly than normal
    • Eating alone because you are embarrassed by how much you’re eating
    • Feeling disgusted, depressed, or guilty after overeating
  • Marked distress regarding binge eating is present
  • Binge eating occurs, on average, at least 2 days a week for six months
  • The binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e. purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

From the DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Washington D.C.: American Psychiatric Association, 1994.

Some Warning Signs

• • Constant weight fluctuations
  • Frequently eats an abnormal amount of food in a short period of time (usually less than two hours)
  • Does not use methods to purge food
  • Eats rapidly (i.e. frequently chewing without swallowing)
  • Feeling a lack of control over one’s eating (i.e. unable to stop)
  • Eating alone, “secretive eating habits”, hiding food, etc.
  • Eating late at night
  • Eating when not hungry
  • Disgust and shame with self after overeating.
  • Hoarding food (especially high calorie/junk food)
  • Coping with emotional and psychological states such as stress, unhappiness or disappointment by eating.
  • Eating large amounts of food without being hungry
  • Consuming food to the point of being uncomfortable or even in pain
  • Attribute ones successes and failures to weight
  • Avoiding social situations especially those involving food.
  • Depressed mood
  • Anxious mood
  • Obesity
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Kidney disease and/or failure
  • Gallbladder disease
  • Arthritis
  • Bone deterioration
  • Stroke
  • Upper respiratory problems
  • Skin disorders
  • Menstrual irregularities
  • Ovarian abnormalities
  • Complications of pregnancy
  • Depression, anxiety and other mood disorders
  • Suicidal thoughts

Eating Disorder NOS:

Not everyone with an eating disorder will fit into one of the three above diagnostic categories.  If you have any problem with food you may still need treatment for an Eating Disorder (not otherwise specified).

Treatment for Eating Disorders:

Treatment for eating disorders is very complex and multifaceted. Traditional approaches to treatment include medical stabilization, refeeding, strict meal plans, individual and family therapy and sometimes medication. Too often treatment fails for people with eating disorders and patients give up. Treatment needs to be individualized. A multidisciplinary approach is critical. The medical issues associated with an eating disorder need to be monitored, so a physician specializing in eating disorders is critical. There needs to be a nutritional component involved where meals plans are developed and monitored. The behavioral, emotional, family, social and spiritual pieces need to fit together as the individual seeks to find their own journey through recovery. It is critical to work with someone who truly understands eating disorders.