It is estimated that 10 million Americans suffer from an eating disorder, with millions more having significant stress or anxiety over weight related issues. Eating disorders cover a range of illnesses, from anorexia nervosa (a person being dangerously underweight and still believing they're overweight), bulimia nervosa (a normal weight person who tries to control binge eating by purging food after they've eaten it) and binge-eating disorder (eating large amounts of food due to stress or anxiety) among others.

People with these disorders are unable to change their behavior despite suffering the negative health consequences that result from being dangerously underweight, morbidly obese, or purging behaviors. Patients are overwhelmingly women, but men make up about 10% of patients as well.

Treatment for all eating disorders involves psychotherapy and learning healthy behaviors, and in the case of bulimia and binge eating disorder, anti-depressant medications (Prozac, Zoloft, Lexapro, Paxil, Celexa) have been shown to help as well.

Anorexia Nervosa

Anorexia nervosa is characterized by:

  • extreme thinness (emaciation)
  • a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
  • intense fear of gaining weight
  • distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
  • lack of menstruation among girls and women
  • extremely restricted eating

Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. People with anorexia nervosa typically weigh themselves repeatedly, portion food carefully, and eat very small quantities of only certain foods. Some people with anorexia nervosa may also engage in binge-eating followed by extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of laxatives, diuretics, or enemas.

Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness.

Other symptoms may develop over time, including:

  • thinning of the bones (osteopenia or osteoporosis)
  • brittle hair and nails
  • dry and yellowish skin
  • growth of fine hair all over the body (lanugo)
  • mild anemia and muscle wasting and weakness
  • severe constipation
  • low blood pressure, slowed breathing and pulse
  • damage to the structure and function of the heart
  • brain damage
  • multiorgan failure
  • drop in internal body temperature, causing a person to feel cold all the time
  • lethargy, sluggishness, or feeling tired all the time
  • infertility

Bulimia Nervosa

Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge-eating and purging cycle happens anywhere from several times a week to many times a day.

Other symptoms include:

  • chronically inflamed and sore throat
  • swollen salivary glands in the neck and jaw area
  • worn tooth enamel, increasingly sensitive and decaying teeth as a result of exposure to stomach acid
  • acid reflux disorder and other gastrointestinal problems
  • intestinal distress and irritation from laxative abuse
  • severe dehydration from purging of fluids
  • electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack

Binge-Eating Disorder

With binge-eating disorder a person loses control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, peoplewith binge-eating disorder often are over-weight or obese. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure.9 They also experience guilt, shame, and distress about their binge-eating, which can lead to more binge-eating.

Diagnosis of eating disorders is based on symptoms and behavior, although a physician will run several tests of the blood chemistry and functions of the liver, kidneys and thyroid to rule out any other cause of the extreme weight loss. Addison’s disease, Celiac disease and inflammatory bowel disease can cause similar symptoms of weight loss. While it has undergone some criticism, eating disorders is also considered a clinical psyciatric disorder by the American Psyciatric Association, and is defined as having an intense fear of gaining weight, a refusal to maintain a body weight above 85% of normal for age and body type, three consecutive missed periods, a refusal to admit to the seriousness of the weight loss, and an undue influence of body shape and weight on a person’s self image.

Adequate nutrition, reducing excessive exercise, and stop-ping purging behaviors are the foundations of treatment. Specific forms of psychotherapy, or talk therapy, and medica-tion are effective for many eating disorders. However, in more chronic cases, specific treatments have not yet been identified. Treatment plans often are tailored to individual needs and may include one or more of the following:

  • individual, group, and/or family psychotherapy
  • medical care and monitoring
  • nutritional counseling
  • medications

Some patients may also need to be hospitalized to treat problems caused by mal-nutrition or to ensure they eat enough if they are very underweight.

Treating anorexia nervosa

Treating anorexia nervosa involves three components:

  • restoring the person to a healthy weight
  • treating the psychological issues related to the eating disorder
  • reducing or eliminating behaviors or thoughts that lead to insufficient eating and preventing relapse.

Some research suggests that the use of medications, such as antidepressants, antipsychotics, or mood stabilizers, may be modestly effective in treating patients with anorexia nervosa. These medications may help resolve mood and anxiety symptoms that often occur along with anorexia nervosa. It is not clear whether antidepressants can prevent some weight-restored patients with anorexia nervosa from relapsing. Although research is still ongoing, no medication yet has shown to be effective in helping someone gain weight to reach a normal level.

Different forms of psychotherapy, including individual, group, and family-based, can help address the psychological reasons for the illness. In a therapy called the Maudsley approach, parents of adolescents with anorexia nervosa assume responsibility for feeding their child. This approach appears to be very effective in helping people gain weight and improve eating habits and moods. Shown to be effective in case studies and clinical trials, the Maudsley approach is discussed in some guidelines and studies for treating eating disorders in younger, nonchronic patients.

Other research has found that a combined approach of medical attention and supportive psychotherapy designed specifically for anorexia nervosa patients is more effective than psychotherapy alone. The effectiveness of a treatment depends on the person involved and his or her situation. Unfortunately, no specific psychotherapy appears to be consistently effective for treating adults with anorexia nervosa. However, research into new treatment and prevention approaches is showing some promise. One study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder. Also, specialized treatment of anorexia nervosa may help reduce the risk of death.

Treating bulimia nervosa

As with anorexia nervosa, treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. To reduce or eliminate binge-eating and purging behaviors, a patient may undergo nutritional counseling and psychotherapy, especially cognitive behavioral therapy (CBT), or be prescribed medication. CBT helps a person focus on his or her current problems and how to solve them. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize, and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.

CBT that is tailored to treat bulimia nervosa is effective in changing binge-eating and purging behaviors and eating attitudes. Therapy may be individual or group-based.
Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration (FDA) for treating bulimia nervosa, may help patients who also have depression or anxiety. Fluoxetine also appears to help reduce binge-eating and purging behaviors, reduce the chance of relapse, and improve eating attitudes.

Treating binge-eating disorder

Treatment options for binge-eating disorder are similar to those used to treat bulimia nervosa. Psychotherapy, especially CBT that is tailored to the individual, has been shown to be effective. Again, this type of therapy can be offered in an individual or group environment.

Fluoxetine and other antidepressants may reduce binge-eating episodes and help lessen depression in some patients.

The causes of eating disorders are thought to be both biological and environmental. Genetic studies have shown that eating disorders can run in families, and have also shown that there are several different genetic and hormonal factors in play. Environmental risk factors and social factors also have been shown to play a large role in the development of eating disorders, and professions and social situations where there is pressure to be thin play a large role. Women who have suffered sexual abuse are also at greater risk for the development of eating disorders.

If someone you know is showing signs of anorexia, you may be able to help.

  • Set a time to talk. Set aside a time to talk privately with your friend. Make sure you talk in a quiet place where you won’t be distracted.
  • Tell your friend about your concerns. Be honest. Tell your friend about your worries about her or his not eating or over exercising. Tell your friend you are concerned and that you think these things may be a sign of a problem that needs professional help.
  • Ask your friend to talk to a professional. Your friend can talk to a counselor or doctor who knows about eating issues. Offer to help your friend find a counselor or doctor and make an appointment, and offer to go with her or him to the appointment.
  • Avoid conflicts. If your friend won’t admit that she or he has a problem, don’t push. Be sure to tell your friend you are always there to listen if she or he wants to talk.
  • Don’t place shame, blame, or guilt on your friend. Don’t say, “You just need to eat.” Instead, say things like, “I’m concerned about you because you won’t eat breakfast or lunch.” Or, “It makes me afraid to hear you throwing up.”
  • Don’t give simple solutions. Don’t say, "If you'd just stop, then things would be fine!"
  • Let your friend know that you will always be there no matter what.

Eating disorders can also cause someone to not act like her or himself. She or he may talk about weight and food all the time, not eat in front of others, be moody or sad, or not want to go out with friends. People with eating disorders may also have other psychiatric and physical illnesses, including:

  • depression
  • anxiety
  • obsessive behavior
  • substance abuse
  • issues with the heart and/or brain
  • problems with physical development

The slow starvation of an anorexic patient can cause a multitude of health problems, not limited to imbalances in the blood chemistry (low potassium, low sodium), loss of the menstrual cycle diarrhea and constipation, osteoporosis and bone loss, damage to the nerves of the eyes, atrophy of the brain, and a disrupted immune system. Ultimately patients can suffer cardiac arrest.

Anorexia Nervosa

Those who suffer from anorexia fluctuate between extremes. If you suffer from anorexia you may may severely reduce the amount of food you take in, or begin to eat an unusually large amount of food. You may also become very concerned with your physical appearance, especially your weight. These affects can start out small in the form of minor adjustments to the amount of food eaten, but generally will expand until they are out of the individuals control.

Many individuals who suffer from anorexia deny that they have a problem. They will not seek treatment until their condition has worsened to a serious state. If you believe you or someone you know is suffering from the effects of anorexia it is very important to seek the help of a medical professional.

Bulimia Nervosa

Those suffering from bulimia nervosa can get better. A health care team of doctors, nutritionists, and therapists will help the patient recover. They will help the person learn healthy eating patterns and cope with their thoughts and feelings. However, bulimia is a long-term illness that requires vigilance on the part of the patient, and patients may have symptoms even with treatment. People with fewer medical complications of bulimia, and those who are willing and able to take part in therapy have the best chance of recovery.

Binge Eating Disorder

If you think you might have binge eating disorder, it is important to know that you are not alone. Most people who have the disorder have tried but failed to control it on their own. You may want to get professional help. Talk to your health care provider about the type of help that may be best for you. The good news is that most people do well in treatment and can overcome binge eating.

People with binge eating disorder are usually very upset by their binge eating and may become depressed. Research has shown that people with binge eating disorder report more health problems, stress, trouble sleeping, and suicidal thoughts than do people without an eating disorder. Other complications from binge eating disorder could include joint pain, digestive problems, headache, muscle pain, and menstrual problems.

People with binge eating disorder often feel bad about themselves and may miss work, school, or social activities to binge eat.

People with binge eating disorder may gain weight. Weight gain can lead to obesity, and obesity puts people at risk for many health problems. People with binge eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure. They also experience guilt, shame, and distress about their binge eating, which can lead to more binge eating. 

Review Date: 
March 13, 2012
Overview Video: 
Eating Disorders