Eating Disorders: Facts About Eating Disorders and the Search
for Solutions
Eating is controlled by many factors, including appetite, food
availability, family, peer, and cultural practices, and attempts
at voluntary control. Dieting to a body weight leaner than
needed for health is highly promoted by current fashion trends,
sales campaigns for special foods, and in some activities and
professions. Eating disorders involve serious disturbances in
eating behavior, such as extreme and unhealthy reduction of food
intake or severe overeating, as well as feelings of distress or
extreme concern about body shape or weight. Researchers are
investigating how and why initially voluntary behaviors, such as
eating smaller or larger amounts of food than usual, at some
point move beyond control in some people and develop into an
eating disorder. Studies on the basic biology of appetite
control and its alteration by prolonged overeating or starvation
have uncovered enormous complexity, but in the long run have the
potential to lead to new pharmacologic treatments for eating
disorders. Eating disorders are not due to a failure of will or
behavior; rather, they are real, treatable medical illnesses in
which certain maladaptive patterns of eating take on a life of
their own. The main types of eating disorders are anorexia
nervosa and bulimia nervosa. A third type, binge-eating
disorder, has been suggested but has not yet been approved as a
formal psychiatric diagnosis. Eating disorders frequently
develop during adolescence or early adulthood, but some reports
indicate their onset can occur during childhood or later in
adulthood. Eating disorders frequently co-occur with other
psychiatric disorders such as depression, substance abuse, and
anxiety disorders. In addition, people who suffer from eating
disorders can experience a wide range of physical health
complications, including serious heart conditions and kidney
failure which may lead to death. Recognition of eating disorders
as real and treatable diseases, therefore, is critically
important. Females are much more likely than males to develop an
eating disorder. Only an estimated 5 to 15 percent of people
with anorexia or bulimia and an estimated 35 percent of those
with binge-eating disorder are male. Anorexia Nervosa
An estimated 0.5 to 3.7 percent of females suffer from anorexia
nervosa in their lifetime. Symptoms of anorexia nervosa include:
* Resistance to maintaining body weight at or above a minimally
normal weight for age and height * Intense fear of gaining
weight or becoming fat, even though underweight * Disturbance in
the way in which one's body weight or shape is experienced,
undue influence of body weight or shape on self-evaluation, or
denial of the seriousness of the current low body weight *
Infrequent or absent menstrual periods (in females who have
reached puberty) People with this disorder see themselves as
overweight even though they are dangerously thin. The process of
eating becomes an obsession. Unusual eating habits develop, such
as avoiding food and meals, picking out a few foods and eating
these in small quantities, or carefully weighing and portioning
food. People with anorexia may repeatedly check their body
weight, and many engage in other techniques to control their
weight, such as intense and compulsive exercise, or purging by
means of vomiting and abuse of laxatives, enemas, and diuretics.
Girls with anorexia often experience a delayed onset of their
first menstrual period. The course and outcome of anorexia
nervosa vary across individuals: some fully recover after a
single episode; some have a fluctuating pattern of weight gain
and relapse; and others experience a chronically deteriorating
course of illness over many years. The mortality rate among
people with anorexia has been estimated at 0.56 percent per
year, or approximately 5.6 percent per decade, which is about 12
times higher than the annual death rate due to all causes of
death among females ages 15-24 in the general population. The
most common causes of death are complications of the disorder,
such as cardiac arrest or electrolyte imbalance, and suicide.
Bulimia Nervosa
An estimated 1.1 percent to 4.2 percent of females have bulimia
nervosa in their lifetime. Symptoms of bulimia nervosa include:
* Recurrent episodes of binge eating, characterized by eating an
excessive amount of food within a discrete period of time and by
a sense of lack of control over eating during the episode *
Recurrent inappropriate compensatory behavior in order to
prevent weight gain, such as self-induced vomiting or misuse of
laxatives, diuretics, enemas, or other medications (purging);
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 Because purging or other
compensatory behavior follows the binge-eating episodes, people
with bulimia usually weigh within the normal range for their age
and height. However, like individuals with anorexia, they may
fear gaining weight, desire to lose weight, and feel intensely
dissatisfied with their bodies. People with bulimia often
perform the behaviors in secrecy, feeling disgusted and ashamed
when they binge, yet relieved once they purge. Binge-Eating
Disorder
Community surveys have estimated that between 2 percent and 5
percent of Americans experience binge-eating disorder in a
6-month period. Symptoms of binge-eating disorder include: *
Recurrent episodes of binge eating, characterized by eating an
excessive amount of food within a discrete period of time and by
a sense of lack of control over eating during the episode * The
binge-eating episodes are associated with at least 3 of the
following: eating much more rapidly than normal; eating until
feeling uncomfortably full; eating large amounts of food when
not feeling physically hungry; eating alone because of being
embarrassed by how much one is eating; feeling disgusted with
oneself, depressed, or very guilty after overeating * Marked
distress about the binge-eating behavior * The binge eating
occurs, on average, at least 2 days a week for 6 months * The
binge eating is not associated with the regular use of
inappropriate compensatory behaviors (e.g., purging, fasting,
excessive exercise) People with binge-eating disorder experience
frequent episodes of out-of-control eating, with the same
binge-eating symptoms as those with bulimia. The main difference
is that individuals with binge-eating disorder do not purge
their bodies of excess calories. Therefore, many with the
disorder are overweight for their age and height. Feelings of
self-disgust and shame associated with this illness can lead to
bingeing again, creating a cycle of binge eating. Treatment
Strategies
Eating disorders can be treated and a healthy weight restored.
The sooner these disorders are diagnosed and treated, the better
the outcomes are likely to be. Because of their complexity,
eating disorders require a comprehensive treatment plan
involving medical care and monitoring, psychosocial
interventions, nutritional counseling and, when appropriate,
medication management. At the time of diagnosis, the clinician
must determine whether the person is in immediate danger and
requires hospitalization. Treatment of anorexia calls for a
specific program that involves three main phases: (1) restoring
weight lost to severe dieting and purging; (2) treating
psychological disturbances such as distortion of body image, low
self-esteem, and interpersonal conflicts; and (3) achieving
long-term remission and rehabilitation, or full recovery. Early
diagnosis and treatment increases the treatment success rate.
Use of psychotropic medication in people with anorexia should be
considered only after weight gain has been established. Certain
selective serotonin reuptake inhibitors (SSRIs ) have been shown
to be helpful for weight maintenance and for resolving mood and
anxiety symptoms associated with anorexia. The acute management
of severe weight loss is usually provided in an inpatient
hospital setting, where feeding plans address the person's
medical and nutritional needs. In some cases, intravenous
feeding is recommended. Once malnutrition has been corrected and
weight gain has begun, psychotherapy (often cognitive-behavioral
or interpersonal psychotherapy) can help people with anorexia
overcome low self-esteem and address distorted thought and
behavior patterns. Families are sometimes included in the
therapeutic process. The primary goal of treatment for bulimia
is to reduce or eliminate binge eating and purging behavior. To
this end, nutritional rehabilitation, psychosocial intervention,
and medication management strategies are often employed.
Establishment of a pattern of regular, non-binge meals,
improvement of attitudes related to the eating disorder,
encouragement of healthy but not excessive exercise, and
resolution of co-occurring conditions such as mood or anxiety
disorders are among the specific aims of these strategies.
Individual psychotherapy (especially cognitive-behavioral or
interpersonal psychotherapy), group psychotherapy that uses a
cognitive-behavioral approach, and family or marital therapy
have been reported to be effective. Psychotropic medications,
primarily antidepressants such as the selective serotonin
reuptake inhibitors (SSRIs ), have been found helpful for people
with bulimia, particularly those with significant symptoms of
depression or anxiety, or those who have not responded
adequately to psychosocial treatment alone. These medications
also may help prevent relapse. The treatment goals and
strategies for binge-eating disorder are similar to those for
bulimia, and studies are currently evaluating the effectiveness
of various interventions. People with eating disorders often do
not recognize or admit that they are ill. As a result, they may
strongly resist getting and staying in treatment. Family members
or other trusted individuals can be helpful in ensuring that the
person with an eating disorder receives needed care and
rehabilitation. For some people, treatment may be long term.
Research Findings and Directions Research is contributing to
advances in the understanding and treatment of eating disorders.
* NIMH-funded scientists and others continue to investigate the
effectiveness of psychosocial interventions, medications, and
the combination of these treatments with the goal of improving
outcomes for people with eating disorders. * Research on
interrupting the binge-eating cycle has shown that once a
structured pattern of eating is established, the person
experiences less hunger, less deprivation, and a reduction in
negative feelings about food and eating. The two factors that
increase the likelihood of bingeing--hunger and negative
feelings--are reduced, which decreases the frequency of binges.
* Several family and twin studies are suggestive of a high
heritability of anorexia and bulimia, and researchers are
searching for genes that confer susceptibility to these
disorders. Scientists suspect that multiple genes may interact
with environmental and other factors to increase the risk of
developing these illnesses. Identification of susceptibility
genes will permit the development of improved treatments for
eating disorders. * Other studies are investigating the
neurobiology of emotional and social behavior relevant to eating
disorders and the neuroscience of feeding behavior. * Scientists
have learned that both appetite and energy expenditure are
regulated by a highly complex network of nerve cells and
molecular messengers called neuropeptides . These and future
discoveries will provide potential targets for the development
of new pharmacologic treatments for eating disorders. * Further
insight is likely to come from studying the role of gonadal
steroids. Their relevance to eating disorders is suggested by
the clear gender effect in the risk for these disorders, their
emergence at puberty or soon after, and the increased risk for
eating disorders among girls with early onset of menstruation
Anorexia Nervosa -------------------------------------------
Anorexia Nervosa is a serious, potentially life-threatening
eating disorder characterized by self-starvation and excessive
weight loss.
Anorexia Nervosa has four primary symptoms: Resistance to
maintaining body weight at or above a minimally normal weight
for age and height Intense fear of weight gain or being "fat"
even though underweight. Disturbance in the experience of body
weight or shape, undue influence of weight or shape on
self-evaluation, or denial of the seriousness of low body
weight. Loss of menstrual periods in girls and women
post-puberty. Eating disorders experts have found that prompt
intensive treatment significantly improves the chances of
recovery. Therefore, it is important to be aware of some of the
warning signs of anorexia nervosa. Warning Signs of Anorexia
Nervosa: Dramatic weight loss. Preoccupation with weight, food,
calories, fat grams, and dieting. Refusal to eat certain foods,
progressing to restrictions against whole categories of food
(e.g. no carbohydrates, etc.). Frequent comments about feeling
"fat" or overweight despite weight loss.