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. 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.
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.