Eating disorders are so common in America that 1 or 2 out of every 100 students will struggle with one.
Eating disorders are more than just going on a diet to lose weight or trying to make sure you exercise every day. They're extremes in eating behavior — the diet that never ends and gradually gets more restrictive, for example. Or the person who can't go out with friends because he or she thinks it's more important to go running to work off a piece of candy.
The most common types of eating disorder are anorexia nervosa and bulimia nervosa (usually called simply "anorexia" and "bulimia"). But other food-related disorders, like binge eating disorders, body image disorders, and food phobias, are showing up more frequently than they used to.
Anorexia
People with anorexia have an extreme fear of weight gain and a distorted view of their body size and shape. As a result, they can't maintain a normal body weight. Some people with anorexia restrict their food intake by dieting, fasting, or excessive exercise. They hardly eat at all — and the small amount of food they do eat becomes an obsession.
Other people with anorexia do something called binge eating and purging, where they eat a lot of food and then try to get rid of the calories by forcing themselves to vomit, using laxatives, or exercising excessively.
Bulimia
Bulimia is similar to anorexia. With bulimia, a person binge eats (eats a lot of food) and then tries to compensate in extreme ways, such as forced vomiting or excessive exercise, to prevent weight gain. Over time, these steps can be dangerous.
To be diagnosed with bulimia, a person must be binging and purging regularly, at least twice a week for a couple of months. Binge eating is different from going to a party and "pigging out" on pizza, then deciding to go to the gym the next day and eat more healthfully. People with bulimia eat a large amount of food (often junk food) at once, usually in secret. The person typically feels powerless to stop the eating and can only stop once he or she is too full to eat any more. Most people with bulimia then purge by vomiting, but may also use laxatives or excessive exercise.
Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight but those with bulimia may be a normal weight or even overweight.
Binge Eating Disorder
This eating disorder is similar to anorexia and bulimia because a person binges regularly on food (more than three times a week). But, unlike the other eating disorders, a person with binge eating disorder does not try to "compensate" by purging the food.
Anorexia, bulimia, and binge eating disorder all involve unhealthy eating patterns that begin gradually and build to the point where a person feels unable to control them.
Anorexia and Bulimia: What to Look For
Sometimes a person with anorexia or bulimia starts out just trying to lose some weight or hoping to get in shape. But the urge to eat less or to purge spirals out of control.
People with anorexia or bulimia frequently have an intense fear of being fat or think that they are fat when they are not. A person with anorexia may weigh food before eating it or compulsively count the calories of everything. When it seems "normal" or "cool" to do things like restrict food intake to an unhealthy level, it's a sign that a person has a problem.
So how do you know if a person is struggling with anorexia or bulimia? You can't tell just by looking at someone. A person who loses a lot of weight may have another health condition or may be losing weight through healthy eating and exercise.
Here are some signs that a person may have anorexia or bulimia:
Anorexia
- becomes very thin, frail, or emaciated
- obsessed with eating, food, and weight control
- weighs herself or himself repeatedly
- counts or portions food carefully
- only eats certain foods, avoiding foods like dairy, meat, wheat, etc. (of course, lots of people who are allergic to a particular food or are vegetarians avoid certain foods)
- exercises excessively
- feels fat
- withdraws from social activities, especially meals and celebrations involving food
- may be depressed, lethargic (lacking in energy), and feel cold a lot
Bulimia
- fears weight gain
- intensely unhappy with body size, shape, and weight
- makes excuses to go to the bathroom immediately after meals
- may only eat diet or low-fat foods (except during binges)
- regularly buys laxatives, diuretics, or enemas
- spends most of his or her time working out or trying to work off calories
- withdraws from social activities, especially meals and celebrations involving food
What Causes Eating Disorders?
No one is really sure what causes eating disorders, although there are many theories about why people develop them. Many people who develop an eating disorder are between 13 and 17 years old. This is a time of emotional and physical changes, academic pressures, and a greater degree of peer pressure. Although there is a sense of greater independence during the teen years, teens might feel that they are not in control of their personal freedom and, sometimes, of their bodies. This can be especially true during puberty.
For girls, even though it's completely normal (and necessary) to gain some additional body fat during puberty, some respond to this change by becoming very fearful of their new weight. They might mistakenly feel compelled to get rid of it any way they can.
When you combine the pressure to be like celeb role models with the fact that during puberty our bodies change, it's not hard to see why some teens develop a negative view of themselves.
Many people with eating disorders also can be depressed or anxious, or have other mental health problems such as obsessive-compulsive disorder (OCD). There is also evidence that eating disorders may run in families. Although part of this may be our in genes, it's also because we learn our values and behaviors from our families.
Sports and Eating Disorders
Athletes and dancers are particularly vulnerable to developing eating disorders around the time of puberty, as they may want to stop or suppress growth (both height and weight).
Coaches, family members, and others may encourage teens in certain sports — such as gymnastics, ice-skating, and ballet — to be as thin as possible. Some athletes and runners are also encouraged to weigh less or shed body fat at a time when they are biologically destined to gain it.
Effects of Eating Disorders
Eating disorders are serious medical illnesses. They often go along with other problems such as stress, anxiety, depression, and substance use. People with eating disorders also can have serious physical health problems, such as heart conditions or kidney failure. People who weigh at least 15% less than the normal weight for their height may not have enough body fat to keep their organs and other body parts healthy. In severe cases, eating disorders can lead to severe malnutrition and even death.
With anorexia, the body goes into starvation mode, and the lack of nutrition can affect the body in many ways:
- a drop in blood pressure, pulse, and breathing rate
- hair loss and fingernail breakage
- loss of periods
- lanugo hair — a soft hair that can grow all over the skin
- lightheadedness and inability to concentrate
- anemia
- swollen joints
- brittle bones
With bulimia, constant vomiting and lack of nutrients can cause these problems:
- constant stomach pain
- damage to a person's stomach and kidneys
- tooth decay (from exposure to stomach acids)
- "chipmunk cheeks," when the salivary glands permanently expand from throwing up so often
- loss of periods
- loss of the mineral potassium (this can contribute to heart problems and even death)
A person with binge eating disorder who gains a lot of weight is at risk of developing diabetes, heart disease, and some of the other diseases associated with being overweight.
The emotional pain of an eating disorder can take its toll, too. When a person becomes obsessed with weight, it's hard to concentrate on much else. Many people with eating disorders become withdrawn and less social. People with eating disorders might not join in on snacks and meals with their friends or families, and they often don't want to break from their intense exercise routine to have fun.
People with eating disorders often spend a lot of mental energy on planning what they eat, how to avoid food, or their next binge, spend a lot of their money on food, hide in the bathroom for a long time after meals, or make excuses for going on long walks (alone) after a meal.
Treatment for Eating Disorders
Fortunately, people with eating disorders can get well and gradually learn to eat normally again. Eating disorders involve both the mind and body. So medical doctors, mental health professionals, and dietitians will often be involved in a person's treatment and recovery.
Therapy or counseling is a critical part of treating eating disorders — in many cases, family therapy is one of the keys to eating healthily again. Parents and other family members are important in helping a person see that his or her normal body shape is perfectly fine and that being excessively thin can be dangerous.
If you want to talk to someone about eating disorders and you don't feel as though you can approach a parent, try talking to a teacher, a neighbor, your doctor, or another trusted adult. Remember that eating disorders are very common among teens. Treatment options depend on each person and their families, but many options are available to help you overcome an eating disorder. Therapy can help you feel in charge again and learn to like your body, just as it is.
Reviewed by: Michelle New, PhD
Date reviewed: November 2007
