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Eating disorders in the US

Eating Disorders in the US: Types, Symptoms, and Treatments

“I try so hard to be so perfect. I am a good student and do a great job at work, but no one knows how hard it is for me. I try to concentrate on my work, but I keep having these obsessive thoughts about how fat I am. I get on the scale and have only lost one pound. I just want to lose five more pounds. I thought when I got to this weight I would be skinny enough, but now that I’m there I still need to lose more.”

This excerpt written by a woman suffering from an eating disorder illustrates the kinds of obsessive thoughts that plague those with eating disorders every day.

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When many of us think of eating disorders, we automatically picture a severely emaciated woman. The reality is that disordered eating affects both women and men, and comes in a variety of forms, many of which may not be obvious to others.

Eating disorders are illnesses that affect a person’s behavior around their diet. Co-occurring disorders, such as obsessive-compulsive disorder (OCD), and dual diagnosis are not uncommon.

A person may severely restrict their diet and eat very little, as with anorexia nervosa, or they may gorge themselves with food as a method of coping with stress, and then purge later, as with the binge-purge form of bulimia. They may also exercise obsessively and take laxatives or diuretics to lose weight, along with many other dysfunctional behaviors. 

We’ll take a look at common eating disorders and how they manifest in sufferers.

Anorexia Nervosa
People with anorexia nervosa see themselves as overweight, even those who are underweight—sometimes dangerously so. Weight control, diet, and exercise become obsessions for people with anorexia, negatively affecting every aspect of their lives. The symptoms of anorexia include:

  • Extremely restricted eating
  • Extreme pickiness about food
  • Thinness (sometimes extreme thinness)
  • Intense fear of gaining weight
  • Seeing oneself as fat (distorted body image)
  • Self-esteem based around weight and body image

Additional physical signs can set in over time, including brittle hair and nails, dry, yellowish skin, and fine hair that develops all over the body. Those with anorexia can develop osteoporosis or osteopenia (thinning of the bones), low blood pressure, anemia, muscle wasting, infertility—even organ failure and brain damage. Many report feeling tired or sluggish much or all of the time. At its root, anorexia is a psychological illness, with the need to control at the center.

Researchers are finding that the cause of anorexia involves a combination of genetic, biological, behavioral, psychological, and social factors—it is becoming increasingly apparent that anorexia is a complex disease.

A Deadly Illness
Anorexia can be deadly, although the mortality rate varies considerably from one study to the next. This could be due to a variety of factors, including length of follow-up and other factors. Importantly, a medical complication is often reported as the cause of death in those with eating disorders—complications like heart failure, organ failure, or malnutrition—rather than the root cause.1 Most people with the disorder will require help, such as care at an anorexia treatment center.

Bulimia Nervosa
There are two commonly recognized types of bulimia nervosa:

  • Purging type: Involves bingeing and self-induced vomiting or misuse of laxatives, diuretics, or enemas.
  • Non-purging type: Involves bingeing and then using excessive exercise, fasting, or other compensatory behaviors, aside from regular self-induced vomiting or misuse of laxatives, diuretics, and enemas.

It’s important to note, however, that these specifiers no longer exist in the DSM-5, since people with bulimia may switch back and forth between different types of compensatory behavior.

Bulimia can be a fairly easy illness to conceal, since those with the disorder often binge and purge in secret and maintain normal or above normal body weight.

Symptoms of Bulimia
Bulimia generally involves repeated episodes of binge-eating, during which the person eats more food than most people would eat during the same period under the similar circumstances, feels out of control during the episode, and later compensates by inducing vomiting, exercising excessively, fasting, or abusing laxatives, diuretics, enemas, or other medications.

Bulimia can range from milder forms—from one or two episodes of inappropriate compensatory behaviors a week, such as self-induced vomiting, to severe or extreme forms, in which the person engages in a dozen or more episodes of inappropriate compensatory behaviors every week.

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Health Risks of Bulimia
Acid from the stomach can damage the esophagus in those who self-induce vomiting, leading to chronic inflammation, sore throat, acid reflux disease, and other gastrointestinal problems. Chronic misuse of laxatives can also cause inflammation in the intestines, and can reduce a person’s ability to have bowel movements on their own. Purging can cause severe dehydration and electrolyte imbalance, which could lead to heart attack. Bulimia treatment in a monitored setting is often required for full recovery.

Binge-Eating Disorder
Binge-eating disorder involves recurrent binge eating without purging or other compensatory behaviors like exercising or misusing laxatives. People who binge eat typically consume large amounts of food, feel out of control during the episode, and experience feelings of guilt or shame as a result of their bingeing. Eating when not hungry to the point of discomfort, or eating alone because of feelings of shame, are typical behaviors in those with the disorder.  

People who binge eat often suffer from depression, and binge eating disorder is more common in women than men. Because there is generally no purging behavior involved, binge eaters are often overweight or obese. The associated complications of being overweight or obese include high cholesterol, diabetes mellitus, heart disease, high blood pressure, and musculoskeletal problems (such as knee problems from carrying around excess weight).

Eating Disorder Not Otherwise Specified (EDNOS)
EDNOS is a feeding or eating disorder that does not meet the criteria for another disorder but nevertheless causes significant emotional and psychological distress. EDNOS has been updated in the DSM-V and is now referred to as “Other Specified Feeding or Eating Disorder” (OSFED).

Examples of OSFED include someone who exhibits the behaviors associated with bulimia nervosa, but with less frequent compensatory behaviors, or someone who eats excessively at night, but doesn’t meet all the criteria for binge-eating disorder.

OSFED may, in fact, be the most common type of disordered eating,2 since many people may have issues around food and body image, but do not meet all of the clinical criteria for any one particular eating disorder.

The common thread among those with OSFED is experiencing significant emotional and psychological suffering. Anyone who is concerned that something isn’t right with their relationship with food, exercise habits, or use of substances (like laxatives) should seek help.

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There Is Hope
Eating disorder treatment programs can help those suffering with eating disorders to eliminate unhealthy patterns of thinking, correct unhealthy behaviors, and learn coping methods for dealing with life’s stressors.

Treatment can include any one or a combination of the following:

Healing begins in a nurturing environment with experts who understanding eating disorders and who are trained to provide effective treatment. When the mind, body, and spirit are in balance, healing can begin.