Eating Disorders: What You Should Know

An addiction to a behavior like gambling or sex is no less troubling for the addicted individual and their family and friends than is an addiction to a substance (Read Profile of a Gambling Addict). Addictions to substances or behaviors that are a common part of everyday life - like alcohol, sex, and food - can be particularly hard to stop because the person in recovery still encounters these regularly and, in the case of food, cannot live without it. Although, on one hand, America has a prevalent problem with obesity (Read Obesity: America's Biggest Problem), on the other hand, we have an equally disturbing problem with eating disorders, some of which do not necessarily lead to extreme changes in weight.

How common are eating disorders in the United States?

According to the National Institute of Mental Health, the percentages of the total population that has or has had an eating disorder are: anorexia (0.6%), bulimia (0.6%), and binge eating disorder (2.8%) (Read Eating Disorders: Not Just a Female Problem).  Keep in mind that these are the patients who have met the strict diagnostic criteria and millions more may have less severe yet similar disorders. Although young women ages 15-24 have been identified as being at the greatest risk, anyone of any age, sex, race, or socioeconomic background may develop one of these conditions.

What eating disorders are recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)?

• Anorexia: Anorexia Nervosa is often characterized by extreme weight loss. The person may either severely restrict their caloric intake or may induce vomiting to keep themselves from absorbing calories from food.

• Bulimia: Bulimia Nervosa most often involves a cycle of severely over-eating (i.e., binging) and then attempting to undo the effects of this over-consumption through vomiting, excessive exercise, inappropriate use of diuretics and/or laxatives, or fasting for other periods of time. People with bulimia usually maintain their weight and even sometimes gain weight.

• Binge Eating Disorder: The primary distinguishing feature of this disorder is the consumption of abnormally large portions of food within a very short period of time.  Unlike patients with bulimia, patients with binge eating disorder will not try to compensate for their increased intake of calories following a binge and are often overweight or obese.

• Other/”Not Otherwise Specified”: Although the 5th edition of the DSM promises to provide more detailed information about eating disorders that do not fit into the existing categories, for now, "Eating Disorder Not Otherwise Specified (NOS)" remains the catch-all psychiatric diagnosis for other detrimental eating behaviors (Read Who’s Who in Addiction Medicine). For example, a patient in this category might chew food but spit it out and not swallow it.  Many behaviors may overlap with the other eating disorders, but if the patient does not meet the minimum number of diagnostic criteria, they will likely receive an “NOS” diagnosis.

Remember that most behaviors including eating fall on a spectrum of normalcy. Many people will overeat on special occasions like Thanksgiving, will severely restrict calories for an important event (e.g., their wedding or the prom), or will use food (e.g., ice cream or chocolate) as a reward. It is only when these behaviors become frequent and obsessive and begin interfering with a person's life and physical/emotional well-being that there should be cause for concern.

What causes eating disorders?

Numerous social, emotional, biological, and psychological factors are at play in the development of eating disorders.  Among the factors that may contribute are:

• Turbulent interpersonal relationships
• Poor self-esteem
• Feeling lonely
• Feeling emotionally overwhelmed and having only immature and unhealthy coping mechanisms (10 Healthy Alternatives for Coping with Stress)
• Past sexual abuse
• Past physical abuse
• Feeling pressure from others in one’s social circle or society in general to be thin
• Feeling judged based on physical appearance
• Feeling unable to control one’s life
• Past experiences of teasing related to body weight
• Depression
• Genetics (Read Addiction and Genetics)

What are signs that someone might have an eating disorder?

Some behaviors that overlap between disorders include an obsession over one's weight, negative body image, extreme exercise behaviors, and rituals related to making and eating meals (Read 10 Ways to Improve Your Body Image). For signs specific to each eating disorder, consult the following articles:

• Anorexia: What Are the Signs?
• Bulimia: What Are the Signs?
• Binge Eating Disorder: What Are the Signs?

What other problems does having an eating disorder put someone at risk for?

• Suicide: People with eating disorders have a high rate of suicide attempts and successful suicides - not caused by starvation or poor eating behaviors – compared to other mental health conditions including drug addiction (Read Suicide and Substance Abuse: Know the Risks).  Some research suggests that as many as 20% of people with anorexia attempt suicide.
• Heart problems: Starvation and purging deplete the body of sodium and potassium and can produce electrolyte imbalances, which, in turn can cause arrhythmias and other cardiac problems that can, ultimately, lead to heart failure.
• Malnutrition-related problems: Tooth decay (can also be caused by stomach acids from vomiting) and other dental problems, hair loss, and other complications associated with malnutrition.
• Weight-related consequences: People who have binge eating disorder may develop obesity-related problems like diabetes, hypertension, heart disease, and high cholesterol.
• Emotional distress: All eating disorders can cause feelings of shame, guilt, depression, and anxiety.
• Reproductive problems: Hormonal shifts of dehydroepiandrosterone (DHEA) and estrogen in women can lead to amenorrhea (absent menses) and infertility.  Women who have not recovered from anorexia yet conceive are at a high risk for having a miscarriage or a baby with birth defects and/or low birth weight.
• Osteopenia and osteoporosis: Low estrogen levels in anorexic patients can cause varying degrees of bone loss.
• Neurological problems: Patients with anorexia may experience neurological problems including convulsions.
• Esophageal problems: Individuals who engage in self-induced vomiting over an extended period of time may cause their esophagus to become inflamed or even rupture.
• Gastrointestinal (GI) issues: Chronic laxative abuse can cause long-term problems with constipation and other GI problems.

Can I do anything to help a person with an eating disorder?

Having people in their life who have high self-esteem and can make the person feel good about themselves is a helpful foundation. If the person has lost a lot of weight and body fat and looks very thin, they may need immediate hospitalization to avoid potentially serious consequences including death as a result of starvation or organ failure. Someone who is in the early stages may benefit from seeing both a psychiatrist and a psychologist on a regular basis (Read Talk It Out: Is Therapy Right for You?).