EATING DISORDERS

The are three main types of eating disorders.

1. Anorexia nervosa

Anorexia nervosa is an eating disorder in which people have an intense fear of gaining weight and can become dangerously thin.

Anorexia affects both the body and the mind. It may start as dieting, but it gets out of control. You think about food, dieting, and weight all the time. You have a distorted body image. Other people say you are too thin, but when you look in the mirror, you see your body as overweight.

Anorexia usually starts in the teen years. It’s much more common in females than males. Early treatment can be effective. The earlier it is treated, the better the chances someone can recover from anorexia. Untreated anorexia can lead to starvation and serious health problems, such as bone thinning (osteoporosis), kidney damage, and heart problems. Some people die from these problems.

The cause of anorexia nervosa is not fully understood. It is thought to develop from a mix of physical, emotional, and social triggers.

• Extreme dieting changes how the brain and metabolism work, and it stresses the body. These changes may make you more likely to develop an eating disorder.
• Genetics play a big part in anorexia and bulimia. Compared with people who don’t have these disorders, people who have eating disorders are more likely to have a family history of an eating disorder, obesity, or a mood disorder (such as anxiety or depression).
• A combination of certain personality traits (such as low self-confidence along with perfectionism) and cultural and social pressures can play a part in anorexia.
• For some teens, anorexia may be a way of coping with stress and the challenges of the teen years. Stressful life events, such as moving, divorce, or the death of a loved one, can trigger anorexia.

Anorexia Nervosa – Symptoms

Feelings and actions

Common feelings and actions that are linked to anorexia nervosa include:

• Having an intense fear of gaining weight.
• Restricting food or types of food, such as food that contains any kind of fat or sugar.
• Weighing much less than is normal or expected for your age, gender, stage of development, or physical health. (In a child or teen, losing or not gaining weight during a growth spurt is a concern.)
• Seeing your body as overweight, in spite of being underweight. This is called having a distorted body image.
• Exercising too much.
• Being secretive around food and not recognizing or wanting to talk about having a problem with eating or weight loss.

Some people who have anorexia may also have times where they binge eat and make themselves vomit or use laxatives or diuretics to lose weight. Breakdown of the enamel on the teeth is a common symptom of long-term vomiting.

Physical signs

Common physical signs of malnutrition from anorexia include:

• A low body weight.
• Constipation and slow emptying of the stomach.
• Thinning hair, dry skin, and brittle nails.
• Shrunken breasts.
• Stopping or never getting a monthly menstrual period.
• Feeling cold, with a lower-than-normal body temperature.
• Low blood pressure.

Food rituals

People who have anorexia often form rituals associated with eating. These may include:

• Having special ways of eating food, hoarding food, collecting recipes, and preparing elaborate meals for other people but not eating the meals themselves.
• Spending a lot of time cutting and rearranging food on their plates to make it look as though they have eaten. They may also hide food or secretly get rid of it during meals.

Suicidal feelings

In some cases, people who have eating disorders can feel suicidal.

• Warning signs of possible suicide in children and teens can include making suicide threats, being preoccupied with death or suicide, giving away belongings, withdrawing, being angry, or having failing grades.
• Warning signs and possible triggers of suicide in adults can include suicide threats, alcohol or substance abuse, depression, giving away belongings, a recent job loss, or divorce.

If someone you know shows warning signs of suicide, make sure that the person is not left alone. Seek help from a mental health professional immediately.

2. Bulimia nervosa

People with bulimia will eat a larger amount of food than most people would in a similar situation, in a short period of time (binge). Then, in order to prevent weight gain, they will do something to get rid of the food (purge). They may vomit, exercise too much, or use medicines like laxatives.

Bulimia affects mostly women and teens. People who have bulimia judge themselves harshly on their body weight and shape. In order to help them cope with these feelings, they follow a strict diet to try to lose weight. But over time the hunger from the strict diet triggers them to binge eat. After binge eating, they feel out of control, ashamed, guilty, and afraid of gaining weight. This distress causes them to purge, in hopes of “undoing” any possible weight gain from the binge.

Without treatment, this “binge and purge” cycle can lead to serious, long-term health problems. Acid in the mouth from vomiting can cause tooth decay, gum disease, and loss of tooth enamel. Any type of purging can lead to bone thinning (osteoporosis), kidney damage, heart problems, or even death.

The cause of bulimia is not clear, but it probably results from a combination of genetics, family behaviors, social values (such as admiring thinness), and other things that can put someone at risk (such as perfectionism).

Your risk for bulimia increases if your parent, sister, or brother has the condition. But family history may be only part of the cause.

Stressful life events such as moving, divorce, or the death of a loved one can trigger bulimia in some people.

Many young women, such as those in college or high school, have unhealthy attitudes toward eating and toward their bodies. Socially, they may accept and encourage destructive behaviors like extreme dieting or binge eating and purging. These beliefs and behaviors are not normal or healthy. They can play a part in developing eating disorders that need treatment. Women who begin to severely restrict their diets in order to lose weight are at risk for bulimia.

Symptoms of bulimia include:

• Repeated binge eating, or eating larger amounts of food than most people would in a similar situation, in a short period of time (2 hours or less).
• Frequently getting rid of the calories you’ve eaten (purging) by making yourself vomit, fasting, exercising too much, or misusing laxatives, diuretics, ipecac syrup, or enemas. Misuse of these medicines can lead to serious health problems and even death.
• Feeling a loss of control over how much you eat.
• Feeling ashamed of overeating and very fearful of gaining weight.
• Basing your self-esteem and value upon your body shape and weight.
• Thinking about food, your body, or dieting so much that it distracts you from other tasks.

Any of the above symptoms can be a sign of bulimia or another eating disorder that needs treatment. If you or someone you know has any of these symptoms, talk to a doctor, friend, or family member about your concerns right away.

Bulimia and other eating disorders can be hard to diagnose, because people often keep unhealthy thoughts and behaviors secret and may deny that they have a problem. Often a person won’t get evaluation and treatment until someone else notices the signs of bulimia and encourages the person to seek the help that he or she needs.

Other signs that a person may have bulimia

Common signs that a person may have bulimia are when the person:

• Is very secretive about eating and does not eat around other people.
• Sneaks food or hides food in the house. You may notice that large amounts of food are missing.
• Has frequent weight changes. For example, the person may gain and lose large amounts of weight in short periods of time.
• Has irregular menstrual cycles.
• Seems preoccupied with exercise.
• Often talks about dieting, weight, and body shape.
• Seems to be overusing laxatives and diuretics.
• Has low levels of potassium or other blood electrolyte imbalances.
• Looks sick or has symptoms such as:
• Tooth decay or erosion of tooth enamel.
• Sore gums or mouth sores.
• Dry skin.
• Loose skin.
• Thin or dull hair.
• Swollen salivary glands.
• Bloating or fullness.
• Lack of energy.
• Teeth marks on the backs of the hands or calluses on the knuckles from self-induced vomiting.
• Feels depressed, anxious, or guilty.
• Shoplifts food, laxatives, or diuretics.
• Drinks large amounts of alcohol or uses illegal drugs and may have a substance abuse problem.

Conditions that commonly occur with bulimia, such as depression, substance abuse, or anxiety disorders, can make treatment of bulimia harder. Recovery from bulimia can take a long time. And relapse is common. If the person feels extremely discouraged, be sure to tell the doctor immediately so that the person can get immediate help.

In some cases, people who have an eating disorder may feel suicidal.

• Warning signs of possible suicide in children and teens can include being preoccupied with death or suicide, giving away belongings, withdrawing, being angry, or having failing grades.
• Warning signs and possible triggers of suicide in adults can include alcohol or substance abuse, depression, giving away belongings, a recent job loss, or divorce.

If you or someone you know shows warning signs of suicide, seek help immediately.

Bulimia is different from anorexia. People with anorexia have an extremely low body weight. But most people with bulimia are in their normal weight range. Some people who have anorexia make themselves vomit, but this is a different eating disorder.

3. Binge-eating disorder

Binge eating disorder is compulsive overeating. People who binge use food as a way to cope with unwanted emotions or stress.

Most people have had times when they ate too much, especially during a special occasion or holiday. Binge eating disorder is different.

You feel like you can’t stop, even if you’re already uncomfortably full. You may eat a lot, quickly, even if you’re not hungry. You feel ashamed about it. Unlike bulimia, you don’t try to make yourself throw up or exercise a lot after a binge.

Experts don’t know why some people develop binge eating disorder. It’s more common in women than in men. The disorder also runs in some families.

People who are obese are at a higher risk of getting binge eating disorder, although people of normal weight can also get it. About two of every three people in the U.S. who have the condition are obese.

If you have binge eating disorder, you may have trouble handling your emotions or feel out of control in other ways. You may use food as a way to comfort or reward yourself. Skipping meals and other severe dieting may trigger a backlash of binge eating.

The disorder often goes hand-in-hand with depression. Researchers are studying whether brain chemicals or metabolism (the way your body uses food) play roles.

Some people with binge eating disorder have gone through emotional or physical abuse, or had addictions, such as alcoholism. If that sounds like you, getting help with those issues will be part of getting better.

If you have binge eating disorder, you:

• Eat more food than other people do in the same situation.
• Feel like you can’t control how much you eat.
• Feel upset after you binge.
• Have an eating binge at least once a week for 3 months, on average.

You also have three or more of these symptoms:

• Eat much more quickly than normal.
• Eat enough to be uncomfortably full.
• Even when you’re not hungry you eat a lot.
• Eat alone so no one will see how much food you’re having.
• Feel guilty, disgusted, or depressed about your eating.

People with binge eating disorder don’t try to throw up after overeating. You can get other health problems related to gaining weight or unhealthy eating, too, such as type 2 diabetes, high blood pressure, or heart disease.

You also may have trouble sleeping, muscle and joint pain, and digestive problems. Women may have irregular or infrequent menstrual periods.

DIAGNOSIS

Common exams and tests for a possible eating disorder include:

• A medical history of your physical and emotional health, present and past.
• A physical exam, including checking your heart, lungs, blood pressure, weight, mouth, skin, and hair for problems from malnutrition.
• Screening questions about your eating habits and how you feel about your health.
• A mental health assessment, to check for depression or anxiety.
• Blood tests, to check for signs of malnutrition.
• X-rays, which can show whether your bones have been weakened (osteopenia) by malnutrition.

If your doctor thinks that you may have organ damage, doing heart or kidney tests can be helpful.

 

TREATMENT

1. Anorexia Nervosa

All people with anorexia need treatment. In most cases, this involves seeing a doctor and having regular counseling sessions. A hospital stay is needed for those who are seriously underweight or who have severe medical problems. The goals of treatment are to restore a healthy weight and healthy eating habits.

If you have an eating disorder, try not to resist treatment. Although you may be very afraid of gaining weight, try to think of weight gain as a life-saving measure. With help, you can learn to eat well and keep your weight at a healthy level.

Ideally, you can take charge of anorexia with the help of a team that includes a mental health professional (such as a psychologist or licensed counselor), a medical health professional (such as a doctor or nurse), and a registered dietitian.

If your medical condition is not life-threatening, your treatment likely will include:

• Medical treatment. If malnutrition or starvation has started to break down your body, medical treatment will be a top priority. Your doctor will treat the medical conditions that have been caused by anorexia, such as osteoporosis, heart problems, or depression. As you begin to get better, your doctor will continue to follow your health and weight.
• Nutritional counseling. A registered dietitian will help you take charge of your weight in a healthy way. You will learn healthy eating patterns and gain a good understanding of nutrition.
• Therapy. Talking with a psychologist or mental health professional will help you cope with the emotional reasons behind anorexia. For example, you may discuss life stresses, unhelpful beliefs about food and weight, or certain personality traits that may be, in part, causing anorexia.

An important part of your recovery will include:

• Taking control of your eating habits.
• Learning emotional self-care.
• Building trust in people who are trying to help youBuilding trust in people who are trying to help you.

For the teen with anorexia, family involvement is a key part of treatment. Family therapy helps parents support their child, both emotionally and physically.

2. Bulimia Nervosa

Treatment for bulimia involves psychological counseling and sometimes medicines such as antidepressants. Treatment does not usually require staying in the hospital, although this is sometimes needed. Both professional counseling and antidepressant medicine can help reduce episodes of binging and purging and help you recover from bulimia. Both are long-term treatments that may require weeks or months before you notice significant results. You may need treatment with counseling and possibly medicines for more than a year.

Bulimia that occurs with another condition may take longer to treat. And you may need more than one type of treatment. If you have another condition that commonly occurs with bulimia, such as depression or substance abuse, your doctor may want to treat that condition first.

People who seek treatment for bulimia or another eating disorder may have other health problems caused by the disorder. If you have had bulimia for a long time without treatment, or if you have used substances such as laxatives, diuretics, or ipecac syrup to purge, then you may have a health problem such as dehydration that needs treatment first. In serious cases, these conditions related to bulimia may require you to spend time in the hospital.

Initial treatment

Initial treatment depends how severe the bulimia is and how long you have had it.

If you have no other conditions that need treatment first, then treatment for bulimia usually consists of:

Medicines. Antidepressants, such as fluoxetine (Prozac, for example), are sometimes used to reduce binge-purge cycles and relieve symptoms of depression that often occur along with eating disorders. They work best when combined with counseling.

Psychological counseling. Two types of counseling are useful in treating bulimia. They are cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT). In CBT you learn how to change negative thoughts that you may have about food, your weight, your body, or beliefs about yourself. In IPT you learn how relationships-and feelings about those relationships-affect binge eating and purging.

The goals of CBT are:

• To use nutritional counseling to help you learn how to eat three meals and two snacks a day and avoid unhealthy diets.
• To reduce concern about your body weight and shape.
• To understand and reduce triggers of binge eating by examining your relationships and emotions.
• To develop a plan to learn proper coping skills to prevent future relapses.

The goals of IPT are:

• To identify relationships that are connected to binge eating and purging.
• To learn how emotions that come up from these relationships are related to binge eating and purging.
• To help correct these relationship patterns, so that you won’t binge eat or purge in response to bad feelings.

Ongoing treatment

Continuing treatment will depend on the how long you have had bulimia and how severe it is. Continuing treatment usually consists of:

• Psychological counseling, such as interpersonal psychotherapy or cognitive-behavioral therapy (CBT).
• Antidepressant medicines. Antidepressants can help lower the number of binge-purge cycles you have and may also be used to treat another related condition, such as depression or anxiety.

Treatment if the condition gets worse

If you develop other health problems such as dehydration or an esophageal tear because of bulimia, you may need to stay in the hospital or in an eating disorder treatment facility.

Sometimes people with bulimia get discouraged because recovery can take a long time and relapse is common. If you or the person with bulimia feels very discouraged or feels suicidal, call a doctor or other health professional immediately to get help.

What to think about

Treatment with an antidepressant medicine alone may not be enough. Antidepressants work best when combined with psychological counseling.

Eating disorders are hard to treat. Recovery may take months to years. The sooner treatment begins, the better the chance for a full recovery.

Unfortunately, many people don’t seek treatment for mental health problems. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

3. Binge eating disorder

Beating binge eating disorder is not about willpower. Sometimes medications such as lisdexamfetamine (Vyvanse) will be prescribed to suppress the desire to binge eat. It is the first FDA-approved drug to treat moderate to severe binge eating by curbing the binge eating episodes.

You also need the help of a specialist, such as a psychiatrist or psychologist. She may use an approach called cognitive behavior therapy, which focuses on what you do and how you feel. It can help you change your thoughts about eating and understand what triggers your binges.

Your therapist may suggest that you include your family in counseling so they can learn about the disorder, spot sources of stress at home, and know how to support you.

Ask your doctor or therapist about finding a support group in your area. It can help to talk to other people who know what you’re going through.

You also may need help with other conditions, such as depression or anxiety. A doctor may prescribe an antidepressant, a drug to help manage the urge to binge (such as the anti-seizure drug topiramate), or other medications.

Taking Care of Yourself

Feeling stressed makes it more likely that you’ll binge eat, so you’ll need positive ways to manage that. Yoga, meditation, exercise, and massage therapy can help you feel calm.

Ask your doctor or therapist to recommend a nutritional counselor who can teach you about healthy eating. If you have type 2 diabetes or high cholesterol, you may need to limit certain types of foods or lose weight. You need your doctor’s advice on how to lose extra weight without triggering binge eating.

The goal is to get healthier. It’s not about numbers on a scale or serving sizes. It’s also about how you relate to food and to your own body.