Scott Carroll, MD is the Director of Psychiatric Consultation Services at the University of New Mexico Children’s Hospital and Carrie Tingley Children’s Rehabilitation Hospital. He is currently an associate professor of Child and Adolescent Psychiatry at the University of New Mexico – School of Medicine.
|Anorexia Nervosa||Bulimia Nervosa||Binge Eating Disorder|
|What It Is||Self-starvation resulting in drastic and unhealthy weight loss||Binge eating followed by purging, such as self-induced vomiting||Frequent occurrences of eating large quantities of food, usually accompanied by the feeling of the loss of control|
|Physical Signs||Extreme weight loss, fatigue, irregular or absent menstruation||Scars or calluses on back of hands, eroded teeth, acid reflux, electrolyte imbalance and irregularity||Excessive weight gain|
|Emotional Signs||Intense fear of gaining weight, depression, anxiety, equating self-worth to body weight and denial of eating disorder||Low self-esteem, depression, anxiety and feelings of guilt.||Low self-esteem, depression, anxiety and feeling of loss of control|
|Eating Behavior||Eating very small amounts of food||Eating large amounts of food, followed by purging (usually from vomiting and/or laxatives)||Eating large amounts of food in short periods of time (at least once a week for three straight months), secretive eating, arranging schedule to binge eat|
|Body Image Issues||Belief in being overweight even though objective evidence indicates otherwise||Poor self-image, perfectionist and extreme concern with physical appearance||Feelings of disgust with respect to own body image|
|Weight||Substantially underweight||Ranges from underweight to overweight, but often of average body weight||Often overweight|
|Social Interaction||May choose to eat alone or withdraw from interacting with others||Still has relationships with others, but may be more withdrawn than usual||Ranges from being overly defensive to avoiding confrontation at all costs|
Dr. Carroll offers some expertise and insight into how to spot eating disorders and how to get help.
Anorexia – warm baggy clothing, especially in the summer, think sweat pants and sweat shirts or coats. Sallow, tired looking skin. Increased comments about being fat despite being thin and coming up with excuses not to eat with family/friends like, “I just ate, but you go ahead.” Alternatively, eating and then disappearing to the bathroom or working out excessively. Also, rapid weight loss, even if it seems healthy at first. Increasing OCD type behavior (technically Obsessive-Compulsive Personality Disorder) is also common.
Bulimia – any signs of binging, especially at night, finding lots of empty food containers, but never seeing them eat. Increased dental problems such as cavities and inflamed gums or scars on the backs of their hand from making themselves vomit. Also, buy/using lots of laxatives. Increasing depression is another common sign in Bulimia. Repeated attempts to lose weight unsuccessfully or being suddenly successful after numerous failed attempts.
Bulimia typically starts in college, but anorexia typically starts in late puberty (~13yo) or late high school/early college age. Anorexia is moderately genetic and is also associated with high IQ and high educational levels so that is why you see more anorexia in college. Also, many women had anorexia has a young teen, get treated and do well, but the stress of college and being away from family often conspire to trigger a relapse.
Professional treatment is absolutely necessary. Being supportive does little to help if someone really has an eating disorder. Probably the most important thing is to watch what a love one does and how they look and not be swayed by their attempts to conceal or deny their disorder.
Anorexia under 18 years old, we often initiate treatment on an inpatient basis for weeks or even months at first if the disorder is severe enough. Adults with anorexia are harder to treat since they have more legal ability to refuse inpatient treatment (people with anorexia often don’t think that anything is wrong with them). The important thing is that anorexia takes about 5 years to fully recover and many people never fully recover and have a waxing and waning course. Also, psychiatric medication is of modest benefit and specialized eating disorder therapy (1-3 times per week) over a few years is what it typically takes to recover on top of any inpatient treatment.
Families often need to force the ill person in to treatment because a key feature of anorexia is to not be aware that you are sick (or even to like being emaciated). Also, even when people don’t die from the anorexia, they still have severe, life-long health problems such as osteoporosis, infertility, heart problems and increased risk of dementia and learning problems.
Eating disorders are mental illnesses that manifest in some form concerning food. The most common symptoms include either excessive overeating, sometimes including binge eating and then purging, or severe restriction of calories. The obsession with eating and food, as well as weight and body image, can lead to significant distress; in fact, eating disorders can often go hand-in-hand with other problems, such as depression, anxiety and even substance abuse. Eating disorders might manifest in childhood, or they might surge to the forefront during the teenage years – more rarely, they manifest in adults.
Eating disorders have many causes, which are usually a complex interaction of genetic, psychological and social factors. However, social and psychological factors appear to be the leading causes. Specifically, many eating disorders relate to feelings of low self-esteem and poor body image.
Low self-esteem and/or poor body image often originate from societal pressure about how someone should look. There is also a link between certain personality traits and eating disorders. For example, those suffering from anorexia tend to be perfectionists, while those who have bulimia nervosa have impulsive tendencies. Combine a perfectionist personality with comments from friends, family members or the mainstream media telling someone they aren’t “good enough” unless they lose some weight and it’s no surprise if an eating disorder develops.
But keep in mind that the cause of an eating disorder is not always this simple. Eating disorders can be triggered by a wide variety of things, some of which is not well understood. Research is ongoing to learn more about what causes an eating disorder.
The most common eating disorders include anorexia nervosa and bulimia nervosa. Binge-eating disorder is also a common problem for many people. Eating disorders not otherwise specified, often referred to as EDNOS, include eating disorders that don’t fit neatly into the first three disorders.
This often manifests as a desire to eat as little as possible, an obsession with counting calories, and sometimes excessive exercise in order to burn off any calories consumed.
Bulimia usually takes the form of eating regularly or excessively, then purging – in other words, throwing up – in order to expel the calories.
This disorder often manifests in eating a great deal of food in one sitting, usually with an excessive amount of calories consumed.
This might include any issues with food, including starving, binging, purging, serious food aversions, and much more. These issues don’t fit neatly into the definition of binge-eating, bulimia or anorexia.
We will discuss these eating disorders in-depth in the following sections.
The impacts of an eating disorder can be both immediate and long-term. In the short-term, eating disorders can cause tooth erosion, low heart rate, abnormally low or high blood pressure, muscle atrophy, hair loss, electrolyte imbalance, high cholesterol, peptic ulcers, inflamed esophagus, constipation and fatigue.
But keep in mind that these are simply the physical impact that might be experienced – the emotional and psychological impact can be just as devastating.
In the long-term, those who suffer from eating disorders might experience an increased risk of diabetes, osteoporosis, anemia, kidney failure, a drop in internal body temperature, infertility, organ failure, severe constipation, growth of fine hair over the body, brittle hair or finger nails, dry skin, heart disease and brain damage.
These long-term consequences can be deadly. In fact, research indicates that those who are anorexic have a mortality rate that is 18 times higher than those without an eating disorder.
The signs of an eating disorder can sometimes be difficult to spot, especially in the earliest stages. That’s because someone with an eating disorder often knows that they will be encouraged to eat or otherwise do things that they might not want to do, and so hiding the disorder becomes a priority. However, over time an eating disorder becomes much more difficult to hide, especially when someone begins to drop weight – or gain weight – at an alarming rate. Here are some of the most common signs that might tip off friends and family to those who have an eating disorder.
What exactly turns disordered eating or a diet into an eating disorder? The simple answer is that it’s a question of degree. A slightly more complex answer is that in addition to the degree to which someone controls what or how they eat, the person’s motivation for the behavior can turn a “diet” into an eating disorder. We can start explaining the differences by defining what a diet, disordered eating and eating disorders are.
A diet is the regulation of food intake in order to modify the body. This is usually to lose weight or to meet some sort of health expectation, such as dieting in the hopes of reducing sodium intake or the like. A diet has a finite goal, whether it’s to put on 15 pounds of muscle before the next sport season begins or lose 10 pounds before summer vacation starts. There usually is no compulsive or extreme behavior concerning food or exercise while on a diet – though intake might be strict, it is reasonable.
Also, choices made on a diet are usually universally accepted as beneficial. An example might be eating more fruit and vegetables and eating fewer hamburgers.
Disordered eating refers to abnormal eating that doesn’t meet the criteria for an eating disorder. Put another way, someone suffering from disordered eating may have certain eating disorder criteria, such as binge eating, compulsive eating and purging. However, someone with disordered eating doesn’t engage in these activities as often or in as extreme fashion as someone with an eating disorder. Another way of thinking of disordered eating is abnormal eating, but not bad enough to warrant calling it an eating disorder.
An eating disorder takes something like dieting or disordered eating to the extreme. Instead of replacing a chili cheeseburger with healthier options, such as a turkey sandwich on wheat toast, the person with the eating disorder skips the meal entirely.
One of the biggest differences between a diet and an eating disorder is the motivation for the eating behavior. Someone on a diet wants to lose a set amount of weight and once that goal is reached, the eating behavior stops. Someone with an eating disorder will never be satisfied with the weight they have lost. They may say they just want to lose 10 pounds, but once they reach that goal, they’ll set another goal to lose weight. The eating habits become a compulsion, especially once that person suffering from an eating disorder sees the results of those habits.
Besides having an emaciated appearance, those who suffer from anorexia can face severe health problems. These can range from anemia to irregular periods to osteoporosis to death. When someone has anorexia, their body is being starved to death. Not only does the body not have enough energy to function, but the lack of nutrients causes serious medical complications.
One of the worst things about anorexia is that the person suffering from it believes they are fat or overweight, despite the fact that they are about extremely underweight and are on path to die from malnutrition. They also tend to express disbelief when someone suggests there might be something wrong. About 8% of those who suffer from anorexia will die, either from starvation or suicide.
As with other illnesses, the earlier treatment begins, the more likely it will be successful. Treatment will consist of several elements, depending on the individual and the severity of the problem.
If there are imminent medical problems, they will be addressed first. This can include medical treatment for osteoporosis or heart issues. Once medical complications have been treated or stabilized, the individual can receive counseling for proper eating habits and therapy to address the underlying cause of the anorexia. Individuals with anorexia usually suffer from anxiety, depression and body image issues.
Therapy can include psychotherapy and cognitive-behavioral therapy. Medication for mental health issues may be prescribed to help cope with things such as depression and anxiety.
The first step is to realize there is a problem. Visiting the websites listed below can help identify if you or someone you know has anorexia. They can also provide contact information for places to receive treatment as well as providing additional treatment information.
Once the problem is identified, a visit to your primary care physician will be an ideal next step. The primary care physician will be trained to treat and assess the eating disorder and can refer you to a specialist if necessary.Resource List
Bulimia is a serious mental health condition that is especially hard on the digestive system. Repeated vomiting causes long-term damage to the esophagus, mouth and teeth. Use of laxatives can cause long-term problems with bowel movements. No matter the purging methods used, bulimics usually suffer from osteoporosis, electrolyte imbalance and low blood pressure.
Another serious problem with bulimia is that in addition to problems with eating habits and the constant desire for food, as well as the guilt that comes with eating it, vomiting can actually become addictive. Vomiting results in the release of endorphins, a “feel good” hormone. Therefore, bulimics may force themselves to vomit, just to achieve this euphoric feeling, even if they haven’t eaten anything.
Depending on how long the individual has suffered from bulimia, treatment usually focuses on therapy, such as psychotherapy, interpersonal psychotherapy, family therapy or cognitive-behavioral therapy. Medical issues may need to be addressed such as tooth loss and esophageal damage. Prescription medication may also be needed to address feelings of depression and anxiety usually associated with bulimia.
First, identify the problem. Bulimia is one of the hardest eating disorders to treat because it is often undetected. It is usually done in secret, which makes it tough for friends or family members to spot the problem.
Second, seek treatment. This may ultimately require a trip to the hospital or to see a licensed mental health professional. Getting support from friends and family or support groups can also make things easier. If you have a doctor you see regularly, making an appointment will be the great first step in getting help. More information about where to get help can be found at any of the below websites.Resource List
Binge eating is much more than simply overeating on occasion – that’s something all of us do. Binge eating becomes a disorder when it becomes an uncontrollable urge and interferes with everyday life. Binge eating can become a serious problem that leads to depression, social isolation, and medical complications such as obesity, heart disease, type 2 diabetes, sleep apnea, high blood pressure and joint problems.
The focal point for treating binge eating disorder will likely be therapy, whether it’s family, group, cognitive-behavioral or psychotherapy. Therapy may be combined with prescription medications if deemed necessary by the treating therapist. If there are health problems caused by overeating, such as high blood pressure, type 2 diabetes or heart disease, inpatient care may be required.
As with bulimia, identifying a problem with binge eating can be difficult due to its inherently secret nature. However, once the problem has been identified, contacting a doctor is the best course of action. A physician will not only be able to assess the situation and refer to a specialist if needed, but may be able to begin treatment of certain medical complications. Additional information about binge eating can be found at the below websites.Resource List
There are other types of eating disorders, usually classified under “eating disorders not otherwise specified,” or ENDOS. These eating disorders might not get as much press as anorexia or bulimia, but they can be just as lethal. These are just a few examples of the wide range of eating disorders that might affect anyone of any age.
Orthorexia is the compulsion to avoid eating foods that are perceived to be unhealthy or unpure. Orthorexia might also be defined as an unhealthy obsession with healthy eating or eating only pure foods.
What’s the difference between orthorexia and being a picky eater or someone who is extra careful about what foods they eat? With orthorexia, the desire to avoid eating unhealthy foods is so extreme that it limits potential food selection to a very small amount of foods and/or creates isolation due to intolerance of other people’s eating habits or beliefs. There may also be a connection of self-worth to the success in keeping up with the “healthy” eating habits, resulting in “punishments” for any mistakes in eating. It should be noted that orthorexia is not a clinical diagnosis under the DSM-5.
Yo-yo dieting refers to the cycle of losing and gaining weight. Yo-yo dieting often occurs when someone decides to lose weight, is successful, but promptly gains the weight back. Another attempt to lose weight is initiated; weight is lost, but again gained back. This creates an up and down cycle, mimicking the up and down movements of a yo-yo toy.
Yo-yo dieting can be unhealthy because it alters the body’s muscle-fat ratio. When weight is initially lost, a combination of muscle and fat is lost. When weight is gained back, usually from overeating, mostly fat returns instead of both the fat and muscle originally lost. When the cycle continues, more and more muscle is lost, only to be replaced with fat.
Many yo-yo dieters lose weight through food deprivation, rather than additional exercise and healthier food choices. However, because the differences in yo-yo dieting methods, there is still debate about the adverse consequences of yo-yo dieting.
This unique form of bulimia is isolated to those with diabetes who are dependent upon insulin. Those with Type 1 diabetes are often diagnosed after they spot one of the key symptoms: severe weight loss. That’s because when blood glucose is too high, the cells in the body are actually starving for energy. The eventual result is dropping weight quickly, among other symptoms, such as extreme thirst and frequent urination. A regimen of proper insulin dosage can keep those with Type 1 diabetes healthy.
However, some with Type 1 diabetes will choose to limit their insulin intake and let their blood sugar levels skyrocket. The result of this is rapid weight loss. Some take only enough insulin to keep them from falling into a diabetic coma, and continue to lose weight until they become ill from the many symptoms of anorexia or bulimia. This is a very dangerous practice: In addition to the problems that can be caused by an eating disorder, a person suffering from diabulimia also faces the issues of diabetic complications, including long-term kidney and vision problems, heart issues, and much more.
Approximatelyeight million Americans currently have an eating disorder.
Only 30-40%of anorexics will recover from their eating disorder.
42% of all first through third grade girls wish to be thinner.
Of the eight million Americans that have an eating disorder,seven million are female and one million are male.
Almost1 in 5 peoplewho suffer from anorexia will die within 20 years of becoming an anorexic.
About one in two peoplein the United States know someone who has an eating disorder.
The average cost of treating an eating disorder is $1,250 per day.
95% of those suffering from eating disorders are between the ages of 12 and 25.
More than half of 9-10 year old girls feel better about themselves when they are on a diet.
About 25% of men and 45% of women in the United States are currently dieting.
It’s been estimated that almost one in five college women are bulimic.
2-5% of Americans suffer from binge eating disorder.
13.5% of athletes have an eating disorder.
College students often suffer from eating disorders at a rate much higher than the average population. Why are eating disorders so prevalent among those in college? Let’s focus on the issues that surround college students and their healthy – or unhealthy – choices about food.
Eating disorders are prevalent on college campuses for a variety of reasons. First and foremost, there is academic pressure and stress that is unlike anything many students have ever experienced. Students may need to maintain certain grades to keep scholarships or to avoid disappointing family members.
Second, there are social stresses. College students, especially women, are pressured to “fit-in” and become popular and accepted. Consequences for not fitting in may be especially harsh in college compared to high school due to the fact that students are away from home and their familiar environment and family support net. Combined this with society and the media’s portrayal of an ideal body type or appearance, it’s almost no surprise that eating disorders are so prevalent in college.
Third, there is a sense of shame college students feel when confronted with the fact that they may have an eating disorder. For example, 82% of those with eating disorders did not seek treatment because they were unwilling to get it and face the social stigma that might come along with it.
Women are the vast majority of college students who suffer from eating disorders. One of the reasons is the pressure to be a certain weight, which is related to larger social pressure to fit in, make friends and have romantic relationships. Women in general are more sensitive to media and societal pressures regarding body image and college is no different. This fact, coupled with increase in desire for acceptance, academic pressure and being away from home, results in a high percentage of women in college suffering from eating disorders.
In addition to social and academic stresses, other factors of campus life can contribute to the development of eating disorders. One significant component is the increase alcohol use, which can lead to increase caloric intake and weight gain. There is then subsequent pressure to lose the weight, yet the social norm that encourages students to drink remains.
All-you-can-eat meal plans can contribute to eating disorders. A plethora of practically unlimited food choices can cause an increase in food consumption that goes without notice until a person steps on the scale and sees (often to their horror) that their weight has climbed dramatically. The result can be sudden crash dieting, which can eventually morph into an eating disorder.
Athletes, especially those that compete based on judging, are at a higher risk of developing an eating disorder. Some of the behaviors associated with eating disorders, such as excessive exercising, can be explained away as additional training for competition.
Even if an eating behavior does not qualify as an eating disorder, there may be rampant dieting and abnormal eating habits, such as disordered eating.
Feeling guilty after a meal
Defining your measure as a human being by the food choices you make and how much you eat
Feeling nervous, anxious and/or tense when faced with unplanned eating (being invited out to eat, etc.)
Having trouble being social
Excessive exercising to compensate for food consumed
Frequent weight fluctuations
Very rigid eating and/or exercising schedules
Feelings of guilt when eating, especially certain types of foods
Emotionally driven eating
Occasional purging or binge eating
Feeling possessive of your food
Categorizing certain foods as “good” or “bad”
Drinking a large amount of fluids to feel full faster when eating
Preoccupation with weight gain
Use of diet pills
Irregular eating patterns
If you believe you or someone you know suffers from disordered eating or an eating disorder, one of the first steps is to contact or visit your campus medical/health center or your school’s counseling center. All schools recognize the problem of eating disorders and have resources to help you seek treatment, either on campus or elsewhere.
Fiction. Only about 10% of those with eating disorders receive any treatment.
Fiction. Eating disorders have the highest mortality rate of all mental illnesses.
Fact. However, about one in four people with an eating disorder are male.
Fact. Of the 30 million, about 20 million will be women and 10 million will be men.
Fact. However, anorexia nervosa will kill about 4% of those with who suffer from it.
Fiction. Anorexia nervosa is a mental illness.
Fiction. Bulimics can also use methods such as taking laxatives.
Fact. Bulimics often feel a sense of euphoria after purging.
Fiction. The desire to exercise often and to build muscle can be a sign of an eating disorder.
Fiction. Individuals who have parents or siblings with an eating disorder are 11 times more likely to have an eating disorder themselves.
Fiction. Young women and teenage girls are more likely than their male peers to suffer from an eating disorder.
Fiction. The environment is a major cause for eating disorders, but is not the sole cause. There is also a genetic cause for eating disorders.
If you or someone you care about is facing an eating disorder, these resources can lead to valuable information and help.
NOTE: Beware of some blogs that promise “inspiration” to overcome an eating disorder. Unfortunately, there are numerous blogs out there that actually promote anorexia, bulimia and other disorders, but try to masquerade as “helpful.”
Exists to educate women and girls on the effect media has on their self-esteem and body image.
The primary goal is to provide information about eating disorders through the promotion of research and creation of expert knowledge.
The National Association of Anorexia Nervosa and Associated Disorders is a non-profit organization which aims to prevent and stop eating disorders.
A nonprofit organization focusing on self-help, prevention and recovery information.
An in-depth discussion of eating disorders, including how psychologists may be able to help.
Online resource for all eating disorders, including how to get treatment.
Provides a self-assessment tool for helping identify eating disorders, as well as ways to get immediate help.
Provides treatment and support for people of all ages who are struggling with eating disorders and/or body image.
Provides a wide array of health information useful, including what to do if a friend has an eating disorder.
Providing news, videos, blogs, articles and support for those suffering from (or know someone who suffers from) eating disorders.
Provides resources, education, treatment options and support for those with eating disorders.
A series of articles concerning body image and eating disorder recovery issues.
A center for eating disorder treatment and recovery. Also provides information about eating disorders.
Exists to prevent and treat eating disorders by providing a comprehensive resource of eating disorder treatments and information.
An international organization designed to help those who are caregivers for those suffering from eating disorders.
The National Institute of Health’s online library of eating disorder information. Statistics, journals, research and references are all available here.
A British charitable organization with the goal of helping men who suffer from eating disorders.
Provides an online community whose goal it is to support those who have body image issues and/or eating disorders. A list of events and resources is provided.
Provides information and help to those who may have eating disorders.
The National Association for Males with Eating Disorders: A nationwide organization focused on males who have eating disorders.
National Institute of Mental Health, Eating Disorders: The NIH’s Health & Education discussion about eating disorders, including what they are, causes, symptoms and treatments.
A non-profit organization which advocates and supports those who suffer from eating disorders as well as their families.
A non-profit Canadian website with comprehensive information about eating disorders and weight issues.
This website promotes “attuned eating” and provides plenty of resources.
Presented by PBS, this website provides the full television aired Nova episode called “Dying to Be Thin.” Additional information about eating disorders is also provided.