What
are eating disorders?
Eating
disorders are real illnesses that can affect how we eat and how we feel
about food. They can be treated to help people who have them have healthy
and full lives. From time to time, we all change our eating habits.
Sometimes we reduce the amount of food we eat or go on a diet to shed some
pounds, or we eat more to gain weight. These can be healthy ways to control
or reach our ideal body weight. But, people who have eating disorders have
unhealthy ways, or patterns, of eating. They may eat too much and become
overweight, or way too little and become very thin.
Sometimes a
person can eat so little, or nothing at all, they actually begin to starve
(called
anorexia nervosa). A person can also eat an extreme
amount of food all at once and then do things like vomit to rid the body of
food (called
bulimia nervosa). And, a person may not be able to
control the need to overeat, often keeping it a secret (called
binge eating disorder). People can also have wrong
ideas, or misperceptions, of their body weight. People with eating disorders
can feel certain they weigh too much, even though they may be well under the
ideal body weight for a person their size.
Eating
disorders affect people of all ages, race, and income levels. But, these
disorders affect women much more than they do men. Women make up more than
90% of people with these disorders. Without treatment, an eating disorder
can take over a person's life and cause serious illness and death. These
disorders can increase risk for
osteoporosis (thinning of the bones) and heart problems. People who
have eating disorders can also have
depression and anxiety, and may turn to alcohol and drugs for
relief.
Experts Note Rise In Compulsive Eating
Experts in
psychology and nutrition, it was reported in mid-December 2005, have noted a
significant increase in compulsive eating. They claim that in the United
States, our fixation on weight is making the disorder more prevalent. The
number of support groups for people whose lives are controlled by food has
grown sharply in recent years. Since 1998, the number of support groups
hosted by Food Addicts has risen from 20 to 300 nationwide. Overeaters
Anonymous, which was started back in 1960, now has more than 4,300 meetings.
Binge-eating disorder is more prevalent than anorexia or bulimia,
according to the National Association of Anorexia and Associated Disorders.
A study by the American Psychiatric Assn. in the year 2000 suggested that
between 0.7% and 4% of the population had the disorder, but researchers
think the actual figure is much higher.
Who is at risk for eating disorders?
In the
United States and other Western countries, women are more at risk for eating
disorders than are men. These disorders affect 8 to 10 times more women than
men. In the U.S., it was thought that eating disorders affected mostly white
women. But, recent research has shown that black women are affected as well.
One study found that black women were more likely than white women to have
repeated episodes of binge eating disorder. This may put black women more at
risk for obesity (being
overweight).
Women may
be more at risk for eating disorders because of a need to have the "ideal"
figure often shown in the media (TV, magazines, movies). The "thin is best"
view can affect girls and young women in particular. They often go on strict
diets to look like the girls and women they see in the media. Pressure from
friends to be thin and to diet can also happen. For women, body image, or
how you feel about how you look, can affect feelings about body weight. Not
liking how much you weigh, feeling fat, and wanting to be thin can make you
worry more about how you look than other things, such as your own ideas or
what you want to do in your life. Sometimes, young women who are at a normal
weight, or even underweight, may feel that they are too fat. A woman may
also feel that how she looks or how much she weighs makes up a major part of
her
self-esteem. While young women may be most at risk for eating
disorders, these disorders are affecting older women in growing numbers.
What causes eating disorders?
No one
knows for sure what causes eating disorders. It is known, though, that these
disorders can't be willed or wished away - treatment is needed. If you or
someone you know has an eating disorder, don't wait to get help. Talk with a
health care provider, the sooner the better.
Much
research has been focused on how personality and environment can put a
person at risk for an eating disorder. People with eating disorders are
thought to share certain traits, such as low
self-esteem (how you feel about
who you are), feelings of helplessness, and a fear of becoming overweight.
Eating disorders seem to develop as a way of dealing with stress. These
disorders appear to run in families, affecting women more than men. Research
has shown that a woman's social environment, including her family and
friends, can affect how she feels about body weight. For instance, frequent
talk about being thin and dieting may put pressure on a person to be thin.
Being teased about being overweight by family and friends can lead to low
self-esteem and unhealthy eating in young girls and women. Also, young
people who are involved in sports or activities that emphasize thinness
(modeling, dancing, long distance running, gymnastics) are more likely to
develop eating disorders.
Research is
also looking at the role genetics and a person's biological make-up and body
chemistry play in eating disorders. Studies funded by the National Institute
of Mental Health have focused on
serotonin, a substance found in the brain that can affect
appetite and a person's ability to control impulses and moods. In women,
researchers are exploring how eating disorders may affect serotonin levels
and how the brain signals the body about hunger and fullness. For example,
most women feel better - in terms of fullness and mood - after eating. But
for women with anorexia, not eating can actually improve mood and feelings
of well-being. Knowing how serotonin affects eating disorders will help
researchers to figure out which women are more at risk for these disorders
and better ways to treat them.
What are the most common types of eating disorders?
What effects do they have on a person's health?
The three
most common types of eating disorders are:
·
Anorexia nervosa
- starving yourself by eating very little or nothing at all. People who have
this condition can have a strong fear of body fat and weight gain. To stay
thin, a person may diet, fast, or exercise too much. Taking laxatives,
diuretics, or enemas to rid the body of food is also common. Women with
anorexia can have menstrual periods that are not regular, or none at all.
Girls with anorexia often get their periods later than girls who don't have
this illness. People with this illness may think they are overweight, even
when they are very skinny. The process of eating becomes an
obsession, or something you
can't stop thinking about. Eating habits develop that are not normal, such
as staying away from food and meals, picking out only a few foods and eating
these in small amounts, or carefully weighing out food portions to eat.
People with anorexia may also check their body weight a lot.
Anorexia can cause the same types of problems that happen when a person is
starving. The lack of food can cause a person to become very thin, develop
brittle hair and nails, dry skin, and a low pulse rate, become not able to
stand the cold, and suffer from constipation and sometimes
diarrhea. It can also affect a person's blood count, causing mild
anemia, reduce muscle mass, stop a woman's menstrual period, and
lead to swollen joints. Lack of calcium, due to a poor diet, places
anorexics at higher risk for
osteoporosis (bone thinning) later in life. Many people with
this illness have depression, anxiety, and problems with alcohol or drugs.
The most serious problems include death from starvation, the heart stopping,
or suicide.
·
Bulimia nervosa
- when a person binges, or eats an extreme amount of food all at once and
then purges - vomits, takes laxatives or
diuretics (water pills) - to
rid the body of food. Exercising to excess and fasting can also occur to
make sure no weight is gained after binge eating. People with this eating
disorder feel no control during the times they are eating to excess. This
illness most often starts in the late teenage years or early adult life.
Like anorexics, people with bulimia have extreme worry about food, body
weight, and body shape. Many bulimics binge and purge in secret, and still
keep a normal body weight. By doing so, a person can often hide this illness
for years. Feelings of disgust and shame after binge eating are common, as
well as feelings of relief after
purging. Eating binges can happen once or twice a week or as much as
a few times a day. They can be triggered by depression, boredom, or anger.
The need to binge and purge can be constant or can happen once in a while,
with periods of time where no bingeing occurs.
Health problems from bulimia are mostly related to
electrolyte imbalance (when the
amounts of sodium and potassium in the body become too much or too little)
and repeated purging behaviors. Purging causes the body to lose potassium,
which can damage heart muscle and increase a person's risk for heart attack.
Frequent vomiting can inflame the
esophagus (tube that connects the throat with the stomach) and
damage tooth enamel. Other problems caused by bulimia include scarring on
the back of fingers from pushing them down the throat to cause vomiting,
loss of or change in menstrual periods, and no sex drive. People with this
illness can have trouble dealing with and controlling impulses, stress, and
anxiety. They may also have depression,
obsessive-compulsive disorder
(an illness where you have unwanted thoughts and behaviors you can't stop
repeating), and other mental illnesses. Problems with alcohol and drugs is
not uncommon. Bulimics are also likely to be anorexic.
·
Binge eating disorder
(BED) - when a person can't control the desire to overeat
and often keeps the extreme eating a secret. People with this eating
disorder feel no control during the times they are eating to excess. During
binge eating, a person may eat more quickly than normal, eat until feeling
discomfort, eat large amounts of food when not hungry, and eat alone. Unlike
bulimia and anorexia, a person doesn't try to rid the body of extra food by
doing things like vomiting, fasting, or exercising to the extreme. Because
of this, many people who have this illness are overweight. A person can feel
disgust, shame, and guilt during a binge, which can lead to bingeing again,
causing a cycle of binge eating. Like with anorexia, people with BED can
fear gaining weight, want to lose weight, and dislike the way their bodies
look. BED most often starts in the late teenage years or early adult years.
Some experts believe BED is the most common eating disorder. The illness
often develops soon after extreme weight loss from a diet. BED can be hard
to diagnose and can be mistaken for other causes of
obesity (being overweight).
People with BED are often overweight because they maintain a high calorie
diet without exercising. Medical problems can happen, like those found with
obesity, such as high cholesterol levels, high blood pressure, and
diabetes. BED also increases a person's risk for gallbladder
disease, heart disease, and some types of cancer. People with BED often
suffer from depression.
There are
two other types of eating disorders.
Eating disorder not otherwise specified (EDNOS) is the name for
disorders of eating that don't fit into one of the three disorders described
above. With EDNOS, a person has some form of abnormal eating but not all the
symptoms needed to be diagnosed with an eating disorder. For instance, a
person with EDNOS may purge themselves after eating, but do so with less
frequency or intensity than someone who has bulimia.
More common
than eating disorders is a condition called
disordered eating. This is when
a person diets, binges, or purges, but doesn't do so often or severely
enough to be diagnosed with an eating disorder. A person may change how they
eat after a stressful event or an illness, before an important speech or
work event, or before a sports competition. Disordered eating can lead to
weight loss or weight gain, but rarely requires treatment. But, if the
disordered eating becomes long lasting, causes upset and stress, changes the
way a person feels about themselves or how they look, or starts to get in
the way of daily activities, they need to get help right away. Don't wait to
see if the problem goes away by itself, talk with a health care provider
about where to go for help.
How can you tell if someone has an eating disorder?
Because
many people with eating disorders keep them a secret, their conditions can
go unnoticed for long periods of time, even years. With anorexia, signs such
as extreme weight loss are easier to see. But, bulimics who can stay at
their normal body weight may be better able to hide their illness. Family
members and friends may notice some of the warning signs of an eating
disorder.
A person with anorexia may:
-
Eat only "safe" foods, low in calories and fat.
-
-
Have odd rituals, such as cutting food into small pieces or measuring
food.
-
Spend more time playing with food than eating it.
-
Cook meals for others without eating.
-
Exercise to excess.
-
Dress in layers to hide weight loss.
-
Spend less time with family and friends.
-
Become withdrawn and secretive.
A person with bulimia may:
-
Become very secretive about food.
-
Spend a lot of time thinking about and planning the next eating binge.
-
Keep making trips to the bathroom after eating.
-
Steal food or hoard it in strange places.
-
Eat to excess.
A person with binge-eating disorder may:
-
Become very secretive about food.
-
Spend a lot of time thinking about and planning the next eating binge.
-
Start eating alone most of the time.
-
Steal food or hoard it in strange places.
-
Eat to excess.
-
Become overweight.
-
Become withdrawn, not wanting to go out or see family and friends.
If you or
someone you know has any of these warning signs, see a health care provider
right away. There is help for people with these disorders and, with help,
they can lead a healthy and full life.
What are the treatments for eating disorders?
Eating
disorders can be treated and a person can return to a healthy weight.
Success in treating eating disorders is greatest when they are found early
and treated right away. The longer abnormal ways of eating go on, the harder
it is to overcome the disorder. Plus, more damage is done to the body over
time, which can result in serious health problems.
There is no
one, or best, way to treat these complex disorders. Most people with eating
disorders are treated by a team of health care providers and receive medical
care, psychotherapy (sometimes called "talk therapy"), and nutritional
counseling. Professionals who provide psychotherapy can be therapists,
psychologists,
psychiatrists,
social workers, or
counselors. Types of psychotherapy include
cognitive-behavioral therapy
(changes how a person thinks about, and then reacts to, a situation that
makes them anxious or fearful) family therapy, and group therapy. In some
cases, a person may need to go into the hospital or into an in-patient or
residential program. Medication is also sometimes used to treat the disorder
and prevent relapse (or keep it from coming back). Certain
antidepressants, called
selective serotonin reuptake inhibitors or SSRIs, have been
shown to help maintain weight and reduce anxiety for people with anorexia
and bulimia. Training to build self-esteem can also be helpful.
Talk with
your health care provider about treatment options. Also, look under mental
health services in your local phone book or call the National Association of
Anorexia Nervosa and Associated Disorders, (847) 831-3438, for referrals to
service providers, treatment centers, and special programs.
Will having an eating disorder keep me from getting
pregnant or having a healthy baby?
Having an
eating disorder can make it harder for a woman to get pregnant. It may cause
early delivery, or premature birth, which can cause problems (sometimes life
threatening) in a newborn. Women with eating disorders have higher rates of
miscarriage than do women who don't have these disorders. If a woman doesn't
eat lots of different healthy foods during pregnancy, she and her baby can
have health problems. It is best to get treated for an eating disorder
before you try to get pregnant. But, even if your eating disorder was
treated and now gone, it could come back during the stress of pregnancy.
Making sure you have good support from family, friends, and your health care
provider is key to having a healthy pregnancy. Keep in mind you will also
need plenty of support after the baby is born. Some women can feel "blue" or
have depression after giving birth, which can make an eating disorder come
back. Talk with your health care provider if you are thinking about getting
pregnant or are pregnant.
What should you do if you or someone you know has an
eating disorder?
Support is
important when you or someone you know has an eating disorder. Tell someone
you trust about your problem. It may be a family member, friend, counselor,
religious or community leader, or doctor. Talking to a school counselor or
mental health professional is a good place to start. Seeing a health care
provider as soon as you can is important too. Your doctor can help you get
the help you need for your eating disorder. You can also learn about
healthier ways to eat. Don't put off seeing a doctor, thinking you will get
better on your own. Keep in mind, an eating disorder can cause serious harm
to your body and to your emotional health.
What is the latest research on eating disorders?
The
National Institutes of Mental Health (NIMH) conducts and funds research on
eating disorders. Researchers are looking at how well psychotherapy and
medications work, either when used alone or together, to help people with
these disorders. Also being studied is the role family background
(genetics), appetite and exercise, and emotions and social behaviors play in
eating disorders. New research is focused on whether brain serotonin (a
substance that affects appetite, impulses and moods) is linked to eating
disorders in women. To find information on government-sponsored clinical
trials for eating disorders, go to
http://www.clinicaltrials.gov.
This FAQ
was adapted from eating disorder fact sheets from the National Institute of
Mental Health and the Department of Health and Human Services Office on
Women's Health.
