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Eating Disorders Overview

Millions of Americans suffer through eating disorders, the most lethal of all mental illnesses. Doctors can’t say exactly what causes a person to start using food as a means of controlling emotion and self image, but likely causes include genetics, popular culture, dieting and low self esteem. Unfortunately, eating disorders are often concealed from family and friends for years, and since denial is such a characteristic part of these disorders – too many women (and men) fail to get the help they need. Treatment is available and treatment works.

If you have an eating disorder, your life revolves around food, and/or your control over food. Your self esteem is likely tied to the way you look and the way others look at you and it’s through food or your control over what you eat that you manage the emotions in your life.

Eating disorders are very dangerous and left untreated, they can eventually kill. Denial is a big part of a lot of eating disorders, so if you’ve decided that you might want some help you’re halfway home to getting better. You can get help and treatment works. You can learn to manage the way you feel without manipulating the way you eat and you can regain a healthy weight and self image!

What Are Eating Disorders?

Eating disorders aren’t well understood. They are characterized, generally, by a loss of control over the consumption of food. People with certain eating disorders might consume very few calories each day (anorexia nervosa), might consume an enormous amount of food and purge it (bulimia nervosa) or might simply consume enormous quantities of food (binge eating disorder).

No one chooses an eating disorder, and no one really knows exactly what causes their development, but for some people, risk factors like aggressive dieting, perfectionism, a genetic link to eating disorders and low self esteem combine into something terrible and dangerous, and all of a sudden – food is the central focus of life.

Eating disorders are the most dangerous of mental health disorders. If you have an eating disorder, you put your health at risk, and sadly, run a greatly increased risk of an early death.

Fortunately, effective treatments are available, and people who get appropriate treatment are very likely to return to a more normal weight. Denial can complicate treatment and relapse is often a problem. For many people in recovery, the battle against disordered eating lasts a lifetime.

Who Gets Eating Disorders?

Millions of Americans suffer with eating disorders, most are women, but between 5% and 15% are men. There is no one cause of an eating disorder and there is no clear way to predict who will succumb, but there are some genetic and environmental variables that can increase the risks.

Women are more likely than men to develop an eating disorder, but men still account for between 5% and 15% of total cases. Eating disorders typically develop during adolescence or early adulthood, but they can begin even in childhood. 1

According to the National Institute of Mental Health (NIMH):

  • In a lifetime, between 0.5% and 3.7% of females will experience anorexia – between 1.1% and 4.2% will suffer from bulimia.
  • In any given 6 month period, between 2% and 5% of Americans suffer from binge eating disorder
  • 5.6% of those with anorexia will die within a decade of onset. This mortality rate is 12 times the normal mortality rate for women from the ages of 15 to 24 – some research indicates that the mortality rate within a decade of onset could reach 10% 2
  • In one study, 20% of 14 and 15 year old girls who engaged in ‘strict dieting’ succumbed to an eating disorder within a year 3
  • In the last 30 days, 12.3% of high school students have fasted for at least 24 hours in an effort to lose weight, 6.3% of high school students have used a diet medication not recommended by a doctor and 4.5% have used a laxative or vomited to keep from gaining weight. 4

Why Do People Get Eating Disorders?

There is no single reason why people get eating disorders – mostly it is an interplay between environmental and biological factors that raises a person’s risk of disordered eating. Some of the ‘causes’ of eating disorders include:

Family Influences

Having a parent that encourages dieting can increase the risks, as can having a parent who suffers from an addiction or mental health disorder - suffering abuse in the home also increases the risks. Teenagers who are teased in the home about their weight, even ‘in fun’ are also at an elevated risk of an eating disorder.


There is a genetic link to eating disorders. People who have a close genetic relative with anorexia are 800% more likely to experience anorexia than the general population. Researchers think that hormonal or neurochemical imbalances may play a role in the establishment and perpetuation of these disorders.


Media presentations of very thin men and women as desirable or even normal can pressure people into unhealthy eating practices as they try to emulate these ‘impossible’ body shapes.5

Generic risk factors for eating disorders include:6

  • Being female
  • Being a teen or young adult
  • Engaging in dieting
  • Having a mental health disorder or addiction
  • Having low self esteem or a perfectionist personality
  • People who play certain sports or (wrestling, gymnastics and others) may also be at increased risk

Types of Eating Disorders

The three most common forms of eating disorders are anorexia nervosa, bulimia nervosa and binge eating disorder.

Anorexia Nervosa

Anorexia is a disorder that is characterized by:

  1. Extreme calorie intake reduction or calorie intake reduction with extreme exercise or purging
  2. Extreme weight loss and a maintenance of a very low body weight – 15% lower than the recommended minimum for age and height
  3. A distorted body image and a fear of weight gain
  4. A loss of menstruation (in women)

Many anorexics would consider themselves to be ‘fat’ even when dangerously underweight and will go to great lengths to limit their daily caloric intake. People with chronic anorexia often suffer serious health deficits and an increased risk of early death.7

Men and women with anorexia will often deny the existence of a problem, which can complicate treatment. With appropriate treatment, anorexics can regain a healthy weight and better overall health. Relapse is common.

Bulimia Nervosa

Bulimia nervosa is a disorder characterized by frequent and reoccurring food binges that are followed by a purging of what was consumed. Bulimics will repeat this cycle of binging and purging several times a week, or even several times a day. Bulimics may also have anorexia nervosa, but they may also be at a healthy weight, or even overweight.

People with bulimia often worry about their body shape and image but cannot control their urges to binge eat. Binging and purging is generally done alone, in secret, as people with bulimia are often ashamed and disgusted with themselves and their behavior.

Bulimia can lead to gastrointestinal problems, kidney problems, dental decay and other health problems. Many people with bulimia also suffer from a co-occurring mood disorder, such as anxiety or depression.

Cognitive behavioral therapy (CBT) and, in some cases, antidepressants, are effective treatments for bulimia nervosa.

Binge Eating Disorder (Eating Disorders Not Otherwise Specified)

People with binge eating disorder will eat in uncontrolled binge sessions, similar to the binges of a bulimic, eating until uncomfortably full – sometimes consuming many thousands of calories in a single episode. People with binge eating disorder will not purge, however, after eating.

These binges create feelings of self disgust and shame, and people with binge eating disorder frequently suffer from another mood disorder, like anxiety or depression. Because binges are not followed by purges, people suffering this disorder are often overweight or obese.8

Eating Disorder Warning Signs and Treatments

Many with eating disorders successfully hide their disease from friends and family for years. Since eating disorders are serious disease that can be fatal if left untreated, this is not ideal – and the quicker a person gets treatment the better.

Although these disorders can be tough to spot, there can also be some warning signs that hint at the existence of a problem, such as:

  • Constant dieting - or a preoccupation with counting calories or avoiding certain types of foods entirely
  • Categorizing foods as ‘good or bad’
  • Never eating in public
  • Eating very slowly – playing with food
  • Always claiming to ‘not be hungry’, or frequently claiming food allergies as an excuse for not eating
  • Obsessive exercise
  • Hiding food (to avoid eating, or for later consumption)
  • Developing strict rituals about eating
  • Developing a preoccupation with buying and preparing food, but not eating it
  • Finding hidden evidence of binges, such as hidden food wrappers
  • The use of laxatives or diet pills
  • Being very focused on appearance and body shape
  • Wearing very baggy clothes to hide body shape
  • Seeming very afraid of weight gain

Some physical signs of eating disorders include:9

  • Sudden weight loss or a very thin appearance
  • The growth of soft hair on the face and body
  • Fainting or dizziness
  • The loss of menstruation
  • Constipation and abdominal pain
  • Feeling cold frequently
  • Low blood pressure and/or heart beat irregularities
  • Dehydration
  • Dental problems (from bulimia)
  • Scarred knuckles (bulimia)
  • Swollen salivary glands (chipmunk cheeks) (from frequent vomiting)
  • Bowel problems
  • Others

Men with Eating Disorders

Although we stereotypically think of only women as victims of eating disorders, more than a million American men also suffer from these disorders.

Men with eating disorders typically have a distorted body image and may either seek to lose weight or to gain muscle through unhealthy means.

Eating Disorder Treatments

Eating disorder treatment works well to help people regain a healthy weight.

Treatment is typically multidisciplinary and tailored to the needs of the individual. Treatment can combine elements such as:

  • Psychotherapy or cognitive behavioral therapy
  • Group therapy and involvement in support groups
  • Nutritional counseling and education
  • Treatment for co-occurring mental or physical health problems

People who are in physical danger due to their weight loss may need a period of hospitalization, to address nutritional needs and any other physical health complaints.

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