Diseases & Conditions

Eating disorders

Eating disorders are a broad group of serious conditions in which you're so preoccupied with food and weight that you can often focus on little else. The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder, and there are also many subtypes.

Most people with eating disorders are females, but males also have eating disorders. The exception is binge-eating disorder, which appears to affect almost as many males as females.

Treatments for eating disorders usually involve psychotherapy, nutrition education, family counseling, medications and hospitalization.

The signs and symptoms of eating disorders vary with the particular type of eating disorder.

Anorexia nervosa
When you have anorexia nervosa (an-o-REK-se-uh nur-VOH-suh), you're obsessed with food and being thin, sometimes to the point of deadly self-starvation. You may exercise excessively or simply not eat enough calories.

Anorexia symptoms may include:

• Thin appearance
• Abnormal blood counts
• Fatigue
• Dizziness or fainting
• Brittle nails
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Constipation
• Dry skin
• Frequently being cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Bone loss

Emotional and behavioral symptoms of anorexia may include:

• Refusal to eat
• Denial of hunger
• Excessive exercise
• Flat mood or lack of emotion
• Difficulty concentrating
• Preoccupation with food

Red flags that family and friends may notice include:

• Skipping meals
• Making excuses for not eating
• Eating only a few certain "safe" foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
• Weighing food
• Cooking elaborate meals for others but refusing to eat them themselves
• Repeated weighing of themselves
• Frequent checking in the mirror for perceived flaws
• Wearing baggy or layered clothing
• Complaining about being fat

Bulimia nervosa
When you have bulimia, you have episodes of bingeing and purging. During these episodes, you typically eat a large amount of food in a short amount of time and then try to rid yourself of the extra calories by vomiting or excessive exercise. In between these binge-purge episodes, you may eat very little or skip meals altogether. You may be a normal weight or even a bit overweight.

Bulimia symptoms may include:

• Abnormal bowel functioning
• Damaged teeth and gums
• Swollen salivary glands in the cheeks
• Sores in the throat and mouth
• Bloating
• Dehydration
• Fatigue
• Dry skin
• Irregular heartbeat
• Sores, scars or calluses on the knuckles or hands
• Menstrual irregularities or loss of menstruation (amenorrhea)

Emotional and behavioral symptoms of bulimia may include:

• Constant dieting
• Feeling that you can't control your eating behavior
• Eating until the point of discomfort or pain
• Self-induced vomiting
• Laxative use
• Excessive exercise
• Unhealthy focus on body shape and weight
• Having a distorted, excessively negative body image
• Going to the bathroom after eating or during meals
• Hoarding food
• Depression or anxiety

Binge-eating disorder
When you have binge-eating disorder, you regularly eat excessive amounts of food (binge), sometimes for hours on end. You may eat when you're not hungry and continue eating even long after you're uncomfortably full. After a binge, you may try to diet or eat normal meals, triggering a new round of bingeing. You may be a normal weight, overweight or obese.

Emotional and behavioral symptoms of binge-eating disorder may include:

• Eating to the point of discomfort or pain
• Eating much more food during a binge episode than during a normal meal or snack
• Eating faster during binge episodes
• Feeling that your eating behavior is out of control
• Frequent dieting without weight loss
• Frequently eating alone
• Hoarding food
• Hiding empty food containers
• Feeling depressed, disgusted or upset over the amount eaten
• Depression or anxiety

Eating disorders in youngsters
Eating disorders can affect people of any age. In children, it's sometimes hard to tell what's an eating disorder and what's simply a whim, a new fad, or experimentation with a vegetarian diet or other eating styles. In addition, many girls and sometimes boys go on diets to lose weight, but stop dieting after a short time. If you're a parent or guardian, be careful not to mistake occasional dieting with an eating disorder. On the other hand, be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders.

Because of its powerful pull, an eating disorder can be difficult to manage or overcome by yourself. Eating disorders can virtually take over your life. You may think about food all the time, spend hours agonizing over options in the grocery store, and exercise to exhaustion. You also may have a host of physical problems because of your eating disorder, such as irregular heartbeats, fatigue, bowel troubles and dizziness. You may feel ashamed, sad, hopeless, drained, irritable and anxious.

If you're experiencing any of these problems, or if you think you may have an eating disorder, you'd probably benefit from a medical evaluation. Remind yourself that you're not actually in control anymore — the eating disorder is. When everything revolves around what you eat and how you look, it's difficult to take part in normal activities and live life to its fullest. You may not even be able to enjoy a simple meal with family and friends.

Unfortunately, many people with eating disorders resist treatment. If you have a loved one you're worried about, urge him or her to talk to a doctor. But unless you have legal authority to do so, you can't force loved ones to get treatment. If you think your child may have an eating disorder, talk to him or her. Your child may not be ready to acknowledge having an issue about food, but you may be able to open the door by expressing concern and a desire to listen. You may also want to consider contacting your child's doctor about your concerns. You can get a referral to qualified mental health providers for treatment.

Eating disorders are diagnosed based on signs, symptoms and eating habits. When doctors suspect someone has an eating disorder, they typically run a battery of tests and exams. These can help pinpoint a diagnosis and also check for related complications. You may see both a medical doctor and a mental health provider for a diagnosis.

Physical evaluations
These exams and tests generally include:

• Physical exam. This may include such things as measuring height and weight; assessing body mass index; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin for dryness or other problems; listening to the heart and lungs; and examining your abdomen.
• Laboratory tests. These may include a complete blood count (CBC), as well as more specialized blood tests to check electrolytes and protein, as well as liver, kidney and thyroid function. A urinalysis also may be done.
• Other studies. X-rays may be taken to check for broken bones, pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. You may also have a bone density test.

Psychological evaluations
In addition to a physical exam, you'll have a thorough psychological evaluation. Your doctor or mental health provider may ask you a number of questions about your eating habits, beliefs and behavior. The questions may focus on your history of dieting, bingeing, purging and exercise. You'll explore how you perceive your body image and how you think others perceive your body image. You may also fill out psychological self-assessments and questionnaires.

Diagnostic criteria
To be diagnosed with an eating disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Each eating disorder has its own set of diagnostic criteria. Your mental health provider will review your signs and symptoms to see if you meet the necessary diagnostic criteria for a particular eating disorder. Some people may not meet all of the criteria but still have an eating disorder and need professional help to overcome or manage it.

Eating disorder treatment depends on your specific type of eating disorder. But in general, it typically includes psychotherapy, nutrition education and medication. If your life is at risk, you may need immediate hospitalization to stabilize your health. You may have a treatment team of medical doctors, mental health providers and dietitians.

Psychotherapy
Individual psychotherapy can help you learn how to exchange unhealthy habits for healthy ones. You learn how to monitor your eating and your moods, develop problem-solving skills, and explore healthy ways to cope with stressful situations. Psychotherapy can also help improve your relationships and your mood. A type of psychotherapy called cognitive behavioral therapy is commonly used in eating disorder treatment. Family therapy and group therapy also may be helpful for some people.

Nutrition education
Dietitians and other health care providers can offer information about a healthy diet and help design an eating plan to achieve a healthy weight and healthy-eating habits. If you have binge-eating disorder, you may benefit from medically supervised weight-loss programs.

Hospitalization
If you have serious health problems or if you have anorexia and refuse to eat or gain weight, your doctor may recommend hospitalization. Hospitalization may be on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.

Medications
Medication can't cure an eating disorder. However, medications may help you control urges to binge or purge or to manage excessive preoccupations with food and diet. Medications such as antidepressants and anti-anxiety medications may also help with symptoms of depression or anxiety, which are frequently associated with eating disorders.