Eating Disorders 101

Material on this page is cited from the National Eating Disorders Association’s website: www.NationalEatingDisorders.org

What is an eating disorder?

Eating disorders -- such as anorexia, bulimia, and binge eating disorder -- include extreme emotions, attitudes, and behaviors surrounding weight and food issues. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males.

Q: What are the main types of eating disorders?

A: Anorexia Nervosa (AN), Bulimia Nervosa (BN), Eating Disorder Not Otherwise Specified (EDNOS), and Binge Eating Disorder (BED)

Anorexia Nervosa

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.

Anorexia Has Four Primary Symptoms:

• Resistance to maintaining body weight at or above a minimally normal weight for age and height.
• Intense fear of weight gain or being fat, even though underweight.
• Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation or denial of the seriousness of low body weight.
• Loss of menstrual periods in girls and women post-puberty.

Eating disorders experts have found that early intervention improves the chances of anorexia recovery. Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.

Warning Signs of Anorexia Nervosa

• Dramatic weight loss
• Preoccupation with weight, food, calories, fat grams and dieting
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.)
• Frequent comments about feeling fat or overweight despite weight loss
• Anxiety about gaining weight or being fat
• Denial of hunger
• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate)
• Consistent excuses to avoid mealtimes or situations involving food
• Excessive, rigid exercise regimen despite weather, fatigue, illness or injury
• Withdrawal from usual friends and activities
• In general, behaviors and attitudes indicating that weight loss, dieting and control of food are becoming primary concerns

Treatment Goals of Anorexia

McCallum Place is an eating disorder treatment center specializing in treating anorexia offering a residential treatment program, partial hospital and transition living. In these programs, individuals who suffer from anorexia nervosa will meet with an eating disorder specialist to receive individualized treatment designed to meet their specific needs. The primary goals at McCallum Place are stabilization of symptoms, weight restoration and beginning to build the foundation for a strong recovery. In all we do, we strive to help individuals build the confidence and skills necessary to let go of their patterns of restrictive eating. Our protocols are designed to help patients restore weight ideal body weight and to minimize relapse from vomiting and compulsive exercise. Patients practice weight maintenance and flexible eating prior to discharge. When possible, a gradual step down is recommended to ease the transition back to independent living. We give individuals the power to manage the fears associated with new meal expectations and changes in body size. Our goal is to change the way each individual uses food and body image to express underlying emotional needs and concerns.

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of binge eating and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Bulimia Nervosa

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of binge eating and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Three Primary Bulimia Nervosa Symptoms:

• Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
• Regular use of inappropriate compensatory such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.
• Extreme concern with body weight and shape.

The chance for recovery increases the earlier a binge eating disorder, such as bulimia, is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

Warning Signs of Bulimia Nervosa:

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food.
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
• Excessive, rigid exercise regimen despite weather, fatigue, illness or injury
• Unusual swelling of the cheeks or jaw area.
• Calluses on the back of the hands and knuckles from self-induced vomiting.
• Discoloration or staining of the teeth.
• Creation of lifestyle schedules or rituals to make time for binge and purge sessions.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting and control of food are becoming primary concerns.

Treatment Goals of Bulimia Nervosa

McCallum Place is an eating disorder treatment center specializing in treating bulimia offering a residential treatment program, partial hospital and transitional living programs. In these programs, individuals who suffer from bulimia nervosa will meet with an eating disorder specialist to receive individualized treatment designed to meet their specific needs. The primary goals at McCallum Place for bulimia are stabilization of symptoms, weight restoration and beginning to build the foundation for a strong recovery. In all we do, we strive to help individuals build the confidence and skills necessary to let go of their patterns of binge eating, purging and compulsive exercise. Our protocols are designed to help patients restore weight to within ideal body weight and to minimize relapse with binge eating, vomiting and compulsive exercise. Patients practice weight maintenance and flexible eating prior to discharge. When possible, a gradual step down is recommended to ease the transition back to independent living. We give individuals the power to manage the fears associated with new meal expectations and changes in body size. Our goal is to change the way each individual uses food and body image to express underlying emotional needs and concerns.

Binge Eating Disorder (also known as Compulsive Overeating)

Binge Eating Disorder is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge. People who overeat compulsively may struggle with anxiety, depression, and loneliness, which can contribute to their unhealthy episodes of binge eating. Body weight may vary from normal to mild, moderate, or severe obesity.

 

Eating Disorder Not Otherwise Specified (EDNOS) or OTHER EATING DISORDERS

EDNOS typically includes some combination of the signs and symptoms of anorexia, bulimia, and/or binge eating disorder. While these behaviors may not be clinically considered a 'full' syndrome eating disorder, they can still be physically dangerous and emotionally draining. All types of eating disorders require professional help.

Medical Complications of Eating Disorders

• Dizziness could be: dehydration, low blood pressure, arrhythmia, hypoventilation, medication effects
• Chest-pain could be: esophageal spasm, esophagitis, tearing from vomiting, reflux, muscular pain secondary to purging, anxiety; less common: cardiac ischemia, hypertension, viral, pneumonia, autoimmune, pulmonary emboli
• Fainting could be: dehydration, anxiety, medications, low blood pressure, cardiac effusion, arrhythmia, seizures
• Irregular heart beat could be: too slow, too fast, skipped beats, abnormal rhythm. Might be caffeine, dehydration, electrolyte abnormalities… especially potassium, magnesium, phosphorus
• Spontaneous Vomiting could be: gastro-paresis, gall bladder disease, pancreatitis, obstruction, superior mesenteric syndrome, mal-absorption, viral, food poisoning, electrolyte abnormalities, migraine, anxiety, medications
• Nausea could be: low blood pressure, hypoglycemia, mal-absorption, electrolyte abnormalities (low sodium), pancreatitis, gastritis, medications
• Swelling of hands and feet could be: re-feeding syndrome, electrolyte imbalance, low phosphorus, low protein, hormonal changes, medications, thrombosis, fluid overload, heart failure
• Spitting up blood could be: esophageal tear, nose bleed, ulcer, mechanical erosion secondary to vomiting, infection
• Pain after eating could be: anxiety, esophagitis, reflux, obstruction, pancreatitis, hepatitis, ulcer, tears, mal-absorption, irritable bowel
• Diarrhea could be: mal-absorption, irritable bowel, electrolyte abnormalities, infection, laxatives
• Frequent Urination could be diabetes, low potassium, bladder infection, excessive fluids, kidney damage, anxiety, bladder weakness

Common Medical Complications of Eating Eating Disorders

• Gastro-intestinal: constipation, reflux, mal-absorption, regurgitation, gastro-paresis and dys-motility, pancreatitis, gall bladder disease, ulcers, gastritis, esophagitis, hiatal hernia, rectal prolapsed, fissures, irritable bowel
• Cardiovascular: hypotension (BP systolic < 90), postural tachycardia, hypertension (BP diastolic > 90), tachycardia (>120 b/m) , bradycardia (slow <60 b/m) , arrhythmias, acrocyanosis (blue fingers and toes), mitral valve prolapse, cardiac effusion
• Metabolic/ endocrine: hypothermia (low body temperature), metabolic acidosis (laxatives), metabolic alkalosis (vomiting), low potassium (vomiting/restricting), amenorrhea, osteopenia/osteoporosis, hypoglycemia

Direct Effects

• Dehydration from vomiting or fluid restriction: weakness, dizziness, nausea, shakiness, rapid or increased pulse, sometimes lack of hunger or thirst/ vs. increased thirst, fatigue, dry skin, concentrated urine, headaches, poor concentration
• Cognitive/ brain changes from low weight, inadequate energy, poor perfusion, lack of estrogen/testosterone: body image distortion, poor concentration, slowing of speech, slowing of processing, increased obsessions , numbing, autonomic disregulation, sleep disregulation, energy disregulation

Health Consequences of Eating Disorders

• Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health.
• Eating disorders are not just a “fad” or a “phase.” People do not just “catch” an eating disorder for a period of time. They are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships.
• People struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery.

Health Consequences of Anorexia Nervosa:

In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences:

• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.
• Reduction of bone density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin; hair loss is common.
• Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

Health Consequences of Bulimia Nervosa:

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the health consequences of bulimia nervosa include:

• Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium, sodium and chloride from the body as a result of purging behaviors.
• Potential for gastric rupture during periods of bingeing.
• Inflammation and possible rupture of the esophagus from frequent vomiting.
• Tooth decay and staining from stomach acids released during frequent vomiting.
• Chronic irregular bowel movements and constipation as a result of laxative abuse.
• Peptic ulcers and pancreatitis.

Health Consequences of Binge Eating Disorder:

Binge eating disorder often results in many of the same health risks associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:

• High blood pressure.
• High cholesterol levels.
• Heart disease as a result of elevated triglyceride levels.
• Type II diabetes mellitus.
• Gallbladder disease.

What Should I Say? How to Talk to a Loved One with an Eating Disorder.

If you are worried about your friend’s eating behaviors or attitudes, it is important to express your concerns in a loving and supportive way. It is also necessary to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders. In a private and relaxed setting, talk to your friend in a calm and caring way about the specific things you have seen or felt that have caused you to worry.

What to Say—Step by Step

Set a time to talk. Set aside a time for a private, respectful meeting with your friend to discuss your concerns openly and honestly in a caring, supportive way. Make sure you will be some place away from other distractions.

Communicate your concerns. Share your memories of specific times when you felt concerned about your friend’s eating or exercise behaviors. Explain that you think these things may indicate that there could be a problem that needs professional attention.

Ask your friend to explore these concerns with a counselor, doctor, nutritionist, or other health professional who is knowledgeable about eating issues. If you feel comfortable doing so, offer to help your friend make an appointment or accompany your friend on their first visit.

Avoid conflicts or a battle of the wills with your friend. If your friend refuses to acknowledge that there is a problem, or any reason for you to be concerned, restate your feelings and the reasons for them and leave yourself open and available as a supportive listener.

Avoid placing shame, blame, or guilt on your friend regarding their actions or attitudes. Do not use accusatory “you” statements like, “You just need to eat.” Or, “You are acting irresponsibly.” Instead, use “I” statements. For example: “I’m concerned about you because you refuse to eat breakfast or lunch.” Or, “It makes me afraid to hear you vomiting.”

Avoid giving simple solutions. For example, “If you’d just stop, then everything would be fine!”

Express your continued support. Remind your friend that you care and want your friend to be healthy and happy.

After talking with your friend, if you are still concerned with their health and safety, find a trusted adult or medical professional to talk to. This is probably a challenging time for both of you. It could be helpful for you, as well as your friend, to discuss your concerns and seek assistance and support from a professional.

Treating Eating Disorders

Eating disorders are serious health conditions that can be both physically and emotionally destructive.

• People with eating disorders need to seek professional help.
• Early diagnosis and intervention may enhance recovery.
• Eating disorders can become chronic, debilitating, and even life-threatening conditions.

What Does Treatment Involve?

Treatment is available. Recovery is possible.

The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Some medications have been shown to be helpful. Ideally, whatever treatment is offered should be tailored to the individual, and this will vary according to both the severity of the disorder and the patient’s individual problems, needs and strengths.

Typically care is provided by a licensed health professional, including but not limited to a psychologist, psychiatrist, social worker, nutritionist, and/or primary care physician.

Care should be coordinated and provided by a health professional with expertise and experience in dealing with eating disorders.

Treatment must address the eating disorder symptoms, as well as psychological, biological, interpersonal and cultural forces that contribute or maintain the eating disorder. Nutritional counseling is also necessary and should incorporate education about nutritional needs and planning for and monitoring rational choices of the individual patient.

Many people with eating disorders respond to outpatient therapy, including individual, group or family therapy and medical management by their primary care provider. Support groups, nutrition counseling, and psychiatric medications under careful medical supervision have also proven helpful for some individuals.

Inpatient care (including hospitalization and/or residential care in an eating disorders specialty unit or facility) is necessary when an eating disorder has led to physical problems that may be life-threatening or when an eating disorder has reached a level of severe psychological or behavioral problems. Inpatient stays typically require a period of outpatient follow-up and aftercare to address the underlying issues in the individual’s eating disorder.

The exact treatment needs of each individual will vary. It is important for individuals struggling with an eating disorder to find a health professional they trust to help coordinate and oversee their care.