Introduction to Eating disorders

Eating Disorders are serious emotional and physical problems that can have life-threatening consequences for females and males.

Eating Disorders -- such as anorexia, bulimia, and binge eating disorder -- include extreme emotions, attitudes, and behaviors surrounding weight and food issues

ANOREXIA NERVOSA is characterized by self-starvation and excessive weight loss.

Symptoms include:

BULIMIA NERVOSA is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food--more than most people would eat in one meal--in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising.

BINGE EATING DISORDER (also known as COMPULSIVE OVEREATING) 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.
More Information

OTHER EATING DISORDERS can include 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 eating disorders require professional help.

Partial Listing of Physical Problems Brought About by Eating Disorders

	EXTERNAL PROBLEMS	INTERNAL PROBLEMS	CAUSE
SKIN	Dryness Fine Rash Pimples	Dehydration	Reduced fluid intake Excessive fluid elimination Frequent vomiting Laxative abuse
SALIVARY GLANDS	Swelling Pain Tenderness	Possible Infection	Frequent vomiting
CONSTIPATION		Insufficient material Insufficient fluid	Failure to take in or retain sufficient food and fluid
EDEMA (water retention)	Swelling and puffiness more frequently ankles and feet	Electrolyte imbalance? Perhaps general systems problems<	Malnutrition Frequent vomiting Excessive laxatives or diuretics
BLOATING	Swelling over stomach or abdominal area	Electrolyte imbalance? Time required for body system to adjust?	Long periods of starvation and probable excessive vomiting, laxatives or diuretics
ABDOMINAL PAIN		Peptides? Hunger pangs?	Failure to identify hunger? Emotional attitudes? Insufficient Intake
FEELING OF FULLNESS/EMPTINESS			Fear? Emotional attitudes
TEETH	Frequent caries Frequent caries plus erosion of enamel		Inadequate diet Frequent vomiting or regurgitation. Diet limited to citrus fruits, abnormal carbohydrate intake
AMENHORRHEA	No menstrual period	Inability to produce hormones	Lack of body fat. Rigorous athletic training, emotional attitudes, sometimes gorging/purging

Short List of Salient Warning Signs For Eating Disorders

(1) Preoccupation with weight, food, calories, and dieting, to the extent that it consistently intrudes on conversations and interferes with other activities.

(2) Excessive, rigid, exercise regimen—despite weather, fatigue, illness, and injury, the need to "burn off’ calories taken in.

(3) Withdrawal from, or avoidance of, numerous activities because of weight and shape concerns.

(4) Expressions of anxiety about being fat which do not diminish as weight is lost.

Bathroom smells or messes,
Rushing to the bathroom immediately after a meal and returning with bloodshot eyes,
Swelling of the submandibular glands to yield a "chipmunk" facial appearance.

(6) Evidence (e.g., wrappers, advertisements, coupons) of use of laxatives, diuretics, purgatives, enemas, or emetics.

(7) Evidence of binge-eating, including hoarding and/or stealing food, or consumption of huge amounts of food inconsistent with the person’s weight.

(8) Alternating periods of severely restrictive dieting and overeating; these phasic fluctuations may be accompanied by dramatic weight fluctuations of 10 pounds or more.

(10) Extreme concern about appearance as a defining feature of self-esteem, often accompanied by dichotomous, perfectionist thinking (e.g., either I am "thin and good" or "gross and bad").

(11) Paleness and complaints (evidence) of lightheadedness or disequilibrium not accounted for by other medical problems.

Possible Overt Signs of an Eating Disorder

1. Unusual redness and puffiness around the eyes caused by purging, binge eating and overeating.

2. Irritation and swelling of the salivary glands in the neck, caused by purging, binge eating and overeating.

3. Poor dental hygiene, bad breath, dryness of the mouth area and cracked lips, caused by purging and the inability to replenish the body with liquids, resulting in dehydration.

6. Coldness or numbness, even in warm temperature. (Poor circulation and menstrual arrest result when the body slows its metabolism and enters the starvation mode.)

9. Obsessive tendencies concerning body weight: overtraining, denying feelings of hunger, constantly weighing oneself, etc.

Who Has Eating Disorders?

Eating disorders are reaching epidemic proportions: 10-15% of all Americans suffer from some type of serious eating disorder; adults as well as children are affected. At least 1/3 of all Americans are now considered to be obese and 60% are overweight. These numbers are staggering when we consider that we live in the age of "fat-free" food and fitness. Anorexia, bulimia, and B.E.D. (Binge Eating Disorder) can affect anyone regardless of social class, age, race, or gender. Eighty six percent of people with eating disorders report onset by age 20; 10% report onset at ten years or younger. According to TIME magazine, 80% of all children have been on a diet by the time they've reached fourth grade.

Approximately 10% of all people with eating disorders are men. Many clinicians believe that this figure is underreported because many men are ashamed to admit that they may be suffering from something thought to affect only women. According to Newsweek magazine's May 2, 1994 issue, a study done of 131 Cornell University football players, found that 40% engaged in eating disordered behaviors (bingeing and purging), with 10% classified as having clinical eating disorders. Many men can be suffering from bulimia under the guise of "staying in shape" when they use compulsive exercise as a form of purging. "I only run 4-5 miles daily. I can't miss a day, or I'll feel depressed, or sluggish, or....." Men have the same issues with body image as do women. They want to be thin and look good to attract women. They may not want to look older or look like their fathers. The reasons are numerous.

Seventy-seven percent of individuals with eating disorders report that the illness can last anywhere from one to fifteen years or even longer in some cases. It is estimated that approximately six percent of serious cases die. In many others, there are long-term, irreversible consequences which can affect one's physical and emotional health. Up to now, only 50% of all people with this devastating disease report being cured.

The cost of treatment is staggering. If the disease becomes acute and the person needs expensive medical monitoring and treatment, the cost of in-patient treatment can be $30,000 or more per month. Many people will need repeated hospitalizations. This underlines the importance of early intervention before costs spiral to staggering levels.

A Short List of Salient Warning Signs For Eating Disorders

(1) Preoccupation with weight, food, calories, and dieting, to the extent that it consistently intrudes on conversations and interferes with other activities.

(2) Excessive, rigid, exercise regimen—despite weather, fatigue, illness, and injury, the need to "burn off" calories taken in.

(3) Withdrawal from, or avoidance of, numerous activities because of weight and shape concerns.

(4) Expressions of anxiety about being fat which do not diminish as weight is lost.

Bathroom smells or messes,
Rushing to the bathroom immediately after a meal and returning with bloodshot eyes,
Swelling of the submandibular glands to yield a "chipmunk" facial appearance.

(6) Evidence (e.g., wrappers, advertisements, coupons) of use of laxatives, diuretics, purgatives, enemas, or emetics.

(7) Evidence of binge-eating, including hoarding and/or stealing food, or consumption of huge amounts of food inconsistent with the person's weight.

(8) Alternating periods of severely restrictive dieting and overeating; these phasic fluctuations may be accompanied by dramatic weight fluctuations of 10 pounds or more.

(10) Extreme concern about appearance as a defining feature of self-esteem, often accompanied by dichotomous, perfectionist thinking (e.g., either I am "thin and good" or "gross and bad").

(11) Paleness and complaints (evidence) of lightheadedness or disequilibrium not accounted for by other medical problems.

What Causes Eating Disorders

"Why don't you just stop?" This is the question with which people with eating disorders are confronted again and again by parents, spouses, friends, and themselves. Costly experiences with programs promising an end to the food behaviors once and for all frequently lead to brief abstinence followed by devastating resumption of old and familiar patterns. Regardless of whether the person starves, binges, binges and purges, abuses laxatives, compulsively overeats, gains weight, or loses weight the story of a roller coaster experience with behavior changes is all too common. Until the behaviors in an eating disorder are viewed as the symptoms rather than the problem the focus of recovery remains in the wrong place, and the person is likely to experience limited success in attempts to recover.

Most people have great difficulty understanding the function of the behaviors in an eating disorder. Why would someone starve herself to the point of death, as often happens in anorexia nervosa? Why would someone binge and then induce vomiting or painful diarrhea, as happens in bulimia nervosa? Why would someone eat so much that her stomach hurts so badly that all she can do is he down and fall asleep, as often happens for compulsive overeaters? Why would someone maintain a body weight that is so high that she is physically uncomfortable and potentially endangering her health, as often happens in obesity?

There is rarely a simple explanation for an eating disorder. It is an extremely complex problem and may be caused by a number of factors, which may include family and cultural pressures. Eating disorders may also occur as a result of psychological and interpersonal factors. Feelings of inadequacy, depression, anxiety and loneliness, difficult family and personal relationships may all play a part.

Frequently the person who has an eating disorder outwardly appears to be managing life very well. She is also a person who feels she would look better if she lost some weight, which means she could be virtually anyone in our society. At some point in that person's life there is an event or a series of occurrences and situations which symbolizes one or more of the following seven scenarios.

This is an occurrence that causes extreme emotional pain for a person. Another person may have minimal difficulty facing the same situation, but for this person the pain is too intense, and she doesn't know what to do with it. Examples of such an event include death of a close relative or friend, divorce of a parent, leaving home for the first time, rape, abortion, rejection in a relationship, divorce, first sexual experience, or a degrading comment.

This person would have been able to manage adequately had only one thing happened, but too much happened too fast, and the stress/pain level became too great. An example of this would be the person who leaves home for the first time, has her first sexual experience, is rejected in a relationship, and her mother dies, all within a two- to three-year period.

The person has lived in a painful situation for a period of years and finally reaches the point where she can no longer tolerate the pain. Examples include growing up in an alcoholic family, growing up with physical, sexual or emotional abuse, and living in an unhappy marriage.

All of a sudden, the person begins to experience depression or mood swings at a level of intensity she has never before experienced. She is not able to control the feelings because they are due to bio-chemical changes. Usually, the person does not understand what is happening, feels scared and out of control, and does not know how to or is afraid to ask for help.

This is a case of a very sensitive child growing up in a family in which there was emotional pain that was not acknowledged or discussed. The family outwardly appeared to be "perfect" and problem-free. Frequently, the family is very religious and spends a significant amount of time attending church or synagogue activities. The source of the family's pain is often very subtle, thus difficult to identify. This child acted like a sponge for the pain and absorbed it, but did not know what to do with it after that.

The person either grows up in, or marries into a situation in which she has a relationship with a parent or spouse who is a very controlling person. The only way she is able to survive is by giving up her own identity while trying to please the other person. Finally, she reaches a point where she finds this too painful and is no longer willing to do it any more, but does not know how to change.

The people with eating disorders who have the most difficulty identifying a "reason" why they developed an eating disorder are those who grew up in families and/or married into relationships in which there was no overt abuse or problem but rather a very subtle undermining of self-esteem. The person whom this describes is someone who repeatedly experienced lack of validation of her thoughts or feelings. She was given the message that she shouldn't feel that way, or that it was wrong to feel that way, or that she was selfish to feel that way. Since she did feel that way, the only explanation she could find as a child was that she must be bad or crazy. Over time, she learned to direct her negative emotions inwardly or to take them out on herself, since direct expression was not allowed.

The common thread in all seven scenarios is that a person is experiencing emotional pain at a level of intensity that she does not know how to manage in a healthy way, mainly because she did not learn to express feelings directly while growing up. Many families are not able to model or teach how to express feelings in a way that promotes closeness, support, or resolution of conflict. So when a person who grew up lacking these skills experiences intense emotional pain she lacks the tools to talk about it or to ask for support.

It is at this point that something very significant happens. The person begins to focus upon her body or food, looking outside rather than inside for the source and solution to the emotional pain. Once this starts, the person travels one of two paths. Following the first path she begins to eat and finds food a source of comfort and nurturing. Food is consistent, reliable, and always there. It is something to look forward to coming home to at the end of the day as well as something to which to turn to when alone and scared. The person finds that when she eats, the pain does not hurt quite so much. This person is vulnerable to becoming overweight or obese due to compulsive eating.

Following the second path, the person begins to restrict food intake or to binge and purge and starts to lose weight. As she loses weight, people make comments like "Oh, you look so good! You've lost weight!" In a world that is very painful, suddenly there is something that feels good, brings positive attention, and is within her control. The person finds that the more she focuses on counting calories, exercising, dieting, losing weight, or purging, the less she feels the emotional pain. This person is vulnerable to developing anorexia nervosa or bulimia nervosa.

Portions of this article are reprinted from Eating Disorders: Nutrition Therapy in the Recovery Process (1990) by Dan Reiff and Kim Reiff phD of Mercer Island, WA published by Aspen Publishers, Inc. Aspen, Co.

More Information

The following links will provide information on what an Eating Disorder is and suggestions on how to obtain help.

Eating Disorders

Introduction to Eating Disorders

What Is an Eating Disorder?

Partial Listing of Physical Problems Brought About by Eating Disorders

Short List of Salient Warning Signs For Eating Disorders

Possible Overt Signs of an Eating Disorder

Who Has Eating Disorders?

A Short List of Salient Warning Signs For Eating Disorders

What Causes Eating Disorders

More Information

Introductory Books