The information contained on this page is written from the point of view of someone that knows nothing about eating disorders. The point of this page is to raise awareness about eating disorders in a simple, easy to read format. I will only cover the basics here. If you are looking for more detailed information or just want to learn more about eating disorders and what you can do to help someone with an eating disorder, please refer to the links and references at the bottom of the page.
What Is An Eating Disorder
An eating disorder is a condition where thoughts of food, behavior around food or the act of eating causes feelings of anxiety to such a degree that it interferes with a person’s daily life and ability to maintain ‘normal’ eating behaviors.
What Causes Eating Disorders
Eating disorders are complex conditions that arise from a combination of psychological, interpersonal, and social conditions. Scientists and researchers are always learning about the underlying causes of these emotionally and physically damaging conditions. We do know, however, about some of the general issues that can contribute to the development of eating disorders.
While eating disorders may begin with preoccupations with food and weight, they are most often about much more than food. People with eating disorders often use food and the control of food in an attempt to compensate for feelings and emotions that may otherwise seem over-whelming. Dieting, bingeing, and purging may begin as a way to help some people cope with painful emotions and to feel as if they are in control of their lives, but ultimately, these behaviors will damage their physical health, self-esteem, and sense of competence and control.
Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be imbalanced. The exact meaning and implications of these imbalances is still under investigation.
Eating disorders are complex conditions that can arise from a variety of potential causes. Once started, however, they can create a self-perpetuating cycle of physical and emotional destruction.
Factors That Can Help Lead To The Development Of Eating Disorders
Psychological Factors that can Contribute to Eating Disorders:
• Low self-esteem
• Feelings of inadequacy or lack of control in life
• Depression, anxiety, anger, or loneliness
Interpersonal Factors that Can Contribute to Eating Disorders:
• Troubled family and personal relationships
• Difficulty expressing emotions and feelings
• History of being teased or ridiculed based on size or weight
• History of physical or sexual abuse
Social Factors that Can Contribute to Eating Disorders:
• Cultural pressures that glorify "thinness" and place value on obtaining the "perfect body"
• Narrow definitions of beauty that include only women and men of specific body weights and shapes
• Confusion about ones sexual identity
• Sports that place emphasis on ‘thinness’ – wrestling, gymnastics, running, etc…
• Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths
Other Factors that can Contribute to Eating Disorders:
• Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating
disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be imbalanced. The exact meaning and
implications of these imbalances remains under investigation.
• Eating disorders often run in families. Current research is indicates that there are significant genetic contributions to eating disorders.
Eating disorders are complex conditions that can arise from a variety of potential causes. Once started, however, they can create a self-perpetuating cycle of physical and emotional destruction.
Types Of Eating Disorders (clinical diagnoses)
While there exists many kinds and forms of eating disorders, I will focus on the most common types of eating disorders here. These eating disorders are commonly known as the clinical eating disorders and are recognized as medical conditions under the DSM-IV criteria for eating disorders.
Anorexia Nervosa
Anorexia Nervosa is a serious, potentially life threatening condition characterized by ones obsession to control their eating. The reason for this obsession is usually the false belief that by controlling their bodies they can control their lives. This obsession is usually achieved through starvation.
Anorexia Nervosa can usually be recognized by the following warning signs:
• Dramatic weight loss without any logical reason such as illness.
• 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--the need to “burn off” calories taken in.
• Withdrawal from usual friends and activities.
• An inability to maintain a weight that is normal for ones age and height.
• Dieting when one is not over ones healthy weight range.
• An obsessive desire to be thinner.
• Frequently preparing meals for others but not eating any themselves.
• Being unable to see ones body as it really is.
• Allowing ones shape and body to overly influence how one feels about themselves.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns
• A powerful feeling to take control of ones life and feel competent. One usually feels that they achieve this by controlling ones eating and weight.
• Abnormal menstrual periods in women.
• Signs of starvation. This can include the thinning or actual loss of hair, the appearance of fine white hair on the body, frequent bloated feelings, dark
under-eye circles, yellowing palms or soles of the feet and/or dry, pasty skin.
Anorexia Nervosa is a condition that caused by self-starvation. The body is denied the essential nutrients that are needed to function normally, so it is forced to slow down normal bodily functions in order to conserve energy and maintain much needed blood flow to the brain. This ‘slowing down’ can have serious medical consequences such as fatigue, fainting, dehydration, osteoporosis, bradycardia, kidney failure, heart failure and ultimately death.
Bulimia Nervosa
Bulimia Nervosa is characterized by cycles of binging and purging. The cycle begins with a person rapidly eating large amounts of food at a single sitting. The eating feels automatic and helpless. This eating may initially numb uncomfortable feelings such as anger or sadness, but it also creates physical discomfort and anxiety about weight gain. As a consequence, the person tries to rid the body of the food that was consumed. This is usually attempted by vomiting, the use of laxatives, enemas or diuretics, by excessive exercising, by skipping meals, or by dieting. Usually these purging behaviors do not achieve the desired goals of feeling more physically comfortable and losing weight. Instead, purging can frequently lead to weight GAIN, and these behaviors are very harmful to one’s health.
Bulimia Nervosa can usually be recognized by the following warning signs:
• 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.
• Feeling out of control while eating.
• Frequent dieting.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury--the need to “burn off” calories taken in.
• 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 caused by stomach acids due to frequent vomiting.
• Creation of complex lifestyle schedules or rituals to make time for binge-and-purge sessions.
• Drastic shifts in mood or energy levels.
• Laxatives, diuretics or diet pills found in ones room or bathroom. Often times these products may be hidden from view.
• Using body weight and shape as the main measure of ones self worth.
• Withdrawal from usual friends and activities, especially avoiding activities where food is involved.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
• People with Bulimia Nervosa may have a weight that is regarded as ‘normal’. In other words they may not ‘look like’ they have an eating disorder.
People who engage in bingeing and purging for an extended period of time often can appear ‘flabby’- in other words, their muscle mass is starved
away, and the body begins to adapt by producing a major rush of insulin during binges, which causes fat to be stored more readily.
Those suffering from Bulimia Nervosa often times know that their behavior is harmful but feel powerless to stop. Depression and changes in social adjustment are often times associated with Bulimia Nervosa.
Bulimia Nervosa is a serious condition that can be extremely harmful to the body. The cycle of binging and purging can impact the entire digestive system and lead to electrolyte and chemical imbalances. The reoccurrence of purging can lead to dehydration, potassium and sodium imbalances which are critical to normal heart functions. Bulimia can also cause irregular heart beat, heart failure, esophageal inflammation and/or rupture, tooth decay, irregular bowel movements and constipation, gastric rupture, the acute onset of diabetes, osteoporosis and decalcification of bones and teeth, and death. Often times the health consequences of Bulimia Nervosa will plague a person long after they have recovered from their illness.
Binge Eating Disorder
People with Binge Eating Disorder eat excessive amounts of food at one sitting. There are usually two reasons for this behavior. First, they are very hungry due to either dieting or restricting food in some way. The binge is the response to that hunger. Second, they over-eat to comfort themselves, to avoid uncomfortable situations or to numb their feelings. The binge is an attempt to comfort themselves emotionally.
People who binge-eat are often embarrassed and ashamed of their behavior. They often times have a history of diet failures and tend to be genetically larger or obese than the ‘average’ person. About one in five obese persons suffer from Binge Eating Disorder. A person suffering from Binge Eating Disorder differs from a person with Bulimia Nervosa by the fact that they generally do not try and compensate for their over-eating by vomiting, fasting, over exercising or abusing laxatives, or they specifically binge when they know they are not physically hungry. Binge Eating Disorder is the most common type of eating disorder.
Binge Eating Disorder can usually be recognized by the following warning signs:
• Frequent episodes of eating large quantities of food in short periods of time or at one sitting.
• Feeling out of control and/or unable to stop over eating behavior. • Feeling ashamed or disgusted by the behavior.
• Feeling uncomfortably full after eating.
• There are also several behavioral indicators of BED including eating when not hungry, eating quickly and eating in secret.
Binge Eating Disorder usually is not fatal, but there exist serious health risks associated with Binge Eating Disorder. Some of these health risks include high blood pressure, high cholesterol levels, heart disease, acute onset of diabetes and gallbladder disease.
Eating Disorder Not Otherwise Specified (ED-NOS)
Individuals who experience a mix of anorexic and/or bulimic and/or binge-eating symptoms, but do not fall neatly into one of the medical categories are said to have an Eating Disorder Not Otherwise Specified (ED-NOS). For instance, an individual may experience all the signs and symptoms of anorexia and still lose weight but still remain within their ‘normal’ weight range. Or, an individual may exhibit all the signs and symptoms of bulimia but not binge and purge as often as is required to be categorized as having bulimia.
Many people with ED-NOS also engage in other symptoms associated with anorexia, bulimia or binge-eating such as:
• Purging, or compensating for normal eating by inducing vomiting, using laxatives or over-exercising, but don’t do it often enough to diagnosed with
one of the other clinical eating disorders.
• Chewing food repeatedly and often spitting it out rather than swallowing it.
• Binge eating frequently and compensating for it through the use of laxatives or by vomiting, etc…
• Remaining within their normal weight range despite disordered eating.
Even though those suffering from ED-NOS do not neatly fall into one of the other clinical categories, they still can have an eating disorder just as severe as anorexia, bulimia or binge-eating. Sometimes those with ED-NOS are in the beginning stages of an eating disorder and sometimes they just have a very severe eating disorder that just does not fall neatly into any other category. Because of this, those with ED-NOS should still be taken as seriously as someone with anorexia, bulimia or binge-eating and still receive the same help and recourses.
Types Of Eating Disorders (non-clinical)
Dieting
Dieting is about restricting what one eats or how much one eats in order to lose weight. One usually diets because they believe that being thinner will make them healthier, happier and/or more worthy. The pressure to diet in contemporary society is huge. We are driven by a media and diet industry that defines ‘normal’ weight and shape as unhealthily thin. This encourages the false belief that everyone can be slim if they try hard enough. It also makes it difficult for one to understand that health and happy people actually come in all shapes and sizes.
Dieting can lead to eating disorders because it encourages an obsession with food and weight, and suggests that thinness is an ideal that one must strive for. The effects of dieting include:
• A preoccupation with food.
• A strong desire to binge.
• Mood changes such as increased irritability and depression.
• Increased nail-biting and other self-soothing behaviors.
• Lowered self-esteem when diets inevitability fail.
• Social withdrawal. • Reduction in sexual interest.
• Impaired concentration and judgment.
• Decreased body temperature, heart rate and respirations.
• Lowered metabolism and thus weight gain.
• Increased use of salt, spices, coffee, tea, chewing gum, cigarettes.
Disordered Eating
Disordered eating includes a wide range of abnormal eating. This includes the behaviors seen in eating disorders such as anorexia and bulimia, chronic restrained eating, compulsive eating and habitual dieting. It includes irregular, chaotic eating patterns. Often physical hunger and ‘fullness’ are ignored.
Disordered eating has negative effects on overall health – emotional, social and physical. It may cause the individual to feel tired and depressed, decrease mental functioning and concentration, and can lead to malnutrition with risk to bone health, physical growth and brain development.
Who Is At An Increased Risk For Developing An Eating Disorder
Eating disorders usually appear in bright, attractive young women between the ages of twelve and twenty-five, although there are both older and younger exceptions. At least ten percent (10%) of the people with eating disorders are male, possibly more. Researchers are just now beginning to determine how widespread these problems are in men and boys.
People who become anorexic often were good children -- eager to please, conscientious, hard working, and good students. Typically they are people-pleasers who seek approval and avoid conflict. They may take care of other people and strive for perfection, but underneath they feel defective and inadequate. They want to be special, to stand out from the mediocre masses. They try to achieve that goal by losing weight and being thin.
People who develop anorexia often feel stressed and anxious when faced with new situations. Many are perfectionists who have low tolerance for change (including the normal physical changes their bodies experience at puberty), feeling that it represents chaos and loss of control. Some set rigid, unrealistic standards for themselves and feel they have failed totally when they cannot achieve and maintain the degree of excellence they demand of themselves.
In addition to restricting food, classic anorexics also restrict other areas of their lives. They are risk-averse individuals, preferring to live closely circumscribed lives, with few changes in established routines, to which they tightly cling. They need to become more adventurous and learn how to cope with expanded horizons.
Although people who have anorexia nervosa don't want to admit it, many fear growing up, taking on adult responsibilities, and meeting the demands of independence. Many are overly engaged with parents to the exclusion of peer relationships. They use dieting and weight preoccupations to avoid, or ineffectively cope with, the demands of a new life stage such as adolescence, living away from home, or adult sexuality.
People who become bulimic often have problems with anxiety, depression, and impulse control; for example, shoplifting, casual sexual activity, binge shopping, alcohol and drug abuse, and cutting and other self-harm behaviors. They do not handle stress gracefully. They may be dependent on their families even though they fiercely profess independence. Many have problems trusting other people. They have few or no truly satisfying friendships or romantic relationships.
They may diet, thinking to improve their lives and feel better about themselves. The deprivation leads to hunger, which leads to powerful cravings, which lead to binge eating. Feeling guilty, and afraid of weight gain, they try to remove calories from their bodies by vomiting, laxative abuse, fasting, or other methods of purging.
Bulimics binge not only on food but also in other areas of their lives, often taking in more than they can handle: relationships, jobs, responsibilities, family duties, and sometimes possessions and alcohol and other drugs. They need to learn to set limits and boundaries, slowing down and stepping back a bit so they don't feel so overwhelmed, rather than "purging" by cut-and-run behaviors when they find themselves over-involved.
Because of intense demands for thinness, some people are at high risk for eating disorders -- wrestlers, jockeys, cheerleaders, sorority members, socialites, dancers, gymnasts, runners, models, actresses, entertainers, and male homosexuals.
Some clinicians find that a high percentage of their clients with eating disorders also have histories of physical, emotional or sexual abuse. Research, however, suggests that people who have been abused have about the same incidence of eating disorders as those who have not been mistreated. Nevertheless, the subject arises often enough to warrant discussion here.
People who have survived abuse often do not know what to do with the painful feelings and overwhelming memories that remain, sometimes even many years later. Some try to escape those feelings and memories by numbing themselves with binge food or through starvation. Some try to symbolically cleanse themselves by vomiting or abusing laxatives. Some starve themselves because they believe they are "bad" and do not deserve the comfort of food and the nurture it represents.
As with all eating disorders, the starving and stuffing that follow abuse are coping behaviors. The key to recovery is finding out what the person is trying to achieve, or avoid, with the behaviors. S/he then needs to find, and use, healthier and more effective behaviors to feel better and make life happier. Almost always professional counseling is necessary to complete the process.
People with eating disorders seek external solutions for internal problems. They feel empty, depressed, anxious, fearful, sorrowful, guilty, frustrated, insecure and depressed. They want to feel better, which is good, but they choose woefully ineffective ways of doing that. In fact, starving and stuffing have the opposite effect: they cause MORE emotional pain and distress.
Nonetheless, manipulating food and body weight is encouraged by Western culture, which exhorts all of us, and especially women, to improve ourselves by "fixing" the external package, the body. Make-over reality shows on TV are a prime example. The message is, "Change your hair color and style, buy new clothes, paint your face, shove your feet into shoes that hurt and make walking difficult, tone your muscles AND LOSE WEIGHT and you will be happy, admired, and loved -- an instant new identity, a new you.
The problem is, of course, that sprucing up the outside (or starving it to death) does not fix what's wrong on the inside. True happiness and deep contentment are achieved through psychological and spiritual growth and ultimate realization of one's worth and place in the world, not by abusing the body. It takes a lot of wisdom and maturity to realize and accept this hard truth, and the young people most vulnerable to eating disorders are those who most lack those characteristics.
What Can You Do To Help Prevent Eating Disorders
Be a model of healthy self-esteem and body image. Recognize that others pay attention and learn from the way you talk about yourself and your body. Choose to talk about yourself with respect and appreciation.
• Learn all you can about anorexia nervosa, bulimia nervosa, and binge eating disorder. Genuine awareness will help you avoid judgmental or
mistaken attitudes about food, weight, body shape, and eating disorders.
• Discourage the idea that a particular diet, weight, or body size will automatically lead to happiness and fulfillment.
• Choose to challenge the false belief that thinness and weight loss are great, while body fat and weight gain are horrible or indicate laziness,
worthlessness, or immorality.
• Avoid categorizing foods as “good/safe” vs. “bad/dangerous.” Remember, we all need to eat a balanced variety of foods.
• Decide to avoid judging others and yourself on the basis of body weight or shape. Turn off the voices in your head that tell you that a person’s body
weight says anything about their character, personality, or value as a person. • Avoid conveying an attitude that says, “I will like you better if you lose
weight, or don’t eat so much, etc.”
• Become a critical viewer of the media and its messages about self-esteem and body image. Talk back to the television when you hear a comment or
see an image that promotes thinness at all costs. Rip out (or better yet, write to the editor about ) advertisements or articles in your magazines that
make you feel bad about your body shape or size.
• If you think someone has an eating disorder, express your concerns in a forthright, caring manner. Gently but firmly encourage the person to seek
trained professional help.
• Be a model of healthy self-esteem and body image. Recognize that others pay attention and learn from the way you talk about yourself and your body.
Choose to talk about yourself with respect and appreciation. Choose to value yourself based on your goals, accomplishments, talents, and character.
Avoid letting the way you feel about your body weight and shape determine the course of your day. Embrace the natural diversity of human bodies and
celebrate your body’s unique shape and size.
• Support local and national nonprofit eating disorders organizations
What Can You Do To Help A Person With Eating And Body Image Issues
You cannot force someone to seek help, change their habits, or adjust their attitudes. You will make important progress in honestly sharing your concerns, providing support, and knowing where to go for more information. This list may not tell you everything you need to know about what to do in your specific situation, but it will give you some helpful ideas on what to do to help your friend. • Learn as much as you can about eating disorders. Read books, articles, and brochures.
• Know the differences between facts and myths about weight, nutrition, and exercise. Knowing the facts will help you reason against any inaccurate
ideas that your friend may be using as excuses to maintain their disordered eating patterns.
• Be honest. Talk openly and honestly about your concerns with the person who is struggling with eating or body image problems. Avoiding it or
ignoring it won’t help!
• Be caring, but be firm. Caring about your friend does not mean being manipulated by them. Your friend must be responsible for their actions and the
consequences of those actions. Avoid making rules, promises, or expectations that you cannot or will not uphold. For example, “I promise not to tell
anyone.” Or, “If you do this one more time I’ll never talk to you again.”
• Compliment your friend’s wonderful personality, successes, or accomplishments. Remind your friend that “true beauty” is not simply skin deep.
• Be a good role model in regard to sensible eating, exercise, and self-acceptance.
• Tell someone. It may seem difficult to know when, if at all, to tell someone else about your concerns. Addressing body image or eating problems in
their beginning stages offers your friend the best chance for working through these issues and becoming healthy again. Don't wait until the situation
is so severe that your friend's life is in danger. Your friend needs as much support and understanding as possible.
Treatment Of 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 significantly enhance recovery. Eating disorders can become chronic, debilitating, and even life-threatening conditions. 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. Ideally, this treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patient's individual problems, needs, and strengths.
Eating Disorder Acronym Dictionary
The following is a list of some common terms and abbreviations commonly used among people with eating disorders and the treatment community.
Ana: Anorexia Nervosa
Mia: Bulimia Nervosa
Coe: Compulsive Over-eating disorder
EDNOS: Eating disorder not otherwise specified
BED: Binge eating disorder.
ED: Eating disorder
SI: Self injury, or SIB: Self-injurious behavior
DSM-IV: The Diagnostic and Statistical Manual of the American Psychiatric Association- Fourth Revision. The DSM-IV outlines the diagnostic criteria
for various mental illnesses.
MiAna or AnaMia: Having both anorexia and bulimia
B/p: Short for binge and purge.
C/s: Short for Chew/Spit. This is the act of chewing, then spitting out food without swallowing it.
Thinspiration: Collection of thin looking peoples pictures, used to inspire those with ana/mia.
Anorectic: One who has anorexia.
CW: Current weight.
HW: Highest weight.
LW: Lowest weight.
GW: Goal Weight.
STGW: Short term goal weight.
LTGW: Long term goal weight.
FGW: Final goal weight.
IP: Inpatient
OP: Outpatient treatment
IOP: Intensive Outpatient
Tx, Rx, Dx:Short for Treatment, Prescription, and Diagnosis
BMI: Body Mass Index.
RESTRICTING food intake: Purposely eating less than what one is hungry for, or continually eating only a fraction of what a person would normally
eat.
STARVATION: The state of nutritional deficiency that occurs as a result of long-term restriction. Also, total cessation of eating, or eating nearly nothing
for weeks.
DIET: Attempting to minimize one's calorie intake, or restricting specific foods from the diet.
GP, T, & N: General Practitioner, Therapist, and Nutritionist
References
The information contained on this page was complied from the following sources:
• The Joy Project
• National Eating Disorders Association
• National Eating Disorders Information Center – Canada
• Anorexia Nervosa and Related Eating Disorders, Inc.
To learn more about eating disorders including treatment, recovery, how you can help and what to look for – please visit the following web sites listed below:
The Joy Project www.joyproject.org
National Eating Disorders Association www.nationaleatingdisorders.org
National Eating Disorders Info Center – Canada www.nedic.ca
Anorexia Nervosa and Related Eating Disorders, Inc. www.anred.com
Academy For Eating Disorders www.aedweb.org
Eating-Disorder-Information.com www.eating-disorder-information.com
