TYPES OF EATING DISORDERS

 

Anorexia Nervosa

Anorexia nervosa is a dangerous condition in which people can literally starve themselves to death. People with this disorder eat very little even though they are already thin. They have an intense and overpowering fear of body fat and weight gain, repeated dieting attempts, and excessive weight loss. This particular eating disorder affects from 0.5% to 1% of the female adolescent population with an average age of onset between 14 and 18 years.3 Anorexia is identified in part by refusal to eat, an intense desire to be thin, repeated dieting attempts, and excessive weight loss. To maintain an abnormally low weight, people with anorexia may diet, fast, or over exercise. They often engage in behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. People with anorexia believe that they are overweight even when they are extremely thin. Often, the beginning of illness will occur after a stressful life event such as initiation of puberty or moving out of the parents' home.

Those with anorexia are often characterized as perfectionists and overachievers who appear to be in control. In reality, they suffer from low self-esteem and confidence and overly criticize themselves. They are also very concerned about pleasing others.

Complications - The most severe and noticeable consequences of anorexia nervosa resemble those of starvation. The body reacts to the lack of food by becoming extremely thin, developing brittle hair and nails, dry skin, lowered pulse rate, cold intolerance, and constipation as well as occasional diarrhea. In addition, mild anemia, reduced muscle mass, loss of menstrual cycle and swelling of joints often accompany anorexia.

Beyond experiencing the immediate effects of anorexia nervosa, individuals suffer long-term consequences throughout the life cycle, regardless of treatment. In addition to the risks of recurrence, malnutrition may cause irregular heart rhythms and heart failure. Lack of calcium places anorexics at increased risk for osteoporosis both during their illness and in later life. A majority of anorexics also have clinical depression while others suffer from anxiety, personality disorders or substance abuse, and many are at risk for suicide. Approximately 1 in 10 women afflicted with anorexia will die of starvation, cardiac arrest, or other medical complication, making its death rate among the highest for a psychiatric disease.4

Bulimia Nervosa

Individuals suffering from Bulimia Nervosa follow a routine of secretive, uncontrolled or binge eating (ingesting an abnormally large amount of food within a set period of time) followed by behaviors to rid the body of food consumed. This includes self - induced vomiting and/or the misuse of laxatives, diet pills, diuretics (water pills), excessive exercise or fasting. Bulimia afflicts approximately 1% - 3% of adolescents in the US with the illness usually beginning in late adolescence or early adult life.3 As with anorexia nervosa, those with bulimia are overly concerned with food, body weight, and shape. Because many individuals with bulimia 'binge and purge' in secret and maintain normal or above normal body weight, they can often hide the disorder from others for years. Binges can range from once or twice a week to several times a day and can be triggered by a variety of emotions such as depression, boredom, or anger. The illness may be constant or occasional, with periods of remission alternating with recurrences of binge eating.

Individuals with bulimia are often characterized as having a hard time dealing with and controlling impulses, stress, and anxieties. Bulimia nervosa can and often does occur independently of anorexia nervosa, although half of all anorexics develop bulimia.

Complications - Most medical complications attributed to bulimia nervosa result from electrolyte imbalance and repeated purging behaviors. Loss of potassium due to vomiting, for example, damages heart muscle, increasing the risk for cardiac arrest. Repeated vomiting also causes inflammation of the esophagus and possible erosion of tooth enamel as well as damage to the salivary glands. Some individuals with bulimia struggle with addictions such as drugs and alcohol, and compulsive stealing. Like those with anorexia, many people with bulimia suffer from clinical depression, anxiety, obsessive-compulsive disorder and other psychiatric illnesses.

Binge Eating Disorder (BED)

Binge eating disorder (BED) is the newest clinically recognized eating disorder. BED is primarily identified by repeated episodes of uncontrolled eating. The overeating or bingeing does not typically stop until the person is uncomfortably full. Unlike anorexia nervosa and bulimia nervosa, however, BED is not associated with inappropriate behaviors such as vomiting or excessive exercise to rid the body of extra food. The illness usually begins in late adolescence or in the early 20s, often coming soon after significant weight loss from dieting. Some researchers believe that BED is the most common eating disorder, affecting 15% - 50% of participants in weight control programs. In these programs, women are more likely to have BED than males. Current findings suggest that BED affects 0.7% - 4% of the general population.3

To the lay person, BED can be difficult to distinguish from other causes of obesity. However, the overeating in individuals with BED is often accompanied by feeling out of control and followed by feelings of depression, guilt, or disgust.

Complications - People with BED are often overweight because they maintain a high calorie diet without expending a similar amount of energy. Medical problems for this disorder are similar to those found with obesity such as increased cholesterol levels, high blood pressure, and diabetes, as well as increased risk for gallbladder disease, heart disease, and some types of cancer. Researchers have shown that individuals with BED also have high rates of depression.

Eating Disorder not Otherwise Specified (ENDOS)

The Eating Disorder Not Otherwise Specified (EDNOS) category is for disorders of eating that do not meet the criteria for any specific eating disorder. In EDNOS, individuals engage in some form of abnormal eating but do not exhibit all the specific symptoms required to diagnose an eating disorder. For instance, an individual with EDNOS may meet all the criteria of anorexia nervosa but manage to maintain normal weight while someone else may engage in purging behavior with less frequency or intensity than a diagnosed bulimic.

Causes of Eating Disorders

No exact cause of eating disorders has yet been found. However, some characteristics have been shown to have influence in the development of the illnesses.

Personality Factors

Most people with eating disorders share certain personality traits: low self-esteem, feelings of helplessness, and a fear of becoming fat. In anorexia, bulimia, and binge eating disorder, eating behaviors seem to develop as a way of handling stress.

Genetic and Environmental Factors Eating disorders appear to run in families, with female relatives most often affected. However, there is growing evidence that a girl's immediate social environment, including her family and friends, can emphasize the importance of thinness and weight control. For example, regular discussion of weight and dieting may normalize societal pressure to be thin. Weight related teasing by peers and family is related to low body esteem and eating disturbances in young girls. The National Institute of Mental Health (NIMH) reports that girls who live in families that tend to be strict and place strong emphasis on physical attractiveness and weight control are at an increased risk for inappropriate eating behaviors.4

Additionally, people pursuing professions or activities that emphasize thinness - like modeling, dancing, gymnastics, wresting, and long distance running - are more susceptible to the problem.

Body Image

The idealization of thinness has resulted in distorted body image and unrealistic measures of beauty and success. Cultural and media influences such as TV, magazines, and movies reinforce the belief that women should be more concerned with their appearance than with their own ideas or achievements. Body dissatisfaction, feelings of fatness, and drive for thinness has led many women to become overly concerned about their appearance. Research has shown that many normal weight and even underweight girls are dissatisfied with their body and are choosing inappropriate behaviors to control their appetite and food intake. The American Association of University Women found that adolescent girls believe physical appearance is a major part of their self-esteem and that their body image is a major part of their sense of self.6

Biochemistry

Recent studies have revealed a connection between biological factors associated with clinical depression and the development of anorexia nervosa and bulimia nervosa. Stress hormones such as cortisol are elevated in those with eating disorders, while neurotransmitters such as serotonin may not function correctly. Research continues to better understand this relationship.

Information from: The U.S. Department of Health and Human Service's Office on Women's Health www.4woman.gov