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Eating disorders happen as a result of severe disturbances in eating behavior, such as unhealthy reduction of food intake or extreme overeating. These patterns can be caused by feelings of distress or concern about body shape or weight and they harm normal body composition and function. Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood. Many adolescents are able to hide these behaviors from their family for months or years.

Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa. A person with anorexia nervosa starves himself or herself to be thin, experiencing extreme weight-loss. An estimated .5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime. Bulimia nervosa is binge eating followed by purging (vomiting). An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime. A third disorder, binge-eating disorder, is characterized by frequent episodes of out-of-control eating. A cycle develops due to feelings of shame and disgust caused by obesity brought on by the overeating and leading to bingeing again. Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a six-month period. This illness has only been suggested but has not yet been approved as a formal psychiatric diagnosis.

Eating disorders frequently occur together with other psychiatric illness such as depression, substance abuse, and anxiety disorders. In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure, which may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorders are male.

Anorexia Nervosa:

• Significant weight loss
• Continual dieting
• Intense fear of gaining weight or becoming fat, even though underweight
• Undue influence of body weight or shape on self-evaluation
• Preoccupation with food calories or nutrition
• Preference to eat alone
• Compulsive exercise
• Bingeing and purging
• Brittle hair or nails
• Depression
• Infrequent or absent menstrual periods (in females who have reached puberty)

Bulimia Nervosa:

• Recurrent episodes of binge eating
• Purging by strict dieting, fasting, vigorous exercise or vomiting
• Abuse of laxatives or diuretics to lose weight
• Frequent use of bathroom after meals
• Reddened fingers
• Swollen cheeks
• Self-evaluation is unduly influenced by body shape and weight
• Depression or mood swings
• Irregular menstrual periods
• Dental problems, like tooth decay
• Heartburn or bloating

Binge-Eating Disorder:

• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts of food when not hungry
• Eating alone because of embarrassment cause by how much one is eating
• Marked distress about the binge-eating behavior
• Binge eating occurs, on average, at least 2 days a week for 6 months
• Binge eating not associated with regular use of compensatory behaviors (purging, fasting, excessive exercise)

Emotional stresses like depression or difficulties adapting to family problems can trigger a disturbance in a child or teen's nutrition. Drug or alcohol abuse by family members can also be risk factors, with an affected child adopting poor eating habits as a manner of coping. In addition, media images have been cited as raising the incidence of eating disorders in both males and females who may drastically reduce their intake of food while exercising compulsively.

People with anorexia nervosa see themselves as overweight even though they are dangerously thin. In bulimia nervosa, despite sufferers usually weighing within the normal range for their age and height, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. Many with binge-eating disorders are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.

Eating disorders can be treated and a healthy weight can be restored. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling and, when appropriate, medication management.

Treatment of anorexia calls for a specific program that involves three main phases: restoring weight lost to severe dieting and purging; treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts; and achieving long-term remission and rehabilitation, or full recovery. Use of psychotropic medication in people with anorexia should be considered only after weight gain begins. Certain selective serotonin reuptake inhibitors (SSRIs) have proved helpful for weight maintenance and countering mood and anxiety symptoms.

Treatment of severe weight loss is usually provided in a hospital setting for an average of two months, where feeding plans address the person's medical and nutritional needs. Once nutrition is balanced and weight gain has begun, psychotherapy can help people with anorexia overcome low self-esteem and address issues about body size, shape and eating.

The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some fluctuate between weight gain and relapse; and others chronically deteriorate over many years. The mortality rate among people with anorexia has been estimated at.56 percent per year which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. Nutritional rehabilitation, psychosocial intervention and medication management are often employed. Establishment of a pattern of regular, non-binge meals, encouragement of healthy but not excessive exercise, and resolution of co-occurring conditions such as mood or anxiety disorders are among the specific aims of these strategies. Individual psychotherapy, group psychotherapy, and family or marital therapy have been reported to be effective. Psychotropic medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety, or those who have not responded to psychosocial treatment. These medications also may help prevent relapse.

The treatment goals and strategies for binge-eating disorder are similar to those for bulimia, and studies are currently evaluating the effectiveness of various interventions.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation.

Sources:

• American Psychiatric Association
• National Institutes of Health