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Eating Disorders

What Are Eating Disorders?

Eating disorders are psychological conditions with both emotional and physical symptoms. The disorders include anorexia nervosa (voluntary starvation), bulimia nervosa (binge-eating followed by purging), binge-eating disorder (binge-eating without purging), and unspecified eating disorders (disordered eating that does not fit into another category). 

Eating disorders occur frequently—but not exclusively—in affluent cultures. A disproportionate number of those diagnosed are young women in their teens and 20s, but anyone, including young men and older adults, can develop an eating disorder at any age. Among the most baffling of conditions, eating disorders take on a life of their own so that eating, or not eating, becomes the focus of everyday existence.

Biological factors, social pressure, and family history and dynamics are some of the factors associated with eating disorders. Culturally mediated body-image concerns and personality traits like perfectionism and obsessiveness also play a large role in eating disorders, which are often accompanied by depression and/or anxiety.

Treatment is never simple for these conditions. They often create multiple medical problems and can even be acutely life-threatening, requiring hospitalization and forced nourishment. It can take a multidisciplinary team of health professionals, including a psychotherapist, a medical doctor, and a specialized dietitian or nutritionist to bring about full recovery in someone with an eating disorder.

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How Eating Disorders Begin

A disturbed relationship to food marks all eating disorders, as does emotional fragility. Since eating is a normal part of life, these are conditions marked by extremes. Eating disorders typically start out unnoticed––a person eats a little more or a little less food than usual. The urge to eat more or to eat less becomes increasingly compelling, until it can become the focus of a person's existence.

There is no single cause of any of the eating disorders, but they exist largely in affluent cultures where there is an abundance of food. No one knows why voluntary behaviors, such as eating smaller or larger than usual amounts of food, turn into an eating disorder for some people.

Biology plays a role: Appetite control and the regulation of food intake is highly complex, with many hormones in the brain and the body signaling hunger and satiety.

Culture is thought to also play a significant role, as women, especially, are pressured to fit an ideal of beauty that is increasingly defined by the sole criterion of body weight. Families contribute, too; parents who emphasize looks and/or dieting or who criticize their children's bodies are more likely to raise a child who develops an eating disorder.

Other circumstances figure in, too; the conditions can be triggered by stress, social difficulty, loneliness, depression, other unpleasant emotions, or by dieting itself.


Anorexia nervosa is an eating disorder marked by an extreme obsession with weight loss or exercise. It is especially prevalent among young to middle-aged women and, increasingly, among young men, but it can affect anyone at any age.

Characterized by a distorted sense of body image and extreme voluntary starvation or overexercising, and closely associated with perfectionism and depression, it is the most deadly psychiatric disorder. The most common behavioral signs of anorexia include extreme dieting, obsessive food rituals, and secretive and antisocial behavior.

Anorexia is highly resistant to treatment and is often accompanied by anxiety and depression. Treatment may include cognitive behavioral therapy, medication, nutrition education and management, and family-based therapies, all of which may take place at specialized eating-disorder centers. If the condition becomes life-threatening, the only recourse may be hospitalization with forced feeding, which may create ethical and legal dilemmas for all caregivers involved. 


The eating disorder known as bulimia nervosa is marked by frequent cycles of binge-eating excessive amounts of food in one sitting and then purging the food, usually by self-induced vomiting but sometimes by the use of laxatives or diuretics or nonpurging compensatory behaviors, such as fasting or overexercising. The disorder typically begins during adolescence and it can be difficult to identify because those with bulimia are often secretive about their eating and purging habits. 

Although many people with bulimia are overweight, they generally have an intense fear of weight gain and often suffer anxiety, depression, and poor self-esteem. Some signs of bulimia include unusual eating behaviors, constant weight fluctuation, frequent use of the bathroom, and avoidance of social events. Treatment usually includes cognitive-behavioral or other forms of psychotherapy, antidepressant medication, and nutrition counseling.

Binge Eating

Binge-eating disorder is marked by recurrent episodes of extreme overeating not accompanied by compensatory behavior; as a result, those with the disorder are usually overweight to obese. People with this disorder tend to eat much more rapidly than normal and don't stop until feeling uncomfortably full. They may consume large amounts of food even when they're not hungry. They often eat alone because of shame or embarrassment over their eating behaviors. To be considered a disorder, these behaviors must occur at least two days a week for six months or more.

In Their Own Words

Eating disorders tear families apart and affect every aspect of sufferers' lives: Cognitive faculties suffer due to nutritional deficits, mood is erratic or severely depressed, and relationships are strained to the breaking point.

Case studies of anorexia, bulimia, and binge eating can be heartbreaking, but often they are highly instructive. Here are three women's stories.

More on Eating Disorders

Eating disorders encompass a number of other conditions. Avoidant/Restrictive Food Intake disorder is characterized by the avoidance or restriction of food intake. People with the condition may be uninterested in food, trying to avoid a negative experience they had in the past, or unsettled by particular sensory characteristics of food, such as its smell or texture.

Rumination disorder is characterized by repeated regurgitation of food after eating, bringing previously swallowed food up into the mouth without displaying nausea, involuntary retching, or disgust. The food is typically then re-chewed and spit out or swallowed again.

Pica is a condition characterized by the eating of one or more nonnutritive, nonfood substances on a regular basis, such as paper, soap, or hair. Those with the disorder typically do not have an aversion to food in general. 


Bulimia Nervosa, Anorexia Nervosa

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