Understanding Eating Disorders

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Eating disorders are not a choice.

Eating disorders (EDs) are complex medical and psychiatric illnesses. Decades of genetic research show that biological factors play a significant role in who develops an eating disorder. EDs commonly co-occur with other mental health conditions like major depression, anxiety, social phobia, and obsessive compulsive disorder. The consequences of eating disorders can be life-threatening; many individuals delay a timely diagnosis and adequate treatment due to the stigma associated with mental illness (and eating disorders in particular). Eating disorders affect all types of people, although not evenly. Half of all teenage girls and almost a third of teenage boys have unhealthy weight control behaviors. They have an unhealthy preoccupation – possibly even an obsession – with food, their weight, and their body type or shape. These thoughts may signal an eating disorder such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. Anorexia also has the highest mortality rate of any psychiatric disorder.

What are the factors that put some people at greater risk for developing an eating disorder?

  • Age. Eating disorders are much more common during a person’s teens and early 20s.
  • Gender. Women and girls are more likely to have a diagnosed eating disorder, but men and boys may be under-diagnosed due to resistance in seeking treatment. 
  • Family history. Having a parent or sibling with an eating disorder increases the risk.
  • Dieting. Dieting taken too far can become an eating disorder.
  • Change. Transitions like going to college, starting a new job, getting divorced (or experiencing parental divorce) are stressors that can trigger the development of an eating disorder.
  • Interests and activities. Eating disorders are especially common among models, gymnasts, runners, swimmers, wrestlers and ballet dancers; even football players who have to maintain a specific weight.

Eating disorders are often hidden from others – either by happenstance or design. Unless someone is with a friend or family member 24/7, it is almost impossible to get a complete picture of the habits that, taken together, add up to a disorder. Skipping meals, fasting, smoking cigarettes, purging (throwing up), taking laxatives, over-exercising, taking diet pills, hiding food, and drinking highly caffeinated energy drinks can happen without anyone else knowing or noticing. And, as with many other brain health conditions, the folks who are struggling can become very skilled at hiding their concerning behaviors and appearing “fine” to others. Detecting eating disorders among loved ones can require some detective work.

Most people have a passing knowledge of anorexia and bulimia due to mainstream media, but the general media and social media are also responsible for promulgating myths and stigmas surrounding eating disorders. Common misconceptions include the belief that eating disorders are a personal lifestyle choice, or that they are caused by dysfunctional families or by society in general. Many perceive the “remedy” to be encouraging someone to eat more (or less). To achieve a full recovery, eating disorders often require some combination of medical, psychiatric, therapeutic and dietary intervention.

Warning signs of common eating disorders.

Anorexia nervosa: People see themselves as overweight, even when they are dangerously underweight. Anorexia nervosa has the highest mortality rate of any mental disorder. While many people with this disorder die from complications associated with starvation, others die of suicide.

Behaviors include:
  • Extremely restricted eating
  • Extreme thinness (emaciation) and a relentless pursuit of thinness
  • Excessive exercising
  • Intense fear of gaining weight; and weighing themselves repeatedly
  • Distorted body image; self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
Serious symptoms may develop over time, including:
  • Thinning of the bones (osteopenia or osteoporosis)
  • Mild anemia and muscle-wasting and weakness
  • Brittle hair and nails; dry, yellowish skin
  • Growth of fine hair all over the body (lanugo)
  • Severe constipation
  • Low blood pressure, slowed breathing and low pulse rate
  • Damage to the structure and function of the heart
  • Brain damage or multi-organ failure
  • Drop in internal body temperature (feeling cold all the time)
  • Lethargy, sluggishness, or feeling tired all the time
  • Infertility

Bulimia nervosa: People with bulimia nervosa do not fit a specific body type. They may be slightly underweight, normal weight, or overweight.

Behaviors include:
  • Recurrent and frequent episodes of eating unusually large amounts of food (feeling a lack of control over, and need to compensate for these episodes)
  • Forced vomiting
  • “Disappearing” after meals to purge (throw up) what they just ate
  • Excessive use of laxatives or diuretics
  • Fasting
  • Excessive exercise
  • A combination of these behaviors.
Symptoms include:
  • Chronically inflamed and sore throat
  • Swollen salivary glands in the neck and jaw area
  • Worn tooth enamel and sensitive or decaying teeth as a result of exposure to stomach acid
  • Acid reflux disorder and other gastrointestinal problems
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration from purging of fluids
  • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

Binge-eating disorder: Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or even obese. Binge-eating disorder is the most common eating disorder in the U.S.

Behaviors include:
  • Eating unusually large amounts of food in a specific amount of time (often a 2-hour period)
  • Eating rapidly during binge episodes
  • Eating until feeling uncomfortably full
  • Eating even when full or not actually hungry
  • Eating alone or in secret
  • Feeling embarrassed, distressed, ashamed, or guilty about eating
  • Frequent dieting, possibly without weight loss

Multi-faceted treatments are effective

Luckily, many treatment options exist for Eating Disorders. There is no singular approach because the conditions are multi-faceted, requiring integrated treatment plans that combine medical care, nutritional counseling, psychotherapy (often cognitive behavioral therapy) and possibly medication. Treatment can be provided through intensive in-patient treatment centers that remove many of the temptations of a teen’s normal environment and replace them with supportive resources. For less severe cases, an ecosystem of specialist providers can work together on an outpatient basis. The need for such services is critical given that research shows that 4% of adolescents and teens, ages 13 to 18, suffer from an anorexia, bulimia, or binge eating disorder. (Polaris Teen Center, 2021) When applied to an average high school population of 1,000 students, this statistic points to a minimum of 40 students suffering from at least one eating disorder which is highly likely to be intertwined with another mental illness condition. Taking the first step toward getting help for themselves or a loved one is the most important action someone could take to begin to reverse the trends associated with brain health conditions such as eating disorders.

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