Eating disorders are serious conditions related to persistent eating behaviors that negatively impact your health, your emotions, and your ability to function in important areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Most eating disorders involve focusing too much on your weight, body shape, and food, leading to dangerous eating behaviors. These behaviors can significantly impact your body's ability to get appropriate nutrition. Eating disorders can harm the heart, digestive system, bones, and teeth and mouth, and lead to other diseases.
Eating disorders often develop in the teen and young adult years, although they can develop at other ages. With treatment, you can return to healthier eating habits and sometimes reverse serious complications caused by the eating disorder.
Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder are known as the deadliest mental health disorders. Men and women are usually diagnosed in their teens or early adolescent years however eating disorders can affect men and women of all ages. Eating disorders often occur due to underlying causes such as low self-esteem, mental health disorders, substance abuse disorders, or a past history of trauma or neglect. When an eating disorder such as anorexia nervosa, binge eating, or bulimia nervosa occurs with another mental health disorder such as depression or with a substance abuse disorder such as alcohol use disorder, it is coined co-occurring disorders.
Co-occurring disorders are defined as having 2 or more mental health or substance abuse disorders at one time and was formerly known as dual diagnosis. The term dual diagnosis is no longer used as the word “dual” often refers to two where individuals may have more than two disorders occurring at the same time. More often than not individuals will only be treated for their specific eating disorder and their depression or anxiety goes untreated.
This is problematic because their depression or anxiety could be the underlying problem driving the eating disorder. If the depression or anxiety remains untreated then the individual has a higher chance of relapsing and falling back into their binging and purging behavior. The following are co-occurring disorders that are commonly found with eating disorders:
Anxiety disorders are characterized by an excessive state of worry that does not resolve once the stressor is eliminated. This state of worry can interfere with the individual’s everyday life and can affect their occupation, their personal life, and their relationships. Approximately 18% or 40 million adults are affected by an anxiety disorder each year in the United States and these disorders affect one in eight children in the U.S. Anxiety disorders are considered the most common type of psychiatric disorders in the general population. Anxiety disorder often co-occurs with eating disorders and the binging and purging behavior can be an unhealthy coping mechanism to control the anxiety.
Depression is a common mood disorder characterized by an intense state of sadness, changes in sleep, changes in appetite, lack of interest, feelings of guilt, decreased energy, poor concentration, psychomotor agitation, and suicidal ideations lasting for a minimum of two weeks duration. Eating disorders can lead to depression and depression is known is be a common trigger for eating disorders. Depression is the leading cause of disability in the United States for individuals 15-44 years of age. Lost wages, medications, psychotherapy treatment, suicide treatment, co-occurring mental health disorders, and associated medical diseases all contribute to this disability cost. Living with untreated depression can be unbearable and lead to substance abuse, medical disorders, and even suicide.
Substance abuse and alcohol are common co-occurring disorders associated with eating disorders and can lead to severe addiction, tolerance, and dependence resulting in dangerous and compulsive behaviors. Commonly abused substances include alcohol, opioids, cocaine, marijuana, and benzodiazepines. Death can occur from an overdose or in some cases withdrawal and serious medical complications can result from substance abuse and alcohol addiction. Depending on the specific substance, medications can be used to help prevent cravings and ease withdrawal effects. Additionally, psychotherapy is needed in order to teach individuals coping skills and uncover the underlying reason for their addiction.
Self-harm is the deliberate action of causing physical harm to oneself and is a very dangerous sign of emotional distress. According to the Statistical and Diagnostic Manual of Mental Disorders, Fifth Edition (DSM-5), self-harm is formally known as nonsuicidal self-injury disorder (NSSID) as these self-destructive behaviors are carried out without any intention of suicide. Cutting, skin carving, extreme scratching, or burning oneself as well as punching or hitting walls to induce pain are examples of self-injurious behavior. Other examples include ingesting toxic chemicals, extreme skin picking, hair pulling, and deliberate interference with wound healing. Approximately 30% of individuals who engage in self-injury behavior also engage in binging and purging and therefore self-injury commonly co-occurs with eating disorders, especially in the teenage and adolescent populations.
Borderline personality disorder (BPD)
A borderline personality disorder is characterized by unstable and intense moods and interpersonal relationships resulting in impaired impulse control and unhealthy behaviors such as cutting and binging and purging. This personality disorder is classified under Cluster B, which is characterized, by dramatic and emotional. These individuals usually have chronic feelings of emptiness, unstable relationships, unstable self-image, intense anger, and a deep fear of abandonment. This is the most over-diagnosed personality disorder and is more prevalent in women than men. Personality disorders are often very difficult to treat because they are ingrained since childhood.
Obsessive-compulsive disorder (OCD)
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by intrusive unwanted thoughts known as obsessions that are relieved through repetitive acts known as compulsions. This relatively common disorder results in significant distress and impairment in one’s social, personal, and professional life and is known as ego-dystonic meaning the individual realizes these thoughts are abnormal and unpleasant. Fear of contamination followed by ritualistic cleaning, need for symmetry and order followed by organizing, and concerns about losing something valuable followed by hoarding are common obsessive thoughts and compulsive actions that occur with OCD. Eating disorders are a manifestation of self-control and often co-occur with OCD.
Symptoms vary, depending on the type of eating disorder. Anorexia nervosa, bulimia nervosa, and binge-eating disorder are the most common eating disorders. Other eating disorders include rumination disorder and avoidant/restrictive food intake disorder.
Anorexia (an-o-REK-see-uh) Nervosa — often simply called anorexia — is a potentially life-threatening eating disorder characterized by abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight or shape. People with anorexia use extreme efforts to control their weight and shape, which often significantly interferes with their health and life activities.
When you have anorexia, you excessively limit calories or use other methods to lose weight, such as excessive exercise, using laxatives or diet aids, or vomiting after eating. Efforts to reduce your weight, even when underweight, can cause severe health problems, sometimes to the point of deadly self-starvation.
Bulimia (boo-LEE-me-uh) Nervosa — commonly called bulimia — is a serious, potentially life-threatening eating disorder. When you have bulimia, you have episodes of bingeing and purging that involve feeling a lack of control over your eating. Many people with bulimia also restrict their eating during the day, which often leads to more binge eating and purging.
During these episodes, you typically eat a large amount of food in a short time and then try to rid yourself of the extra calories in an unhealthy way. Because of guilt, shame, and an intense fear of weight gain from overeating, you may force vomiting or you may exercise too much, or use other methods, such as laxatives, to get rid of the calories.
If you have bulimia, you're probably preoccupied with your weight and body shape and may judge yourself severely and harshly for your self-perceived flaws. You may be at a normal weight or even a bit overweight.
When you have a binge-eating disorder, you regularly eat too much food (binge) and feel a lack of control over your eating. You may eat quickly or eat more food than intended, even when you're not hungry, and you may continue eating even long after you're uncomfortably full.
After a binge, you may feel guilty, disgusted, or ashamed by your behavior and the amount of food eaten. But you don't try to compensate for this behavior with excessive exercise or purging, as someone with bulimia or anorexia might. Embarrassment can lead to eating alone to hide your bingeing.
A new round of bingeing usually occurs at least once a week. You may be normal weight, overweight or obese.
Rumination disorder is repeatedly and persistently regurgitating food after eating, but it's not due to a medical condition or another eating disorder such as anorexia, bulimia, or binge-eating disorder. Food is brought back up into the mouth without nausea or gagging, and regurgitation may not be intentional. Sometimes regurgitated food is rechewed and swallowed or spit out.
The disorder may result in malnutrition if the food is spat out or if the person eats significantly less to prevent the behavior. The occurrence of rumination disorder may be more common in infancy or in people who have an intellectual disability.
Avoidant/restrictive food intake disorder
This disorder is characterized by failing to meet your minimum daily nutrition requirements because you don't have an interest in eating; you avoid food with certain sensory characteristics, such as color, texture, smell, or taste; or you're concerned about the consequences of eating, such as fear of choking. Food is not avoided because of fear of gaining weight.
The disorder can result in significant weight loss or failure to gain weight in childhood, as well as nutritional deficiencies that can cause health problems.
When to see a doctor
An eating disorder can be difficult to manage or overcome by yourself. Eating disorders can virtually take over your life. If you're experiencing any of these problems, or if you think you may have an eating disorder, seek medical help.
Urging a loved one to seek treatment
Unfortunately, many people with eating disorders may not think they need treatment. If you're worried about a loved one, urge him or her to talk to a doctor. Even if your loved one isn't ready to acknowledge having an issue with food, you can open the door by expressing concern and a desire to listen.
Be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders. Red flags that may indicate an eating disorder include:
Skipping meals or making excuses for not eating
Adopting an overly restrictive vegetarian diet
Excessive focus on healthy eating
Making own meals rather than eating what the family eats
Withdrawing from normal social activities
Persistent worry or complaining about being fat and talk of losing weight
Frequent checking in the mirror for perceived flaws
Repeatedly eating large amounts of sweets or high-fat foods
Use of dietary supplements, laxatives, or herbal products for weight loss
Calluses on the knuckles from inducing vomiting
Problems with loss of tooth enamel that may be a sign of repeated vomiting
Leaving during meals to use the toilet
Eating much more food in a meal or snack than is considered normal
Expressing depression, disgust, shame, or guilt about eating habits
Eating in secret
If you're worried that your child may have an eating disorder, contact his or her doctor to discuss your concerns. If needed, you can get a referral to a qualified mental health professional with expertise in eating disorders, or if your insurance permits it, contact an expert directly.
Establishing A Support Network
Whenever possible, seek support from friends and family members. If you feel you cannot discuss your situation with friends or other family members, find a self-help or support group. These groups provide an opportunity for you to talk to other people who are experiencing the same type of problems. They can listen and offer valuable advice.
Therapy can be beneficial for both the individual with mental illness and other family members. A mental health professional at Wellmore can suggest ways to cope and better understand your loved one’s illness. We offer an array of outpatient and intensive in-home programs for children, teens, and adults to treat ADHD, depression, anxiety as well as other behavioral health issues.