Eating disorders are a group of complex mental disorders that significantly impair physical and mental health and social functioning. Individuals with eating disorders suffer from serious disturbances in eating, such as extreme calorie restriction, overeating, and/or preoccupation with body image and weight. An eating disorder may also occur with an underlying psychological problem such as depression, anxiety, low self-esteem or suppressed trauma. Treatment from a multidisciplinary team of psychologists, psychiatrists and medical professionals is often necessary.
Who develops eating disorders?
It is estimated that about 30 million Americans (20 million women and 10 million men) struggle with eating disorders. Eight percent of females and 2% of males are affected at some point during their lives. Ninety five percent of eating disorders occur by age 25. Although eating disorders can occur across all demographics and socioeconomic groups, the prevalence of anorexia and bulimia is higher in women, while binge eating is found equally in men and women. However, men are less likely to seek treatment, suggesting a higher incidence than what has been reported.
There is a common misconception that eating disorders affect white adolescent and young women. In actuality, diverse groups of people are at higher risk for developing eating disorders. These include:
- Female athletes pressured to control weight and performance.
- College students. Studies report that 8-17% of college students have an eating disorder.
- 3.5% of women over age 40 and 1-2% of older men.
What are the symptoms of eating disorders?
There are several different categories of eating disorders, but there are symptoms that are consistent across all groups. In general, individuals with eating disorders tend to be preoccupied with weight, food, calories, carbohydrates, fat grams, and dieting. They tend to follow food rituals and are often uncomfortable eating around others, frequently skip meals, and withdraw during mealtimes. You might observe noticeable fluctuations in weight, menstrual irregularities, dental problems, and abnormal lab findings in people with eating disorders.
What causes eating disorders?
Research has shown that eating disorders are caused by the interplay of genetic, biological, psychological and social factors. Eating disorders tend to run in families. It is thought that both genetic and environmental issues are causative agents.
There are three main eating disorders:
- Anorexia Nervosa (Anorexia)
- Bulimia nervosa (Bulimia)
- Binge eating disorder (BED)
Anorexia is an important cause of physical and psychological illness. Although it can be diagnosed at any weight or BMI, it is often characterized by a low body mass index (BMI) due to extreme dieting, fear of weight gain and a distorted body image. It affects 2% or less of young women. Comorbid psychiatric conditions may include depression, obsessive compulsive disorder, and anxiety.
Individuals with anorexia experience dramatic weight loss and an overwhelming preoccupation with feeling “fat.” Affected individuals resist or are unable to maintain an appropriate body weight for their age and height. Anorexics often engage in ritualized behaviors to prevent weight gain such as extreme exercise regimens and calorie restriction. They may also binge eat and purge. Anorexics share a consistent irrational fear of being overweight.
Genetic factors influence risk. Psychological and social factors and interpersonal factors can trigger onset; and changes in the brain can sustain the illness. It is treated with psychotherapy, psychopharmacology, and nutritional support.
Bulimia is a serious and potentially life-threatening disorder that involves cycles of binge eating and purging. A binge is defined as eating in a discrete period of time an amount of food that is definitely larger than what most people eat during a similar period, and a sense of lack of control during this period. This is typically followed by a purge, or compensatory behavior such as vomiting, taking laxatives, fasting, or excessive exercise to prevent weight gain. Lifetime risk ranges from 4% to 6.7%.
Bulimics are at risk for developing severe medical problems such as ulcers, sore throat, tooth decay, acid reflux, dehydration, intestinal distress, and stomach damage. Affected individuals often suffer from electrolyte disturbances as a result of excessive vomiting or purging, putting them higher risk for seizures. As with other eating disorders, bulimia is associated with malnutrition. Treatment for bulimia involves both psychotherapy as well as medication.
Binge Eating Disorder
Binge eating disorder is the most common eating disorder in the United States with an estimated lifetime prevalence of 2.6%. It occurs equally among men and women. Binge eating is more common than either anorexia or bulimia, affecting 3.5% of women and about 2% of men. It co-occurs most commonly with mood, anxiety and sleep disorders; and is also associated with overweight and obesity.
Binge eating disorder is a serious eating disorder characterized by recurrent episodes of eating large quantities of food accompanied by feelings of loss of control but is not commonly followed by purging. Binges are often followed by negative emotions of depression, guilt or disgust at overeating. Binge eating is treated with psychotherapy and psychotropic drugs,
What is the impact of eating disorders?
Eating disorders are associated with high morbidity and mortality. They can cause disturbances in the cardiovascular system such as low blood pressure, arrythmias, and myopathies, the musculoskeletal system such as osteopenia (low bone mass) and osteoporosis and produce metabolic abnormalities. Frequent purging or laxative abuse causes electrolyte abnormalities resulting in syncope, seizures, and even death. Hormonal irregularities are common, causing missed periods and fertility disturbance.
What are the treatments for eating disorders?
If you are diagnosed with an eating disorder, your therapist might refer you for a full medical workup to diagnose and address any underlying medical conditions. The primary treatment for the psychological aspects of an eating disorder is a mixture of psychotherapy and medication management. Additionally, nutritional counseling is essential. If an individual is not improving with these measures, referral to a comprehensive eating disorder facility may be necessary.
When you or a loved one is exhibiting disordered eating, contact the Midtown Practice to schedule a consultation with one of our esteemed mental health professionals. Treatment can reduce long-term disease and disability and decrease the shame and humiliation that comes from struggling with an eating disorder.