Everything You Need To Know About Eating Disorders

Eating disorders are shockingly common. Epidemiologists calculate that 10 million men in the United States will have an eating disorder at some time in their lives. Twenty million women will develop ad eating disorder. Eating disorders are even more common in some European countries.

Eating disorders are serious, potentially deadly, but treatable psychiatric illnesses that can strike any person of any sex, at any age, without regard to race or economic status. Many eating disorders begin in adolescence, but an ever-increasing number of young children and seniors are diagnosed with these chronic illnesses.

What are the symptoms of eating disorders? Consider these statements from survivors of eating disorders:

• “I was always tired.”
• “I was always hungry.”
• “I had horrible ulcers in my mouth and yellow skin.”
• “My cheeks puffed up like a chipmunk’s.”
• “My fingers and toes turned blue.”
• “I couldn’t stop exercising for even an hour.”
• “I would wake up in the middle of the night and eat everything in the refrigerator.”
• “I made myself throw up every meal.”
• ‘My blood pressure was low, and my heartbeat was irregular.”
• “My hands were always freezing.”
• “My teeth were rotting.”
• “I was 18 and I had osteoporosis.”
• “I was anxious and depressed all the time. Antidepressants and psychotherapy helped, but I still felt terrible.”
• “My friends and family abandoned me.”

Eating disorders affect every aspect of health and life. People who live with eating disorders often believe that their eating disorders define who they are, until they take back control of their eating and their lives.

What are the types of eating disorders?

The best-known eating disorder is anorexia nervosa. The condition is often simply called anorexia, but there are other forms of anorexia that are a reaction to cancer or HIV. Anorexia nervosa is the psychiatric condition.

In anorexia nervosa, eating is less than the body needs for normal maintenance and growth. Restricted intake of calories leads to significantly lower than expected body weight. Avoidance of carbohydrates can result in repeated bouts of hypoglycemia. Most people who live with anorexia nervosa have a severely disordered body image and see themselves as fat even though everybody else sees them as dangerously thin. People who have anorexia nervosa have a morbid fear of gaining weight. Many people living with the condition will do anything to avoid gaining weight, and anorexia nervosa can lead to numerous medical complications.

People who have the eating disorder bulimia nervosa will eat large amounts of food in a single sitting. Then they will try to purge the food from their bodies so they don’t become fat. They may induce vomiting or use ever-increasing doses of laxatives and diuretics. Some people who have exercise bulimia try to burn off calories by constant exercise. Some people who have bulimia abuse insulin or diet pills. Like people who have anorexia nervosa, people who have bulimia nervosa have a severely distorted body image and an intense fear of gaining weight. As with anorexia nervosa, the health consequences and complications of bulimia can be severe.

In binge eating disorder, binge eating occurs without compensatory behaviors. These episodes must occur once a wee for three months for a diagnosis of binge eating disorder to be made. There will be episodes of eating rapidly without self-awareness when not hungry until extreme fullness. Binge eaters often experience depression. They become ashamed of their behavior and feel guilty that they cannot control it. They withdraw from social engagements where they fear they may lose control over their eating. Many binge eaters hoard food for special binge-eating sessions they carry out in secret. Binge eating occurs in people of all sizes. Some binge eaters are obese. Others are of normal weight. A small number of people who have binge-eating disorder weigh less than is expected for their height.

Avoidant-restrictive intake disorder does not involve weight or shape concerns. People who have this disorder nonetheless may restrict their caloric intake so severely that their health Is threatened. People who have avoidant-restrictive intake disorder may develop nutritional deficiencies so severe that they cannot maintain friendships or keep their jobs.

There are also people who exhibit symptoms of multiple eating disorders. There are also people who symptoms are not sufficiently severe as to meet the diagnostic characteristics of any of the most commonly diagnosed eating disorders. People in this latter group are said to have EDNOS, or eating disorders not otherwise specified. The rate of death is higher for people who have EDNOS that it is for people who have anorexia nervosa, bulimia nervosa, binge-eating disorder or avoidant-restrictive intake disorder, probably because they do not receive the treatment they need.

The sooner eating disorders are recognized and treated, the greater the opportunities for a normal and happy life. This is particularly important for people who develop eating disorders as teenagers or pre-teens.

What is it like to live with eating disorders?

Consider these personal stories.

Here’s the story of a 25-year-old woman who after many years of therapy is in remission from anorexia nervosa.

“I developed an eating disorder at the age of 15. It was anorexia nervosa. My parents spit up. I felt a lot of stress. The way I could control all of those outside things was by taking charge of my body. At first I would avoid eating at all costs. I wouldn’t eat at family meals. I would throw away mu lunches. I wasn’t purging. It was all restricting. I was cutting back on meals. I would eat only low-fat and low-calories meals.

Then I would skip meals altogether. I hid my behavior from my parents. I would take a normal plate of food and shove part of it inside a napkin and throw the napkin away.

One day, mother asked me to stand in front a mirror and she said, ‘Do you see how small you are?’ I thought she was totally wrong. I thought I looked perfectly fine.

I think the low point for me was when I went from only doing food restriction and I added bulimic behaviors. My mind would go blank. I would just eat anything I could find, not things that I enjoyed. And after I ate them, I would make myself vomit to get the food out of my body. I would sit on the bathroom floor and just think about how I had no control over what just happened.

Even when I started treatment I was still resisting a little bit. I didn’t want to talk with my medical providers about anything even though I was sure they were perfectly qualified. Then my therapist told me told me that I needed to get more intensive help or I was going to die.

I got into a hospital-based treatment program. The doctors at the program never quite seemed to understand what I was saying or why I was there. There were a few doctors who were so ignorant that it was to the point it was kind of damaging.

But I persevered. I don’t know whether I have defeated my anorexia or I’m just constantly recovering from it. But I truly believe that the way I was living is no longer an option for my life. You just have to decide that no matter what life throws at you dealing with it by developing an eating disorder is not an option.”

Here is a story of a 23-year-old woman who now lives well despite avoidant-restrictive intake disorder.

“I was 11, maybe 12. At that age I was already reading women’s magazines and fashion magazines. If some super-model said ‘Don’t eat bread’ I wouldn’t eat bread. I would eat rice crackers instead of bread. Then when another super-model would say that she didn’t eat rice crackers, I would give them up, too. I guess that was when this thing started. I realized I would never become a super-model. I decided to focus on school. I didn’t have time to think about eating. I only thought about my schoolwork. At some point I discovered coffee. Coffee would allow me to keep on working and to ignore my hunger. There was a point that I realized that my eating habits weren’t supporting my ambitions, and I got in-patient help.

Even now, when I am stressed about something, I become very precise in what I eat. It’s almost as if I need to take control over my body when I feel that everything else is falling apart.”

And here is the story of a 30-year-old woman in remission from her binge-eating disorder.

“It was my sophomore year in college. I began to binge regularly. Slowly, binging took over more and more of my life. In the early stages I couldn’t have told you what was going on with me. I didn’t have a vocabulary for it. I didn’t know what binge-eating was. I didn’t know why I was doing it. The idea of eating in front of other people became so shameful.

I became very secretive. I would binge in the dark, in the bedroom, making sure all the doors were locked. I think it’s always been about anxiety. With binging, for those moments, there would be a little bit of relief. It was the only time I felt any relief from my anxiety. The problem with eating disorders is that you get an immediate sense of shame.

With help, I have control over my eating disorder. But I am always in recovery.”

Finally, here is the story of 28-year-old Justin who deals with bulimia.

“It was when I was in the seventh grade. I would compare my body to the bodies of professional football players or professional models and say ‘Oh, my abs don’t look like that. There has to be something wrong with me.’ My friends at school would see me not eating lunch at school and I would say ‘Oh, I had a large breakfast.’ I would do that for days and days and days in a row. I’d doze off in class because I was exhausted because I didn’t give my body any nourishment.

At the end, when I was bulimic, I would spend every hour of every day thinking about the next time and place I could purge. It was pretty scary when I was in my doctor’s office at the end of my freshman year in high school and she was telling me how I could have a heart attack because I was putting that much stress on my heart.

When I first started treatment, my biggest problem was finding doctors who would consider what I needed as a male in the eating disorders community. So many of the programs seem to be oriented exclusively toward girls and women. But with help, I now keep my bulimia almost completely under control. It no longer controls my life.”

What does treatment for an eating disorder look like?

Once doctors recognize that a patient has a significant problem with eating, the first step is to make an accurate diagnosis. All eating disorders are not alike. Then, depending on the severity of the disorder, doctors and their support staff put a treatment plan in place to help the patient achieve normal eating and normal weight.

Malnutrition has profound effects on every aspect of physical health. Eating disorders also have profound effects on psychological health. Not getting calories and nutrients affects level of awareness, attention, and cognitive function. Any underlying mental health issue will be exacerbated by an eating disorder.

For these reasons, many people who have eating disorders don’t get well with “halfway house” care. Treatment of eating disorders often requires full hospital care. In the United States, it can be difficult to work out issues with insurance reimbursement. But in a hospital setting, anorexia nervosa, bulimia nervosa, avoidant-restrictive eating disorder, and binge-eating disorder are very treatable. Most patients regain control over their eating habits, although they will continue to need long-term supportive care and treatment for heart, liver, bone, skin, immune, and psychiatric issues.

Who is on the team treating an eating disorder?

There are specific medications for bulimia nervosa. These medications are dispensed under the supervision of a psychiatrist. 

There are no FDA-approved medications for anorexia nervosa available in the United States. Treatment for anorexia nervosa is largely behavioral, directed by a psychotherapist or psychologist.

Binge-eating disorder is a condition that is medically complicated. Any condition that is complicated by obesity can also be complicated by binge-eating disorder, even when the binge eater is not overweight. Doctors worry about the lengths binge-eaters will go to accommodate their symptoms, and they usually have to plant treatment for the gastrointestinal complications of the disease. Doctors don’t rely on medications to manage the condition, but incorporate psychotherapy and intervention from dietitians.

What happens are the levels of care for eating disorders?

Interventions from mediation to yoga for eating disorders, to treating eating disorders with biofeedback and neurofeedback, to body awareness therapy can be helpful for staying in remission. Support from family and friends is crucial for eating disorder patients at every stage of recovery from an eating disorder. But life-threatening symptoms of eating disorders require hospital care.

Doctors make recommendations for care ranging through:

• Outpatient care.
• Intensive outpatient treatment.
• Partial hospitalization (day treatment).
• Residential care.
• Inpatient hospital care for eating disorders.

Even the least restrictive level of care, outpatient care, usually involves a therapist, a medical doctor, and a dietitian. Increasing levels of care provide more structure with more supervision and more access to full-time medical providers.

Sometimes it’s necessary to start small and build on success to overcome an eating disorder. Eating disorder specialists can direct their patients to the best incremental care for long-term healthy eating.