Eating disorders

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.

Symptoms

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 nervosa

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is a potentially life-threatening eating disorder characterized by an 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 nervosa

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.

Binge-eating disorder

When you have 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

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 reswallowed or spit out.

The disorder may result in malnutrition if the food is spit 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
• Excessive exercise
• 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.

Causes

The exact cause of eating disorders is unknown. As with other mental illnesses, there may be many causes, such as:

• Genetics and biology. Certain people may have genes that increase their risk of developing eating disorders. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.
• Psychological and emotional health. People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior and troubled relationships.

Risk factors

Teenage girls and young women are more likely than teenage boys and young men to have anorexia or bulimia, but males can have eating disorders, too. Although eating disorders can occur across a broad age range, they often develop in the teens and early 20s.

Certain factors may increase the risk of developing an eating disorder, including:

• Family history. Eating disorders are significantly more likely to occur in people who have parents or siblings who've had an eating disorder.
• Other mental health disorders. People with an eating disorder often have a history of an anxiety disorder, depression or obsessive-compulsive disorder.
• Dieting and starvation. Dieting is a risk factor for developing an eating disorder. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. There is strong evidence that many of the symptoms of an eating disorder are actually symptoms of starvation. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.
• Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress, which may increase your risk of an eating disorder.

Complications

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely you are to experience serious complications, such as:

• Serious health problems
• Depression and anxiety
• Suicidal thoughts or behavior
• Problems with growth and development
• Social and relationship problems
• Substance use disorders
• Work and school issues
• Death

Prevention

Although there's no sure way to prevent eating disorders, here are some strategies to help your child develop healthy-eating behaviors:

• Avoid dieting around your child. Family dining habits may influence the relationships children develop with food. Eating meals together gives you an opportunity to teach your child about the pitfalls of dieting and encourages eating a balanced diet in reasonable portions.
• Talk to your child. For example, there are numerous websites that promote dangerous ideas, such as viewing anorexia as a lifestyle choice rather than an eating disorder. It's crucial to correct any misperceptions like this and to talk to your child about the risks of unhealthy eating choices.
• Cultivate and reinforce a healthy body image in your child, whatever his or her shape or size. Talk to your child about self-image and offer reassurance that body shapes can vary. Avoid criticizing your own body in front of your child. Messages of acceptance and respect can help build healthy self-esteem and resilience that will carry children through the rocky periods of the teen years.
• Enlist the help of your child's doctor. At well-child visits, doctors may be able to identify early indicators of an eating disorder. They can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance. These visits should include checks of height and weight percentiles and body mass index, which can alert you and your child's doctor to any significant changes.

If you notice a family member or friend who seems to show signs of an eating disorder, consider talking to that person about your concern for his or her well-being. Although you may not be able to prevent an eating disorder from developing, reaching out with compassion may encourage the person to seek treatment.

Diagnosis

Eating disorders are diagnosed based on signs, symptoms and eating habits. If your doctor suspects you have an eating disorder, he or she will likely perform an exam and request tests to help pinpoint a diagnosis. You may see both your primary care provider and a mental health professional for a diagnosis.

Assessments and tests generally include:

• Physical exam. Your doctor will likely examine you to rule out other medical causes for your eating issues. He or she may also order lab tests.
• Psychological evaluation. A doctor or mental health professional will likely ask about your thoughts, feelings and eating habits. You may also be asked to complete psychological self-assessment questionnaires.
• Other studies. Additional tests may be done to check for any complications related to your eating disorder.

Your mental health professional also may use the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Treatment of an eating disorder generally includes a team approach. The team typically includes primary care providers, mental health professionals and dietitians — all with experience in eating disorders.

Treatment depends on your specific type of eating disorder. But in general, it typically includes nutrition education, psychotherapy and medication. If your life is at risk, you may need immediate hospitalization.

Healthy eating

No matter what your weight, the members of your team can work with you to design a plan to help you achieve healthy eating habits.

Psychotherapy

Psychotherapy, also called talk therapy, can help you learn how to replace unhealthy habits with healthy ones. This may include:

• Family-based therapy (FBT). FBT is an evidence-based treatment for children and teenagers with eating disorders. The family is involved in making sure that the child or other family member follows healthy-eating patterns and maintains a healthy weight.
• Cognitive behavioral therapy (CBT). CBT is commonly used in eating disorder treatment, especially for bulimia and binge-eating disorder. You learn how to monitor and improve your eating habits and your moods, develop problem-solving skills, and explore healthy ways to cope with stressful situations.

Medications

Medication can't cure an eating disorder. However, certain medications may help you control urges to binge or purge or to manage excessive preoccupations with food and diet. Drugs such as antidepressants and anti-anxiety medications may help with symptoms of depression or anxiety, which are frequently associated with eating disorders.

Hospitalization

If you have serious health problems, such as anorexia that has resulted in severe malnutrition, your doctor may recommend hospitalization. Some clinics specialize in treating people with eating disorders. Some may offer day programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.

Lifestyle and home remedies

To improve your chances of success in overcoming your eating disorder, try to make these steps a part of your daily routine:

• Stick to your treatment plan — don't skip therapy sessions and try not to stray from meal plans. Follow your doctor's recommendations on physical activity and exercise.
• Talk to your doctor about appropriate vitamin and mineral supplements. If you're not eating well, chances are your body isn't getting all of the nutrients it needs, such as vitamin D or iron. However, getting most of your vitamins and minerals from food is typically recommended.
• Resist urges to weigh yourself or check yourself in the mirror frequently. This may simply fuel your drive to maintain unhealthy habits.
• Don't isolate yourself from caring family members and friends who want to see you get healthy and have your best interests at heart.

Alternative medicine

Alternative medicine is the use of a nonconventional approach instead of conventional medicine. Complementary or integrative medicine is a nonconventional approach used along with conventional medicine.

Usually, when people turn to alternative or complementary medicine it's to improve their health. But dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be unsafe and abused by people with eating disorders. Such products can have potentially dangerous interactions with other medications.

Weight-loss and other dietary supplements don't need approval by the Food and Drug Administration (FDA) to go on the market. The FDA maintains an online list of tainted weight-loss products, some of which can cause serious harm, such as irregular heartbeats, increased blood pressure, stroke and even death.

Talk with your doctor before trying any alternative or complementary medicine. Natural doesn't always mean safe. Your doctor can help you understand possible risks and benefits before you try a treatment.

Reduce stress and anxiety

Some complementary treatments and approaches may help reduce stress and anxiety, promote relaxation, and increase a sense of well-being in people with eating disorders. Examples include:

• Acupuncture
• Massage
• Yoga
• Meditation

Coping and support

It's difficult to cope with an eating disorder when you're hit with mixed messages by the media, culture, and perhaps your own family or friends. Whether you or your loved one has an eating disorder, ask your doctor or mental health professional for advice on coping and emotional support.

Learning effective coping strategies and getting the support you need from family and friends are vital to successful treatment.

Preparing for an appointment

Here's some information to help you get ready for your appointment, and what you might expect from your doctor and a mental health professional.

You may want to ask a family member or friend to come with you. Someone who accompanies you may remember something that you missed or forgot. A family member may also be able to give your doctor a fuller picture of your home life.

What you can do

Before your appointment, make a list of:

• Any symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment
• Key personal information, including any major stresses or recent life changes
• All medications, vitamins or other supplements that you're taking, and their doses
• Questions to ask your doctor so that you'll remember to cover everything you wanted to

Ask a family member or friend to come with you, if possible. Someone who accompanies you may remember something that you missed or forgot. A family member may also be able to give your doctor a fuller picture of your home life.

Some questions you might want to ask your doctor or other health care provider include:

• What kinds of tests do I need? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• How will treatment affect my weight?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor or mental health professional is likely to ask you a number of questions, such as:

• How long have you been worried about your weight?
• Do you exercise? How often do you exercise and for how long?
• Have you found any other ways to lose weight?
• Are you having any physical symptoms?
• Have you ever vomited because you were uncomfortably full?
• Have others expressed concern about your weight?
• Do you think about food often?
• Do you ever eat in secret?
• Have any of your family members ever had symptoms of or been diagnosed with an eating disorder?

Be ready to answer these questions to reserve time to go over any points you want to focus on.

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