Eating Disorders

Eating disorders

The most common eating disorders are anorexia, bulimia, and binge eating disorder.

Anorexia (Anorexia nervosa)

Pathologically low body weight,

Intense fear of gaining weight

Distorted beliefs about weight and body shape that do not match reality.

Physical symptoms may include:

Irregular heartbeat, low blood pressure, and dehydration. With dehydration, your fingers may turn bluish and your skin may become dry. Your skin tone may change, for example, it may become yellowish. Your hair may become thinner, brittle, or fall out. Soft, fine body hair (lanugo) may appear on your body.

Other physical symptoms include:

Extreme weight loss or failure to reach an age-appropriate normal weight.

Severe fatigue and weakness.

Dizziness or loss of consciousness.

Digestive problems, such as constipation and abdominal pain.

Intolerance to cold or a persistent feeling of being cold, even when others feel comfortable.

Swelling of the hands and feet.

Damage to the teeth caused by self-induced vomiting.

Abdominal pain.

Persistent loss of appetite or feeling full quickly after eating a small amount.

Difficulty concentrating.

Lowered mood.

Increased anxiety.

Bone weakness or fractures.

Stopping of menstrual periods (if the woman is not taking contraceptives).

Emotional and behavioral symptoms may include:

An extreme preoccupation with food. Sometimes this may involve preparing meals for others but not eating oneself.

Skipping meals or refusing food. You may also strictly limit how much you eat through dieting or fasting, deny that you are hungry, or find reasons to avoid eating.

During meals, they eat only a few “safe” foods that are low in calories.

They may be excessively focused on eating only “clean” or “healthy” foods.

You may develop strict eating rules, for example, spitting out food after chewing it.

You may avoid eating in public or lie about how much food you have eaten.

Other emotional and behavioral symptoms may include:

Excessive exercise – continuing to exercise despite physical injuries, choosing exercise instead of enjoyable activities, or exercising at an extreme level that clearly exceeds that of others.

Fear of gaining weight – which may involve frequently measuring one’s own weight and body size.

Preoccupation with appearance – which may involve frequently checking oneself in the mirror and wearing excessively loose clothing.

Excessive worry about weight – which may show up as feeling that certain parts of one’s body are too fat.

Emotional changes – the person may become emotionally blunted and lose social or sexual interest.

Sleep problems – such as insomnia.

The presence of self-harming or suicidal thoughts.

Bulimia (Bulimia nervosa)

Excessive food intake (binge), followed by attempts to eliminate the calories (purge).

Periods of severely restricted eating that lead to a strong urge to binge on food, followed by subsequent purging.

Symptoms of bulimia may include:

Living in constant fear of gaining weight and trying to lose it through unhealthy methods.

Eating a large amount of food in one sitting and repeating this behavior.

A feeling of losing control while eating – as if they cannot stop or cannot control what they are eating.

Deliberately inducing vomiting or engaging in extreme exercise after eating in order to avoid gaining weight.

Using diuretics (water pills), laxative medications, or enemas when this is not medically necessary.

Fasting, severely restricting calories, or avoiding specific foods between episodes of overeating.

Using dietary supplements or herbal products for weight loss.

Dissatisfaction with one’s body shape and weight.

Basing your self-esteem on your body shape and weight.

Extreme mood swings.

Compulsive overeating disorder (Binge eating disorder)

Symptoms of binge eating disorder may include:

A feeling of losing control over eating – for example, once you start, you feel unable to stop.

Eating a large amount of food within a short period of time.

Eating even when not hungry.

Eating very quickly.

Eating until feeling uncomfortably full.

Eating alone or in secret.

Feeling depressed, ashamed, guilty, or resentful because of your eating habits.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Symptoms may include:

Extremely selective eating and a general lack of interest in food, which progressively worsens over time.

Avoidance of certain foods based on their textures, smells, or colors.

Eating only a limited range of preferred foods.

Weight loss that leads to delayed growth and development — although in some cases the child may have a normal weight.

Fear of vomiting or choking when eating certain foods.

Gastrointestinal problems, such as stomach irritation or feeling full very quickly.

Warning signs of an eating disorder that should never be ignored:

Skipping meals or inventing reasons to avoid eating,

Following a diet that has not been prescribed by a doctor,

Excessive preoccupation with food and “healthy eating,”

Eating only food you have prepared yourself

Avoiding social eating activities,

Excessively frequent checking and judging of one’s body in the mirror,

Eating a large amount of food in one sitting,

Using laxatives or herbal supplements to lose weight,

Excessive physical activity, such as exercising even when you are ill or injured,

Calluses on the knuckles (due to self-induced vomiting),

Damage to tooth enamel (due to vomiting),

Going to the bathroom immediately after eating,

Feeling depressed, guilty, disgusted, or ashamed because of your eating habits,

Eating in secret.

Causes:

Genetics – some people may have genes that increase their risk of developing eating disorders.

Biology – Biological factors, such as chemical changes in the brain, may play a role in the development of eating disorders.

Risk factors

Family history – if a person has a parent or sibling who has had an eating disorder, they may also be at risk of developing a similar condition.

Other mental health conditions – trauma, anxiety, depression, obsessive-compulsive disorder, and other psychiatric problems increase the risk of developing an eating disorder.

Diets and starvation – frequent dieting increases the risk of developing an eating disorder, especially when body weight is constantly fluctuating due to different diets. There is strong evidence that many symptoms of eating disorders are in fact the result of starvation. Starvation harms the brain and leads to mood changes, anxiety, distorted thinking, and reduced appetite. This, in turn, promotes ongoing restriction of food intake and makes it more difficult to return to normal eating.

Weight-related bullying – people who have been mocked or bullied because of their weight are more likely to experience eating problems and are at higher risk of developing eating disorders.

Stress – life changes such as changing school, moving to a new place of residence, starting a new job, or experiencing family problems can all become sources of stress. This stress, in turn, increases the risk of developing an eating disorder.

Possible complications:

Serious health complications

Depression and anxiety

Suicidal thoughts or behavior

Delayed growth and development

Social and relationship difficulties

Substance dependence

Career and educational difficulties

Death

Prevention:

Tips for adults:

Choose a healthy eating plan that includes whole-grain products, fruits, and vegetables. Reduce your intake of salt, sugar, alcohol, and saturated and trans fats. Avoid extreme diets. If you need to lose weight, consult a doctor or dietitian to develop an individualized plan.

Do not use dietary supplements, laxatives, or herbal products for weight loss.

Adequate physical activity is important. Aim for at least 150 minutes per week of aerobic exercise, such as brisk walking. Choose activities that you enjoy, so you feel more motivated to keep doing them.

Seek support for mental health concerns such as depression, anxiety, or low self-esteem.

If you are concerned about your eating behaviors, be sure to talk to a doctor. Timely treatment can help prevent your condition from worsening.

Tips for children:

Avoid dieting in front of your child – family eating habits have a significant impact on a child’s attitude toward food. Eating together gives you the opportunity to teach your child about the harms of dieting and to observe whether they are getting enough food and a varied diet.

Talk with your child – there are many websites and social media platforms that present anorexia as a lifestyle rather than recognizing it as an eating disorder. Some sites encourage adolescents to start dieting. It is important to challenge these misleading views and to discuss with your child, in an appropriate way, the consequences of different eating choices.

Foster a healthy body image – your child should learn to accept their own body, regardless of its shape and size. Talk with them about the importance of self-esteem and explain that bodies come in different shapes. Do not criticize your own body in front of your child. Messages of acceptance and respect can help your child build self-esteem and strengthen their resilience, which will support them in coping with the challenges of adolescence.

Consult a doctor – regular medical check-ups for children can help with the early detection of eating disorders. The doctor will ask your child about their eating habits and will assess changes in height, weight, and body mass index, which may indicate potential problems.

Treatment

Your personal doctor

Mental health specialist

If needed, a dietitian

education about healthy nutrition

developing healthy eating habits

achieving a healthy weight when the patient is significantly underweight

Psychotherapy – both individual (CBT) and family-based (FBT)

If outpatient treatment is ineffective or the illness is severe, we recommend our Day Clinic – a highly effective, comprehensive treatment program that offers multidisciplinary, integrated, and outcome-focused services.

Medications

Hospitalization or day program

Lifestyle:

Find a mental health professional who has experience in treating eating disorders.

Follow your treatment plan strictly—do not miss therapy sessions and do not deviate from your nutritional plans.

Ask your doctor about the vitamins and minerals you may need, as an unbalanced diet often leads to their deficiency.

Try to avoid frequent weighing and looking in the mirror too often, as this only increases the likelihood of continuing unhealthy habits.

Do not distance yourself from your loved ones – the support of family and friends is vital.

Alternative medicine

Acupuncture

Massage

Yoga

Meditation

Coping and support

To help you prepare better for your visit:

Prepare a list of your symptoms – write down everything that is bothering you, including symptoms that you may not think are related to eating.

Try to recall when these symptoms first began.

Write down important personal information—stressful events and recent life changes.

Prepare a list of all the medications, supplements, and vitamins you are taking.

Write down any questions you would like to ask your doctor.

See also

→ Diagnosis and treatment of eating disorders

→ Cognitive-behavioral therapy for eating disorders

Related topics: Depression · Anxiety · Psychiatrist consultation

Source: NIMH — Eating Disorders.

Source: Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724–731. doi:10.1001/archgenpsychiatry.2011.74