AUTHOR: The National Institute of Mental Health Information Resource Center

Title: Eating Disorders

Copyright Date: February 2016
URL: https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

Eating Disorders
Overview
There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are
actually serious and often fatal illnesses that are associated with severe disturbances in people’s eating
behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also
signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-
eating disorder.

Signs and Symptoms

Anorexia nervosa
People with anorexia nervosa may see themselves as overweight, even when they are dangerously
underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the
amount of food they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to
lose weight. Anorexia nervosa has the highest mortality rate of any mental disorder. While many people with
this disorder die from complications associated with starvation, others die of suicide.

If you or someone you know is in crisis and needs immediate help, call the toll-free National Suicide
Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week.

Symptoms include:

 Extremely restricted eating

 Extreme thinness (emaciation)

 A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight

 Intense fear of gaining weight

 Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and
shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

 Thinning of the bones (osteopenia or osteoporosis)

 Mild anemia and muscle wasting and weakness

 Brittle hair and nails

 Dry and yellowish skin

 Growth of fine hair all over the body (lanugo)

 Severe constipation
 Low blood pressure slowed breathing and pulse

 Damage to the structure and function of the heart

 Brain damage

 Multiorgan failure

 Drop in internal body temperature, causing a person to feel cold all the time

 Lethargy, sluggishness, or feeling tired all the time

 Infertility

Bulimia nervosa
People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food
and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates
for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive
exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight,
normal weight, or over overweight.

Symptoms include:

 Chronically inflamed and sore throat

 Swollen salivary glands in the neck and jaw area

 Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach
acid

 Acid reflux disorder and other gastrointestinal problems

 Intestinal distress and irritation from laxative abuse

 Severe dehydration from purging of fluids

 Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals)
which can lead to stroke or heart attack

Binge-eating disorder
People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of
binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-
eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in
the U.S.

Symptoms include:

 Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period

 Eating even when you're full or not hungry

 Eating fast during binge episodes

 Eating until you're uncomfortably full

 Eating alone or in secret to avoid embarrassment

 Feeling distressed, ashamed, or guilty about your eating

 Frequently dieting, possibly without weight loss

Risk Factors
Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Eating
disorders frequently appear during the teen years or young adulthood but may also develop during childhood
or later in life. These disorders affect both genders, although rates among women are higher than among
men. Like women who have eating disorders, men also have a distorted sense of body image.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological,
behavioral, psychological, and social factors. Researchers are using the latest technology and science to
better understand eating disorders.

One approach involves the study of human genes. Eating disorders run in families. Researchers are working
to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers
have found differences in patterns of brain activity in women with eating disorders in comparison with
healthy women. This kind of research can help guide the development of new means of diagnosis and
treatment of eating disorders.

Treatments and Therapies

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for
suicide and medical complications. People with eating disorders can often have other mental disorders (such
as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

 Individual, group, and/or family psychotherapy

 Medical care and monitoring

 Nutritional counseling

 Medications

Psychotherapies
Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents
with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping
people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral
therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or
unhelpful thinking patterns and recognize and change inaccurate beliefs.

Medications
Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may
also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression.
Check the Food and Drug Administration’s (FDA) website: (http://www.fda.gov/), for the latest information
on warnings, patient medication guides, or newly approved medications.

Join a Study
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions,
including eating disorders. During clinical trials, treatments might be new drugs or new combinations of
drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials
is to determine if a new test or treatment works and is safe. Although individual participants may benefit
from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is
to gain new scientific knowledge so that others may be better helped in the future.

Please Note: Decisions whether to apply for a clinical trial and which ones are best suited for a given
individual are best made in collaboration with your licensed health professional.

Clinical Trials at NIMH/NIH

Scientists at the NIMH campus conduct research on numerous areas of study, including cognition, genetics,
epidemiology, and psychiatry. The studies take place at the NIH Clinical Center in Bethesda, Maryland and
require regular visits. After the initial phone interview, you will come to an appointment at the clinic and
meet with a clinician. Visit the NIMH Clinical Trials — Participants or Join a Study pages for more
information.

2.

3. AUTHOR: Rae Jacobson

Title: Signs a College Student May Have an Eating Disorder
Copyright Date:
URL: https://childmind.org/article/signs-a-college-student-may-have-an-eating-disorder/

Signs a College Student May Have an Eating

Disorder
What to look for if you are concerned about your
child, or a friend
Rae Jacobson
The first warning signs that your college-age child, or your friend in college, may have an eating
disorder is often not what she does but what she says.

Try tuning in to how she talks (and how much she talks) about herself.

“I’m so fat. I’m a pig.”

“I wish I looked like her.”

“I’m on a diet.”

Of course not everyone who wishes she was thinner or looked a bit more like a supermodel has an
eating disorder, but this kind of self-loathing language can be a warning flag. When someone
begins to show constant preoccupation with thinness, diet, or body image it might be time to listen
a little more closely.

Hating her body

“I couldn’t stop comparing myself to every girl I saw,” says Jessica, who struggled
with anorexia during her late teens and early twenties. ” ‘Am I thinner than her? Am I fatter?’ It
was endless, and I was almost always the fat one. It was all I thought about so it was all I wanted to
talk about.”

This kind of constant self-criticism is pretty common, and can be a clue to friends, parents, and
clinicians that an eating disorder may be developing.

“Eating disorders are not about vanity or just the desire to be thin,” explains Dr. Alison Baker, “but
it’s important not to dismiss that piece of it because it can be the language of distress. In a lot of
cases this is the first clue. People express their anxieties and complaints by wishing they looked
more like someone in their community or a movie star.”

College is a place where you can find people to participate in almost anything you’re interested in,
and criticizing your body is no exception. Now 25 and in recovery, Jessica says it was easy to get
other girls talking about how much they hated their bodies—even if they didn’t have an eating
disorder. “We were all worried about our weight. Someone was always willing to go down the
rabbit hole with me,” she says.

Related: Eating Disorders and College

Weighty worries
While some weight concerns are normal, the mix of anxiety and the constant pressure to be thin
can be a very dangerous mix for some. A history of serious anxiety is a strong indicator for eating
disorders during college.

Dr. Baker, a child and adolescent psychiatrist, notes that if a student seems very stressed out,
or down, and has been obsessing over losing weight, it’s important to intervene.

“If she’s reporting that she’s unhappy or very anxious, and she looks very different than the last
time you saw her, then it’s time to ask,” says Dr. Baker. Eating disorders include anorexia, bulimia,
and binge eating disorder, and each disorder has a different set of signs.

Anorexia
Anorexia is characterized by an intense fear of gaining weight. People with anorexia go to
extremes, restricting food and over-exercising to prevent weight gain.

Signs that someone might be anorexic include:

Obsession with getting thinner: Constant preoccupation with gaining weight, calories, food
intake, or food ingredients that might be “fattening.” A general obsession with body size and
weight.

Excessive exercising: This goes way beyond being a gym rat. If someone spends hours running
on the treadmill to “work off” a small snack, or insists on going jogging outside even when she’s
sick or the weather’s bad, that may be cause for concern.

Food avoidance, hiding and lying: People with eating disorders often try to hide what’s
happening from friends and family, which can make it harder to spot a problem. This might mean:

 Skipping meals, or parties where eating or drinking are the main event.

 Avoiding the dining hall

 Always saying she’s had a big breakfast or is in “too much of a hurry” to eat.

 Wearing baggy clothes to hide weight loss.

A need for control: People at risk for anorexia are perfectionists and often set impossible goals
for themselves, whether it’s getting straight A’s, having a super-clean room, or being the president
of every club on campus. When the chaos of college makes it hard to control their environment,
people with anorexia try to alleviate stress and anxiety by controlling the one thing they feel in
charge of—their bodies.

Serious weight loss: Losing a ton of weight, especially in a short period of time, is a sign of real
danger. If someone looks painfully thin it’s time to seek help.

Bulimia
Like anorexia, bulimia is a serious eating disorder characterized by an overpowering obsession
with body image and desire to lose weight. However, it takes a very different form when it comes to
signs and symptoms.

Bulimia is a cycle of binging—eating large amounts of food in a short period of time—and purging,
which could include self-inducing vomiting, abusing laxatives or diuretics, over-exercising, or a
combination of all three. People with bulimia aren’t necessarily noticeably thin, which can make it
harder to spot.

Signs someone might be bulimic include:

Binging and purging:

 Buying and hiding large amounts of food

 Hiding uneaten food or wrappers from binges

 Inventing reasons to go to the bathroom to purge—if someone is always disappearing after a meal,
that’s a big tip-off.
  Bad breath, swelling under the jaw or cheeks, tooth discoloration, acid reflux, or even knuckle
calluses from self-induced vomiting.

Obsessing about weight: Talking about weight and size more than is usually considered
normal. Constantly comparing her body to the bodies of friends, strangers, and movie stars—and
always finding herself wanting.

Withdrawal from social events:

 Skipping parties where eating is important

 No longer engaging in things she used to enjoy.

 Passing on activities that interfere with the routine of binging and purging.

Binge eating disorder

People who struggle with binge eating disorder (BED) will frequently eat large amounts of food,
but unlike a person with bulimia, they don’t engage in any of the “purging” behaviors. The disorder
is different from anorexia and bulimia because people with BED are not preoccupied with
thinness, although they may struggle with poor self-esteem and often feel guilty and ashamed over
any weight they’ve gained from their binges.

People with binge eating disorder may be feeling overwhelmed or out of control—they may
struggle with managing stress or difficult emotions—and use food as a way to comfort themselves.
Binge eating disorder is often associated with depression.

Signs that someone may have BED include:

Rapid weight gain: Binge eating leads to weight gain and can cause serious health problems
including heart disease, diabetes, high blood pressure, and others. Kids who are binge eating may
be wearing really baggy clothes to hide weight gain.

Hiding out: For people with BED, binging is usually done in private. If someone is making
excuses to eat alone, hiding food around her room, or you’ve notice large amounts of food missing
from the dorm, it might be a sign of trouble.

Depression and withdrawal: People with BED often struggle with feelings of guilt and shame
after a binge, becoming depressed and isolated which perpetuates the binge-eating cycle.

Related: Helping College Kids With Depression

Eating disorders don’t discriminate

Recognizing an eating disorder sometimes means looking beyond the typical stereotype.

Eating disorders are more prevalent in females, but approximately 10% of people with anorexia
and 40% of those with binge eating disorder are male. Boys and men with an eating disorder often
go overlooked. If the signs are there, don’t discount the possibility of an eating disorder because
someone doesn’t fit the stereotype.

4. AUTHOR: Robert Glatter, MD

Title: National Eating Disorders Week: How Parental Behavior May Impact A Child's Body Image
Copyright Date: ©2019 Forbes Media LLC. All Rights Reserved.
URL: https://www.forbes.com/sites/robertglatter/2014/02/22/national-eating-disorders-week-how-parental-
behavior-may-impact-a-childs-body-image/#672615a244e5

National Eating Disorders Week: How

Parental Behavior May Impact A Child's
Body Image

Robert Glatter, MDContributor

Healthcare

I cover breaking news in medicine, med tech and public health

As National Eating Disorders Week begins, (Feb 23-March 1), it’s a good opportunity to raise awareness of
these devastating disorders, not only affecting individuals but significantly impacting loved ones and
families. Teens are clearly at risk, especially in this age of constant social media, with readily available
images of perfect bodies, and the continuing desire to attain perfection.

The National Eating Disorders Association (NEDA), formed in 2001, and sponsor of National Eating
Disorders Week, is a major advocacy organization in the US working to help and support individuals and
families affected by eating disorders. Their goal is to focus on prevention, assist with better access to
treatment, and advocate for broader and increased research backing to take care of those with eating
disorders.

Eating disorders include anorexia nervosa, bulimia nervosa, as well as binge eating disorder, characterized
by binging without the act of purging.

“Eating disorders are complicated and vexing problems and we don’t exactly understand the
pathophysiology of them”, explained Dr. Aaron Krasner, a practicing psychiatrist, and Director of the
Adolescent Transitional Living Program at Silver Hill Hospital in New Canaan, Connecticut. “Certainly
there is both a genetic component and an environmental component.”

“For all psychiatric illnesses and eating disorders in particular, it is not a one size fits all remedy or a
preventive strategy,” added Krasner.

The Grim Statistics

Looking at the overall picture of those who develop eating disorders, one is reminded of the multifactorial
nature of the disorder, and the underlying conditions which may predispose those to develop such a disorder.

It turns out that nearly 50% of people with eating disorders actually meet the criteria for having depression,
with just 1 out of 10 men and women with eating disorders receiving some form of therapy. And just about
35% of people that undergo some form of therapy for an eating disorder receive that treatment at a
specialized facility for eating disorders.

In the US alone, it is estimated that about 24 million people of all ages and genders suffer from an eating
disorder (anorexia, bulimia and binge eating disorder). Unfortunately, eating disorders have the highest
mortality rate of any identified mental illness.

Leading by Example
Parents lead by example. Unfortunately, parents can also forget how their actions, thoughts and words can
impact the lives of their children. When it involves body image and eating behavior, this can be especially
relevant. Krasner feels that parents need to be mindful of how they eat, their relationship with their own
bodies, and the potential impact on their kids.

Based on more recent data, eating disorders are not only becoming more prevalent, but
are also being noted in younger children. According to the National Eating Disorders
Association, nearly 80% of 10-year-olds are afraid of being overweight.

While many factors contribute to the appearance and development of eating disorders,
a mother’s attitude regarding body image significantly influences how children view
themselves. One analysis found that a mom's concerns about weight are actually the
third leading cause of body image problems in adolescents and girls who believed their
mothers wanted them to be thin and were two to three times more likely to worry about
their weight. However, body image concerns aren't just found in girls: a study from the
Harvard School of Public Health in 2013 noted that close to 18% of teen boys in their
study were "extremely concerned" about their bodies.

In fact, casually discussing diet plans or describing a desire to lose weight when you are
with teens or children can negatively influence your child's body image.

Dr. Krasner offers constructive support and suggestions describing how parents can
help promote a positive body image in teens and children:

1. Try to avoid criticizing yourself or others about weight or shape in front of your
children.

2. Avoid talking negatively about food - "I can't eat potatoes because they're carbs" or
"That cake will go straight to my thighs." It's more important to teach the importance of
healthy eating and exercise without references to weight.

3. Compliment children on their talents and accomplishments - a little praise goes a

long way, especially when it's well deserved

4. Let your teens and children know that weight gain and changes to body shape are a
natural part of the growing process.

5. Have a discussion with your children about their use of social media and what they
view in movies and on TV. Only about 5% of American women have the body type that
is portrayed in advertising as the ideal size and shape for women.

Because parents are the most influential role models in a child's life, they must be
careful with their words and actions. Children and teens are quite good listeners, and
are quite aware of these unfiltered conversations.

Krasner explains that if there is a concern that there is a brewing eating disorder or if
there is some behavior around eating that is concerning to a parent or loved one,
reviewing the preceding list is a good start.
“But seriously consider having a meeting, at the very least, with a nutritionist who may
have some more experience and may be able to tailor some of the recommendations
more specifically for your child,” added Krasner.

Therapies For Eating Disorders

“There is good news and bad news”, Krasner explains, referring to the challenging
nature of treating those with eating disorders.

“The goods news, in particular for bulimia and binge eating disorders, is that cognitive
behavior therapy (CBT) has shown clear evidence compared to placebo psychosocial
conditions to help with symptoms associated with both bulimia and binge eating
disorder’.

Krasner explains that for bulimia in particular, there are a number of medication
studies that have demonstrated efficacy of SSRI medications.

“Specifically, Prozac at doses between 20-40 mg, has attenuated, or in some cases, help
remit signs and symptoms consistent with bulimia”.

Meanwhile, binge eating disorder has been less well studied. The main difference
between bulimia and binge eating disorder is that in binge eating disorder there is not
necessarily purging associated with each binging episode.

“When it comes to anorexia, which is the most lethal of all psychiatric illnesses--with a
high morbidity and mortality rate--the outcomes are a little less reassuring’ added
Krasner. “There certainly have been trials which have demonstrated interval
improvements with respect to severe malnourishment with treatment with CBT, but in
general, the course of the illness is more intransigent, and more difficult to treat. The
outcomes are not as good as in the first two primary eating disorders.”

Parental and Family Role in Pathogenesis of Eating Disorders

According to Krasner, over the past decade, there have been a significant interesting effort to understand
what role families play in the idiopathogenesis of eating disorders.

The early speculation, based more on early psychoanalytic models, had to do with the concept of food as
nourishment.

“Some of this psychosocial understanding is related to behavioral concepts such as the role of attachment--
rooted in “mother’s milk”, Krasner explained. “This primordial understanding is the role food plays in a
relational understanding of eating disorders in the family”.

As Krasner describes, early hypotheses of the pathogenesis of eating disorders related to difficulties between
parents as it pertained to “mothers milk”: giving love, receiving love, sharing in food, sharing in food-
related celebrations.”

“And inherent to this theory comes the history of eating problems either of the parents bring to the picture--
if either of the parents have a disordered eating behavior, the likelihood that that gets transmitted from a
social learning standpoint is high, and then it’s also hard to disaggregate the social learning piece from the
genetic predisposition. Inevitably, there is a co-mingling of the two vulnerability factors that produce a
phenotype like someone with an eating disorder”.
For a long time we have debated what role families play in eating disorders--but it’s clearly evolved believes
Krasner.

“I think we have come to understand more so than the earlier psychoanalytic models that the social learning
theory has a larger piece to play…there has been a lot of speculation about the role of media on idealized
body types both for men and women on eating behaviors and “disordered eating”.

“I think that there is a relatively new avenue of inquiry and discovery in the role that disordered eating plays
in emotion regulation and management and one of the key hypotheses of CBT and related therapies such as
DBT in treating disorders is that the disordered eating in and of itself becomes a way of managing emotion”.

Krasner believes that we have to address disordered eating by stabilizing it--for example, in someone who is
perilously underweight or has uncontrollable binging, it is essential to stabilize the environment, and then
open up the door for the discussion about the cognitive distortions that underlie the disordered eating
behavior--that is where the rubber meets the road in terms of people getting a meaningful recovery from an
eating disorder”.

The Perception Of Obesity

“80 percent of 10 year olds are afraid of being fat,” according to the National Eating Disorder Association.

Quite an alarming statistic, as media exposure plays a larger role with more and more visual images
bombarding us on a daily basis.

“When you look at these perfect bodies promulgated in the media-- they are rare, roughly 2-5% of the
population”. The stars and celebrities have a team to look this way- to attain this stereotyped notion of
beauty”.

According to Krasner, it rings quite hollow. And, as he explains, “the impact on our young teens is quite
devastating, especially as it then becomes wielded in the bullying domain. People become incredibly fearful
and worried about their body when they are being ridiculed for being overweight or even in some cases,
underweight”.

How can we stop the media explosion, especially of images and imagery? “The steak cannot be uncooked”,
explained Krasner, and we, as parents, really have to understand that for the most part, we may not
understand how they use media and how they use their phones.

Krasner explains that a teen views his or her phone as a portal to different worlds, often referred to as
“second lives” where they can create avatars that are completely distinct.

The best approach, according to Krasner, is to “build rapport with your children to understand how they are
engaging with social media."

“Denying them access to social media comes at a cost, however. So before you get into denying them social
media--which is a potent negative re-enforcer--get in there, roll your sleeves up and be available to learn
what your child knows, how they approach things, and what their conception is of the media diet they are
consuming, ”offered Krasner.

“It’s very hard when we as parents struggle ourselves with body images problems that are often left over
from our youth,” Krasner explains when describing his approach to intergenerational perspectives regarding
body image.

“Having a culture of transparency where we are at once honest, but not overly divulging nor overly
pathologizing of our relationship with food and our relationship to our bodes is critically important to help
protect our kids”.
Working together to create this understanding is well worth it to help our children, according to Krasner.

Robert Glatter, MD

I am an emergency physician on staff at Lenox Hill Hospital in New York City, where I have practiced for
the past 15 years. I also serve as an adviser and editor to Med...