A single cause of eating disorders has not been found to date. There are a variety of influences with eating disorders including personality and genetics, as well as biochemical , socio-cultural, familial, and experiential factors. Each individual is different and there are no two stories the same. It is important be educated about eating disorders and find the type of treatment that works best for each person. There are a variety of types of eating disorders: Anorexia, Bulimia, Binge Eating Disorder, and Eating Disorder Not Otherwise Specified (EDNOS).
Anorexia Nervosa 1) Weight is 15% below ideal body weight.
Anorexia nervosa is the refusal to maintain a normal weight / above normal weight for height and age. Not everyone who is of low weight is anorexic: it is important to recognize that it is the REFUSAL to maintain a normal weight that is the key factor. It is sometimes difficult in children to identify anorexia because for their height they may be normal weight. A possible complication of an eating disorder is stunted growth in children. A pediatrician will need to carefully monitor him/her with a growth chart. Also, young children may not talk about weight but rather may describe physical complaints such as nausea or feeling full.
2) There is intense fear of gaining weight or becoming fat, even if underweight.
The intense fear is powerful enough to cause individuals to diet to the point of starvation. A person with anorexia is hungry but s/he is afraid to eat because of fear. Often individuals will become restrictive with the pretense of wanting to eat healthily, when indeed the issue is the fear of gaining weight. A person with anorexia constantly thinks about food – how many calories, how many fat grams, how much exercise do you need to do if you eat a cookie, etc. How many times does someone check the scale? There is always the attempt to try to control eating because of the fear of gaining weight. Often meals are avoided, or eaten very slowly or cut into small portions.
3) Body image is distorted.
When a person with anorexia looks into a mirror s/he does not often see an accurate reflection. Instead, the person sees him/herself as fat, even if s/he is dangerously thin. This is a very frightening experience and feels very real – driving the person to diet. Sometimes a person with anorexia can accept that s/he is very thin but cannot accept how dangerous the situation really is. It is difficult for these individuals to understand that a very low weight and dangerous dieting habits can actually be fatal. The death rate for anorexia is higher than for any other psychiatric illness.
4) Amenorrhea or absence of menstruation exists in females.
Missing three continuous menstrual cycles is usually the criteria for this definition. This criterion does not apply to a female who is on birth control pills or to a young female who has not begun menstruating, although delayed onset of menstruation can be an indicator.
Bulimia Nervosa 1) Binge Eating
A binge is characterized by:
A larger amount of food than most people would eat during the same time period (may consist of thousands of calories)
A short period of time for consuming the food (usually two hours or less)
A feeling that one CANNOT STOP or CONTROL one’s eating
Accompanying physical or emotional distress.
Following a binge, an individual may feel consumed with fear, guilt, or shame and the need to try to undo their behavior. Purging is a way to compensate for binging. Purge behaviors come in many forms: vomiting, taking laxatives or water pills, starving or excessive exercise. It is important to recognize that purging is not a solution to weight loss. Laxatives and diuretics increase water release, not weight. Even vomiting seems to be ineffective – it has been reported that 50-75% of the calories have already been absorbed before a purge.
3) Binging and purging occur more than two times per week for at least three months.
4) In relation to body image, self-evaluation and self-esteem are overly influenced by weight and shape.
Many people in our culture are concerned with how they look, what they weigh or how to change the body parts they don’t like. With bulimia nervosa, there is an intense connection between self-respect and the way the body looks.
5) Weight can be normal, underweight, or overweight.
Unlike anorexia nervosa, which can be identified by low weight, it is more difficult to identify bulimia nervosa, as one could be underweight, at normal weight, or overweight. Weight can also dramatically shift and large swings might be an indicator that someone is developing an eating disorder.
Binge Eating Disorder (BED) This was once referred to as compulsive overeating, and is typically characterized by:
1) A larger amount of food is eaten than would normally be eaten under the circumstances (usually over 2500 calories) within about a two hour period of time.
2) Accompanying feelings of physical discomfort and emotional distress
3) Binging at least two times per week for six months. There is no purging associated with BED.
Eating Disorders Not Otherwise Specified (NOS) Most individuals will not have all of the characteristics of a particular eating disorder as listed above. ED-NOS can be diagnosed if an individual meets some but not all of the criteria.
Changing Diagnoses is Common
Individuals may begin as anorexic but then go on to develop bulimia. Up to 50% of patients with anorexia develop bulimic symptoms, often resulting in not holding low weight (15% below norm). Some patients with bulimia develop anorexic symptoms although the likelihood is not as high.