Eating disorders are mental disorders. They
develop when a person has an unrealistic attitude
toward or abnormal perception of his or her body.
This causes behaviors that lead to destructive eating
patterns that have negative physical and emotional
consequences. Individuals with eating disorders often
hide their symptoms and resist seeking treatment.
Depression, anxiety disorders, and other mental illnesses
often are present in people who have eating
disorders, although it is not clear whether these cause
the eating disorder or are a result of it.
The two best-known eating disorders, anorexia
nervosa and bulimia nervosa, have formal diagnostic
criteria and are recognized as psychiatric disorders in
the Diagnostic and Statistical Manual for Mental Disorders
Fourth Edition (DSM-IV-TR) published by the
American Psychiatric Association (APA). Other eating
disorders have recognized sets of symptoms, but
have not been researched thoroughly enough to be
considered separate psychiatric disorders as defined
by the APA.
Well-known eating disorders
In the North America and Europe, anorexia nervosa
is the most publicized of all eating disorders. It
gained widespread public attention with the rise of the
ultra-thin fashion model. People who have anorexia
nervosa are obsessed with body weight. They constantly
monitor their food intake and starve themselves
to become thin. No matter how much weight
they lose, they continue to restrict their calorie intake
in an effort to become ever thinner. Some anorectics
exercise to extreme or abuse drugs or herbal remedies
that they believe will help them burn calories faster. A
few purge their body of the few calories they do eat by
abusing laxatives, enemas, and diuretics. In time, they
reach a point where their health is seriously, and
potentially fatally, impaired.
People with anorexia nervosa have an abnormal
perception of their body. They genuinely believe that
they are fat, even when the clearly are life-threateningly
thin. They will deny that they are too thin, or, if they
admit they are thin, deny that their behavior will affect
their health. People with anorexia will lie to family,
friends, and healthcare provides about how much they
eat. Many vigorously resist treatment and accuse the
people trying to cure them of wanting to make them fat.
Anorexia nervosa is the most difficult eating disorder to
recover from.
Bulimia nervosa is the only other eating disorder
with specific diagnostic criteria defined by the (DSMIV-
TR). People with bulimia often consume unreasonably
large amounts of food in a short time. Afterwards,
they purge their body of calories. This is done
most often by self-induced vomiting, often accompanied
by laxative abuse.Asubset of people with bulimia
does not vomit after eating, but fast and exercise
obsessively to burn calories. Both behaviors result in
impaired health.
People with bulimia feel out of control when they
are binge eating. Unlike people with anorexia, they recognize that their behavior is abnormal. Often they
are ashamed and feel guilty about their behavior and
will go to great lengths to hide their binge/purge cycles
from their family and friends. People with bulimia are
often of normal weight. Although their behavior
results in negative health consequences, because they
are less likely to be ultra-thin, these consequences are
less likely to be life-threatening.
The APA does not formally recognize binge eating
as an eating disorder. Binge eating is quite common,
but it only rises to the level of a disorder only
when bingeing occurs at least twice a week for three
months or more. People with binge-eating disorder
may eat thousands of calories in an hour or two.
While they are eating, they feel out of control and
may continue to eat long after they feel full. Binge
eaters do not purge or exercise to get rid of the calories
they have eaten. As a result, many, but not all, people
with binge-eating disorder, are obese, although not all
obese people are binge eaters.
Binge eaters are usually ashamed of their behavior
and try to hide it by eating in secret and hording food
for future binges. After a binge, they usually feel disgusted
with themselves and guilty about their eating
behavior. They often promise themselves that they will
never binge again, but are unable to keep this promise.
Binge-eating disorder often takes the form of an endless
cycle—rigorous dieting followed by an eating
binge followed by guilt and rigorous dieting, followed
by another eating binge. The main health consequences
of binge eating are the development of obesityrelated
diseases such as type 2 diabetes, sleep apnea,
stroke, and heart attack.
Lesser-known eating disorders
Quite a few eating problems are called disorders
even though they do not have formal diagnostic criteria.
They fall under the APA definition of eating
disorders not otherwise specified. Many have only
recently come to the attention of researchers and
have been the subject of only a few small studies.
Some have been known to the medical community
for years but are rare.
Purge disorder is thought by some experts to be a
separate disorder from bulimia. It is distinguished
from bulimia by the fact that the individual maintains
a normal or near normal weight despite purging by
vomiting or laxative, enema, or diuretic abuse.
Anorexia athletica is a disorder of compulsive
exercising. The individual places exercise above
work, school, or relationships and defines his or her
self-worth in terms of athletic performance. People
with anorexia athletica also tend to be obsessed less
with body weight than with maintaining an abnormally
low percentage of body fat. This disorder is
common among elite athletes.
Muscle dysmorphic disorder is the opposite of
anorexia nervosa. Where the anorectic thinks she is
always too fat, the person with muscle dysmorphic disorder believes he is always too small. This believe is
maintained even when the person is clearly well
muscled. Abnormal eating patterns are less of a problem
in people with muscle dysmorphic disorder than
damage from compulsive exercising (even when
injured) and the abuse of muscle-building drugs such
as anabolic steroids.
Orthorexia nervosa is a term coined by Steven
Bratman, a Colorado physician, to describe ‘‘a pathological
fixation on eating ‘proper,’ ‘pure,’ or ‘superior’
foods.’’ People with orthorexia allow their fixation
with eating the correct amount of properly prepared
healthy foods at the correct time of day to take over
their lives. This obsession interferes with relationships
and daily activities. For example, they may be unwilling
to eat at restaurants or friends’ homes because the
food is impure or improperly prepared. The limitations
they put on what they will eat can cause serious
vitamin and mineral imbalances. Orthorectics are
judgmental about what other people eat to the point
where it interferes with personal relationships. They
justify their fixation by claiming that their way of
eating is healthy. Some experts believe orthorexia
may be a variation of obsessive-compulsive disorder.
Rumination syndrome occurs when an individual,
either voluntarily or involuntarily, regurgitates food
almost immediately after swallowing it, chews it, and
then either swallows it or spits it out. Regurgitation
syndrome is the human equivalent of a cow chewing its
cud. The behavior often lasts up to two hours after
eating. It must continue for at least one month to be
considered a disorder. Occasionally the behavior simply
stops on its own, but it can last for years.
Pica is eating of non-food substances by people
developmentally past the stage where this is normal
(usually around age 2). Earth and clay are the most
common non-foods eaten, although people have been
known to eat hair, feces, lead, laundry starch chalk,
burnt matches, cigarette butts, light bulbs, and other
equally bizarre non-foods. This disorder has been
known to the medical community for years, and in
some cultures (mainly tribes living in equatorial
Africa) is considered normal. Pica is most common
among people with mental retardation and developmental
delays. It only rises to the level of a disorder
when health complications require medical treatment.
Prader-Willi syndrome is a genetic defect that
spontaneously arises in chromosome 15. It causes
low muscle tone, short stature, incomplete sexual
development, mental retardation, and an uncontrollable
urge to eat. People with Prader-Willi syndrome
never feel full. The only way to stop them from eating
themselves to death is to keep them in environments
where food is locked up and not available. Prader-
Willi syndrome is a rare disease, and although it is
caused by a genetic defect, tends not to run in families,
but rather is an accident of development. Only 12,000–
15,000 people in the United States have Prader-Willi
syndrome.
Demographics
In general, more women have eating disorders
than men. About 90% of people with anorexia and
bulimia nervosa are female. Almost as many men as
women develop binge-eating disorder. Anorexia athletica,
muscle dysmorphic disorder, and orthorexia
nervosa tend to be more common in men. Rumination,
pica, and Prader-Willi syndrome affect men and
women equally.
Anorexia nervosa begins primarily between the
ages of 14 and 18 and affects mainly white girls. Bulimia
usually develops slightly later in the late teens and
early twenties. Binge-eating disorder is a problem of
middle age and affects blacks and whites equally.
Prader-Willi syndrome begins in the toddler years.
Not enough is known about the other disorders to
determine when they are most likely to develop or
which races or ethnic groups are most likely to be at
risk.
Depression, low self-worth, and anxiety disorders
are all common among people with eating disorders.
Some disorders have obsessive-compulsive elements.
The association between these psychiatric disorders
and eating disorders is strong, but the cause and effect
relationship is still unclear.
