In many affluent industrialized nations, eating disorders have reached near epidemic proportions. According to the February 2007 issue of Biological Psychiatry, 4.5% of people in the US will suffer from an eating disorder in their lifetime. An estimated 24 million people currently suffer from an eating disorder, with some groups, such as adolescent and college-age women, suffering in alarming numbers. In 2006, the National Eating Disorder Association reported that 1 in 5 college women suffers from an eating disorder. Yet these disorders often go undiagnosed and untreated. It is estimated that only about 35% of sufferers get treatment for their illnesses.
This page is designed to provide readers with both basic eating disorder “warning signs” and more detailed clinical information. If you have concerns about yourself or others, we encourage you to complete an online screening and/or visit your local health care professional.
Bradley students may access an online screening service at Mental Health Screening. (Keyword: Bradley University).
Are my body concerns and eating practices “normal”?
Only a health care professional can provide a comprehensive and accurate assessment of your health. However, you might want to consider these broad guidelines.
Normal body-image and eating concerns
- Interest in improving physical appearance, health, and overall wellness
- Enthusiasm about a new fitness or healthy eating plan
- Focus on body image, while maintaining a reasonable level of self-acceptance
- Pursuit of a challenging physical training program that incorporates good nutrition and balance
Problematic body-image and eating concerns
- Singular focus on weight loss or obsession with restrictive (yo-yo) dieting
- Punitive approach to body image which includes self-denigrating comments and/or excessive exercise or purging after eating
- Working out to lose weight without regard for health and nutritional needs
- Self-worth based entirely on body image
- Compulsive, rigid or inflexible approach to a diet/exercise routine.
Etiology: What Causes Eating Disorders?
There is no single cause of eating disorders but rather they result from multiple influences—social, psychological, developmental, biological, and genetic.
- Twin Studies look at Heritability (a percentage representing how much genes contribute to the development of an eating disorder in a particular group of people):
- Bulimia = 54%. Bullik et al (2001) found evidence of bulimia susceptibility on chromosome 10
- Anorexia = 52%. Grice et al. (2002) found evidence of anorexia susceptibility on chromosome 1
- Binge-Eating = 41%. (Striegel-Moore & Bulik, 2007)
- Evidence suggests that eating disorders are likely the result of the combined influence of many genes, not just a single gene.
- Family studies examine the prevalence of eating disorders within groups of genetically related individuals. They have found that:
- Biological relatives of individuals with Anorexia and Bulimia are 7 to 12 times more likely to have an eating disorder than the general population.
- Family members of an individual with an eating disorder are 2 to 3.5 times more likely to suffer from bipolar or unipolar depression.
- Family members of an individual with bulimia have a 3-4 times higher risk for substance abuse.
Psychological, behavioral, physiological and cultural factors
Keel (2005) and Striegel-Moore & Bulik (2007) describe a range of psychological, behavioral, physiological and cultural factors associated with the development of eating disorders:
- Anorexia: high levels of perfectionism and constraint, higher levels of negative emotion (i.e. depression and anxiety)
- Bulimia: high levels of impulsiveness and poor emotional regulation, higher levels of negative emotion (i.e. depression and anxiety)
- Dieting behavior and initial weight loss is positively reinforced through compliments and attention; increasing value and using foods as rewards can reinforce binges.
- The experience of eating can become a punishing experience, due to physical discomfort, anxiety, shame over eating, and shame over one’s body/shape.
- Those with anorexia or bulimia pay more attention to information about food and body weight/shape than those without an eating disorder.
- Dichotomous thinking (or black-and-white thinking) – foods get classified as good/bad; losing weight = good, gaining weight = bad.
- Cognitive rigidity – individuals continue with a specific course of action, without reevaluating it consequences.
- These cognitions may reflect a consequence of an eating disorders and don’t necessarily predate the onset of an eating disorder.
- Low or abnormal Serotonin (5-HT)
- Serotonin plays a role in eating and weight regulation.
- Even after recovery some functioning of serotonin is still abnormal, suggesting that a serotonin abnormality may predispose certain individuals to the development of an eating disorder.
- Western culture’s emphasis on thinness is internalized leading to body dissatisfaction, dieting, and restriction which then leads to over-eating in some individuals.
- For females: widespread objectification of the female body teaches girls and women that they are valued only for their looks.
Many individuals with eating disorders never receive any form of treatment. Why is this?
- Reluctance to treat those who don’t appear ill and emaciated
- Lack of money or access to health services
- Lack of insurance coverage (See http://www.eatingdisorderscoalition.org/)
Treatment is more likely when an individual has more severe symptoms, impaired psychosocial functioning (i.e. problems at school, home, or job) or a personality disorder or mood disorder (Keel, 2005).
- Spend 24 hours per day in treatment
- Controlled environment, close monitoring, intensive therapy
- Patients are often either underweight or purging frequently or suicidal, but very often treatment centers encourage patients to begin treatment as inpatients in order to break their cycle.
- Day programs, evening programs, or intensive group and individual therapy that occurs weekly, biweekly, or monthly
- Day programs involve 2 or 3 monitored meals and snacks and group therapy, but there is less medical monitoring and patients spend evenings and nights at home.
- A empirically supported directive therapy that is organized around the theory that disorders are composed of reinforced behaviors to which there are healthier alternatives and irrational beliefs that need to be elicited, challenged, and replaced
- Shown to be particularly effective with bulimia and binge-eating disorder, but similar results are lacking for anorexia.
- In 30-50% of Bulimia cases it eliminates binge-eating and purging
- Over 50% of Binge Eating Disorder individuals recover with this treatment
- Antidepressants and mood stabilizers have been used to treat Anorexia, Bulimia, and Binge Eating Disorder, particularly when used to address simultaneous disorders such as depression, bipolar disorder, and anxiety disorders.
- National Association of Anorexia Nervosa and Associated Disorders
- National Eating Disorders Association
- National Institute of Mental Health
- The International Association of Eating Disorders Professionals Foundation
Eating disorder warning signs
Anorexia Nervosa (Detailed Diagnostic Criteria)
- Deliberate self-starvation with weight loss
- Intense, persistent fear of gaining weight
- Refusal to eat or highly restrictive eating
- Continuous dieting
- Excessive facial/body hair because of inadequate protein in the diet
- Compulsive exercise
- Abnormal weight loss
- Sensitive to cold
- Absent or irregular menstruation
- Hair loss
Bulimia Nervosa (Detailed Diagnostic Criteria)
- Preoccupation with food
- Binge eating, usually in secret
- Vomiting after bingeing
- Abuse of laxatives, diuretics, diet pills
- Denial of hunger or drugs to induce vomiting
- Compulsive exercise
- Swollen salivary glands
- Broken blood vessels in the eyes
Binge-Eating Disorder (Detailed Diagnostic Criteria)
- Recurrent episodes of binge eating, defined as
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of being embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or feeling very guilty after overeating
- A sense of lack of control over eating during binging episodes
- Marked psychological distress regarding binge eating
Eating Disorder Not Otherwise Specified (Detailed Diagnostic Criteria)
Some disordered eating does not fit neatly into the categories described above. Individuals may suffer from a variety of symptoms, but not meet the diagnostic criteria for any specific eating disorder. Such individuals may be diagnosed with an Eating Disorder Not Otherwise Specified (ED-NOS). Examples include the following:
- For females, all of the criteria for anorexia nervosa are met except that the individual has regular periods.
- All of the criteria for anorexia nervosa are met, however, despite significant weight loss the individual's current weight is in the normal range.
- All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms (eg. purging, laxative abuse, excessive exercise, etc.) occur less than 2 times a week or for less than 3 months.
- The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food
- Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
Men and Eating Disorders
Although eating disorders are commonly considered women’s disorders, men account for approximately 10% of those diagnosed with anorexia or bulimia. In addition, there is a growing awareness of Muscle Dysmorphia (one form of Body Dysmorphic Disorder), a body image disturbance suffered primarily by men. It is characterized by the following:
- Viewing one’s body as puny despite efforts and success at body building.
- Having a distorted body perception that leads to extreme efforts to increase lean muscle mass and overall body size.
- Taking extreme measures to increase muscle mass, including excessive exercise, dietary manipulation and high protein intake, use of anabolic steroids.