I hope that through this article you can find the answers you are looking for and begin the process of discerning the type of help you need. Eating disorders are some of the most difficult things to live with, and if you begin to see yourself or a loved one in the words below, I strongly encourage you to help them or yourself.
Help comes in various ways, and this article may be the first of many steps towards health and restoration. I have collected information created by the American Psychiatric Association (APA) on the definitions, symptoms, behaviors, and treatment of Binge Eating Disorder, Bulimia Nervosa, and Anorexia Nervosa.
The APA is the guiding body that creates diagnosis for doctors and therapists to use and is the standard model for which empirically supported treatments are governed.
Eating disorders are illnesses in which people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become preoccupied with food and their body weight.
People with Anorexia Nervosa and Bulimia Nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies. They usually “feel fat” and see themselves as overweight, sometimes even despite life-threatening semi-starvation (or malnutrition). Intense fear of gaining weight and of being fat may become all-pervasive. In the early stages of these disorders, patients often deny that they have a problem.
In many cases, eating disorders occur together with other psychiatric disorders like anxiety, panic, obsessive-compulsive disorder, and alcohol and drug abuse problems. New evidence suggests that heredity may play a part in why certain people develop eating disorders, but these disorders also afflict many people who have no prior family history.
Without treatment of both the emotional and physical symptoms of these disorders, malnutrition, heart problems, and other potentially fatal conditions can result. However, with proper care, those with eating disorders can resume suitable eating habits, and return to better emotional and psychological health.
Three Common Types of Eating Disorders
I have listed an outline of the three most common types of eating disorders. Each section illustrates how the disorder presents in people’s lives as well as the behaviors associated with each eating disorder.
Binge Eating Disorder
People with binge eating disorder have episodes of binge eating in which they consume large quantities of food in a brief period and feel out of control during the binge. Unlike with Bulimia Nervosa, they do not try to get rid of the food by inducing vomiting or by using other unsafe practices such as fasting or laxative abuse.
The binge eating is chronic and can lead to serious health complications, particularly severe obesity, diabetes, hypertension, and cardiovascular diseases. Binge Eating Disorder involves frequent overeating during a discreet period of time (at least once a week for three months), combined with a lack of control and associated with three or more of the following:
- Eating more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed or very guilty afterward
Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa can be slightly underweight, normal weight, overweight, or even obese. But they are not as underweight as people with anorexia nervosa.
Patients with bulimia nervosa binge eat frequently, and during these times sufferers may eat an astounding amount of food in a short time, often consuming thousands of calories that are high in sugars, carbohydrates, and fat. They can eat very rapidly, sometimes gulping down food without even tasting it.
Their binges often end only when they are interrupted by another person, or they fall asleep or their stomach hurts from being stretched beyond normal capacity. During an eating binge, a sufferer feels out of control. After a binge, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative.
This cycle is usually repeated at least several times a week or, in serious cases, several times a day. Many people don’t know when a family member or friend has bulimia nervosa because people almost always hide their binges. Since they don’t become drastically thin, their behaviors may go unnoticed by those closest to them. But bulimia nervosa does have symptoms that should raise red flags:
- Chronically inflamed and sore throat
- Salivary glands in the neck and below the jaw become swollen; cheeks and face often become puffy, causing sufferers to develop a “chipmunk” looking face
- Tooth enamel wears off; teeth begin to decay from exposure to stomach acids
- Constant vomiting causes gastroesophageal reflux disorder
- Laxative abuse causes irritation, leading to intestinal problems
- Diuretics (water pills) cause kidney problems
- Severe dehydration from purging of fluids
Bulimia can lead to rare but potentially fatal complications including esophageal tears, gastric rupture, and cardiac arrhythmias.
Anorexia nervosa is diagnosed when patients weigh at least 15 percent less than the normal healthy weight expected for their height. Hallmarks of anorexia include:
- Limited food intake
- Fear of being “fat”
- Problems with body image or denial of low body weight
People with anorexia nervosa don’t maintain a normal weight because they refuse to eat enough, often exercise obsessively, and sometimes force themselves to vomit or use laxatives to lose weight. Over time, the following symptoms may develop as the body goes into starvation:
- Menstrual periods cease
- Osteopenia or osteoporosis (thinning of the bones) through a loss of calcium
- Hair/nails become brittle
- Skin dries and can take on a yellowish cast
- Mild anemia; and muscles, including the heart muscle, waste away
- Severe constipation
- Drop in blood pressure, slowed breathing and pulse rates
- Internal body temperature falls, causing a person to feel cold all the time
- Depression and lethargy
Treatment for Various Types of Eating Disorders
Eating disorders clearly illustrate the close links between emotional and physical health. The first step in treating anorexia nervosa is to assist patients with regaining weight to a healthy level; for patients with bulimia nervosa interrupting the binge-purge cycle is key. For patients with Binge Eating Disorder, it is important to help them interrupt and stop binges.
However, restoring a person to normal weight or temporarily ending the binge-purge cycle does not address the underlying emotional problems that cause or are made worse by the abnormal eating behavior. Psychotherapy helps individuals with eating disorders to understand the thoughts, emotions, and behaviors that trigger these disorders. Some medications have also proven to be effective in the treatment process.
Because of the serious physical problems caused by these different types of eating disorders, any treatment plan for a person with Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder must include general medical care, nutritional management, and nutritional counseling. These measures begin to rebuild physical well-being and healthy eating practices.
Eating disorders are complicated and often more than one professional is needed to help a person find sustainable results. If you have any questions or concerns for yourself or a loved one, please do not hesitate to contact me and schedule an appointment or consultation.
Ranna Parekh, M.D., M.P.H. (2020, November). What Are Eating Disorders? https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
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