Kevin Lutz, MD, FACP
Aug 1 2019

Eating disorders are serious mental illnesses that can cause patients severe disturbances in their eating behaviors, as well as related thoughts and emotions

DietMental Health

What are eating disorders?

Eating disorders are serious mental illnesses that can cause patients severe disturbances in their eating behaviors, as well as related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight. Eating disorders are bio-psycho-social diseases, not phases or lifestyle choices. It is important to note that severe cases of eating disorders can be fatal. The three most common eating disorders are, Anorexia Nervosa (fear of gaining weight or becoming fat), Bulimia Nervosa (the act of binge eating then purging or vomiting) and Binge Eating Disorder (eating until uncomfortably full in one sitting).

What is Anorexia Nervosa?

Anorexia nervosa is diagnosed when an individual weighs at least 15% less than the normal healthy weight projected for their height. Hallmarks of anorexia include limited food intake, intense fear of being “fat” and 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: loss of menstrual periods, electrolyte disturbances, osteoporosis, brittle hair and nails, dry skin, anemia, muscle dystrophy, lethargy and low blood pressure and decreased body temperature.

What is Bulimia Nervosa?

Individuals with bulimia nervosa can be slightly underweight, normal weight, overweight or even obese. It is important to note that they are not as underweight as people with anorexia nervosa. People with bulimia nervosa binge eat frequently, eating an overwhelming amount of food in a short time, often consuming thousands of calories that are high in sugars, carbohydrates and fat. They can eat very quickly, sometimes guzzling down food without even tasting it.

During an eating binge, these individuals feel out of control. After a binge, stomach pains and the fear of weight gain are common reasons that those with bulimia purge by throwing up or using a laxative. This cycle is usually repeated at least several times a week or, in severe cases, several times a day.

Purging does not cause weight loss, nor does it prevent weight gain. Over time, the binge/purge cycle can actually contribute to accelerated weight gain as it affects the body’s metabolic rate. This is why many individuals with bulimia are average or above-average weight.

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. However, bulimia does have symptoms that should raise red flags such as a chronically inflamed and sore throat or teeth decay from exposure to stomach acids. Bulimia can lead to rare but potentially fatal complications including esophageal tears, gastric rupture and cardiac arrhythmias.

What is Binge Eating Disorder?

People with binge eating disorder have episodes of binge eating in which they consume very large quantities of food in a brief period and feel out of control during the binge. Unlike people 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 at least once a week for three months, combined with 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 or feeling disgusted with oneself, depressed or very guilty afterward.

What is the best treatment for eating disorders?

Recovery, though challenging, is absolutely possible! Recovery can take months or years, but with proper treatment, many people do eventually recover and go on to live a life free from their eating disorder.

The critical first step in treatment of anorexia nervosa is re-nutrition via carefully monitored feeding, often with the assistance of a medical team and weight restoration back to the healthy weight range. Additionally, family therapy appears to be helpful for younger patients who have recently developed an eating disorder.

Bulimia nervosa can be treated effectively with cognitive behavioral therapy (CBT). CBT is a type of psychotherapy that addresses an individual's thoughts and feelings to make changes in her behavior. Prozac is the only FDA-approved medication for bulimia nervosa which has been proven to show improvement in symptoms over a short period of time.

Binge-eating disorder also responds to cognitive-behavioral therapy, behavioral weight loss therapy and a class of medications called selective serotonin reuptake inhibitors.

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