Dear Alice,

What are some types of eating disorders?

Dear Reader,

Disordered eating involves an abnormal relationship with food; however, an eating disorder is a psychiatric illness that has more to do with a complex set of emotional and psychological issues, than with food and nutrition. People with eating disorders cope with the stresses and anxieties of life (including low self-esteem, negative body image, feelings of helplessness, problems with school, and/or family or relationship troubles) through food and eating (or lack thereof). Some people also evaluate or judge themselves based on their success in controlling what they eat. While disordered eating behaviors and attitudes are intended to be self-protective, they actually end up being self-destructive. In addition, the physical complications of eating disorders can be severe and even fatal.

The major eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder (BED). According to the National Eating Disorders Association, in the United States as many as ten million people have an eating disorder, such as anorexia or bulimia. In addition, one to five percent of the population may have binge eating disorder.

People of any ethnicity, race, or gender can have eating disorders. It may be harder for men and people of color to acknowledge or get help, because eating disorders are often seen as a "white woman's issue." Furthermore, many people who have eating disorders are undiagnosed.

Anorexia nervosa is characterized by self-starvation and excessive weight loss, but can also include bingeing and purging behavior. It is characterized by an intense fear of becoming fat and a misperception of body size and shape (a.k.a. body dysmorphia). Some physiological signs are:

  • Abnormal or drastic weight loss
  • Refusal to maintain body weight at or above a minimally normal or healthy weight for age and height
  • Amenorrhea (no menstrual periods for at least three consecutive months)
  • Dry skin
  • Brittle hair
  • Weakness
  • Digestive problems, including constipation
  • Insomnia
  • Cold hands and feet
  • Weakened immune system
  • Electrolyte imbalances
  • Stress fractures
  • Life-threatening weakening of heart muscle

Anorexia often begins during mid-adolescence, more commonly among 13 to 14 year olds and 18 to 19 year olds. When a person is diagnosed by their health care provider, the priority is medical treatment to correct any severe medical conditions. Second in line is psychological treatment, such as individual and/or group therapy, which seems to be effective.

Bulimia nervosa typically involves regular and repeated binge eating bouts that are followed by purging, or other compensatory behaviors, to prevent weight gain. These binge-purge episodes are usually done in secret. In general, purging is accomplished by self-induced vomiting and/or misuse of laxatives, diuretics, or enemas. Some people with bulimia may not purge, but resort to other extreme behaviors, such as excessive physical activity or self-induced starvation, to avoid weight gain. Some physiological signs are:

  • Severe dental problems (i.e., erosion of tooth enamel by stomach acid)
  • Enlargement of salivary glands
  • Constipation
  • Digestion problems
  • Dehydration
  • Fluid and electrolyte imbalances
  • Weakened muscles
  • Stomach ulcers
  • Potentially fatal heart problems

In contrast to people with anorexia, who are usually underweight, individuals with bulimia tend to be of normal weight to slightly overweight range. Onset is usually between 15 and 24 years. People with bulimia are primarily treated with antidepressants, which have been a more effective therapy for bulimics than for anorexics. Psychological treatment, particularly cognitive/behavioral therapy and interpersonal therapy, is as effective as antidepressants in the short-term. However, in the long-term, psychological treatment is more effective.

Binge eating disorder (also known as Compulsive Overeating) is similar to bulimia nervosa in that it is typically characterized by regular and repeated binge eating episodes. An episode of binge eating involves rapidly and uncontrollably eating a large amount of food in a single time period at one sitting until uncomfortably full. Unlike bulimia nervosa, binge eating disorder does not include purging or other compensatory behaviors. Affected individuals are often obese and have had problems with fluctuations in their body weight. For many, binge eating begins during a diet. Often with binge eating disorder, people feel ashamed, guilty, and disgusted by their bodies and with their lack of self-control over eating. Treatment is similar to that for bulimia nervosa.

Other eating disorders, including Eating Disorders Not Otherwise Specified (EDNOS), can include some combination of the signs and symptoms of anorexia, bulimia, and/or binge eating disorder. While these behaviors may not be clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining. This is because many people with EDNOS engage in the same risky, damaging behaviors seen in other eating disorders.

Finally, it could be helpful to know what distinguishes disordered eating from normal eating, which is defined as follows:

  • Normal eating is being able to eat when you are hungry and eating until you are satisfied. It is being able to choose food you like and eating until you get enough of it, not just stopping because you think you should.
  • Normal eating is being able to use moderate constraint on your food selection to get the right food, but not being so restrictive that you miss out on pleasurable food.
  • Normal eating is giving yourself permission to eat sometimes because you are happy, sad, or bored, or just because it feels good.
  • Normal eating is three meals a day, or it can be choosing to eat several small meals/snacks throughout the day. It is leaving some cookies on the plate because you know you can have some tomorrow, or it is eating more now because they taste so wonderful and fresh.
  • Normal eating is overeating at times: feeling stuffed and uncomfortable. It is also under eating at times and wishing you had more.
  • Normal eating means trusting your body to make up for your mistakes in eating.
  • Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

In short, normal eating is flexible. It varies in response to your emotions, your schedule, your hunger, and your proximity to food.

"Normal Eating" is reprinted from How to Get Your Kid to Eat... But Not Too Much,
pp. 69 - 70, by Ellyn Satter, with permission of Bull Publishing Co., 1987.

For more information on eating disorders, check out Disordered Eating and Eating Disorders in the Go Ask Alice! archives. If you are concerned you or a friend has an eating disorder, or you have any concerns about your relationship with food, it may bee a good idea to visit a health care provider or counselor.  Hope this information was helpful.


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