When you become so preoccupied with food and weight issues that you find it harder and harder to focus on other aspects of your life, it may be an early sign of an eating disorder. Without treatment, eating disorders can take over a person’s life and lead to serious, potentially fatal medical complications. Eating disorders can affect people of any age or gender, but rates are higher among women. Symptoms commonly appear in adolescence and young adulthood. 

Symptoms

Eating disorders are a group of related conditions that cause serious emotional and physical problems. Each condition involves extreme food and weight issues; however, each has unique symptoms that separate it from the others.

Anorexia Nervosa. People with anorexia will deny themselves food to the point of self-starvation as they obsesses about weight loss. With anorexia, a person will deny hunger and refuse to eat, practice binge eating and purging behaviors or exercise to the point of exhaustion as they attempts to limit, eliminate or “burn” calories.

The emotional symptoms of anorexia include irritability, social withdrawal, lack of mood or emotion, not able to understand the seriousness of the situation, fear of eating in public and obsessions with food and exercise. Often food rituals are developed or whole categories of food are eliminated from the person’s diet, out of fear of being “fat”.

Anorexia can take a heavy physical toll. Very low food intake and inadequate nutrition causes a person to become very thin. The body is forced to slow down to conserve energy causing irregularities or loss of menstruation, constipation and abdominal pain, irregular heart rhythms, low blood pressure, dehydration and trouble sleeping. Some people with anorexia might also use binge eating and purge behaviors, while others only restrict eating.

Bulimia Nervosa. People living with bulimia will feel out of control when binging on very large amounts of food during short periods of time, and then desperately try to rid themselves of the extra calories using forced vomiting, abusing laxatives or excessive exercise. This becomes a repeating cycle that controls many aspects of the person’s life and has a very negative effect both emotionally and physically. People living with bulimia are usually normal weight or even a bit overweight.

The emotional symptoms of bulimia include low self-esteem overly linked to body image, feelings of being out of control, feeling guilty or shameful about eating and withdrawal from friends and family.

Like anorexia, bulimia will inflict physical damage. The binging and purging can severely harm the parts of the body involved in eating and digesting food, teeth are damaged by frequent vomiting, and acid reflux is common. Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death.

Binge Eating Disorder (BED). A person with BED losses control over their eating and eats a very large amount of food in a short period of time. They may also eat large amounts of food even when he isn’t hungry or after he is uncomfortably full. This causes them to feel embarrassed, disgusted, depressed or guilty about their behavior. A person with BED, after an episode of binge eating, does not attempt to purge or exercise excessively like someone living with anorexia or bulimia would. A person with binge eating disorder may be normal weight, overweight or obese.

Causes

Eating disorders are very complex conditions, and scientists are still learning about the causes. Although eating disorders all have food and weight issues in common, most experts now believe that eating disorders are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Unfortunately, this will eventually damage a person’s physical and emotional health, self-esteem and sense of control.

Factors that may be involved in developing an eating disorder include:

• Genetics. People with first degree relatives, siblings or parents, with an eating disorder appear to be more at risk of developing an eating disorder, too. This suggests a genetic link. Evidence that the brain chemical, serotonin, is involved also points a contributing genetic and biological factors.
• Environment. Cultural pressures that idealize a particular body type place undue pressure on people to achieve unrealistic standards. Popular culture and media images often tie thinness (for women) or muscularity (for men) to popularity, success, beauty and happiness. 
• Peer Pressure. With young people, this can be a very powerful force. Pressure can appear in the form of teasing, bullying or ridicule because of size or weight. A history of physical or sexual abuse can also contribute to some people developing an eating disorder.
• Emotional Health. Perfectionism, impulsive behavior and difficult relationships can all contribute to lowering a person’s self-esteem and make them vulnerable to developing eating disorders.

Eating disorders affect all types of people. However there are certain risk factors that put some people at greater risk for developing an eating disorder.

• Age. Eating disorders are much more common during teens and early 20s.
• Gender. Women and girls are more likely to have a diagnosed eating disorder. However, it is important to recognize that men and boys may be under-diagnosed due to differences in seeking treatment.  
• Family history. Having a parent or sibling with an eating disorder increases the risk.
• Dieting. Dieting taken too far can become an eating disorder.
• Changes. Times of change like going to college, starting a new job, or getting divorced may be a stressor towards developing an eating disorder.
• Vocations and activities. Eating disorders are especially common among gymnasts, runners, wrestlers and dancers.

Diagnosis

A person with an eating disorder will have the best recovery outcome if they receive an early diagnosis. If an eating disorder is believed to an issue, a doctor will usually perform a physical examination, conduct an interview and order lab tests. These will help form the diagnosis and check for related medical issues and complications.

In addition, a mental health professional will conduct a psychological evaluation. They may ask questions about eating habits, behaviors and beliefs. There may be questions about a patient’s history of dieting, exercise, bingeing and purging.

Symptoms must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in order to warrant a diagnosis. Each eating disorder has its own diagnostic criteria that a mental health professional will use to determine which disorder is involved. It is not necessary to have all the criteria for a disorder to benefit from working with a mental health professional on food and eating issues.

Often a person with an eating disorder will have symptoms of another mental health condition that requires treatment. Whenever possible, it is best to identified and address all conditions at the same time. This gives a person comprehensive treatment support that helps insure a lasting recovery.

Treatment

Eating disorders are managed using a variety of techniques. Treatments will vary depending on the type of disorder, but will generally include the following.

• Psychotherapy, such as talk therapy or behavioral therapy.
• Medicine, such as antidepressants and anti-anxiety drugs. Many people living with an eating disorder often have a co-occurring illness like depression or anxiety, and while there is no medication available to treat eating disorders themselves, many patients find that these medicines help with underlying issues.
• Nutritional counseling and weight restoration monitoring are also crucial. Family-based treatment is especially important for families with children and adolescents because it enlists the families’ help to better insure healthy eating patterns, and increases awareness and support. 

Treatment

Each person’s treatment will depend on the type of eating disorder, but generally it will include psychotherapy along with medical monitoring and nutritional counseling. Family-based treatment is especially important for families with children and adolescents because it enlists the families’ help to better insure healthy eating patterns and increases awareness and support.

Many people receive treatment for an eating disorder without needing an intensive treatment setting. However, for some people, an inpatient or residential eating disorder treatment center or partial hospital setting is best when they begin treatment. Others may need hospitalization to treat serious problems caused by poor nutrition or for care if they are very underweight.

Support groups, nutrition counseling and medications are also helpful to some individuals.

Psychotherapy should be provided by a mental health professional with experience in treating eating disorders. Because of the complexity, therapy needs to address both the symptoms and a person’s psychological, interpersonal and cultural influences which contributed to the disorder.

Cognitive behavioral therapy (CBT) is often successfully used in the treatment of eating disorders because it helps people understand the relationship between their thoughts, feelings and behaviors. CBT that is developed for the treatment of bulimia is very effective at changing the binge-purge behaviors and eating attitudes.

Wellness and Nutrition Counseling involves professionals helping a patient return to a normal weight. Dietitians and other health care providers can help change old habits and beliefs about food, dieting and exercise with healthy nutrition and eating information and planning. Sometimes planning and monitoring responsibilities are shared with mental health professionals or family members.

Coping with an eating disorder isn’t easy. But if you or a family member or friend is struggling, there is help. NAMI and NAMI Affiliates are there to provide you with support for you and your family and information about community resources.

Contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org if you have any questions about finding support and resources.

Helping Yourself

Although you may realize that your behaviors are destructive it may be difficult to control them. Treatment can teach you ways to cope. Here are some examples:

Lifestyle. It’s important to begin making changes in your life and remove the reminders and stop negative behaviors associated with the disorder. Resist the impulse to check yourself in the mirror frequently or weight your several times a day. Fight the urge to diet or skip meals.

Steer Clear of troublesome reminders. Identify the triggers–a certain place, challenging situations, some friends-for old behaviors or symptoms and prepare a plan to deal with them.

Accept yourself. Your healthy weight is your ideal weight. Don’t be tricked by ultra-thin models and actresses. Look for healthy role models. Focus on activities and interests that make you feel good about yourself.

Partner with your health care providers. Develop trust and communicate openly. Give your healthcare provider the information they need to help you recover. Don’t skip therapy sessions, and be consistent with meal plans. Ask about vitamin and mineral supplements and which type of exercise, if any, is appropriate for strengthening and rebuilding your body.

Complementary therapies. Alternative and complementary therapies and medicines can have negative or positives effects. Always discuss with your health care providers anything you would like to add to your treatment plan. Weight loss supplements, diuretics, laxatives or herbal remedies are commonly unregulated, and often misused. Other treatments generally considered safe and helpful, including acupuncture, massage, yoga, chamomile tea and biofeedback.

Learn all you can. Read self-help books that offer practical, credible advice. Research helpful topics online, but don’t visit websites that promote dangerous eating habits or showcase very thin, unhealthy bodies, as it could trigger a relapse. For men with eating disorders, check out the National Association for Males with Eating Disorders (N.A.M.E.D.).

Find emotional support from others recovering from an eating disorder. Share your thoughts, fears and questions with other people who have dealt with an eating disorder. Connect with others on online message boards or peer-support groups like NAMI Connection Recovery Support Groups.

If you live with a mental health condition, learn more about managing your mental health and finding the support you need.

Supporting Your Family Member Or Friend

Discuss your concerns. If you have concerns about a friend or family member and suspect an eating disorder may be the reason, learn about the different disorders, symptoms and warning signs. When you are knowledgeable, talking with them in a loving and non-confrontational way about your concerns is best. Tell the person you care.

Suggest they see a doctor, counselor or other health professional. This may be tricky, as your loved one may not want to admit or even realize there is a problem, but sometimes seeing a professional who is knowledgeable about eating disorders is the first step in recovery.

Avoid the traps. Conflicts and battles are hurtful. If a person is not ready to acknowledge a problem, you can be a supportive friend. Avoid placing blame, guilt or shame on them about behaviors or attitudes related to the eating disorder. Remember that giving simple solutions minimizes the courage and strength a person needs to recover from an eating disorder.

Be a good role model. Reflect on your attitudes and actions. Do you maintain sensible eating and exercise habits? Also, focus on the other person’s successes, accomplishments or personality.

Parenting. Having a child with an eating disorder places significant responsibility on parents, making them active partners in treatment planning and implementation. Your family needs to feel comfortable and confident in the professional’s approach and abilities, and in discussing the disorder. Finding a mental health professional with experience treating young people or children with eating disorders and their families is important.

Find emotional support. Family support groups provide people with a chance to share thoughts, fears and questions with other people who are in similar situations and understand. NAMI Basics, and NAMI Family-to-Family programs are offered in many communities by NAMI Affiliates.

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