What are Eating Disorders
Anorexia Nervosa
Bulemia Nervosa
Binge Eating
Other Eating Disorders
Statistics
Warning Signs
Online Screening Test
Resources

What are Eating Disorders (back to top)

There are many diseases, disorders, and problem conditions involving food, eating, and weight, but in everyday conversation, the term "eating disorders" has come to mean anorexia nervosa, bulimia, and binge eating, which are defined on this page. Definitions of lesser-known problems follow.

Anorexia nervosa (back to top)

• Person refuses to maintain normal body weight for age and height.
  
• Weighs 85% or less than what is expected for age and height.
  
• In women, menstrual periods stop. In men levels of sex hormones fall.
  
• Young girls do not begin to menstruate at the appropriate age
  
• Person denies the dangers of low weight.
  
• Is terrified of becoming fat.
  
• Is terrified of gaining weight even though s/he is markedly underweight.
  
• Reports feeling fat even when very thin.
  
• In addition, anorexia nervosa often includes depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories.
  
• Person may have low tolerance for change and new situations; may fear growing up and assuming adult responsibilities and an adult lifestyle. May be overly engaged with or dependent on parents or family.
  
• Dieting may represent avoidance of, or ineffective attempts to cope with, the demands of a new life stage such as adolescence.

Bulimia nervosa (back to top)

• Person binge eats.
  
• Feels out of control while eating.
  
• Vomits, misuses laxatives, exercises, or fasts to get rid of the calories.
  
• Diets when not bingeing. Becomes hungry and binges again.
  
• Believes self-worth requires being thin. (It does not.)
  
• May shoplift, be promiscuous, and abuse alcohol, drugs, and credit cards.
  
• Weight may be normal or near normal unless anorexia is also present.
  
• Like anorexia, bulimia can kill. Even though bulimics put up a brave front, they are often depressed, lonely, ashamed, and empty inside. Friends may describe them as competent and fun to be with, but underneath, where they hide their guilty secrets, they are hurting. Feeling unworthy, they have great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger.
  
• Impulse control may be a problem; e.g., shoplifting, sexual adventurousness, alcohol and drug abuse, and other kinds of risk-taking behavior. Person acts with little consideration of consequences.

Binge eating disorder (back to top)

• The person binge eats frequently and repeatedly.
  
• Feels out of control and unable to stop eating during binges.
  
• May eat rapidly and secretly, or may snack and nibble all day long.
  
• Feels guilty and ashamed of binge eating.
  
• Has a history of diet failures
  
• Tends to be depressed and obese.
  
• People who have binge eating disorder do not regularly vomit, over-exercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which at present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger. Or they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. In fact, diets almost always make matters worse. Information reported in the March 2002 New England Journal of Medicine suggests that for some, but not all, people a genetic flaw in combination with lifestyle factors can predispose to binge eating and subsequent obesity.

Eating disorders not otherwise specified (ED-NOS) (back to top)

An official diagnosis The phrase describes atypical eating disorders Including situations in which a person meets all but a few of the criteria for a particular diagnosis. What the person is doing with regard to food and weight is neither normal nor healthy.

Statistics: How many people have eating disorders? (back to top)

Anorexia nervosa

• Research suggests that about one percent (1%) of female adolescents have anorexia. That means that about one out of every one hundred young women between ten and twenty are starving themselves, sometimes to death. There do not seem to be reliable figures for younger children and older adults, but such cases, while they do occur, are not common.

Bulimia nervosa

• Research suggests that about four percent (4%), or four out of one hundred, college-aged women have bulimia. About 50% of people who have been anorexic develop bulimia or bulimic patterns. Because people with bulimia are secretive, it is difficult to know how many older people are affected. Bulimia is rare in children.

Males with eating disorders

• Only about 10% of people with anorexia and bulimia are male. This gender difference may reflect our society's different expectations for men and women. Men are supposed to be strong and powerful. They feel ashamed of skinny bodies and want to be big and powerful. Women, on the other hand, are supposed to be tiny, waif-like, and thin. They diet to lose weight, making themselves vulnerable to binge eating. Some develop rigid and compulsive overcontrol. Dieting and the resulting hunger are two of the most powerful eating disorders triggers known.

What age groups are affected?

• Anorexia and bulimia affect primarily people in their teens and twenties, but studies report both disorders in children as young as six and individuals as old as seventy-six.

Overweight and obesity

• Studies suggest that about sixty percent of adult Americans, both male and female, are overweight. About one third (34%) are obese, meaning that they are 20% or more above normal, healthy weight. Many of these people have binge eating disorder.

Binge eating disorder

• A recent study reported in Drugs and Therapy Perspectives reports that about one percent of women in the United States have binge eating disorder, as do thirty percent of women who seek treatment to lose weight. In other studies, up to two percent, or one to two million adults in the U.S., have problems with binge eating.

Eating disorders and substance abuse

• About 72% of alcoholic women younger than 30 also have eating disorders. (Health magazine, Jan/Feb 2002)

What about compulsive exercising?

• Because anorexia athletica is not a formal diagnosis, it has not been studied as rigorously as the official eating disorders. We have no idea how many people exercise compulsively.

Body dysmorphic disorder

• Not yet an official diagnosis, but may achieve that status soon. BDD affects about two percent of people in the U.S. and strikes males and females equally, usually before age eighteen (70% of the time). Sufferers are excessively concerned about appearance, body shape, body size, weight, perceived lack of muscles, facial blemishes, and so forth. In some cases BDD can lead to steroid abuse, unnecessary plastic surgery, and even suicide. BDD is treatable and begins with an evaluation by a mental health care provider.

Subclinical eating disorders

• We can only guess at the vast numbers of people who have subclinical or threshhold eating disorders. They are too much preoccupied with food and weight. Their eating and weight control behaviors are not normal, but they are not disturbed enough to qualify for a formal diagnosis.

Mortality and recovery rates

• Without treatment, up to twenty percent (20%) of people with serious eating disorders die. With treatment, that number falls to two to three percent (2-3%).

• With treatment, about sixty percent (60%) of people with eating disorders recover. They maintain healthy weight. They eat a varied diet of normal foods and do not choose exclusively low-cal and non-fat items. They participate in friendships and romantic relationships. They create families and careers. Many say they feel they are stronger people and more insightful about life in general and themselves in particular than they would have been without the disorder.

• In spite of treatment, about twenty percent (20%) of people with eating disorders make only partial recoveries. They remain too much focused on food and weight. They participate only peripherally in friendships and romantic relationships. They may hold jobs but seldom have meaningful careers. Much of each paycheck goes to diet books, laxatives, jazzercise classes, and binge food.

• The remaining twenty percent (20%) do not improve, even with treatment. They are seen repeatedly in emergency rooms, eating disorders programs, and mental health clinics. Their quietly desperate lives revolve around food and weight concerns, spiraling down into depression, loneliness, and feelings of helplessness and hopelessness.

Please note: The study of eating disorders is a relatively new field. We have no good information on the long-term recovery process. We do know that recovery usually takes a long time, perhaps on average three to five years of slow progress that includes starts, stops, slides backwards, and ultimately, movement in the direction of mental and physical health.

Miscellaneous statistics

• From England: A 1998 survey done by Exeter University included 37,500 young women between twelve and fifteen. Over half (57.5%) listed appearance as the biggest concern in their lives. The same study indicated that 59% of the twelve and thirteen-year-old girls who suffered from low self-esteem were also dieting.

• Dieting teens: More than half of teenaged girls are, or think they should be, on diets. They want to lose all or some of the forty pounds that females naturally gain between 8 and 14. About three percent of these teens go too far, becoming anorexic or bulimic.

• Unrealistic expectations: Magazine pictures are electronically edited and airbrushed. Many entertainment celebrities are underweight, some anorexically so. How do we know what we should look like? It's hard. The table below compares average women in the U. S. with Barbie Doll and department store mannequins. It's not encouraging. (Health magazine, September 1997; and NEDIC, a Canadian eating disorders advocacy group)

	Average Woman	Barbie	Store Mannequin
Height	145 lbs.	101 lbs.	N/A
Dress Size	11-14	4	6
Bust	36-37"	39"	34"
Waist	29-31"	10"	23"
Hips	40-42"	33"	34"

Determining accurate statistics is difficult. Because physicians are not required to report eating disorders to a health agency, and because people with these problems tend to be secretive, denying that they even have a disorder, we have no way of knowing exactly how many people in this country are affected.

We can study small groups of people, determine how many of them are eating disordered, and then extrapolate to the general population. The numbers are usually given as percentages, and they are as close as we can get to an accurate estimate of the total number of people affected by eating disorders.

Now, that having been said, the National Association of Anorexia Nervosa and Associated Disorders states that approximately eight million people in the U.S. have anorexia nervosa, bulimia, and related eating disorders. Eight million people represents about three percent (3%) of the total population. Put another way, according to ANAD, about three out of every one hundred people in this country eats in a way disordered enough to warrant treatment. If you want to know how they arrived at this number, e-mail their staff.

Eating disorders warning signs (back to top)

Because everyone today seems concerned about weight, and because most people diet at least once in a while, it is hard to tell what is normal behavior and what is a problem that may escalate to threaten life and happiness. No one person will show all of the characteristics listed below, but people with eating disorders will manifest several.

In addition, the early stages of an eating disorder can be difficult to define. When does normative dieting become a health and emotional problem? When does weight loss cross the line and become pathological? Answering these questions is hard, especially when the person has not yet lost enough weight to qualify for a clinical diagnosis. Nevertheless, the questions are important. The sooner an eating disorder is treated, the easier it is for the person to recover. If warning signs and symptoms are allowed to persist until they become entrenched behaviors, the person may struggle for years before s/he can turn matters around.

Food behaviors

• The person skips meals, takes only tiny portions, will not eat in front of other people, eats in ritualistic ways, and mixes strange food combinations.
  
• May chew mouthfuls of food but spits them out before swallowing.
  
• Grocery shops and cooks for the entire household, but will not eat the tasty meals.
  
• Always has an excuse not to eat -- is not hungry, just ate with a friend, is feeling ill, is upset, and so forth.
  
• Becomes "disgusted" with former favorite foods like red meat and desserts.
  
• Will eat only a few "safe" foods.
  
• Boasts about how healthy the meals s/he does consume are.
  
• Becomes a "vegetarian" but will not eat the necessary fats, oils, whole grains, and the denser fruits and veggies (such as sweet potatoes and avocados) required by true vegetarianism.
  
• Chooses primarily low-fat items with low levels of other nutrients, foods such as lettuce, tomatoes, sprouts, and so forth.
  
• Usually has a diet soda in hand.
  
• Drastically reduces or completely eliminates fat intake.
  
• Reads food labels religiously.
  
• If s/he breaks self-imposed rigid discipline and eats normal or large portions, excuses self from the table to vomit and get rid of the calories.
  
• Or, in contrast to the above, the person gorges, usually in secret, emptying cupboards and refrigerator.
  
• May also buy special binge food.
  
• If panicked about weight gain, may purge to get rid of the calories.
  
• May leave clues that suggest discovery is desired -- empty boxes, cans, and food packages; foul smelling bathrooms; running water to cover sounds of vomiting;
  
• excessive use of mouthwash and breath mints;
  
• in some cases, leaves containers of vomit poorly hidden that invite discovery.
  
• Sometimes the person uses laxatives, diet pills, water pills, or "natural" products from health food stores to promote weight loss.
  
• May abuse alcohol or street drugs, sometimes to deaden appetite, sometimes to escape emotional pain, and usually in hopes of feeling better, at least temporarily.

Appearance and body image behaviors

• The person loses, or tries to lose, weight.
  
• Has frantic fears of weight gain and obesity.
  
• Wears baggy clothes, sometimes in layers, to hide fat, hide emaciation, and stay warm.
  
• Obsesses about clothing size.
  
• Complains that s/he is fat even though others truthfully say this is not so. S/he will not believe them.
  
• Spends lots of time inspecting self in the mirror and usually finds something to criticize.
  
• Detests all or specific parts of the body, especially breasts, belly, thighs, and buttocks.
  
• Insists s/he cannot feel good about self unless s/he is thin, and s/he is never thin enough to satisfy her/himself.

Exercise behaviors

• The person exercises excessively and compulsively. May tire easily, keeping up a harsh regimen only through sheer will power. As time passes, athletic performance suffers. Even so, s/he refuses to change the routine.
  
• May develop strange eating patterns, supposedly to enhance athletic performance.
  
• May consume sports drinks and supplements, but total calories are less than what an active lifestyle requires.

Thoughts and beliefs

• In spite of average or above-average intelligence, the person thinks in magical and simplistic ways, for example, "If I am thinner, I will feel better about myself." S/he loses the ability to think logically, evaluate reality objectively, and admit and correct undesirable consequences of choices and actions.
  
• Becomes irrational and denies that anything is wrong. Argues with people who try to help, and then withdraws, sulks, or throws a tantrum.
  
• Wanting to be special, s/he becomes competitive. Strives to be the best, the smallest, the thinnest, and so forth.
  
• Has trouble concentrating. Obsesses about food and weight and holds to rigid, perfectionistic standards for self and others.
  
• Is envious of thin people in general and thinner people in particular. Seeks to emulate them.

Note: Not all, but a subset of people with eating disorders think they do not deserve to eat or enjoy tasty food. They starve, stuff, or purge in deliberate attempts to punish themselves. They may also cut their flesh or otherwise hurt themselves. Some want to become increasingly debilitated, even suffer the indignities of tube feedings and IVs, and eventually weaken and die. They see this not as a cry for help or attention, or an attempt to control their lives, but as well-deserved punishment for misperceived flaws and misdeeds. Their extreme self-hatred must be dealt with in therapy if they are to recover.

Feelings

• Has trouble talking about feelings, especially anger. Denies anger, saying something like, "Everything is OK. I am just tired and stressed."
  
• Escapes stress by turning to binge food, exercise, or anorexic rituals.
  
• Becomes moody, irritable, cross, snappish, and touchy.
  
• Responds to confrontation and even low-intensity interactions with tears, tantrums, or withdrawal.
  
• Feels s/he does not fit in and therefore avoids friends and activities.
  
• Withdraws into self and feelings, becoming socially isolated.
  
• Feels inadequate, fearful of not measuring up.
  
• Frequently experiences depression, anxiety, guilt, loneliness, and at times overwhelming emptiness, meaninglessness, hopelessness, and despair.

Social behaviors

• Tries to please everyone and withdraws when this is not possible.
  
• Tries to take care of others when s/he is the person who needs care.
  
• May present self as needy and dependent or conversely as fiercely independent and rejecting of all attempts to help.
  
• Anorexics tend to avoid sexual activity. Bulimics may engage in casual or even promiscuous sex.
  
• Person tries to control what and where the family eats.
  
• To the dismay of others, s/he consistently selects low-fat, low-sugar non-threatening -- and unappealing -- foods and restaurants that provide these "safe" items.
  
• Relationships tend to be either superficial or dependent.
  
• Person craves true intimacy but at the same time is terrified of it.
  
• As in all other areas of life, anorexics tend to be rigidly controlling while bulimics have problems with lack of impulse control that can lead to rash and regrettable decisions about sex, money, stealing, commitments, careers, and all forms of social risk taking. Adapted from www.anred.com

Online Eating Disorder Screening (back to top)

In order to take an Eating Disorder test go to:
https://www.mentalhealthscreening.org/screening/login.asp

Resources: (back top top)

BVU Counseling Center
Kelly Mattis, Director of Counseling
Phone: 1226 Email: mattisk@bvu.edu

Healthy Meal Planning
Food and Nutrition Information Center
www.nal.usda.gov/fnic/

Chat room
http://www.edrecovery.com/

Eating Disorder information online assistance :
Anorexia Nervosea and Related Eating Disorders, Inc.
http://www.anred.com

Eating Disorder Recovery Online
http://www.edrecovery.com/

The National Eating Disorder Information Centre
http://www.nedic.ca/

National Eating Disorder Association
http://www.edap.org

Harvard Eating Disorders Center
http://www.hedc.org

National Association of Anorexia Nervosa and Associated Disorders
http://www.anad.org

Treatment Referrals
http://edreferral.com/