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What is an eating disorder?

Eating Disorders are serious and complex emotional and physical addictions. Without treatment eating disorders lead to mood swings, physical problems, and potential death. Eating Disorders include a range of conditions that involve an obsession with food, weight and appearance to the degree that a person's heath, relationships and daily activities are adversely affected.

While commonly affecting young women, eating disorders are widespread and can impact people of all ages and sexes. It is estimated that 10 million women and 1 million men in the United States suffer from an eating disorder, and the statistics are growing. The number of men with an eating disorder has more than doubled in the last ten years.

Whether a person restricts food intake, binge eats, binges and purges, abuses laxatives, compulsively overeats, or excessively exercises these behaviors often are symptoms and not the problem. They often develop as a way of coping with emotional pain, conflicts related to separation, low self-esteem, depression, stress or trauma.

Eating disorders are characterized by severe disturbances in eating behavior. The practice of an eating disorder can be viewed as a survival mechanism. Just as an alcoholic uses alcohol to cope, a person with an eating disorder can use eating, purging or restricting to deal with their problems. Some of the underlying issues that are associated with an eating disorder include low self-esteem, depression, feelings of loss of control, feelings of worthlessness, identity concerns, family communication problems and an inability to cope with emotions. The practice of an eating disorder may be an expression of something that the eating disordered individual has found no other way of expressing.

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Types
Anorexia Nervosa: Anorexia nervosa is self-imposed starvation. Anorexia nervosa is a serious, life-threatening disorder, which usually stems from underlying emotional causes. Although people with anorexia nervosa are obsessed with food, they continually deny their hunger. People with anorexia nervosa often also limit or restrict other parts of their lives besides food, including relationships, social activities, or pleasure. Anorexia nervosa can cause severe medical problems and even lead to death. The disorder involves extreme weight loss--at least 15% below the individual's "ideal" weight--and a refusal to maintain body weight that is even minimally normal for their age and height and body frame.

Bulimia Nervosa: Bulimia nervosa is a serious eating disorder that can be fatal if left untreated. People who have bulimia nervosa routinely "binge," consuming large amounts of food in a very short period of time, and immediately "purge," ridding their bodies of the just-eaten food by self-inducing vomiting, taking enemas, or abusing laxatives or other medications. If left untreated, bulimia nervosa can lead to serious and even life-threatening problems, such as depression, anxiety disorders, heart damage, kidney damage, injury to all parts of the digestive system, and severe dental damage. Those with bulimia nervosa are at risk for dangerous impulsive, self-destructive behaviors, such as kleptomania, self-mutilation, alcohol and/or drug abuse, and sexual promiscuity.

Compulsive eating disorder: Compulsive overeating can affect women or men, though it appears twice as often among women. People with compulsive overeating disorder suffer from episodes of uncontrolled eating or bingeing followed by periods of guilt and depression. Compulsive overeating is marked by the consumption of large amounts of food, sometimes accompanied by a pressured, "frenzied" feeling. Compulsive overeating disorder may cause a person to continue to eat even after they become uncomfortably full.

Binge eating disorder: The essential features of binge-eating disorder are recurrent, out-of-control episodes of consuming abnormally large amounts of food. If you suffer from this disorder you eat whether you are hungry or not and consume food well past being uncomfortably full.
Binge-eaters are usually extremely distressed by their eating behavior and experience feelings of disgust and guilt both during and after bingeing. Most feel ashamed and try to hide their problem. Many are so good at concealing their binge-eating habits from others that even close family members or friends are unaware they suffer from an eating disorder.

  • Binge-Eating Disorder: Binge-eating episodes not accompanied by purging at least 2 times per week.
  • Occurs in approximately 30%-50% of subjects in weight control programs (40% are males).

Obesity: 25% or more over ideal body weight: Obesity is one of our nation's most critical health problems; each year, hundreds of thousands of people are affected by serious and sometimes life-threatening mental and physical complications as a direct consequence of their obesity. Appropriate treatment not only improves individuals' quality of life, it can save lives.

The consequences of obesity can be severe. If left untreated, an obese person is at pronounced risk of developing serious mental disorders, such as depression, personality disorders, or anxiety disorders as a direct consequence of their obesity. For many, obesity leads to chronic and often life-threatening eating disorders such as bulimia nervosa or anorexia nervosa. Feelings of shame and a profound sense of isolation often accompany obesity.

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Facts

  • 80% of women who answered a People magazine survey responded that images of women on television and in the movies make them feel insecure.
  • Two out of five women and one out five men would trade three to five years of their life to achieve their weight goals.
  • In one study, three out of four women stated that they were overweight although only one out of four actually were.
  • In 1970 the average age a girl started dieting was 14; by 1990 the average dropped to 8.
  • A study asked children to assign attractiveness values to pictures of children with various disabilities. The participants rated the obese child less attractive than a child in a wheelchair, a child with a facial deformity and, a child with a missing limb.
  • The dieting industry is the only business in the world that has a 98% failure rate.
  • One half of 4th grade girls are on a diet.
  • The average US woman is 5’4” and weighs 140 pounds. In contrast, the average US model is 5’11” and weighs 117 pounds.
  • 51% of nine and ten-year-old girls stated they felt better about themselves when they were adhering to a diet.
  • One out of three women and one out of four men are on a diet at any given time.
  • Four out of five US women are dissatisfied with their appearance.
  • 81% of ten-year-old girls are afraid of being fat.
  • A study found that adolescent girls were more fearful of gaining weight than getting cancer, nuclear war or losing their parents.
  • Some of the pictures of the models in magazines do not really exist. The pictures are computer-modified compilations of different body parts.
  • A study found that 25% of Playboy centerfolds met the weight criteria for anorexia.
  • Eating disorders have the highest mortality rate of all mental illnesses. The mortality (death) rate for eating disorders is approximately 18% in 20-year studies, and 20% in 30-year follow up studies.
  • 52% of girls begin dieting before age 14 (Johnson et al. (1984). Journal of Youth and Adolescence, 13.)
  • Eating disorders cross racial, economic, and educational boundaries.
  • Bulimia can cause damage to the reproductive system, kidney failure, cardiac arrest, and ulcers of the intestinal tract.
  • Many people with eating disorders are addicted to exercise.
  • Victims of eating disorders generally have very low self-esteem.

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Signs and Symptoms

Anorexia: Here are some of the common warning signs that indicate that a person may be suffering from anorexia. The person:
Is thin and keeps getting thinner, losing 15% or more of her ideal body weight.
Continues to diet or restrict foods even though she is not overweight.
Has a distorted body image—feels fat even when she is thin.

  • Is preoccupied with food, calories, nutrition, or cooking.
  • Denies that she is hungry.
  • Exercises obsessively.
  • Weighs herself frequently.
  • Complains about feeling bloated or nauseated even when she eats normal—or less than normal—amounts of food.
  • Loses her hair or begins to experience thinning hair.
  • Feels cold even though the temperature is normal or only slightly cool.
  • Stops menstruating.

Bulimia: Here are some of the common warning signs that a person may be suffering from bulimia. The person:

  • Engages in binge eating and cannot voluntarily stop.
  • Uses the bathroom frequently after meals.
  • Reacts to emotional stress by overeating.
  • Has menstrual irregularities.
  • Has swollen facial glands, giving her chipmunk cheeks.
  • Experiences frequent fluctuations in weight.
  • Cannot voluntarily stop eating.
  • Is obsessively concerned about weight.
  • Attempts to adhere to diets, but generally fails.
  • Feels guilty or ashamed about eating.
  • Feels out of control.
  • Has depressive moods.

Compulsive Overeating: People with compulsive eating disorder feel unable to stop eating, eat very fast, eat when they're not hungry, eat only when alone, or eat nearly non-stop throughout the day. Compulsive eaters often over-indulge in sugary foods and use them in an attempt to elevate their mood. When they don't eat the foods they crave, they often experience severe withdrawal symptoms.


Binge eating disorder: Here are some of the common warning signs that suggest a person may be suffering from binge eating disorder. The person:

  • Eats large amounts of food when not physically hungry.
  • Eats much more rapidly than normal.
  • Eats until the point of feeling uncomfortably full.
  • Often eats alone because of shame or embarrassment.
  • Has feelings of depression, disgust, or guilt after eating.
  • Has a history of marked weight fluctuations.

Obesity:

  • More than 20% over ideal body weight. Ideal weight is based on gender, age, and typical activity level (e.g., sedentary or active).
  • Body-fat percentage greater than 30% for women and 25% for men.

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Health Consequences
Eating disorders can kill! Be aware of medical complications. Get professional help.
Families and friends of eating disordered patients often do not realize the extent to which eating disorders can create serious physical problems. Some of the more common medical consequences of eating disorders are easily recognizable and with early detection can be managed to prevent serious medical complications requiring hospitalization.

  • Hypomagnesemia – a magnesium deficiency
  • Hypolcalcemia – a calcium deficiency
  • Dehydration
  • Malnutrition
  • Metabolic Alkalosis – high levels of bases (negative ions) in the body
  • Metabolic Acidosis – high levels of acids in the body
  • Low Blood Pressure
  • Low Heart Rate
  • Heart Failure
  • Esophageal Damage (leading to possible rupture) – this usually happens quickly and is very dangerous
  • Impacted bowels
  • Osteoporosis
  • Heart Arrhythmia
  • Dental Problems

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Body Image
Body image is . . .

  • How you see yourself when you look in the mirror or when you picture yourself in your mind.
  • What you believe about your own appearance (including your memories, assumptions, and generalizations).
  • How you feel about your body, including your height, shape, and weight.
  • How you sense and control your body as you move. How you feel in your body, not just about your body.

Negative body image is . . .

  • A distorted perception of your shape--you perceive parts of your body unlike they really are.
  • You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure.
  • You feel ashamed, self-conscious, and anxious about your body.
  • You feel uncomfortable and awkward in your body.

Positive body image is . . .

  • A clear, true perception of your shape--you see the various parts of your body as they really are.
  • You celebrate and appreciate your natural body shape and you understand that a person’s physical appearance says very little about their character and value as a person.
  • You feel proud and accepting of your unique body and refuse to spend an unreasonable amount of time worrying about food, weight, and calories.
  • You feel comfortable and confident in your body.

People with negative body image have a greater likelihood of developing an eating disorder and are more likely to suffer from feelings of depression, isolation, low self-esteem, and obsessions with weight loss.

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Causes

 

Eating Disorders are about feelings, not food.


Eating Disorders are not just about food and weight. They are an attempt to use food intake and weight control to manage emotional conflicts that actually have little or nothing to do with food or weight. Eating disorders do not occur in an otherwise satisfied, productive, and emotionally healthy person. People with eating disorders are struggling with a number of emotional problems. This may be a hard concept to accept. Many people with eating disorders appear to be functioning at a high level, such as enjoying success with school or work. Often, the only problem appears to be with eating. However, healthier eating habits or stronger willpower are not the missing ingredients that will make the problem disappear. AN EATING DISORDER IS AN EXTERNAL SOLUTION TO INNER TURMOIL.

Psychological Factors that can contribute to Eating Disorders:

  • Low self-esteem
  • Feelings of inadequacy or lack of control in life
  • Depression, anxiety, anger, or loneliness
    Interpersonal Factors that Can Contribute to Eating Disorders:
  • Troubled family and personal relationships
  • Difficulty expressing emotions and feelings
  • History of being teased or ridiculed based on size or weight
  • History of physical or sexual abuse

Social Factors that Can Contribute to Eating Disorders:

  • Cultural pressures that glorify "thinness" and place value on obtaining the "perfect body"
  • Narrow definitions of beauty that include only women and men of specific body weights and shapes
  • Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths
    Other Factors that can contribute to Eating Disorders:
  • Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be imbalanced. The exact meaning and implications of these imbalances remains under investigation.

Eating disorders are complex conditions that can arise from a variety of potential causes. Once started, however, they can create a self-perpetuating cycle of physical and emotional destruction.


All eating disorders require professional help.

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Coping
The ideas below present some alternatives to patterns of eating disordered behavior. Remember, changes make a difference, no matter how small you believe those changes are.

  • If you feel the urge to binge, try taking a few moments (it may be seconds at first) to identify feelings. You can still binge later - remember you are simply trying to change the usual patterns of behavior.
  • Get a journal where you can write your feelings throughout the day. You may want to focus on meal times or even one meal at first.
  • If you are afraid of eating, make a list of "safe" foods for you. Supply your home with these foods so that you are prepared to let yourself eat.
  • Grow your support system. The point is to find safe people to help you feel supported.
  • Start calling safe people. As you become more accustomed to making calls, you will find yourself turning to others more easily.
  • If you live with someone, plan a discussion about your needs. There may be changes the other person can make to help you.
  • Make a list of safe people with phone numbers. Carry the list with you.
  • Get a list of feelings if you have difficulty identifying your experience. Refer to the list throughout the day, especially meal times.
  • Notice meal times and content. If you record your level of satiety, urges to binge/restrict/purge, you may learn if there are foods that trigger you or length of time between meals that triggers you.
  • Notice the way you speak to yourself about your food, body, or behaviors. Begin to add positive statements, gradually letting go of the negative. No eating disorder was ever cured through self-blame.
  • Consider your spiritual life. Spirituality means different things to different people. Find out what it means for you and start to draw upon this part of you.
  • Do you let yourself have needs and limits in your work or personal life? Holding back anger and resentment and stifling your needs leads to self-punishment through more eating disordered behavior.
  • Find your voice. Practice with safe people. Start by telling them you'd like to practice saying "NO" to them about something that doesn't matter. Let yourself start in a comfortable way.

All eating disorders require professional help.

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Prevention
What You Can Do to Help Prevent Eating Disorders
Basic Principles for the Prevention of Eating Disorders

Every family, group, and community is different in terms of what might contribute to effective primary prevention. Thus, before we offer some specific suggestions for the prevention of eating disorders, we encourage you to consider adopting four principles that are generally applicable to doing prevention work in your family, your community, and your own life.

Eating disorders are serious and complex problems. Their expression, causes, and treatment typically have physical, personal, and social (i.e., familial) dimensions. Consequently, one should avoid thinking of them in simplistic terms like "anorexia is just a plea for attention" or "bulimia is just an addiction to food."

Prevention programs are not "just a women's problem" or "something for the girls." Males who are preoccupied with shape and weight can also develop disordered eating patterns as well as dangerous shape control practices such as steroid use. Moreover, objectification and other forms of mistreatment of women by men contribute directly to two underlying features of an eating disorder: obsession with appearance and shame about one's body.

Prevention efforts will fail, or worse, inadvertently encourage disordered eating, if they concentrate solely on warning parents and children about the signs, symptoms, and dangers of eating disorders. Therefore, any attempt to prevent eating disorders must also address:

  • Our cultural obsession with slenderness as a physical, psychological, and moral issue,
  • The distorted meaning of both femininity and masculinity in today's society, and
  • The development of people's self-esteem and self-respect.

If at all possible, prevention "programs" for schools, churches, and athletics should be coordinated with opportunities for individuals in the audience to speak confidentially with a trained professional and, where appropriate, to receive referrals to sources of competent, specialized care.

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Questionnaire
Do you have an eating disorder?

1. Do you overeat until you feel sick?

2. Do you feel guilt and remorse when you eat?

3. Are you terrified of being overweight?

4. Does it feel as though food controls your life?

5. Do you isolate so that you can eat?

6. Do you have a history of dieting?

7. Do you avoid eating when you're hungry?

8. Do you weigh yourself at least once a day?

9. Do you eat large amounts of food in a brief amount of time?

10. Do other people say you're thin but you think you're fat?

11. Do you make yourself vomit?

12. Do you regularly take laxatives or diuretics to lose weight?

13. Do you exercise no matter how tired or sick you may feel and feel upset when you miss a day?

14. Do you go to the gym or exercise more than once a day?

15. Do you take longer than other people to eat a meal or do you usually finish before everyone else?

16. Are you preoccupied with food or your body size much of the day most days?

17. Do you hide foods?

18. Do you cook for others but never eat what you've made?

19. Do you resist foods when in public but eat them when you're alone?

20. Do you eat or refuse to eat when tense, anxious, or disappointed?

21. Do you feel exhilarated or "in control" when you don't eat?

22. Have you taken drugs to curb your appetite?

23. Do you exercise instead of eating?

24. Do you count calories or fat grams?

25. Do you make unfulfilled promises to yourself about what you will or will not eat?

26. Do you feel defeated or hopeless about food or your body size?

27. Have you kept any of these issues secret?

If you have answered "Yes" to any of these questions, you may have an eating disorder. Eating disorders are very serious. You should get help immediately. Ask a trusted family member, teacher, or friend to help you find professional assistance.

The Eating Disorder Foundation