Questions and Answers on Eating Disorders
The content in this section has been created by the Academy of Eating Disorders (AED) and is used with their kind permission. AED is a US-based, global professional association committed to leadership in Eating Disorders’ research, education, treatment, and prevention.
What are Eating Disorders?
- Eating Disorders are serious mental illnesses. They are treatable, and the sooner someone gets the treatment he or she needs, the better the chance of a good recovery.
- Eating Disorders are NOT choices, passing fads or phases. Eating Disorders are severe and can be fatal.
- Eating Disorders can be recognized by a persistent pattern of unhealthy eating or dieting behavior that can cause health problems and/or emotional and social distress.
- Eating Disorders occur all over the world, especially in industrialized regions or countries.
- The four official categories of Eating Disorders are Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorders and Eating Disorder Not Otherwise Specified (EDNOS). EDNOS includes many types of Eating Disorders including purging in the absence of binge eating, meeting some but not all of the symptoms of anorexia or Bulimia Nervosa, and chewing and spitting out food. Binge Eating Disorder, which used to fall under the EDNOS category and is now listed separately in the latest Diagnostic and Statistical Manual for Mental Disorders (DSM-5), is marked by recurrent episodes of binge eating in the absence of compensatory behaviors.
- Although there are formal guidelines that health care professionals use to diagnose Eating Disorders (DSM-5), unhealthy eating behaviors exist on a continuum. Even if a person does not meet the formal criteria for an eating disorder, he or she may be experiencing unhealthy eating behaviors that cause substantial distress and may be damaging to both physical and psychological health.
What is Anorexia Nervosa?
- Individuals with Anorexia Nervosa do not maintain or have a body weight that is normal or expected for their age and height. Typically, this means that a person is less than 85% of his/her expected weight. Women with Anorexia Nervosa often stop having their periods.
- Even when underweight, individuals with Anorexia continue to be fearful of weight gain. Their thoughts and feelings about their size and shape have profound impact on their sense of self and their self-esteem as well as their relationships.
- They often do not recognize or admit the seriousness of their weight loss and deny that it may have permanent adverse health consequences.
- There are two subtypes of Anorexia Nervosa: In the restricting subtype, people maintain their low body weight by restricting food intake and, sometimes, by exercise. Individuals with the binge eating/purging type also restrict their food intake, but regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics or enemas. Many people move back and forth between subtypes during the course of their illness.
What is Bulimia Nervosa?
- Individuals with Bulimia Nervosa experience binge eating episodes which are marked by eating an unusually large amount of food, usually within a couple of hours, and feeling out of control while doing so. The sense of being out of control is what distinguishes binge eating from regular overeating. For example, during a binge, an individual may feel compelled to eat, and find it extremely difficult, if not impossible to stop eating. Some people experience a sense of being out of control even when eating small amounts of food. These are called subjective binge episodes.
- Binge eating is followed by attempts to “undo” the consequences of the binge by using unhealthy behaviors such as self-induced vomiting, misuse of laxatives, enemas, diuretics, severe caloric restriction or excessive exercising.
- Individuals with Bulimia Nervosa are obsessed and preoccupied with their shape and weight and often feel as if their self-worth is dependent on their weight or shape.
- Formal diagnostic criteria for Bulimia Nervosa describe binge eating and engagement in inappropriate, unhealthy behaviors to counteract the binges at least twice weekly for three months. Regardless of frequency, however, these behaviors are concerning and can have adverse physical and psychological health consequences.
- There are two subtypes of Bulimia Nervosa: The purging type includes those individuals who self-induce vomiting or use laxatives, diuretics, or enemas. The non-purging type refers to those who compensate through excessive exercising or dietary fasting.
What is Binge Eating Disorder?
- Individuals with Binge Eating Disorder (BED) engage in binge eating, but do not regularly use inappropriate or unhealthy weight control behaviors such as fasting or purging to counteract the binges.
- Binge Eating Disorder is more common among individuals who are overweight or obese. Previous terms used to describe these problems included compulsive overeating, emotional eating, and food addiction.
- With the release of the latest Diagnostic and Statistical Manual for Mental Disorders (DSM-5), Binge Eating Disorder is now officially recognized as a specified Eating Disorder.
Who may be affected by Eating Disorders?
- Anyone can be affected. Eating Disorders do not discriminate on the basis of sex, age, or race. They can be found in both sexes, all age groups, and across a wide variety of races and ethnic backgrounds around the globe. But there are groups who display an increased risk for Eating Disorders (see below).
Who is at increased risk for Eating Disorders?
- Eating Disorders are more common in women, but they do occur in men. Rates of Binge Eating Disorder are similar in females and males.
- Athletes in certain sports are at particularly high risk for Eating Disorders. Female gymnasts, ice skaters, dancers, and swimmers, to name a few, have been found to have higher rates of Eating Disorders. In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for Anorexia Nervosa.
- Male athletes are also at increased risk – especially those in sports such as wrestling, bodybuilding, crew, running, cycling, climbing, and football.
- Although white females may be more likely to suffer from Anorexia Nervosa, African-American girls may be especially vulnerable to developing Eating Disorders that involve binge eating. Body dissatisfaction in young girls has been shown in White, African-American, Hispanic, and Asian girls.
How common are Eating Disorders?
- Anorexia Nervosa: Between 0.3 and 1% of young women have Anorexia Nervosa (which makes Anorexia as common as Autism).
- Bulimia Nervosa: Around 1 to 3% of young women have Bulimia Nervosa.
- Binge Eating Disorder: Around 3% of the population has Binge Eating Disorder.
- Between 4% and 20% of young women practice unhealthy patterns of dieting, purging, and Binge Eating.
- Currently, about one in 20 young women in the community has an eating disorder.
Has the prevalence of Eating Disorders increased over the years?
- Anorexia Nervosa: Cases of Anorexia Nervosa have been described throughout history in many different cultural contexts, with the first medical descriptions dating back to the 19th century. The number of new cases presenting increased up to the 1970s and since then has been stable.
- Bulimia Nervosa: Bulimia Nervosa is a newer disorder and between the 1980s and 1990s there was a dramatic rise in the number of cases presenting with this disorder. The largest proportion of people presenting for treatment being adolescents and young adults.
What causes Eating Disorders?
- Eating Disorders are complex and are influenced by BOTH genetic AND environmental (i.e., pressure to be thin, trauma, etc.) factors. Eating Disorders are NOT simply caused by Western cultural values of thinness although those factors are operative.
- While the current Western obsession with slimness and the glamorous portrayal of emaciated women in the media may play a role in the recent increase of Eating Disorders, genetic vulnerability, personality, psychological and environmental factors all contribute to the causes of Eating Disorders.
How devastating are Eating Disorders?
- For women aged 15-24, Eating Disorders are among the top four leading causes of burden of disease in terms of years of life lost through death or disability.
- Anorexia Nervosa has one of the highest overall mortality rates and the highest suicide rate of any psychiatric disorder. The risk of death is three times higher than in depression, schizophrenia or alcoholism and 12 times higher than in the general population.
- Up to 10% of women with Anorexia Nervosa may die due to anorexia-related causes. Early recognition of symptoms and proper treatment can reduce the risk of death. Deaths in Anorexia Nervosa mainly result from complications of starvation or from suicide.
- Health consequences such as osteoporosis (brittle bones), gastrointestinal complications, and dental problems are significant health and financial burdens throughout life.
- Quality of life is severely impaired in all Eating Disorders.
What is the best treatment for Eating Disorders?
- A number of effective treatments for Eating Disorders exist. These have been systematically appraised in the Australian, UK, Dutch and U.S. Eating Disorder guidelines. Specific information for patients and careers on treatment can be found at http://www.nice.org.uk and at http://www.besttreatments.co.uk.
- Anorexia Nervosa: The critical first step in treatment of Anorexia Nervosa is re-nutrition (carefully monitored feeding, often with the assistance of a medical team) and weight restoration back to the healthy weight range. There is no consensus on the best approaches to treating Anorexia Nervosa, but family therapy appears to be helpful for younger patients who have recently developed an eating disorder. CBT may be helpful after weight restoration.
- Bulimia Nervosa: A review of research studies concluded that 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 their behavior. Improvement in symptoms over a short period of time are also seen with the only FDA approved medication for Bulimia Nervosa – fluoxetine (i.e., Prozac).
- Binge Eating Disorder: Binge Eating Disorder also responds to cognitive-behavioral therapy, behavioral weight loss therapy and a variety of medications (e.g., selective serotonin reuptake inhibitors, tricyclic antidepressants) have also been shown to lead to improvement.
Can one recover from an eating disorder?
- In general, early detection and treatment are associated with a better chance of recovery. One reason for this may be that brain development is not complete until about age 20 and the effects of starvation on the developing brain are particularly noxious.
- Anorexia Nervosa: Over a 10-year period, about half of those with Anorexia Nervosa recover fully, a small percentage continues to suffer from Anorexia Nervosa, and the rest develop other Eating Disorders. Even among those individuals who recover from an eating disorder, it is common for them to continue to maintain a low body weight and experience depression.
- Bulimia Nervosa: More than half of those treated for Bulimia Nervosa have recovered at follow-up.
Does Eating Disorders research get US federal funding?
- Eating Disorders research has been hampered by very low US federal funding levels (approximately $28 million/year), compared with research on other conditions:
- Alcoholism: 18 x more funding ($505 million)
- Schizophrenia: 13 x more funding ($352 million)
- Depression: 12 x more funding ($328 million)
- Food safety: 12 x more funding ($333 million)
- Sleep disorders: 7 x more funding ($187 million)
- ADHD: 4 x more funding ($105 million)