Eating Disorders; Overview

Eating Disorders; Overview

Eating disorders are devastating mental illnesses that affect more than seven million American women. Approximately 90 percent of the people who suffer from the eating disorders anorexia nervosa and bulimia nervosa are women. Although eating disorders revolve around eating and body weight, they aren’t entirely about food but also about feelings and self-expression. Women with eating disorders often use food and dieting as ways of coping with life’s stresses. For some, food becomes a source of comfort and nurturing, or a way to control or release stress. For others, losing weight is a way to gain the approval of friends and family. Eating disorders are not diets, signs of personal weakness or problems that will go away without treatment.

Eating disorders occur in all socioeconomic and ethnic groups. Eating problems usually develop in girls between age 12 and 25, with an average age of 17. Estimates are that about five percent of young people have eating disorders. Because of the shame associated with this complex illness, many women don’t seek treatment or get help until years later. Eating disorders also occur in older women and in men, but much less frequently.

Treatment for anorexia nervosa, which typically occurs on an inpatient basis, can be quite expensive, and is not always covered by health insurance. Treatment for bulimia is more likely to be done on an outpatient basis, and may be more affordable.

There are several categories of eating disorders, including anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified (EDNOS). All are considered psychiatric disorders according to the American Psychiatric Association’s DSM-IV diagnostic manual.

Anorexia nervosa is a disorder in which preoccupation with dieting and thinness leads to excessive weight loss. If you suffer from this disease, you may not acknowledge that weight loss or restricted eating is a problem and you may “feel fat” even when you’re emaciated. Women with anorexia nervosa intentionally starve themselves or exercise excessively in a relentless pursuit to be thin, losing from 15 percent to 60 percent of their normal body weight. Roughly half of all women suffering from anorexia nervosa never return to their pre-anorexic health, and 20 percent remain chronically ill.

About half of women with anorexia also purge, but they do not have bulimia. The main difference between someone with anorexia who purges and someone with bulimia is weight: severely underweight individuals receive a diagnosis of anorexia. The death rate for anorexia nervosa is among the highest of any psychiatric illness. The deaths are about evenly divided between suicide and medical complications related to starvation.

Women with bulimia nervosa regularly and sometimes secretly binge on large quantities of food–up to 20,000 calories at a time–then experience intense feelings of guilt or shame and try to compensate by getting rid of the excess calories. Some purge by inducing vomiting, abusing laxatives and diuretics, or taking enemas. Others fast or exercise to extremes. If you suffer from this disease, you feel out of control and recognize that your behavior is not normal but often deny to others that you have a problem. Women with bulimia can be normal weight or overweight, but they often experience weight fluctuations.

A third type of eating disorder, “eating disorders not otherwise specified” (EDNOS), refers to symptoms that don’t fit into the other two categories of eating disorders. Individuals with this type of problem, may have binge eating disorder, or be close to a diagnosis of anorexia or bulimia, but don’t quite meet full diagnostic criteria. EDNOS is simply a catch-all term for anyone with significant eating problems who doesn’t meet the criteria for the other diagnoses. The majority of those who seek treatment for eating disorders fall into this category.

Although it has become synonymous with eating disorders, anorexia is relatively rare, affecting less than one percent of adolescent women. Another two to three percent develop bulimia. Yet statistics don’t tell the whole story. Many more women who don’t necessarily meet all the criteria for an eating disorder are preoccupied with their bodies and are caught in destructive patterns of dieting and overeating that can seriously affect their health and well-being.

There is no single cause of eating disorders. Biological, social and psychological factors all play a role. Evidence suggesting a genetic predisposition shows that anorexia may be more common between sisters and in identical twins. It is estimated that one has roughly a five-to-six greater chance of developing an eating disorder if an immediate relative has one. Other research points to hormonal disturbances and to an imbalance of neurotransmitters, chemicals in the brain that, among other things, regulate mood and appetite. Scientists have also learned that appetite and energy expenditure are regulated by a highly complex network of nerve cells and molecular messages called neuropeptides.

In some women, an event or series of events triggers the eating disorder and allows it to take root and thrive. Triggers can be as subtle as a degrading comment or as devastating as rape or incest. Times of transition, such as puberty, divorce, marriage or starting college, can also provoke eating problems. Parents who are preoccupied with eating and overly concerned about or critical of a daughter’s weight, and coaches who relentlessly insist on weigh-ins or a certain body image from their athletes, especially in weight-conscious sports including ballet, cheerleading, diving, wrestling and gymnastics, may also encourage an eating disorder. So can the pressure of living in a culture where self-worth is equated with unattainable standards of slimness and beauty.

Additionally, the discrepancy between our society’s concept of the “ideal” body size for women and the size of the average American woman has never been greater–leading many women with unrealistic goals where weight is concerned.


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Keywords: eating disorders, women, women with eating disorders, treatment, anorexia, anorexia nervosa, bulimia, bulimia nervosa, weight loss, purge, binge, ednos, triggers

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