What Are Eating Disorders?

By Dr. Jeanne Rust

Eating disorders are among the most complex conditions of any DSM-IV diagnoses to treat. I am always amazed at the number of people who are still unclear about the nature eating disorders. Eating disorders have one of the highest mortality rates of any psychiatric diagnosis. In fact, anorexia nervosa is the leading cause of death among adolescent females.

How Many People Have Eating Disorders?

Because of the secretiveness and shame associated with eating disorders, many cases are probably not reported. In addition, many individuals struggle with body dissatisfaction and dysfunctional disordered eating attitudes and behaviors. For example, 80% of American women are dissatisfied with their appearance.

Eating disorders do not discriminate between gender, class, race, or even age. They have been diagnosed in children as young as three and in adults as old as 90. Researchers have discovered more and more anorexia nervosa in the elderly, and that now the majority of deaths from anorexia nervosa occur in people over age 65. Eating disorders frequently occur with other mental disorders such as depression, substance abuse, and anxiety disorders.

Eating Disorder Signs and Symptoms

There are three types of eating disorders: anorexia nervosa, bulimia nervosa, and EDNOS (eating disorders not other-wise specified). EDNOS includes disorders that are similar to anorexia or bulimia but have slightly different characteristics. Binge eating disorder is an example.

Anorexia nervosa is diagnosed when the patients weigh at least 15 percent less than the normal healthy weight expected for their height. Individuals with anorexia nervosa refuse to eat enough, often exercise obsessively, and sometimes force themselves to vomit or use laxatives to lose weight.

Over time, the following symptoms may develop as the body goes into starvation:

• menstrual periods cease
• osteopenia or osteoporosis (thinning of the bones) through loss of calcium
• hair/nails become brittle
• skin dries and can take on a yellowish cast
• mild anemia and muscles, including the heart muscle, waste away
• severe constipation
• drop in blood pressure, slowed breathing and pulse rates
• internal body temperature falls, causing person to feel cold all the time
• depression

Individuals with bulimia nervosa can be slightly underweight, normal weight, overweight or even obese. Patients with bulimia nervosa binge eat frequently, and when they binge they may eat astounding amounts of food in a short time. They can eat very rapidly, sometimes gulping down food without even tasting it. Their binges often end only when another person interrupts them, or they fall asleep, or they are in extraordinary pain because their stomachs have been stretched beyond normal capacity.

Binge eaters often feel out of control while binging. After a binge, stomach pains and the fear of weight gain may motivate them to purge by throwing up, using laxatives or diuretics, and/or compulsively exercising. This cycle is usually repeated at least several times a week or, in serious cases, several times a day. I have spoken with many young women who literally purge everything they eat without binging, but by eating small amounts of food (which they consider a binge). Since they don't become drastically thin, their behaviors may go unnoticed by those closest to them.

Bulimia nervosa does have symptoms that ultimately can become fatal:

• chronically inflamed and sore throat
• Salivary glands in the neck and below the jaw become swollen. Cheeks and face often become puffy, causing sufferers to develop a "chipmunk" looking face
• Tooth enamel wears off and teeth begin to decay from exposure to stomach acids.
• Constant vomiting causes gastroesophageal reflux disorder.
• Laxative abuse causes irritation, leading to intestinal problems.
• Diuretics (water pills) cause kidney problems.
• severe dehydration from purging of fluids

People with binge eating disorder have episodes during which they consume very large quantities of food in a brief period of time. They do not try to get rid of the food by purging or using laxatives, diuretics, compulsive exercise or any other unsafe methods. Binge eating is chronic and can lead to serious health complications, including severe obesity, diabetes, hypertension and cardiovascular diseases. Binge eaters feel ashamed and disgusted by their behavior, and the binges are typically done in secret.

Eating disorders are real, treatable medical illnesses with complex underlying psychological, sometimes genetic, and physiological causes. If you think you or someone you know has developed an eating disorder, please do not deny that there is a problem. The sooner a person gets treatment for an eating disorder the faster they can return to being their normal selves. Never forget that death may occur if an eating disorder is left untreated.

Jeanne Rust, PhD, is the founder and CEO of Mirasol, a holistic, integrative, eating disorders treatment center in Tucson, Arizona. Her pioneering work in the use of holistic and complementary interventions for eating disorder treatment has been featured in The Chicago Tribune, USA Today, The San Francisco Chronicle, Time magazine in the United States and Flair magazine in Canada.