Eating Disorder Education and Resources

An eating disorder is an illness that manifests itself in a variety of unhealthy eating and weight control habits that become obsessive, compulsive, and/or impulsive in nature. Eating disorders are not just about food and weight, but also may include suffering from issues of self-worth, depression, anxiety, or some other psychological symptoms.

Many sources report approximately 5% to 10% of individuals who suffer from anorexia or bulimia identify as males. Some studies have reported one in six cases of anorexia or bulimia have been found in men and that BED (Binge Eating Disorder) is almost equally present in all genders. Those who identify as male are typically not as likely to seek treatment for an eating disorder, and clinicians are less likely to diagnose these individuals with an eating disorder.

No single approach to eating disorder treatment will work equally for everyone – the right treatment program depends on an individual’s strengths, goals and the nature of their his or her eating disorder. If you or someone you know is suffering from anorexia, bulimia, exercise addiction or an eating disorder not otherwise specified, the first step is to talk about the problem and seek the guidance of an eating disorder therapist and medical professional as soon as possible.

While researching possible treatments, keep the following in mind:

• Treatment often involves a combination of psychotherapy, nutritional counseling, medical and psychiatric management.
• Treatment can take place in an outpatient, partial or day treatment program or 24-hour setting, i.e. residential or hospital setting.
• Treatment can be enhanced by the involvement and participation of family/friends.
• Treatment can be enhanced with the use of recovered professionals or mentors.
• Treatment may require hospitalization, depending upon the severity of the problem.

With any treatment program it is important to explore the behavioral symptoms and any underlying issues that may have caused or serve to perpetuate the eating disorder. Research supports that individuals with eating disorders can become fully recovered.

Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected, or failure to make expected weight gain during period of growth leading to body weight less than 85% of that expected).

Intense fear of gaining weight or becoming fat, even though under-weight.

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.

In postmenarcheal females, amenorrhea,( i.e. absence of at least three consecutive menstrual cycles). An individual is considered to have amenorrhea if their periods occur only following hormone, e.g., estrogen administration.

Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self induced vomiting or the misuse of laxatives, diuretics or enemas).

Binge-Eating/Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge eating or purging behavior (i.e., self induced vomiting or the misuse of laxatives, diuretics, or enemas).

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

• Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
• A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting , misuse of laxatives, diuretics, enemas or other medications; fasting; or excessive exercise.
• The binge eating and other compensatory behaviors both occur, on the average, at least twice a week for three months.
• Self evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa.

Purging Type: during the current episode of bulimia nervosa, the person has regularly engaged in self -induced vomiting or the misuse of laxatives, diuretics or enemas.

Non purging Type: during the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise but has not regularly engaged in self -induced vomiting or the misuse of laxatives, diuretics or enemas.

Recurrent episodes of binge eating. An episode is characterized by:

• Eating a larger amount of food than normal during a short period of time (within any two hour period)
• Lack of control over eating during the binge episode (i.e. the feeling that one cannot stop eating).

Binge eating episodes are associated with three or more of the following:

• Eating until feeling uncomfortably full
• Eating large amounts of food when not physically hungry
• Eating much more rapidly than normal
• Eating alone because you are embarrassed by how much you’re eating
• Feeling disgusted, depressed, or guilty after overeating
• Marked distress regarding binge eating is present
• Binge eating occurs, on average, at least 2 days a week for six months
• The binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e. purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Distinguishing people who overeat from people with binge eating disorder is like distinguishing dieting from anorexia; it is a matter of definition and degree. The marked distress regarding binge eating is present. It is a common misconception that all people with binge eating disorder are overweight, even though most of them are.

In our society, exercise is increasingly being sought, less for the pursuit of fitness or pleasure and more for the means to a thinner body or sense of control and accomplishment. In the climate of this thinness mania, exercisers are particularly vulnerable to problems arising when restriction of food intake is combined with intense physical activity. An individual who loses too much body fat will stop menstruating and ovulating and will become increasingly susceptible to stress fractures and osteoporosis. Yet, similar to individuals with eating disorders, those with an activity disorder are not deterred from their behaviors by medical complications and consequences. People who continue to overexercise in spite of medical and/or other consequences feel as if they can’t stop and that participating in their activity is no longer an option. These people have been referred to as obligatory or compulsive exercisers because they seem unable to “not exercise,” even when injured, exhausted or begged by others to stop. The terms pathogenic exercise and exercise addiction have also been used when describing these individuals who are consumed by the need for physical activity to the exclusion of everything else and to the point of damage or danger to their lives.

The signs and symptoms of activity disorder often, but not always, include those seen in anorexia nervosa and bulimia nervosa. Obsessive concerns about being fat, body dissatisfaction, binge eating and a whole variety of dieting and purging behaviors are often present in activity disordered individuals. Furthermore, it is well established that obsessive exercise is a common feature seen in anorexics and bulimics, in fact, some studies have reported that as many as 75 percent use excessive exercise as a method of purging and/or reducing anxiety. Therefore, activity disorder can be found as a component of anorexia nervosa or bulimia nervosa or, although there is yet no DSM diagnosis for it, as a separate disorder altogether. There are many individuals with the salient features of an activity disorder who do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa. The overriding feature of an activity disorder is the presence of excessive, purposeless, physical activity which, even if the person is an athlete, goes beyond any usual training regimen and ends up being a detriment rather than an asset to their health and well being. Symptoms of Overtraining include:

• Fatigue; loss of emotional vigor
• Reduction in performance and decreased concentration
• Decreased blood lactate, leading to soreness and stiffness
• Autonomic sympathetic insufficiency; inhibited lactic acid response
• Immunosuppression “acute phase” response
• Increased compulsivity
• Decreased anabolic (testosterone) response
• Decreased maximum oxygen uptake
• Increased catabolic (cortisol) response, also known as muscle wasting
• Hypothalamic dysfunction
• Increased central serotonin and GABA adrenal exhaustion

Often, but not always, individuals with eating disorders have other symptoms and co-occurring issues that are not part of the diagnostic criteria for his or her eating disorder. It is not uncommon to see in bulimia and anorexia, symptoms such as:

• Substance abuse
• Self-harming
• Mood disorders
• Personality disorders
• Trauma
• Process disorders

Body Dysmorphic Disorder is a preoccupation with an imagined physical defect in appearance or a vastly exaggerated concern about a minimal defect.

Along with vital signs such as temperature, heart rate, blood pressure, and weight, here are some other tests that are generally recommended:

• Complete Blood Count (CBC)
• Chem-20 panel: Measures electrolytes, liver, kidney, and pancreatic function
• Sma-7 or electrolytes: Usually done with Chem-20, but sometimes alone
• Magnesium and phosphorous levels
• Serum amylase: Indicates pancreatic function and possibly purging
• Thyroid and parathyroid panel: indicates level of metabolic function
• Hormone levels
• EKG: measures heart function
• Chest X-Ray
• Lower esophageal sphincter pressure studies for reflux
• Lactose deficiency tests
• Total bowel transit time
• Protein and iron deficiency tests
• Bone mineral density test

Some medical complications may include:

• Acid Reflux
• Amenorrhea (loss of menstrual cycle)
• Bone density problems (Osteoporosis)
• Bruising of the skin
• Cardiovascular problems
• Dehydration
• Dental problems
• Digestive difficulties
• Dry skin, hair and nails and hair loss
• Edema (swelling of soft tissues resulting from excess water accumulation from laxative or diuretic abuse)
• Electrolyte imbalances
• Gastrointestinal complaints (cramps, bloating, constipation, diarrhea, incontinence)
• Hypo- and Hyperglycemia (low/high blood sugar)
• Hyponatremia (low sodium)
• Infertility
• Iron-deficiency anemia
• Ketoacidosis (high level of acids build up when the body burns fat instead of sugar/carbs)
• Kidney infection and failure
• Lanugo (soft downy hair on face, back, and arms)
• Liver failure
• Low blood pressure or hypotension
• Low body temperature
• Low platelet count
• Malnutrition
• Muscle Atrophy
• Pancreatitis
• Parotid gland swelling
• Seizures
• Sleep problems
• Tearing of esophagus
• Weakness and fatigue