Almost everyone overeats from time to time— taking an extra helping at Thanksgiving dinner, for example, or downing dozens of cookies during a late-night study session. But if overeating is a regular and uncontrollable habit, you may be suffering from binge eating disorder.
Binge eaters use food to cope with stress and other negative emotions, but their compulsive overeating just makes them feel worse. Binge eating disorder is more common than bulimia and anorexia and affects a significant number of men as well as women. Binge eating disorder is treatable, however, and with the right help and support, you can learn to control your binge eating.
Symptoms
Behavioral symptoms of binge eating and compulsive overeating
Inability to stop eating or control what you’re eating
Rapidly eating large amounts of food
Eating even when you’re full
Hiding or stockpiling food to eat later in secret
Eating normally around others, but gorging when you’re alone
Eating continuously throughout the day, with no planned mealtimes
Emotional symptoms of binge eating and compulsive overeating
Feeling stress or tension that is only relieved by eating
Embarrassment over how much you’re eating
Feeling numb while bingeing—like you’re not really there or you’re on auto-pilot.
Never feeling satisfied, no matter how much you eat
Feeling guilty, disgusted, or depressed after overeating
Desperation to control weight and eating habits
What are Eating Disorders?
An eating disorder is defined as a continual disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food, significantly impairing physical health or psychological and social functioning.
Eating disorders are often long-term problems, which can cause immeasurable suffering for victims and their families.
There are generally two recognized types of eating disorders:
1. Anorexia Nervosa (AN)
Anorexia nervosa (AN), also known as simply Anorexia, is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. It is often coupled with a distorted self image which may be maintained by various cognitive biases that alter how the affected individual evaluates and thinks about her or his body, food and eating. Persons with anorexia nervosa continue to feel hunger, but deny themselves all but very small quantities of food. The average caloric intake of a person with anorexia nervosa is 600–800 calories per day, but extreme cases of complete self-starvation are known. It is a serious mental illness with a high incidence of comorbidity and the highest mortality rate of any psychiatric disorder.
Anorexia most often has its onset in adolescence and is most prevalent among adolescent girls. [6] However, more recent studies show that the onset age of anorexia decreased from an average of 13 to 17 years of age to 9 to 12. While it can affect men and women of any age, race, and socioeconomic and cultural background,Anorexia nervosa occurs in females 10 times more than in males.
The term anorexia nervosa was established in 1873 by Sir William Gull, one of Queen Victoria's personal physicians.The term is of Greek origin: an- (ἀν-, prefix denoting negation) and orexis (ὄρεξις, "appetite"), thus meaning a lack of desire to eat.
A person with anorexia nervosa may exhibit a number of signs and symptoms, some of which are listed below. The type and severity vary in each case and may be present but not readily apparent. Anorexia nervosa and the associated malnutrition that results from self-imposed starvation, can cause severe complications in every major organ system in the body.
obvious, rapid, dramatic weight loss
lanugo: soft, fine hair grows on face and body
obsession with calories and fat content
preoccupation with food, recipes, or cooking; may cook elaborate dinners for others but not eat themselves
dieting despite being thin or dangerously underweight
fear of gaining weight or becoming overweight
rituals: cuts food into tiny pieces; refuses to eat around others; hides or discards food
purging: uses laxatives, diet pills, ipecac syrup, or water pills; may engage in self-induced vomiting; may run to the bathroom after eating in order to vomit and quickly get rid of the calories.
may engage in frequent, strenuous exercise
perception: perceives self to be overweight despite being told by others they are too thin
becomes intolerant to cold: frequently complains of being cold due to loss of insulating body fat or poor circulation due to extremely low blood pressure; body temperature lowers (hypothermia) in effort to conserve energy
depression: may frequently be in a sad, lethargic state
solitude: may avoid friends and family; becomes withdrawn and secretive
clothing: some may wear baggy, loose-fitting clothes to cover weight loss if they have been confronted about their health and wish to hide it, while others will wear baggy clothing to hide what they see as an unattractive and overweight body.
cheeks may become swollen due to enlargement of the salivary glands caused by excessive vomiting
swollen joints
abdominal distension
bad breath
This disorder's name means "loss of appetite." In reality, the person has not actually lost their appetite, but chooses to deny the hunger because of an unreasonable fear of becoming fat. If left untreated, anorexia nervosa can be fatal, with an estimated fatality rate of 6% in serious cases.
Restrictive Type: Individuals with this specific type of anorexia nervosa limit the amount of food they eat, typically eliminating foods that contain fat. These individuals also tend to exercise excessively to assist in weight loss.
Binge Eating/Purging Type: These individuals are first diagnosed with the restrictive type of anorexia nervosa and then begin to regularly engage in the binge eating and purging behaviors that are more commonly linked with bulimia nervosa.
Individuals with anorexia nervosa can be further categorized based on their eating behaviors.
2. Bulimia Nervosa (BN)
This eating disorder is described by repeated episodes of binge eating, during which large amounts of food are consumed in a short period of time (sometimes as many as 20,000 calories). To be diagnosed with bulimia nervosa, binge eating needs to occur at least twice every week for a 3-month period. As a result of the repeated binge eating, the person often feels depressed and guilty.
Purging Type: Individuals with this specific type of bulimia nervosa will have an episode of binge eating followed by self-induced vomiting, abuse of laxatives and/or diuretics (water-pills) to avoid gaining weight from the binge.
Non-Purging Type: Individuals with this specific type of bulimia nervosa will have an episode of binge eating and then use other behaviors to offset the behavior, such as fasting or excessive exercise. Individuals with this type of bulimia nervosa do not regularly engage in self-induced vomiting or the misuse of laxatives and/or diuretics.
Individuals with bulimia nervosa can be further categorized based on their purging behaviors.
Many times it is difficult to differentiate between anorexia nervosa and bulimia nervosa. Every individual who resorts to binge eating and purging may not be classified as bulimic because of the subgroup of patients diagnosed with anorexia nervosa who may also display these behaviors. Furthermore, a large percentage of individuals may have both eating disorders at the same time. It has been estimated that 50% of anorexics will develop bulimia nervosa and that 30% to 40% of bulimics will develop anorexia nervosa.
3. Binge Eating Disorder (BED)
This eating disorder is characterized by recurrent consumption of large amounts of food without purging, fasting, or excessive exercise. The difference between binge eating disorder and non-purging type bulimia nervosa is the behavior that takes place after binge eating. In non-purging type bulimia nervosa after binge eating the individual will try to offset their calorie consumption by fasting or excessive exercise. In binge eating disorder the individual does nothing to offset the calorie consumption.
What is EDNOS?
EDNOS, Eating disorder not otherwise specified, is described as a category disorders of eating that do not meet the criteria for any specific eating disorder. People diagnosed with EDNOS may frequently switch between different eating patterns, or may with time fit all diagnostic criteria for anorexia or bulimia. People who eat a normal amount of food, but become exceedingly obsessed with healthy eating, or strictly categorize normal foods or entire food groups as "safe" and "off-limits", may be referred to as having orthorexia. However, this diagnosis is not formally accepted by the psychiatric community.
What causes Eating Disorders?
The exact cause of eating disorders is unknown; however, physical, psychological, personal, and social issues have been associated with triggering eating disorders.
The social pressure to be thin affects everyone to some extent. Society is flooded with messages on TV, in the movies, in magazines, on billboards, and on the Internet that thinness brings beauty, success, and happiness. These messages can also come from an individual's family structure, culture, and way of life. Social and cultural pressures along with a low self-esteem are thought to be the major causes for the development of anorexia nervosa and bulimia nervosa. Compare your technique with the methods recommended in our Using Medicine section.
No one factor causes an eating disorder, but a few or a combination of factors may increase the risk.
Here are some common psychological factors that may contribute to developing eating disorders:
For anorexia:
fear of growing up
inability to separate from the family
need to please or be liked
perfectionism
need to control
need for attention
lack of self esteem
high family expectations
parental dieting
family discord
temperament - often described as the "perfect child"
teasing about weight and body shape
For bulimia:
difficulty regulating mood
more impulsive - sometimes with shoplifting, substance abuse, etc.
sexual abuse
family dysfunction - If individuals are at risk of developing an eating disorder, sometimes all it takes to put the ball in motion is a trigger event that the individual does not know how to handle. A trigger could be something as seemingly harmless as teasing or as devastating as rape.
Who has Eating Disorders?
Currently, it is estimated that 7 million women and 1 million men suffer from an eating disorder. Eating disorders have reached epidemic levels in America in all segments of society; however, eating disorders are most common in individuals who have a higher social or economic background. This may be due to the fact that these individuals are continually striving to achieve the social standards of thinness in order to be accepted into their chosen career or lifestyle.
Almost all (86%) anorexics and bulimics begin their eating disorder related behaviors by the age of 20; however, reports that eating disorders are occurring in children 8 to 11 years of age are on the rise. Also, adults are not immune to eating disorders. A significant number of newly diagnosed anorexics and bulimics are in their upper 20s, 30s, and 40s.
It is estimated that about 6% of persons with serious cases of eating disorders die and only 50% report being cured. Therefore, it is a debilitating disease that has consequences if it is not realized (by the individual or people around them) and treated correctly.
What are the risk factors of Eating Disorders?
Risk factors are characteristics that can make you more likely to develop a condition. The risks associated with developing an eating disorder are related to the following:
Family history of anorexia nervosa or bulimia nervosa
Less than 20 years of age
Female gender
Participating in activities that focus on weight, appearance, and lean body mass (for example, ballet, modeling, gymnastics, acting, figure skating, running, diving)
Existing psychiatric illness such as obsessive-compulsive disorder (a type of anxiety distinguished by patterns of repetitive thoughts and behaviors) or depression.
Presence of personality traits such as being a perfectionist (having the best or expecting the best at all times) and low self-esteem.
Symptoms of Eating Disorders
The main symptom of anorexia nervosa is self-induced starvation.
The main symptom of bulimia nervosa is binge eating with purging.
The main symptom of binge eating is out of control eating without purging.
These disorders may become a compulsive addiction such as alcoholism. Most patients with anorexia nervosa, bulimia nervosa, and binge eating disorder report psychological impairments (mainly depression), shame, guilt, and withdrawal from social events.
Because many people are concerned about their weight, most people diet at least once in a while; however, it may be difficult to distinguish between normal dieting behaviors and abnormal dieting behaviors that could develop into a serious eating disorder. Not every individual will show all of the characteristics listed below for anorexia nervosa and bulimia nervosa, but people with eating disorders may clearly show several of them.
Signs of anorexia nervosa may include the following:
Intentional self-starvation associated with weight loss
Intense, persistent fear of gaining weight
Refusal to eat, except tiny portions
Pretending to eat and trying to hide that you are not eating from others
Continuous dieting
Excessive facial/body hair due to inadequate protein in diet (malnutrition)
Abnormal, rapid weight loss
Hair loss - mainly on the head
Dry, cracked, or discolored skin
Sensitivity to cold temperatures
Absent or irregular menstruation.
Signs of bulimia nervosa may include the following:
Constantly thinking about food
Binge eating, usually in secret
Vomiting after binging
Abuse of laxatives, diuretics, diet pills
Denial of hunger
Denial of induced vomiting
Swollen salivary glands
Anorexia nervosa and bulimia nervosa are closely related and several characteristics of the two eating disorders often overlap.
Signs associated with both anorexia nervosa and bulimia nervosa may include the following:
Poor body image (constant thoughts of thinness)
Malnutrition
Anxiety
Lethargy (sluggish, inactive, or slow moving)
Decreased concentration
Abdominal pain
Constipation/diarrhea
Bloating
Compulsive exercise (a person feels compelled to exercise and struggles with guilt and anxiety if she or he doesn't exercise)
If continued, the starving, binge eating, and purging can lead to irreversible physical damage and even death. Eating disorders can affect every cell, tissue, and organ in the body. The following is a list of some of the physical and medical dangers associated with anorexia nervosa and bulimia nervosa.
Malnutrition (can lead to loss of muscle and bone density [osteoporosis] resulting in dry, brittle bones)
Severe dehydration, which can result in kidney failure and chemical imbalances (can lead to seizures, irregular heartbeats and possibly heart failure and death)
Tearing of the esophagus from excessive vomiting
Chronic irregular bowel movements and constipation as a result of laxative abuse
Potential for a ruptured stomach during periods of binge eating
Tooth decay and gum erosion from stomach acids released during frequent vomiting
Irregular menses or absence of menstruation
Abnormally low blood pressure.
How are Eating Disorders Treated?
There are many factors that contribute to the development of an eating disorder, and because each individual's situation is different, the "best treatment" must be tailored for that individual. The process begins with an evaluation by a physician or psychiatrist. From there, a variety of approaches are used to treat individuals with anorexia nervosa and bulimia nervosa.
Nutritional Therapy
A professional nutritionist or dietician can help patients learn how to manage their weight effectively. Individualized guidance and a meal plan that provides a framework for meals and food choices (but not a rigid diet) are helpful for most individuals. Nutritionists can also help individuals better understand how their eating disorders can create serious medical problems.
Drug Therapy
Drug therapy in the treatment of anorexia nervosa and bulimia nervosa should be used in combination with psychotherapy and nutritional therapy.
For anorexia nervosa, medications are used most frequently after weight and normal eating behaviors have been restored. Medications including certain antidepressants, antipsychotics, and gastrointestinal stimulants are used to treat psychiatric and gastrointestinal symptoms that may coincide with eating disorders. Also calcium plus vitamin D supplementation is recommended for people with low bone mineral density (BMD) because of their high risk of developing bone loss and/or osteoporosis.
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