Need To Know: Eating Disorders
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Oct 7, 2022.
What Are Eating Disorders?
An eating disorder is a condition that leads people to overeat, starve themselves, or adopt other unhealthy behaviors. Many factors can play a role in the causes of eating disorders, including biology, emotional health, societal expectations and trauma.
In the U.S., over 30 million people suffer from an eating disorder, often women between the ages of 12 and 35. Plus, 13% of women over age 50 engage in eating disorder behaviors, too. But many cases likely go unreported.
There are three main types of eating disorders:
- Binge eating disorder.
People with an eating disorder tend to be perfectionists, usually “feel fat”, and see themselves as overweight, even despite life-threatening semi-starvation. An intense fear of gaining weight may consume them.
Are You Suffering From an Eating Disorder? – Red Flag Signs
Ask yourself these questions.
- Do you feel fat even though you’re not?
- Do you lie about how much you eat?
- Are others concerned about your eating habits?
- Do you feel powerful when you go without food, over-exercise, or purge?
- Do you base your self-worth on your body weight?
- Do you vomit or take laxatives to control your weight?
- Do you starve yourself?
- Do you eat until you feel sick?
- Do you think about food all the time?
- Do you feel disgusted or ashamed after eating?
- Do you eat privately so no one will see you eating?
- Do you weigh yourself several times a day?
Did you answer 'yes' to some of these questions? If so, you may have an eating disorder.
What is Anorexia Nervosa?
Anorexia nervosa is an eating disorder where the person severely cuts down on the amount of food they eat, resulting in dramatic weight loss.
In addition, the following may be used inappropriately to lose weight:
- Excessive exercise
- Diet pills
- Vomiting after eating (purging)
Most often the person with an eating disorder has an intense fear of becoming fat and has a distorted view of their body image even if they are already underweight. Someone will typically deny there is a problem even when it is evident to all that it is serious. They can undergo quite sudden personality and mood swings.
Food is the Enemy
Probably the biggest single symptom of anorexia is anxiety around food. This can manifest itself by the person skipping meals, cutting out previously eaten food types and being secretive about eating.
People with anorexia may:
- Portion their food carefully
- Eat very small amounts of restricted foods
- Count calories
- Obsessively weigh food before eating it
- Move food around the plate without actually eating anything
- Be very confrontational and aggressive when asked about eating habits.
Anorexia - Red Flag Symptoms
Signs and symptoms of anorexia may include:
- Extremely low body weight
- Severe food restriction
- Relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body image and self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
- Lack of menstruation among girls and women.
What Are the Physical Effects of Anorexia?
Severe calorie restriction has dire physical effects. When your body doesn’t get the fuel it needs to function normally, it goes into starvation mode. Some of the physical effects include:
- Brittle hair, nails, or yellowing skin
- Fine hair growth all over the body
- Cold sensitivity
- Loss of menstrual periods or infertility
- Lethargy, sluggishness, or feeling tired all the time
- Long-term problems can include anemia, thinning bones, damage to the heart, organ failure, and death.
What is Bulimia Nervosa?
Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, followed by frantic efforts to avoid gaining weight such as:
- Forced vomiting
- Excessive use of laxatives or diuretics
- Excessive exercise
- A combination of these behaviors.
Unlike anorexia nervosa, people with bulimia nervosa usually maintain a normal weight, while some are slightly overweight, but sufferers have an intense fear of gaining weight and are unhappy about their body size.
The binge-purge cycle may happen several times a day or several times a week. It is often done in secret because of feelings of shame, disgust and embarrassment.
Bulimia: All or Nothing Signs of Binge Eating
- Lack of control over eating and eating until the point of physical discomfort and pain.
- Secrecy surrounding eating. Late-night kitchen visits; unexpected food runs; wanting to eat in privacy.
- Eating large amounts of food with no change in weight.
- Disappearance of food, empty wrappers, or hidden stashes of junk food.
- Alternating between overeating and fasting, and rarely eats a normal meals.
With bulimia, it’s all-or-nothing when it comes to food.
Bulimia: Signs Of Purging
Signs of purging may include:
- Disappearing after meals for a bathroom trip to purge, and may run water to hide sounds of vomiting.
- Using laxatives, diuretics, or enemas after eating; diet pills to curb appetite; sauna use to “sweat out” water weight.
- The bathroom or the person may smell like vomit; they may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
- Working out strenuously, especially after eating.
Bulimia – What Are The Physical Signs Of Bulimia?
- Calluses or scars from sticking fingers down the throat to induce vomiting.
- Sore throat, tooth decay and bad breath caused by excessive vomiting
- Swollen salivary glands making the face rounder
- Poor skin condition
- Normal weight or slightly overweight; being underweight while purging might indicate a purging type of anorexia
- Frequent fluctuations in weight
- Irregular periods
The Serious Effects of Bulimia
The most dangerous side effect of bulimia is dehydration due to purging.
- Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels.
- Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death.
- Long term, low levels of potassium can also result in kidney failure.
What is Binge Eating Disorder?
Compulsive overeating, consuming huge amounts of food, and basically feeling out of control characterize binge eating disorder.
Binge eaters may eat when they’re not hungry and continue to gorge after they’re full. Food may not be fulfilling or even taste good.
People with binge eating disorder do not purge; therefore, they often gain weight and may be at risk for high blood pressure, heart disease, and the other risks of obesity.
People with binge eating disorder also suffer emotional distress and guilt, which can compound their binge eating habits.
Binge Eating Disorder – Red Flag Signs
The following warning signs could be due to an eating disorder:
- An 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
The Effects of Binge Eating
People with binge eating disorder report more health issues, stress, insomnia, and suicidal thoughts than people without an eating disorder. Depression, anxiety, and substance abuse are common. The most prominent effect of binge eating disorder is weight gain.
Over time, binge eating usually leads to obesity. Obesity, in turn, causes numerous medical complications, including:
- Type 2 diabetes
- Heart disease
- High blood pressure
- High cholesterol
- Higher risk for cancer
Where To Look For Help
If you or a loved one is struggling with an eating disorder, don't hesitate to talk about it. Voice your concerns respectfully, avoiding guilt or blame. If you need help, consider asking for it. Focus on the specific behaviors that worry you.
- Encourage the loved one to get help, or seek it for yourself with a friend's help. Taking the first step is always the hardest.
- A reputable place to start is the National Eating Disorders Association, or by phone at 1-800-931-2237.
- The road to recovery can begin once you realize help is there. Initially you could seek help from a doctor, school nurse or counselor.
What’s Treatment Like?
The exact treatment needs of someone struggling with an eating disorder will vary according to the individual.
Treatment usually involves a team of health professionals and might include a family doctor, a psychologist, a nutritionist, a social worker, and a psychiatrist.
Treatment may involve a combination of nutritional counseling, talk therapy, and in some cases -- drug treatment. Therefore, it is important that a health care professional help plan any treatment with patients and family members.
Drug Treatment for Anorexia Nervosa
The first step in treating anorexia nervosa is to assist patients with regaining weight to a healthy level. Some patients may need to be hospitalized to treat problems caused by malnutrition.
Psychotherapy is an evidence-based treatment that is used.
No medicines are FDA-approved to treat anorexia as they have limited effect as individual agents. Patients with low body weight may also be at risk for added side effects from drug treatment.
- If nutritional therapy plus psychotherapy is not optimal, the "off-label" use of olanzapine (Zyprexa) 2.5 mg to 10 mg per day may be a useful option. "Off-label" use of a drug refers to when a doctor prescribes a drug for a different purpose than those formally approved by the FDA and found in the package labeling of the drug.
- Antidepressants such as an SSRI may be helpful for depression that is difficult-to-treat with standard psychotherapy. A 4 to 8 week trial of drug treatment is typical used.
- Do not use bupropion (common brands include: Aplenzin, Forfivo XL, Wellbutrin SR, Wellbutrin XL) in patients who have, or have a history of an eating disorder such as anorexia nervosa or bulimia due to an elevated risk for seizures. This Contraindication can be found in the product labeling of bupropion products.
After recovery, maintenance psychotherapy is typically the long-term treatment of choice; long-term drug treatment appears to offer no advantage to prevent a relapse..
Drug Treatment for Bulimia
For patients with bulimia, interrupting the binge-purge cycle is key.
Research has shown that antidepressants including SSRIs like fluoxetine (Prozac) can help break the cycle, prevent relapses and may also help with depression or anxiety. SSRIs are typically preferred as they are better tolerated than tricyclic antidepressants (TCAs). Combining psychotherapy with antidepressants may be the most effective treatment for bulimia.
- Prozac is specifically FDA-approved to treat bulimia and is considered a first-line agent in treatment guidelines.
- Other SSRIs (sertraline, escitalopram, fluvoxamine) may be a reasonable second-line option.
- Tricyclics, trazodone or topiramate are 3rd line choices, and are selected based on weight concerns and presence of anxiety or major depressive disorder.
Maintenance drug therapy is typically extended for at least 6 to 12 months after initial recovery, as relapse is common.
Do not use bupropion in bulimia due to elevated risk for seizures.
Drug Treatment for Binge Eating Disorder
For patients with binge eating disorder it is important to help them interrupt and stop binges. Psychotherapy or behavioral therapies, such as cognitive-behavioral therapy (CBT), are considered first-line therapy for binge eating disorder. Treatment with medications may need to be added in patients who do not fully respond to psychotherapy.
Prozac (fluoxetine), or other SSRIs, have also been used off-label, meaning it is not specifically approved for this use by the FDA, but may be prescribed by your doctor if they feel it will be useful, in their best judgement. SSRIs may be better tolerated than Vyvanse, which also has the potential for abuse or diversion.
The carbonic anhydrase inhibitor anticonvulsants topiramate or zonisamide are other "off-label" options for patients with weight problems and binge eating disorders when psychotherapy is not fully effective or not available.
Where to Get Help
Restoring a person to normal weight only addresses half the problem. Learning to cope and having a reliable support system is key.
Counseling, either individual, group or family, is also needed to help patients understand the thoughts, emotions and behaviors that trigger these disorders. Nutritional counseling and therapy can also help the person establish healthy eating habits and develop a better relationship with food and eating.
While family and friends can be a huge help in providing support, patients may also want to join an eating disorder support group. These groups provide a safe environment for conversation about eating disorders and recommendations.
You can also find online support groups for eating disorders. The following organizations can provide reliable information on eating disorders:
Finished: Need To Know: Eating Disorders
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- Anorexia nervosa in adults: Pharmacotherapy. Up to Date. Accessed Oct 6, 2022 at https://www.uptodate.com/contents/anorexia-nervosa-in-adults-pharmacotherapy
- National Institute of Mental Health (NIMH). National Institutes of Health (NIH). Eating Disorders. Accessed Oct 6, 2022. https://www.nimh.nih.gov/health/topics/eating-disorders
- Eating disorders: Overview of prevention and treatment. Up to Date. Accessed Oct 6, 2022 at https://www.uptodate.com/contents/eating-disorders-overview-of-prevention-and-treatment
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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.