Eating disorders
Eating disorders affect both sexes, but the occurrence of eating disorders in females is 2.5 times greater than it is in males. Eating disorders typically appear during the teen years or young adulthood, but they can start earlier or later in life.
Eating disorders are real, treatable illnesses. They typically co-exist with other illnesses, including substance use, anxiety disorders, and depression. Eating disorders, especially anorexia, can be life threatening without treatment.
Anorexia nervosa
Anorexia nervosa causes people to lose more weight than is healthy. Individuals with this disorder have an intense fear of gaining weight. Often it starts during the preteen to teen years. It is more prevalent in females.
The etiology is unknown. Genetics, hormones, and social attitudes may play a role in developing anorexia nervosa. This condition has the following risk factors:
- A history of anxiety disorder or eating problems as a child
- Worry about the weight and shape of the body, and a negative self-image
- An exaggerated focus on rules and trying to be perfect
Signs and symptoms of anorexia nervosa include the following:
- Being underweight, an intense fear of gaining weight, and a very distorted body image
- Severely limiting the amount of food eaten and refusing to eat around others
- Exercising all the time
- Going to the bathroom right after meals, vomiting secretly after eating, or using diuretics, laxatives, or diet pills
- Blotchy or dry yellow skin covered with fine hair and a dry mouth
- Confused, poor memory or judgment, slow thinking, depression
- Extreme sensitivity to cold
- Osteoporosis, wasting away of muscle, and loss of body fat
The provider will order extensive laboratory tests to look at thyroid, liver, and kidney function. An electrocardiogram and bone density test may also be ordered. Many healthcare facilities have patients with eating disorders who get on the scale backward, so they cannot see their weight. Treatment focuses on helping these patients recognize they have an illness. Many types of treatments are available, including psychotherapy (e.g., cognitive behavioral therapy, group therapy, and family therapy) and support groups. Compliance with treatment is difficult, and it is common for the disease to return.
Binge eating disorder
Binge eating disorder, also called compulsive overeating, is the most common eating disorder in the United States. It occurs when people regularly eat unusually large amounts of food in a short amount of time. They feel out of control and unable to manage what or how much they eat. A person may have a binge eating disorder if this behavior occurs weekly for 3 months. It affects young women and middle-aged men.
The exact cause is unknown. Genetics, depression, stress, unhealthy dieting, and changes in brain chemicals may be factors in the condition. Here are the signs and symptoms of binge eating disorder:
- Eating quickly and eating until uncomfortably full
- Eating when not hungry
- Eating huge amounts of food over a very short period of time
- Eating in secret
- Feeling disgusted, ashamed, or depressed about one’s eating patterns
- Frequent dieting
A physical exam and a psychological evaluation will be done. Blood and urine tests (e.g., cholesterol, blood glucose) may be done to evaluate the consequences of binge eating. Treatment may consist of behavioral weight-loss programs and psychotherapy (e.g., cognitive behavioral therapy, interpersonal psychotherapy, and dialectical behavior therapy). Medications may also be used, including lisdexamfetamine (Vyvanse), topiramate (Topamax, Qudexy XR, Trokendi XR), and antidepressants.
Bulimia nervosa
Bulimia nervosa, or bulimia, causes overeating that leads to purging and can be a life-threatening disorder. Self-induced vomiting, laxatives, weight-loss supplements, and enemas may be used to prevent weight gain. Bulimia may also occur with anorexia nervosa. More females than males have bulimia. It is more common in teens and young women.
The etiology is unknown. Genetics, hormones, and social attitudes may play a role in the development of bulimia. Here are the signs and symptoms of bulimia nervosa:
- Broken blood vessels in the eyes (this occurs from the strain of vomiting)
- Dry mouth and a pouchlike look to the cheeks
- Rashes and pimples
- Small cuts and calluses on the tops of fingers (from inducing vomiting)
- Dehydration and electrolyte imbalance
- Other people may notice the following behaviors:
- Excessive exercising
- Eating large amounts of food or buying large amounts of food that disappear right away
- Trips to the bathroom after meals
- Discarded boxes from laxatives, diet pills, and emetics to induce vomiting, or diuretics
The provider will do a physical exam and urine and blood tests. Treatment is usually on an outpatient basis unless the individual has a co-existing diagnosis. Support groups, counseling, and medications can be helpful.
Other eating disorders
Additional eating disorders to be aware of are as follows:
- Pica: Eating of nonfood materials, such as paper, ice, clay, or dirt. Seen in children and during pregnancy. May be caused by a lack of certain nutrients that produce unusual cravings - cravings for ice, starch, or dirt are often linked to iron deficiency, which is especially important to recognize during pregnancy.
- Rumination disorder: A condition in which a person regurgitates food from the stomach and rechews the food.
- Avoidant/restrictive food intake disorder (ARFID): Similar to anorexia because it limits the amount of food consumed, but with ARFID, the person is not stressed about body shape or size. When the condition occurs in children, the child does not consume enough calories to grow and develop. Previously called selective eating disorder.