Understanding Eating Disorders

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American Academy of Pediatrics

Eating Disorders

Eating is something that most people look forward to. It can mean experiencing good food, doing something healthy for your body, and spending time with family or friends. Many social events such as parties and holidays also involve food. But, for a person who has an eating disorder, eating brings about very different feelings. Constant thoughts about eating and an intense fear of gaining weight become an obsession for a person who has an eating disorder.

Living with an eating disorder is very hard. The road to recovery is not easy but, with treatment, a person can recover and go on to lead a healthy life. Without help, a person with an eating disorder can have a number of medical problems, become very sick, and even die.

The two most common eating disorders are anorexia nervosa and bulimia nervosa. Anorexia is self-starvation. Bulimia is a disorder in which a person eats large amounts of food (“bingeing”) and then rids the body of that food before it can be absorbed (“purging”). A person who is bulimic purges either by vomiting or using laxatives or diuretics (water pills). Some people have symptoms of both anorexia and bulimia.

Anorexia and bulimia starve the body of food. This causes many physical changes to occur which can lead to kidney and liver damage, very low blood pressure, and heart failure. Other physical changes that can happen include:

  • The constant feeling of being cold because the body has lost the fat and muscle it needs to keep warm. This may make the anorexic exercise even more in an attempt to get warm.
  • Eyes become vacant and hollow.
  • Bones stick out and the skin shrinks around the bones, often making the stomach seem like it is sticking out (leading the anorexic to still think that she is fat or overweight).
  • Hair on the head falls out, while fine hair appears on other parts of the body for warmth.
  • Hair and fingernails become brittle and skin becomes dry and rough due to a lack of protein and vitamins in the diet.
  • Menstrual periods stop (or do not start at all if a girl developed anorexia before her first period). This puts the anorexic at higher risk of developing osteoporosis, a disease that causes bones to become brittle and break more easily.
  • Pain in the abdomen, constipation, and bloating.
  • Stunted growth, resulting in permanent short stature.
  • Anemia.

Most anorexics and bulimics are girls; however, boys can suffer from these disorders as well. Adolescents experience many social pressures, especially from the media, to be thin. This pressure to be thin or to diet can be especially strong for teens if their friends are dieting or trying to lose weight. It is easy for teens to get over-the-counter diet pills to reduce their appetite so that they do not eat as much ( a practice that can become habit-forming. Diet pills can raise blood pressure, cause kidney damage, make a person dizzy or hallucinate, or even lead to fatal stroke.

There is no single cause of an eating disorder. Many factors may be involved and are different for each person. Some factors include:

  • Feeling insecure
  • An excessive desire to be in control
  • A distorted body image (feeling fat) and striving for the perfect body
  • A family history of depression or an eating disorder
  • Severe family problems
  • A history of sexual abuse
  • Extreme social pressures
  • Pressure from activities such as running, gymnastics, wrestling, or ballet

It is important, however, for both girls and boys to understand that not everyone has the type of body that is superthin. In fact, only a small number do. If a person is not meant to be naturally thin, that person needs to accept that fact and learn to like his or her body the way it is. It is important to have a healthy attitude toward weight and to feel good about oneself.

Understanding anorexia
Anorexia is self-starvation. This disorder mainly affects females between 14 and 18 years of age. A person with anorexia has such an intense fear of becoming fat that she hardly eats anything and becomes dangerously thin. Anorexics often weigh as little as 80 to 100 pounds. Many anorexics also over-exercise and may abuse diet pills to keep from gaining weight. If the condition gets worse, anorexics can die from suicide, heart attack, or starvation.

Some people who struggle with eating disorders alternate between anorexic and bulimic behaviors. About half of all people who have anorexia at one time or another develop some symptoms of bulimia (mainly the bingeing and purging).

When a person develops anorexia nervosa, her behavior changes, especially in regard to eating. A person with anorexia may:

  • Eat only “safe” foods, usually those low in calories and fat.
  • Cut up food into very small pieces.
  • Spend more time playing with food than eating it, such as rearranging it on the plate throughout a meal.
  • Buy, prepare, and cook food only for others.

As the anorexic becomes more obsessed with food, her personality changes as well. She may become more self-centered, as all her energy and focus is on herself and staying thin. In addition, a person with anorexia may:

  • Exercise compulsively.
  • Wear baggy clothing to hide extreme thinness, or complain that normal clothing is too tight.
  • Spend less time with friends and family, becoming more isolated, withdrawn, and secretive.
  • Develop rituals to keep her mind off her hunger, such as chewing each bite of food 30 times before swallowing.
  • Get angry if she is not able to exercise or if her daily routine is disturbed.

Teens who develop anorexia are usually good students, even overachievers. They try to get along with others, tend to be perfectionists, and do not like to admit they need help with anything. To others they appear to be in control. However, they are actually unsure of themselves, are self-critical, and have low self-esteem. They are very concerned about whether other people like them and about pleasing others. Some of these negative feelings may come from having a poor body image (the way a person feels about how his or her body looks).

Many young people think that losing weight will make them feel better about how they look. This is why most people who develop anorexia start by dieting. The message they get from our culture, including the media, is that a slim body is attractive and desirable. They may also start dieting in response to some kind of major life change, like puberty or going away to college. Because anorexics have low self-esteem, they do not feel confident that they can handle these changes. They do not feel like they have control. Dieting makes them feel better about themselves and becomes something they are able to do well on their own. Over time, the dieting is really no longer about food, but becomes a way for the anorexic to feel like she has control over her life.

Understanding bulimia
Bulimia and anorexia share some of the same symptoms. As with anorexia, food and staying thin become an obsession, but the bulimic does not starve herself. Instead, the bulimic gets an uncontrollable urge to binge (eat a large amount of food in a short period of time) and then purge this food from her body.

Bulimia usually develops between the ages of 15 and 24 and affects mostly females. A bulimic’s weight is usually within the range of what is normal for her size and height, but it tends to go up and down a lot because of all the bingeing and purging.

A bulimic no longer has full control over eating. She may be afraid to eat in restaurants or with other people because she cannot control the urges to binge or the urges to purge after eating normal amounts of food. This fear may cause her to avoid social situations and isolate herself from other people. Bulimics may also change in other ways by:

  • Becoming very secretive about food, spending a lot of time thinking about and planning the next binge, and setting aside certain times to binge.
  • Stealing food or hoarding it in strange places, such as under the bed or in closets.
  • Bingeing on foods with distinct colors in order to know when they are later thrown up.
  • Spending a lot of time, energy, and money, because bulimia is a time-consuming and expensive addiction.

People who develop bulimia often have a hard time dealing with and controlling impulses, stress, and anxieties. They are not happy with their body image and think they are overweight or fat. This leads them to start dieting, but then, in response to anxiety and other emotions, they give in to their impulses and cravings for food by bingeing.

During a binge, a person with bulimia may eat between 3,000 and 7,000 calories, often in less than a few hours. Depression, boredom, or anger often trigger a binge. Eating during a binge is almost robot-like. The bulimic chews and swallows without paying attention to what the food tastes like or whether she is hungry or full. Binges usually end when there is no more food to eat, when the stomach hurts so much from eating, or when something such as a phone call breaks the bulimic’s concentration on bingeing.

After eating large amounts of food, the bulimic feels guilty and is afraid of gaining weight. To ease her guilt and fear, she purges the food from her body by vomiting or taking pills that cause diarrhea. After bingeing she may turn to extreme exercise or strict dieting. This period of “control” lasts until the next binge, and then the cycle starts all over again. Bulimia becomes an attempt to control two very strong impulses ( the desire to be thin and the desire to eat.

The following changes may be signs that a person has bulimia:

  • Teeth start to decay from contact with stomach acids during vomiting. Weight goes up and down.
  • Menstrual periods become irregular.
  • The face and throat look puffy and swollen.
  • Periods of dizziness and blackouts occur.
  • Dehydration due to loss of body fluids occurs. The bulimic may need to be hospitalized if this happens.
  • Damage to vital organs, such as the liver and kidneys, heart failure, and death can occur.

Treating Eating Disorders 

Recognizing the early signs of an eating disorder is important for successful treatment. Otherwise, it may be too late. If someone answers “yes” to any of the following statements, that person should get help right away.

  • I cannot stop dieting, even though my family and friends warn me that I have lost too much weight.
  • Even though I have lost a lot of weight, when I look in the mirror I still think that certain parts of my body are fat.
  • I cannot stop exercising.
  • I do not get my menstrual period monthly.

The chance of successfully treating someone who has an eating disorder is much higher if the disorder is detected early and the person begins to get help. Treatment depends on many things, including the person’s willingness to cooperate, family and support structure, and the stage of the disorder.

Successful treatment of eating disorders involves many health professionals who work together by treating a certain aspect of the disorder. Treatment begins with a visit to a pediatrician, who will examine the person’s medical condition to see how the eating disorder has affected the body. If the effects are severe, the person may need to be hospitalized for treatment.

In treating anorexia, increasing the person’s weight is crucial. If the anorexic needs to be hospitalized, her treatment will focus on getting her weight back up to a normal level. If she refuses to eat, she may need a feeding tube to get the proper nutrients into her body. Hospitalization often helps the anorexic slowly change her behavior so that when she returns home, she can gain weight slowly with outpatient pediatric and psychiatric treatment. A person with bulimia may need hospitalization to control the cycles of bingeing and purging and to replace needed nutrients in the body.

Counseling is necessary to help a person with an eating disorder understand how she uses food as a way of handling problems and feelings. It will help her improve her self-image (including body image) and develop independence so that she can take control of her life in positive ways. A mix of individual therapy and family therapy is usually most effective in treating eating disorders. Since an eating disorder usually affects a person’s entire family, a therapist can try to help family members understand the disorder. The therapist can also help families create a supportive home environment for the person with an eating disorder. Occasionally, people who have eating disorders also have problems with alcohol abuse or other substance abuse, and may need to be treated for those as well.

Anorexia and bulimia are both very serious eating disorders that do not go away by themselves. However, eating disorders are treatable with help. A person with an eating disorder needs professional help to recover and become healthy again.

For other resources and help with eating disorders, contact the following organizations:

National Association of Anorexia Nervosa and Associated Disorders

Box 7
Highland Park, IL 60035
708/ 831-3438

American Anorexia/Bulimia Association

418 E 76th St
New York, NY 10021
212/ 734-1114

Anorexia Nervosa and Related Eating Disorders

Box 5102
Eugene, OR 97405
503/ 344-1144

© Copyright 2000 American Academy of Pediatrics