Eating Disorders

What are eating disorders?

They're psychiatric disorders with physical manifestations that occur when an individual's eating and nutrition becomes unhealthy or dysfunctional. They often start with weight loss, or the intention to lose weight, and take on a life of their own. Approximately 90 percent of eating disorders occur in women.

How many different types of eating disorders are there?

There are three classifications:

1. Anorexia nervosa, which is present when an individual:

   • refuses to maintain weight within a normal range for height and age -- more than 15 percent below ideal body weight

   • has an irrational fear of weight gain or becoming fat

   • has severe body image disturbance

   • no longer has a menstrual cycle -- in women of the appropriate age

   There are two subtypes of anorexia nervosa -- restricting, in which patients only restrict eating to reduce their weight, and binge eating/purging, in which patients may either binge or use purging to control their weight.

2. Bulimia nervosa, which is distinguished by binge eating with:

   • a sense of loss of control

   • behavior to offset it through purging -- self-induced vomiting or laxative or diuretic abuse

   • behavior to offset it through non purging -- excessive exercise, fasting or strict diets

   • dissatisfaction with body shape and weight

3. Eating disorder not otherwise specified, which includes patients with eating patterns and weight management habits that are clearly abnormal, but don't meet the criteria for anorexia nervosa or bulimia nervosa.

What influences eating disorders?

There's really no consensus, but they're probably related to a combination of psychological, biological, family, genetic, environmental and social factors. For example, individuals with a history of eating disorders can also have anxiety, depression or obsessive-compulsive disorder.

There's also a lot of societal pressure. Just look at the cover of most women's magazines -- they typically highlight stories about weight management, dieting or how to tighten specific muscle groups. Also, think about the recent reality TV shows like "The Swan."

What are some of the indicators for eating disorders?

It's important to note that eating disorders are illnesses of denial and secrecy; they're often very difficult to track down. So family members and friends shouldn't feel bad about not figuring out if their loved one has a problem right away. That being said, there are some signs you can look for:

• unexplained weight loss

• dizziness

• fainting

• fatigue

• irritability or moodiness

• going to the bathroom often, especially after meals

• cutting food into tiny pieces and pushing it around the plate

• any major change in eating or exercise behavior

How are eating disorders diagnosed?

A pediatrician or primary care physician can typically diagnose an eating disorder by obtaining a complete medical history from a patient and conducting a thorough physical exam. They will also most likely request a full lab assessment, as well nutritional and psychiatric evaluations. It's important to remember that the sooner an eating disorder is diagnosed, the sooner the person can get help.

How are eating disorders treated?

Eating disorder patients are typically seen by a physician and nutritionist, as well as a psychologist or social worker.

If an individual becomes really sick -- their condition gets worse and worse causing unstable vital signs, for example -- they should be admitted to the hospital and placed on special meal plans with weight gain goals.

What are some of the medical complications that can occur as a result of eating disorders?

Several can occur during starvation or persistent purging, such as:

• cardiovascular issues like an abnormally slow heart rate or arrhythmias

• gastrointestinal dysfunction like constipation, severe heartburn or reflux

• dermatologic problems like hair loss

• bone loss leading to osteoporosis or even growth problems

These and other medical complications put each patient at serious risk.

What are some resources for patients and their families?

The National Eating Disorders Association (nationaleatingdisorders.org) is a good source, as well as the National Association of Anorexia Nervosa and Associated Disorders (www.anad.org).

Source: Sara Forman, MD, director of Children's Hospital Boston's Outpatient Eating Disorders Program.