Eating Disorders

In many affluent industrialized nations, eating disorders have reached near epidemic proportions. According to the National Eating Disorder Association (NEDA), 20 million women and 10 million men in the US will have an eating disorder at some point in their lifetime. An estimated 24 million people currently suffer from an eating disorder, with some groups, such as adolescent and college-age women, suffering in alarming numbers. In 2006, the National Eating Disorder Association reported that 1 in 5 college women suffers from an eating disorder. Yet these disorders often go undiagnosed and untreated. It is estimated that only about 10% of people with eating disorders seek treatment.

This page is designed to provide readers with both basic eating disorder “warning signs” and more detailed clinical information. If you have concerns about yourself or others, we encourage you to complete an online screening and/or visit your local health care professional.

Bradley students may access an online screening service at Mental Health Screening. (Keyword: Bradley University).

Are my body concerns and eating practices “normal”?

Only a health care professional can provide a comprehensive and accurate assessment of your health. However, you might want to consider these broad guidelines.

Normal body-image and eating concerns

Interest in improving physical appearance, health, and overall wellness
Enthusiasm about a new fitness or healthy eating plan
Focus on body image, while maintaining a reasonable level of self-acceptance
Pursuit of a challenging physical training program that incorporates good nutrition and balance

Problematic body-image and eating concerns

Singular focus on weight loss or obsession with restrictive (yo-yo) dieting
Punitive approach to body image which includes self-denigrating comments and/or excessive exercise or purging after eating
Working out to lose weight without regard for health and nutritional needs
Self-worth based entirely on body image
Compulsive, rigid or inflexible approach to a diet/exercise routine.

Etiology: What Causes Eating Disorders?

There is no single cause of eating disorders but rather they result from multiple influences—social, psychological, developmental, biological, and genetic.

Genetic factors

Twin Studies look at Heritability (a percentage representing how much genes contribute to the development of an eating disorder in a particular group of people):

Bulimia = 54%. Bullik et al (2001) found evidence of bulimia susceptibility on chromosome 10
Anorexia = 58%. Thornton et al (2011); Grice et al (2002) found evidence of anorexia susceptibility on chromosome 1
Binge-Eating = 41%. (Striegel-Moore & Bulik, 2007)
Evidence suggests that eating disorders are likely the result of the combined influence of many genes, not just a single gene.

Family studies examine the prevalence of eating disorders within groups of genetically related individuals. They have found that:

Biological relatives of individuals with Anorexia and Bulimia are 7 to 12 times more likely to have an eating disorder than the general population.
Family members of an individual with an eating disorder are 2 to 3.5 times more likely to suffer from bipolar or unipolar depression.
Family members of an individual with bulimia have a 3-4 times higher risk for substance abuse.

Psychological, behavioral, physiological and cultural factors

Keel (2005) and Striegel-Moore & Bulik (2007) describe a range of psychological, behavioral, physiological and cultural factors associated with the development of eating disorders:

Personality

Anorexia: high levels of perfectionism and constraint, higher levels of negative emotion (i.e. depression and anxiety)
Bulimia: high levels of impulsiveness and poor emotional regulation, higher levels of negative emotion (i.e. depression and anxiety)

Behavior
- Dieting behavior and initial weight loss is positively reinforced through compliments and attention; increasing value and using foods as rewards can reinforce binges.
- The experience of eating can become a punishing experience, due to physical discomfort, anxiety, shame over eating, and shame over one’s body/shape.

Cognition
- Those with anorexia or bulimia pay more attention to information about food and body weight/shape than those without an eating disorder.
- Dichotomous thinking (or black-and-white thinking) – foods get classified as good/bad; losing weight = good, gaining weight = bad.
- Cognitive rigidity – individuals continue with a specific course of action, without reevaluating it consequences.
- These cognitions may reflect a consequence of an eating disorders and don’t necessarily predate the onset of an eating disorder.
Physiology

Low or abnormal Serotonin (5-HT)
Serotonin plays a role in eating and weight regulation.
Even after recovery some functioning of serotonin is still abnormal, suggesting that a serotonin abnormality may predispose certain individuals to the development of an eating disorder.

Culture/Society

Western culture’s emphasis on thinness is internalized leading to body dissatisfaction, dieting, and restriction which then leads to over-eating in some individuals.
For females: widespread objectification of the female body teaches girls and women that they are valued only for their looks.

Treatment

Many individuals with eating disorders never receive any form of treatment. Why is this?

Reluctance to treat those who don’t appear ill and emaciated
Lack of money or access to health services
Lack of insurance coverage (See http://www.eatingdisorderscoalition.org/)

Treatment is more likely when an individual has more severe symptoms, impaired psychosocial functioning (i.e. problems at school, home, or job) or a personality disorder or mood disorder (Keel, 2005).

Treatment options for an eating disorder is dependent upon the individual, their symptoms, as well as other factors such as other psychological disorders, but anyone suffering with disordered thoughts should have the ability to seek treatment and find it beneficial.

Inpatient Treatment

Spend 24 hours per day in treatment
Controlled environment, close monitoring, intensive therapy
Patients are often either underweight or purging frequently or suicidal, but very often treatment centers encourage patients to begin treatment as inpatients in order to break their cycle.

Outpatient Treatment

Day programs, evening programs, or intensive group and individual therapy that occurs weekly, biweekly, or monthly
Day programs involve 2 or 3 monitored meals and snacks and group therapy, but there is less medical monitoring and patients spend evenings and nights at home.

Cognitive-Behavioral Treatment

An empirically supported directive therapy that is organized around the theory that disorders are composed of reinforced behaviors to which there are healthier alternatives and irrational beliefs that need to be elicited, challenged, and replaced
Preliminary studies show individuals with anorexia treated with CBT saw 60% good outcomes out of the sample of patients (Murphy 2010).
Shown to be particularly effective with bulimia and binge-eating disorder,
- In 30-50% of Bulimia cases it eliminates binge-eating and purging
- Over 50% of Binge Eating Disorder individuals recover with this treatment

Medication

Antidepressants and mood stabilizers have been used to treat Anorexia, Bulimia, and Binge Eating Disorder, particularly when used to address simultaneous disorders such as depression, bipolar disorder, and anxiety disorders.

More Information

Web-Based Resources

Eating disorder warning signs

Anorexia Nervosa (Detailed Diagnostic Criteria)

Deliberate self-starvation with weight loss
Intense, persistent fear of gaining weight
Refusal to eat or highly restrictive eating
Continuous dieting
Excessive facial/body hair because of inadequate protein in the diet
Compulsive exercise
Abnormal weight loss
Sensitive to cold
Absent or irregular menstruation
Dry, brittle, thinning hair, or hair loss

Bulimia Nervosa (Detailed Diagnostic Criteria)

Preoccupation with food
Binge eating, usually in secret
Vomiting after bingeing
Abuse of laxatives, diuretics, diet pills
Denial of hunger or drugs to induce vomiting
Compulsive exercise
Swollen salivary glands
Calloused knuckles
Broken blood vessels in the eyes

Binge-Eating Disorder (Detailed Diagnostic Criteria)

Recurrent episodes of binge eating, defined as

Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of being embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or feeling very guilty after overeating

A sense of lack of control over eating during binging episodes
Marked psychological distress regarding binge eating

Orthorexia Nervosa

Criterion A.

Obsessive focus on “healthy” heating, as defined by a dietary theory or set of beliefs whose specific details may vary;
Marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy;
Weight loss may ensue as a result of dietary choices, but this is not the primary goal.

As evidenced by the following:

Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health.
Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame.
Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy eating.

Criterion B.

The compulsive behavior and mental preoccupation become clinically impairing by any of the following:

Malnutrition, severe weight loss or other medical complications from restricted diet.
Intrapersonal distress or impairment of social, academic, or vocational functioning secondary to beliefs or behaviors about healthy diet.
Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behavior.

Last update: 18 March 2021

Eating Disorder Not Otherwise Specified

Some disordered eating does not fit neatly into the categories described above. Individuals may suffer from a variety of symptoms, but not meet the diagnostic criteria for any specific eating disorder. Such individuals may be diagnosed with an Eating Disorder Not Otherwise Specified (ED-NOS). Examples include the following:

For females, all of the criteria for anorexia nervosa are met except that the individual has regular periods.
All of the criteria for anorexia nervosa are met, however, despite significant weight loss the individual's current weight is in the normal range.
All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms (eg. purging, laxative abuse, excessive exercise, etc.) occur less than 2 times a week or for less than 3 months.
The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food
Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

Men and Eating Disorders

Although eating disorders are commonly considered women’s disorders, men account for approximately 10% of those diagnosed with anorexia or bulimia. In addition, there is a growing awareness of Muscle Dysmorphia (one form of Body Dysmorphic Disorder), a body image disturbance suffered primarily by men. It is characterized by the following:

Viewing one’s body as puny despite efforts and success at body building.
Having a distorted body perception that leads to extreme efforts to increase lean muscle mass and overall body size.
Taking extreme measures to increase muscle mass, including excessive exercise, dietary manipulation and high protein intake, use of anabolic steroids.