Going to extremes is what sets eating disorders apart from the occasional binge or even yo-yo dieting. Anorexia, bulimia, and binge eating are three of the dangerous eating patterns millions have developed.
Maybe you’ve gone on crash diets in the past, or maybe you tend to go overboard at the buffet table at a certain restaurant or at a friend’s annual holiday party.
Does that mean you have an eating disorder?
The mark of an actual eating disorder is when your relationship with food reaches an extreme level. An estimated 10 million women and 1 million men struggle with eating disorders.
However, because many don’t ever get treatment, the numbers could be much higher, said Suzanne Mazzeo, PhD, associate professor of psychology at Virginia Commonwealth University in Richmond.
There are three main types of eating disorders: anorexia nervosa, bulimia, and binge eating. And they are all serious diseases. Anorexia nervosa has the highest rate of death among psychiatric illnesses, according to the National Alliance on Mental Illness. Here’s what else you need to know.
Eating Disorders: Anorexia Nervosa
People who have anorexia tend to think they’re overweight when they’re actually very thin. They may eat fewer than 1,000 calories a day, exercise excessively, and vomit, use laxatives, take diuretics, or give themselves enemas as they continually attempt to lose more weight.
Approximately 1 percent of American women may have anorexia, and that could actually be a conservative estimate. Anorexia can affect men, children, and the elderly, but the majority of those who have it are adolescent girls or young women.
People with anorexia nervosa tend to:
Maintain a weight that’s more than 15 percent lower than a normal body weight
Have an intense fear of gaining pounds
Have a distorted image of their bodies
Deny that they have an illness
Among women, stop menstruating for at least three months in a row
Anorexics may also have rituals associated with eating, like cutting their food into small pieces, refusing to eat in front of other people, or cooking big meals for others while not eating themselves.
As a result of the disease, people with anorexia may have a low body temperature, brittle bones and nails, dry and yellow skin, and fine hair on the body. Ultimately, anorexia can cause low blood pressure and a low heart rate, and lead to an irregular heart rhythm or heart failure. The disease can also affect the kidneys and brain. People with anorexia have even starved to death.
Eating Disorders: Bulimia Nervosa
People with bulimia nervosa tend to binge on food and then compensate for the calories by purging — by deliberate vomiting or inducing diarrhea with laxatives, exercising excessively, or fasting. The binging part of bulimia is different from simply overeating; people with bulimia feel out of control when binging and eat way beyond being full.
Like anorexia, bulimia primarily affects women and begins during adolescence or early adulthood. Experts estimate that 1.5 percent to 3 percent of women have bulimia and they tend to be of normal weight or are overweight. Research shows that about half of those with anorexia go on to have bulimia.
People with bulimia tend to:
Binge at least twice a week for three months
Feel as if they can’t control eating binges
Think constantly about food and their weight
Eat in secret and very quickly
Binge until there’s no food left, someone interrupts them, or their stomach is very uncomfortable
Feel guilty after the binge and may purge, drastically restrict food later, or exercise excessively
Binging and purging can cause serious problems, such as an imbalance in electrolytes (minerals in your blood and bodily fluids), dehydration, and heart problems. It can even cause sudden death.
Eating Disorders: Binge Eating Disorder
People with binge eating disorder feel out of control as they eat large amounts of food. Unlike those who have bulimia, people who binge don’t purge, fast, or exercise excessively to lose weight afterward. Binge eating disorder also has been called compulsive overeating, emotional eating, or food addiction.
“It’s not just overeating,” Dr. Mazzeo said. “Binge eating is what we call ‘loss of control eating.’ You feel like you can’t stop, even if you want to.”
The most common of the three types of eating disorders, binge eating affects about 3.5 percent of women and 2 percent of men, and it usually starts during their early 20s.
People with binge eating disorder tend to:
Binge at least twice a week for at least six months
Binge in secret
Binge during a negative mood
Feel uncomfortably full afterward
Often feel distressed, guilty, and depressed after binging
Be overweight or obese
Because binge eating can lead to weight gain, people with this disease are at risk for type 2 diabetes and nutrition problems. They may also experience insomnia and poor quality of life.
What Causes Eating Disorders?
Psychologists don’t know exactly what causes eating disorders, but research suggests that there’s a strong genetic risk, Mazzeo said. “Identical twins are more likely to be consistent on whether they have an eating disorder.” In fact, if you have a relative who has anorexia, you’re roughly 10 times more likely to have an eating disorder compared with someone who doesn’t have a relative with anorexia.
However, it may take factors in your environment to trigger the behavior — anything from magazines filled with thin supermodels to stress to abuse, Mazzeo said. Also, people who have careers in which being thin is a requirement, such as models, actors, TV personalities, dancers, and athletes, tend to be at risk for eating disorders.
Experiencing depression and anxiety may increase the risk of developing anorexia or binge eating. Those who have bulimia may have other impulsive behaviors, such as alcohol or drug abuse, or may injure themselves.
Over a lifetime, someone could have all three disorders, crossing over from one to another, Mazzeo said. The good news: Eating disorders can be treated with psychotherapy, cognitive-behavioral therapy, or group therapy; some medications may also be helpful.
Studies have found that about half of those with anorexia are able to make a full recovery, while about 40 percent of people who have bulimia and seek out therapy are successful at stopping the behavior. For people who binge-eat, up to 60 percent find success. Your medical team will help you get the right eating disorder treatment you need to reverse an unhealthy relationship with food.