What Are Eating Disorders?
Eating disorders can be recognized by a persistent pattern of unhealthy eating or dieting behavior. These patterns of eating behavior are associated with emotional, physical, and social distress. Eating disorders do not discriminate on the basis of gender, age, or race. They can be found in both genders, all age groups, and across a wide variety of races and ethnic backgrounds.
Although there are formal guidelines that health care professionals use to diagnose eating disorders [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Text Revision (DSM-IV-TR)(American Psychiatric Association, 2000)], unhealthy eating behaviors exist on a continuum. Even if a person does not meet formal criteria for an eating disorder, she or he may be experiencing unhealthy eating behaviors that cause substantial distress and may be detrimental to both physical and psychological health.
For other sites addressing basic facts and information about eating disorders, please refer to the resources section of our site.
What is Anorexia Nervosa?
Individuals with anorexia nervosa are unable or unwilling to maintain a body weight that is normal or expected for their age and height. Typically, this means that a person is less than 85% of their expected weight. Even when underweight, individuals with anorexia continue to be fearful of weight gain. Their thoughts and feelings about their size and shape have profound impact on their sense of self and their self-esteem. They often do not recognize or admit the seriousness of their weight loss and deny that it may have permanent adverse health consequences. Women with anorexia nervosa often stop having their periods.
There are two subtypes of anorexia nervosa. In the restricting subtype, people maintain their low body weight purely by restricting food intake and, possibly, by exercise. Individuals with the binge-eating/purging type also restrict their food intake, but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics or enemas. Many people move back and forth between subtypes during the course of their illness.
What is Bulimia Nervosa?
Individuals with bulimia nervosa experience binge-eating episodes which are marked by eating an unusually large amount of food, usually in a discrete period of time, and feeling out of control while doing so. The sense of being out of control is what distinguished binge-eating from regular overeating. Binge eating is followed by attempts to “undo” the consequences of the binge by using unhealthy compensatory behaviors such as self-induced vomiting, misuse of laxatives, enemas, diuretics, severe caloric restriction, or excessive exercising.
Individuals with bulimia nervosa are also deeply preoccupied with their shape and weight and often feel as if their self-worth is dependent on their weight or shape.
Formal diagnostic criteria for bulimia nervosa describe binge eat and engage in inappropriate compensatory behavior at least twice weekly for at least three months. However, regardless of frequency, these behaviors are concerning and can have adverse physical and psychological consequences.
There are also two subtypes of bulimia nervosa. The purging type includes those individuals who self-induce vomiting or use of laxatives, diuretics, or enemas. The non-purging type refers to those who compensate through excessive exercising or dietary fasting.
What is Binge Eating Disorder?
Individuals with binge eating disorder (BED) engage in binge eating, but do not regularly use inappropriate compensatory weight control behaviors such as fasting or purging to lose weight. The binge eating may involve rapid consumption of food, uncomfortable fullness after eating, and eating large amounts of food when not hungry. Feelings of shame and embarrassment are prominent. Binge Eating Disorder is often, but not always, associated with overweight and obesity. Previous terms used to describe these problems included compulsive overeating, emotional eating, or food addiction. Binge eating disorder is not an officially recognized eating disorder, but is included in the category titled Eating Disorder Not Otherwise Specified.
What is Eating Disorders Not Otherwise Specified (EDNOS)?
There are many variants of eating disorders that do not fall under the specific heading of anorexia or bulimia nervosa. In fact, most people with eating disorders have variations on those themes. Just because someone doesn’t have classic anorexia or bulimia nervosa does not mean that they do not need treatment. Individuals with eating disordered behaviors that resemble anorexia nervosa or bulimia nervosa but whose eating behaviors do not meet one or more essential diagnostic criteria may be diagnosed with EDNOS. Examples of EDNOS include individuals who regularly purge but do not binge eat, individuals who meet criteria for anorexia nervosa but continue to menstruate, and individuals who meet criteria for bulimia nervosa, but binge eat less than twice weekly.
How Common are Eating Disorders?
We do not know the exact numbers of women and men who suffer from eating disorders. It has been estimated that between 0.3-1% of women suffer from anorexia nervosa and around 3% suffer from bulimia nervosa. Many more suffer from subthreshold conditions (that means they might not have a formal diagnosis of an eating disorder, but they experience many of the symptoms. In addition, many individuals struggle with body dissatisfaction and subthreshold disordered eating attitudes and behaviors. For example, it has been shown that 80% of American women are dissatisfied with their appearance (Smolak, 1996).
- Collins, M.E. (1991). Body figure perceptions and preferences among pre-adolescent children. International Journal of Eating Disorders, 199-208.
- Crowther, J.H., Wolf, E.M., & Sherwood, N. (1992). Epidemiology of bulimia nervosa. In M. Crowther, D.L. Tennenbaum. S.E. Hobfoll, & M.A.P. Stephens (Eds.), The etiology of bulimia nervosa: The individual and familial context (pp. 1-26) Washington, D.C.: Taylor & Francis.
- Fairburn, C.G., Hay, P.J., & Welch, S.L. (1993). Binge eating and bulimia nervosa: Distribution and determinants. In C.G. Fairburn & G.T. Wilson, (Eds.), Binge eating: Nature, assessment, and treatment (pp. 123-143). New York: Guilford.
- Gordon, R.A. (1990). Anorexia and bulimia: Anatomy of a social epidemic. New York: Blackwell.
- Gustafson-Larson, A.M., & Terry, R.D. (1992). Weight-related behaviors and concerns of fourth-grade children. Journal of American Dietetic Association, 818-822.
- Hoek, H.W. (1995). The distribution of eating disorders. In K.D. Brownell & C.G. Fairburn (Eds.) Eating Disorders and Obesity: A comprehensive handbook (pp. 207-211). New York: Guilford.
- Mellin, L., McNutt, S., Hu, Y., Schreiber, G.B., Crawford, P., & Obarzanek, E. (1991). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: The NHLBI growth and health study. Journal of Adolescent Health, 27-37.
- Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The spectrum of eating disturbances. International Journal of Eating Disorders, 18 (3), 209-219.
- Smolak, L. (1996). National Eating Disorders Association/Next Door Neighbors puppet guide book.