Eating Disorders: A Diet to Death
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Eating is controlled by many factors, including appetite, food availability, family, peer, and cultural practices,
and attempts at voluntary control. Dieting to a body weight leaner than needed for health is highly promoted
by current fashion trends, sales campaigns for special foods, and in some activities and professions. Eating
disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food
intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight.
Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger
amounts of food than usual, at some point move beyond control in some people and develop into an eating
disorder. Studies on the basic biology of appetite control and its alteration by prolonged overeating or
starvation have uncovered enormous complexity, but in the long run have the potential to lead to new
pharmacologic treatments for eating disorders.
Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in
which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders
are anorexia nervosa and bulimia nervosa. A third type, binge-eating disorder, has been suggested but has
not yet been approved as a formal psychiatric diagnosis. Eating disorders frequently develop during
adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in
adulthood.
Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse,
and anxiety disorders. In addition, people who suffer from eating disorders can experience a wide range of
physical health complications, including serious heart conditions and kidney failure which may lead to death.
Recognition of eating disorders as real and treatable diseases, therefore, is critically important.
Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent
of people with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder are male.
Anorexia Nervosa
An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime. Symptoms of
anorexia nervosa include:
Resistance to maintaining body weight at or above a minimally normal weight for age and height.
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight
or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Infrequent or absent menstrual periods (in females who have reached puberty).
People with this disorder see themselves as overweight even though they are dangerously thin. The process
of eating becomes an obsession. Unusual eating habits develop, such as avoiding food and meals, picking
out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with
anorexia may repeatedly check their body weight, and many engage in other techniques to control their
weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives,
enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.
The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single
episode; some have a fluctuating pattern of weight gain and relapse; and others experience a chronically
deteriorating course of illness over many years. The mortality rate among people with anorexia has been
estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher
than the annual death rate due to all causes of death among females ages 15-24 in the general population.
The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte
imbalance, and suicide.
Bulimia Nervosa
An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime. Symptoms of
bulimia nervosa include:
Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete
period of time and by a sense of lack of control over eating during the episode.
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced
vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive
exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for
3 months.
Self-evaluation is unduly influenced by body shape and weight.
Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia
usually weigh within the normal range for their age and height. However, like individuals with anorexia, they
may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with
bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved
once they purge.
Binge-Eating Disorder
Community surveys have estimated that between 2 percent and 5 percent of Americans experience
binge-eating disorder in a 6-month period. Symptoms of binge-eating disorder include:
Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete
period of time and by a sense of lack of control over eating during the episode.
The binge-eating episodes are associated with at least 3 of the following: 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 very guilty after overeating.
Marked distress about the binge-eating behavior.
The binge eating occurs, on average, at least 2 days a week for 6 months.
The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g.,
purging, fasting, excessive exercise).
People with binge-eating disorder experience frequent episodes of out-of-control eating, with the same
binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating
disorder do not purge their bodies of excess calories. Therefore, many with the disorder are overweight for
their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing
again, creating a cycle of binge eating.
