Eating disorders include anorexia nervosa, bulimia nervosa, and compulsive overeating. Estimates of the prevalence of eating disorders vary among groups of people.

They are more common in women than in men and in adolescents and young adults than in older people. The prevalence is higher in cultures that value thinness. Recent surveys found that 1 to 4 percent of white, middle-class female students meet criteria for an eating disorder, and the incidence has been rising for several decades. More cases are being identified in males, often presenting as a preoccupation with body building or exercise.

Eating disorders resemble addiction because they involve a loss of control over the behavior and a continuation of it despite negative consequences. Anorexia Nervosa is mentioned because it is an eating disorder, but there are aspects of it that do not resemble an addiction. Classic anorexia nervosa has its onset in childhood or early adolescence and has unique psychological and endocrine characteristics that put it in a class of its own. People with bulimia often go through anorexic phases, particularly during the teen years, and these disorders overlap in some individuals.

Those with eating disorders have a distorted notion of their body image and sense of self. There is frequently a history of trauma and disruption in nurturing relationships during the person’s first three years of life and often a history of sexual abuse in childhood as well. People with eating disorders have difficulty with accurately identifying emotions and also physical needs like hunger, as well as with managing painful emotions by themselves. Depression, dissociative disorders, obsessive-compulsive disorder, and borderline personality disorder are commonly seen in people with eating disorders.

Many people with eating disorders have problems with addiction to alcohol and drugs or come from families in which there is addiction. Eating disorders sometimes emerge during early sobriety in recovering alcoholics and addicts.

Bulimia nervosa is characterized by binge eating followed by purging. Purging, or attempting to rid the body of the food eaten during the binge, may take the form of laxative abuse, self-induced vomiting, rigid dieting, or a combination of these behaviors. A loss of control of the binge/purge cycle is typical. The amount of food eaten during a binge can be enormous, sometimes ten thousand calories or more. Cycles may occur in episodes or daily, sometimes several times a day. Often, people with bulimia will steal food or the money to obtain food or laxatives. Massive doses of laxatives are sometimes used, which can lead to malfunction of the colon.

Medical complications are common. Dehydration and electrolyte imbalances occur as a result of the vomiting and diarrhea associated with purging. Despite the massive intake of food, malnutrition is common. Irritation of the throat and destruction of dental enamel is caused by the frequent vomiting. An inability to eat without spontaneous vomiting can also occur. Many women with both anorexia and bulimia stop having menstrual periods. Sudden death due to heart failure or cardiac arrhythmia is a serious risk.

Although compulsive overeating is common, it is not classified as an eating disorder in the Diagnostic and Statistical Manual. It is characterized by binge eating but does not involve purging. Compulsive overeaters may be of normal weight, but many are obese. Compulsive overeating shares many psychological features with anorexia and bulimia and often coexists with depression or other psychiatric disorders.

People with eating disorders use food to regulate inner emotional states. Changes in physiology and metabolism associated with the intake of large amounts of food are thought to have a calming effect. The ability to detect actual hunger and satiety is often absent.

The treatment of eating disorders involves a combination of approaches. The behavior must be addressed, but underlying psychological issues must be dealt with as well if lasting change is to occur. Psychodynamically based individual psychotherapy is often helpful. An arrest in early development underlies the distorted notions of body image and problems with self-regulation. Memories associated with this developmental arrest are often preverbal, taking the form of sensations and feelings. The use of expressive therapies including art therapy and psychodrama are useful, as are techniques such as videotaping and working with a mirror in order to develop a sense of one’s body shape. Hospitalization may be needed to help a person restore body weight and achieve some control over the disorder. Group support and therapy both in the hospital and after discharge are also helpful.

Elizabeth Connell Henderson, M.D.

 

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information