"Wow, she's so skinny!" "He's lost so much weight!" "I wonder what they're eating to look that good."

Are these statements compliments? What kind of body shapes and sizes are valued in American culture?

• We will look at what constitutes an eating disorder.
• What are the different types of eating disorders?
• What are the symptoms of eating disorders?
• We'll consider what causes these eating disorders.
• Finally, we'll look at how we treat eating disorders.

Definition of Eating Disorders

Although anyone can develop an eating disorder, females are more likely to develop one than men, and younger people are more likely to develop one than older people. Since eating disorders are more common in females, males often get left out of the conversation. This can contribute to males who struggle with eating disorders feeling increased shame and stigma.

It is important to remember that eating disorders are mental illnesses. Even though they usually show up in physical changes like extreme weight loss or fluctuations in weight, the causes of these physical signs include many internal factors.

Types of Eating Disorders

There are six types of eating disorders: anorexia nervosa, binge eating disorder, bulimia nervosa, pica, rumination disorder, and avoidant/restrictive food intake disorder. In this explanation, we will focus mostly on the three most common eating disorders: anorexia, bulimia, and binge eating disorder.

Anorexia Nervosa

When you think of eating disorders, anorexia nervosa is probably the one you think of first. Commonly referred to as just anorexia, this disorder involves a person who has stopped eating, or eats significantly less food than they need. This type of disordered eating leads to significant weight loss. In the most severe cases, it can cause death from starvation or nutrient deficiency. People who struggle with this disorder often count calories and severely limit themselves from getting proper nutrition.

Binge Eating Disorder

Binge eating disorder involves eating large amounts of food, to the point of being physically uncomfortable, and feeling like you can't control how much you are eating. This type of eating becomes a disorder when the person binges frequently. Binge eating can also be a symptom of other eating disorders.

Bulimia Nervosa

Bulimia nervosa is another common eating disorder, usually referred to as bulimia. Episodes of binge eating are one of the symptoms of bulimia. Bulimia differs from binge eating in that those who struggle with bulimia engage in purging behaviors after they eat or binge.

Pica

Pica is an eating disorder that involves consuming items that are not typically viewed as food. This can be something like excessive amounts of ice, but it can also be things like chalk, paint, string, or wool. Since people with pica may not be ingesting enough nutritious food, this eating disorder can lead to major health problems. Pica is more common in those with a neurodevelopmental disorder.

For someone to be diagnosed with pica, they have to be consuming objects that are either not food, or possess no nutritional value for at least one month. Additionally, eating these foods has to be frequent and dangerous enough to pose a clinical concern. Typically those with pica will not be avoidant to other food, but rather choose to include items that are not food into their diet.

Rumination Disorder

Rumination disorder involves bringing undigested food back up out of the stomach into the mouth after swallowing it. This is different from the purging of bulimia, where the person intentionally vomits. Here, the regurgitation is an involuntary action. The food may eventually be consumed, but the frequent rumination episodes can cause damage to the stomach, throat, and mouth.

People have to be regurgitating their food for at least one month in order to be diagnosed with rumination disorder. Clinicians also need to determine that this behavior cannot be attributed to an underlying medical condition.

Avoidant/Restrictive Food Intake Disorder

As you might be able to guess by the name, this disorder involves either avoiding many different foods, or restricting food intake to a harmful degree. An individual may only be willing to eat one particular food, or only once per day. These restrictive eating patterns can have significant health consequences.

Along with avoiding or restricting eating, people diagnosed with this disorder need to have one or more of the following:

• Weight loss (or if a child, insufficient weight gain).
• Lack of proper nutrients.
• Reliance on a feeding tube or supplements.
• Psychosocial struggles.

Symptoms of Eating Disorders

Each eating disorder has its own distinct symptoms. Remember, if the symptoms can be better explained by a different diagnosis, that other diagnosis will be used instead.

Symptoms of Anorexia Nervosa

One of the most prevalent symptoms of anorexia is a restriction of food. It can present itself differently in different people. Someone might eat only once per day, while someone else may only eat one apple for the entire day. In addition to restricting food to lose weight, those who struggle with anorexia may excessively exercise, which is another way to lose weight.

Both of these symptoms lead to weight loss. What happens when someone starts losing a lot of weight in a very short period of time? Losing weight too quickly or losing too much weight is a danger to your health. Here’s a list of some of the symptoms associated with dramatic weight loss and a lack of proper nutrition due to anorexia.

• Fatigue
• Low blood pressure
• Irregular heart rhythms
• Absent or irregular menstruation (for females)
• Thinning hair that eventually falls out
• Dry or yellowish skin
• Dehydration

Other non-physical symptoms of anorexia include extremely rigid guidelines around eating, lying about eating, extreme fear of weight gain, and persistent discontent with body shape or image.

Symptoms of Binge Eating Disorder

The most prevalent symptom of binge eating disorder is binge eating episodes. These episodes generally include:

• Eating faster than usual.
• Eating alone to avoid shame or embarrassment.
• Eating more than is needed/past the point of fullness.
• Continuing to eat due to a loss of control.
• Feeling disgusted or ashamed afterward.

Another symptom is a fluctuation in weight. Although not every person who is overweight has binge-eating disorder, most people who have this disorder are overweight. Individuals may then develop medical problems connected to weight such as joint pain, heart disease, or type 2 diabetes.

Symptoms of Bulimia Nervosa

Bulimia is characterized by binge eating episodes followed by purging. When someone is binging, just like in binge-eating disorder, they are consuming more food than they normally do, due to feeling they can't control how much they're eating.

Our bodies react badly to the binging and purging of bulimia. Often those who struggle with bulimia become extremely dehydrated and malnourished, since nothing they consume remains in their bodies. As with anorexia, since the body is not getting enough sustenance, a female may stop menstruating as her body goes into a "low power mode" to conserve energy.

Recurrent vomiting can cause acid reflux, digestive problems, and stomach problems. In some cases, the esophagus can become damaged and burned from the stomach acid that comes up when someone vomits. The esophagus can develop ulcers and tears (requiring immediate medical attention) in severe cases.

Causes of Eating Disorders

Unfortunately, society plays a big role in the development of eating disorders. While there are movements on social media promoting body acceptance and positivity, only one type of body is usually present in magazines, TV shows, and movies: an extremely thin one.

This glorification of thin bodies communicates to young girls that thin bodies are the best kind of body. They may feel like their bodies aren’t good enough and they need to try to look like the women on social media. Often, the images spread through media are heavily edited.

Another factor in the development of anorexia is psychological. For some, a traumatic event can cause someone to feel like they’ve lost control of life. They may turn to food and eating as something they can control while other parts of life feel out of control. For others, high anxiety and perfectionism tend to be present before and during an eating disorder. Most often, anorexia is attributed to stressful events in life.

Like other eating disorders, poor body image can contribute to the development of bulimia. A fear of gaining weight and an obsession with appearances can lead to binging and purging behaviors. Dieting can occur before other symptoms. As with anorexia, stressful life events can also cause bulimia.

There are so many risk factors for developing anorexia. An existing anxiety disorder, a family member who has/had an eating disorder, a culture that values thinness, and brain abnormalities are all risk factors. Social isolation, a change in personality, and past sexual abuse can increase the risk of developing bulimia. There is also a risk for someone with bulimia to later develop anorexia.

Treatments for Eating Disorders

There are medical professionals who are skilled in helping people recover from an eating disorder. These people include a therapist, psychiatrist (if medicine needs to be prescribed), and a dietician to provide education about healthy eating habits. As with other mental health disorders, finding a therapist who is the right fit for each person is crucial.

There are different types of therapy that can help someone recover from an eating disorder. Cognitive-Behavioral Therapy (CBT) and Family-Based Treatment are helpful in treating both anorexia and bulimia. Healthy-Weight Programs and Interpersonal Psychotherapy are also helpful in treating bulimia. CBT or Interpersonal Psychotherapy are two recommended treatments for binge eating disorder.

Depending on the eating disorder, medication may be helpful. There are also treatment centers that specialize in helping those with eating disorders. People reside at the center for a period of time and get around-the-clock assistance from professionals, with a view to developing better habits and regaining control over their physical and mental health.

What can I do to help someone?

If you are concerned that someone may be struggling with an eating disorder, talk to them. Those with eating disorders may outwardly deny the disorder but understand internally that they need help. Talk to them in private and show compassion and understanding. This is a difficult topic to talk about! Let them know that you are there for them throughout this whole journey.

If you are seriously concerned with someone’s health, talk to someone else about it. Don’t wait until it’s too late. Recovering from an eating disorder is difficult, but it’s better than the alternative.