This pamphlet explains:

Who gets eating disorders Types of eating disorders Warning signs How to get help

If not treated, eating disorders can lead to serious social, emotional, and medical problems—sometimes death.

What Are Eating Disorders?

Eating disorders are not fads and they are not diets. They are serious conditions that can lead to severe health problems—and even death.

A person with an eating disorder is obsessed with food, body weight, and body shape. People with these problems:

• Try to manage their weight in ways that are not healthy
• Eat too little food or too much food

Eating disorders affect the person as well as her family, friends, and others around her. They can cause mental and social problems as well as physical problems. They can harm a person's family, school, social, and career life.

Who Gets Eating Disorders?

People of all backgrounds and ages can have eating disorders. These problems are most common among women and girls. They most often begin between the ages of 11 and 20 years.

Eating disorders are complex problems. There is no single cause, but dieting may trigger them. This does not mean that any person who diets has or will have an eating disorder.

People with eating disorders often:

• Have a fear of being fat
• Have a distorted view of their body shape
• Have low self-esteem
• Are depressed
• Are very unhappy with their bodies
• Want to be perfect

Eating disorders often arise during stressful times, such as the teenage years. Leaving home or losing a loved one through death or divorce also is stressful.

These disorders often hide other problems. They may be a symptom of family, social, school, work, or health problems.

Types of Eating Disorders

Anorexia nervosa (also called anorexia), bulimia nervosa (also called bulimia), and binge-eating disorder are the three main types of eating disorders. They often have different warning signs and result in different health problems.

Anorexia Nervosa

A person with anorexia nervosa diets to extremes because she has a distorted body image. This means she feels she is too fat even when she is not. Most girls or women with anorexia have an intense fear of being fat. They want to be thin so badly that they may starve themselves—sometimes to death.

Some women with anorexia do not eat at all or eat very little. Some women with anorexia eat large amounts of foods high in fat and calories and then purge themselves by vomiting or taking laxatives. They also may exercise to extremes.

People with anorexia often feel shame and guilt. They may become withdrawn. They also may deny that their severe weight loss or dieting is a problem. They may deny that they are underweight. In fact, they do not think they are thin enough.

Anorexia can cause severe and sometimes long-term health problems. These problems may include:

• An irregular heartbeat, which can lead to heart failure and death
• Bone loss, which can lead to osteoporosis
• Low body temperature
• Low blood pressure
• Kidney problems
• A slowed metabolism (the body's way of using energy from food)
• Slow reflexes
• Absence of menstrual periods
• Delay in reaching puberty

About 5–10% of people die from problems caused by anorexia. It may lead to a heart attack, a coma, or suicide.

Many people with anorexia also have bulimia at some point. In fact, about half of people with anorexia also have signs of bulimia, or vice versa.

Signs of Eating Disorders If you or someone you know has some of the symptoms listed here, seek help. These symptoms may be signs of an eating disorder. Anorexia Nervosa Diets nonstop (even when thin), refuses to eat except in small portions, or wants to eat alone Has lost a lot of weight and still thinks they are fat Stops having menstrual periods Exercises excessively Has fine hair growing on the face and arms Is losing hair Has dry, pale, yellowed skin Is withdrawn and irritable Bulimia Nervosa Makes up reasons to go to the bathroom after meals Purges by vomiting or abusing laxatives or diuretics Is on a strict diet, fasts, or exercises to extremes to lose weight Has swelling around the jaw Is bloated Has bloodshot eyes Has problems with teeth and gums Is weak and tired Has mood swings and seems to feel out of control Buys large amounts of food that suddenly disappear Binge Eating Disorder Weight goes up and down Is obese Eats a large amount of food in a short time Eats quickly Diets often Is withdrawn socially and often eats alone Becomes depressed, irritated, and disgusted after overeating

Bulimia Nervosa

People with bulimia nervosa binge (eat large amounts of food in a short time). They then purge the excess calories by:

Vomiting Using laxatives, diuretics (water pills), or emetics (pills that cause vomiting) Fasting Exercising to extremes

People with bulimia sometimes eat 20,000 calories in a single binge. They often feel out of control and know that what they are doing is not normal.

Bulimia is harder than anorexia to detect. This is because the person's weight often is normal or just above normal. The person's weight may quickly go up or down 10 pounds or more because of binges and fasts.

Bulimia can cause severe medical problems such as:

Dehydration Damage to the bowels, liver, and kidney Damage to the throat, esophagus, and stomach (caused by self-induced vomiting) An irregular heartbeat or heart failure Problems with teeth and gums

People with bulimia know their eating is out of control, but they are afraid of being fat and of not being able to stop eating. Ridding the body of excess calories may help them feel they have regained control over their bodies.

They often feel very depressed, guilty, and shameful after they binge. They may feel that they must hide the problem from others.

Binge Eating Disorder

Binge eating (also called compulsive eating) may be the most common of the eating disorders. About 2 out of every 100 American adults have this disorder. Slightly more women than men have it.

Binge eating involves eating large amounts of food. In this way, it is like bulimia. Binge eaters do not purge after binging, though. Binge eaters may eat regular meals and snacks throughout the day. Sometimes they may overeat all day rather than binging.

Binge eaters usually become overweight or obese. In fact, up to 40% of obese people may be binge eaters.

Binge eaters often do their binge eating in secret. They then feel depressed, guilty, or shameful.

Anger, sadness, boredom, or anxiety may trigger a binge. Dieting may worsen binge eating in some people.

The causes of binge eating are not known. However, as many as half of all people with this problem have a history of depression. Many binge eaters have trouble keeping other areas of their lives under control.

Binge eating may cause severe medical problems, such as:

• High blood pressure
• High cholesterol levels (which can cause the arteries to harden and can cause heart disease and heart attacks)
• Gall bladder disease
• Diabetes
• Certain types of cancer

Many of these problems are caused by the weight gained from binge eating.

Getting Help

There is treatment for eating disorders. The first step to overcoming an eating disorder is to know that a problem exists and that help is needed. Family and friends can help the person become aware of the problem. Eating disorders may be diagnosed by a doctor or other health care worker.

People with eating disorders may become angry or defensive when someone tries to help. However, they may be relieved that someone wants to help. Be sensitive to the person's feelings. Let her know that you care about her well-being.

Treatment often involves a doctor's care or going into the hospital. Treatment in a hospital is needed for many people with anorexia. Medication also may be used to help treat the disorder as well as the health problems caused by it. Treatment also includes either single, family, or group counseling.

Ask for help if you believe that you, a family member, or a friend has an eating disorder. Not all doctors are trained to treat eating disorders. Your doctor can refer you to someone who can help. You also may want to contact local self-help and support groups that help people with eating disorders.

Finally . . .

Eating disorders affect the health and well-being of many women. If not treated, eating disorders can lead to serious social, emotional, and medical problems—sometimes death. With treatment and counseling, a woman with an eating disorder can live a happy and healthy life.

Glossary

Anorexia Nervosa: An eating disorder in which distorted body image leads a person to diet excessively.

Binge Eating Disorder: An eating disorder in which a person eats large amounts of food while feeling a loss of control over his or her eating.

Bulimia Nervosa: An eating disorder in which a person binges on food and then forces vomiting or abuses laxatives.

Dehydration: Water loss from the body.

Fasting: Not eating for at least 24 hours.

Obese: Weighing more than 20% above a healthy body weight.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.

Purge: To vomit or use laxatives, diuretics (water pills), or emetics (vomiting inducers) to avoid gaining weight.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © December 2000 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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