Eating Disorders

Anorexia Nervosa

Anorexia, which typically begins during adolescence, is extreme weight loss due to intentional starvation. Starvation can damage vital organs such as the brain and heart. To protect itself, the body shifts into slow gear:

• Monthly menstrual periods stop.
• Breathing, pulse and blood pressure rates drop.
• Thyroid function slows.

Other physical results from anorexia may include:

• Brittle nails and hair.
• Dry and yellowed skin covered with soft hair (lanugo).
• Excessive thirst and urination.
• Dehydration, which contributes to constipation.
• Reduced body fat, leading to lowered body temperatures and inability to withstand cold weather.
• Swollen joints.
• Reduced muscle mass.
• Light-headedness.
• Calcium loss, leading to weakened bones.
• Irregular heart rhythm or heart failure.

In some people with anorexia, the brain shrinks, causing personality changes. Fortunately, this condition can be reversed when normal weight is reestablished.

People with anorexia are typically easygoing but may have sudden outbursts of hostility and anger or become socially withdrawn. Many people with anorexia also suffer from other mental illnesses. While the majority have clinical depression, others suffer from:

• Anxiety.
• Personality disorders.
• Obsessive-compulsive disorder (OCD), characterized by repetitive thoughts and behaviors.
• Substance-abuse disorders.
• High risk of suicide.

Bulimia Nervosa

Similar to anorexia, bulimia typically begins during adolescence. With this eating disorder, a person consumes large amounts of food and then gets rid of it through unhealthy methods. There are two kinds of bulimia:

• Purging bulimia – This involves vomiting, abusing laxatives or diuretics, or abusing enemas.
• Non-purging bulimia – This involves obsessive exercise, fasting or strict dieting after binging.

Some people use multiple purging forms. Dieting heavily between episodes of binging and purging is common.

When purging occurs on average at least twice a week for three months and is accompanied by excessive concern about body shape and weight, bulimia may have developed. Eventually half of those with anorexia develop bulimia.

Bulimia is more likely to occur in women and men who fall into one or more of these categories:

• Participate in activities that emphasize body image.
• Have obese family members.
• Suffer from perfectionism.
• Are recovering from trauma.
• Are related to others with eating disorders.

Because many people binge and purge in secret and maintain a normal or above-normal body weight, they’re able to hide their bulimia for years. Many people, ashamed of the disorder, don’t seek help until their 30s or 40s. By this time, eating behaviors tend to be deeply ingrained and more difficult to change.

Even those of normal weight can severely damage their bodies by frequent binge eating and purging. Bulimia’s physical effects can include:

• Irregular menstrual periods.
• Osteoporosis.
• Dehydration.
• Esophagus inflammation or tears.
• Fainting or loss of consciousness.
• Long-term bowel problems.
• Low body temperature.
• Heart failure.

Vomiting causes other less deadly, but serious, problems:

• The acid in vomit wears down teeth’s outer layer.
• Scarring occurs on the backs of hands when fingers are pushed down the throat to induce vomiting.
• The esophagus becomes inflamed and glands near the cheeks become swollen.

Some people with bulimia struggle with addictions, including abuse of drugs and alcohol, and compulsive stealing. Like people with anorexia, many people with bulimia suffer from clinical depression, anxiety, OCD and other psychiatric illnesses. These problems, combined with their impulsive tendencies, place these persons at increased risk for suicidal behavior.

Binge Eating Disorder

Binge eating disorder is an illness that resembles bulimia. Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging. Binge eating disorder, however, differs from bulimia because people with this disorder do not purge the excess food after eating.

Binge eaters are usually overweight and are prone to the serious medical problems associated with obesity, such as:

• High cholesterol.
• High blood pressure.
• Diabetes.
• Gallbladder disease.
• Heart disease.
• Some types of cancer.

People with a binge eating disorder also have high rates of psychiatric illnesses, especially depression.

Beware of Pro–Eating Disorder Sites

Some websites promote anorexia and bulimia as acceptable and even desirable lifestyles. Teens ages 13 to 19 are the most common visitors to these sites; half of them are looking for ways to lose weight.

Many of these sites include images of thin women designed to inspire visitors (“thinspiration”). They also include weight loss advice, strategies to avoid detection by family members and links to similar sites.

While visiting pro-eating disorder (“pro-ana”) sites, 96 percent of users reported learning new weight loss or purging techniques, as did 46 percent of pro-recovery site visitors.

When surfing the web, be careful with these sites and keep in mind that the information may be false.

Get Help

• National Association of Anorexia Nervosa and Associated Disorders (ANAD). Extensive free resources, including screening tools and support services.
• National Eating Disorders Association. Offers a helpline for support, resources and treatment options.

Last reviewed: July 2019