About Eating Disorders
The Academy for Eating Disorders is committed to disseminating information regarding these disorders to both educate, prevent and assist those in need. Below are facts about eating disorders for concerned friends, family members, healthcare providers, and individuals struggling with their eating. Eating disorders affect individuals irrespective of age, weight, gender, and race/ethnicity. It is important to keep in mind that there is significant symptom overlap among the eating disorder categories listed below, and that individuals can move from one diagnostic category to another over time.
What are the early signs of an eating disorder?; Herzog
- Bulimia Nervosa
- Avoidant and Restrictive Food Intake Disorder (AFRID)
- Other Specified Feeding or Eating Disorder
AN is characterized by failure to maintain an adequate body weight, body image disturbance, and excessive dietary restriction1. It may be accompanied by periodic binge eating and purging (e.g., self-induced vomiting, laxative use). It affects approximately .4 out of every 1000 women in any 12 month period1 and 9 out of 1000 at some point in their lives2. Men are affected less often than women; the exact ratio of women to men who are affected by AN is difficult to determine, but estimates range from 3:12 to 10:11, and these may be underestimates because men are less likely to seek treatment and healthcare providers may fail to assess or diagnoseeating disorders in males2.
AN typically begins during early- to mid-adolescence4, and warning signs include sudden weight loss, extreme dieting, food rituals (e.g., taking very small bites, eating foods in a certain order), hair loss, dry skin or hair, brittle nails, growth of fine, downy hair on the face and body. Certain medical conditions may co-occur with AN and include bone loss, difficulties with temperature regulation, loss of menstrual periods, low heart rate, and low blood pressure1,5.
Similarly, certain psychological conditions and features that often coincide with AN include anxiety, depression, social isolation, and perfectionism6. Approximately 50-60% of individuals with AN recover over time, with better recovery rates observed in younger patients and those with a shorter duration of illness when diagnosed7. For adolescents with AN, a form of family-based treatment has been shown to be successful in improving recovery from the illness8. Unfortunately, the risk of death in AN is increased due to medical complications and suicide7.
BN is characterized by binge eating (consuming large amounts of food while feeling out of control) accompanied by compensatory behaviors to prevent weight gain, and body image disturbances1. These compensatory behaviors may include self-induced vomiting, laxative, diuretic, or enema use or excessive exercise, fasting, or the misuse of certain medications such as insulin. Estimates of what percent of individuals are affected by BN vary between 1-1.5% over the course of their lives2,3 to 1-1.5% of women in any 12 month period1. Men are affected less often than women; the exact ratio of women to men who are affected by BN is difficult to determine, but estimates range from 3:12 to 10:11. These may be underestimates because men are less likely to seek treatment and healthcare providers may fail to assess or diagnose eating disorders in males2. The typical age of onset is mid- to late-adolescence9, and early warning signs include the disappearance of large amounts of food, frequent trips to the bathroom after meals, calluses on knuckles from using fingers to induce vomiting, and swelling of the face. Certain medical conditions that may accompany BN include electrolyte imbalance, esophageal ulcers, and tooth decay 5.
Psychological conditions and features that often co-occur include anxiety, depression, substance use, and difficulties with impulse control6. Approximately 70% of individuals with BN recover over time, and patients with fewer accompanying psychiatric problems seem to fare better7. Treatments for BN in adults include cognitive-behavioral therapy, which has been successful in improving recovery from the illness11, and the anti-depressant medication fluoxetine, which has been FDA-approved for the treatment of adults with BN12. Unfortunately, risk of death is increased in BN, particularly death due to suicide10.
BED is characterized by binge eating without compensatory behaviors (as observed in BN; see above)1. It affects 16 out of every 1000 women in any 12 month period1 and 35 out of 1000 at some point in their lives2. Estimates for men are that approximately 8 out of 1000 are affected in any 12 month period1 and 20 out of 1000 at some point in their lives2. The typical age of onset is during adolescence or young adulthood, but most individuals don’t present for treatment until middle adulthood3,13. Warning signs include sudden weight gain and the disappearance of large amounts of food. Specific medical conditions that co-occur with BED include obesity14 and other related conditions (e.g., type II diabetes, hypertension) and gastric problems15.Related psychological conditions include anxiety, depression, and substance use6. Approximately 70-80% of individuals with BED recover over time, and those with fewer interpersonal problems appear to have a better likelihood of recovery7. For adults with BED, cognitive-behavioral and interpersonal treatments have been successful in increasing recovery from the illness while behavioral weight loss treatment may be helpful with weight loss16.
ARFID is characterized by an avoidance of eating that leads to a failure to meet nutritional or energy needs1. This avoidance may be due to concerns regarding uncomfortable consequences of eating, displeasure with the tastes and/or textures of foods, or a number of other reasons. Importantly, this avoidance must not be explained by a normal culture practice or a food allergy20. The results of this avoidance may be that the individual loses a significant amount of weight, or for children, fails to gain weight as expected, experiences a deficiency in important nutrients, requires food supplements or special feedings, or experiences substantial impairment in his/her life as a result of the avoidance (e.g., is unable/unwilling to socialize with others if food is involved). Although many of these features may be present in anorexia nervosa, a corresponding fear of weight gain and disturbance in body image is not present in ARFID. Information on the prevalence of AFRID are not yet available; however, ARFID most commonly begins in infancy or early childhood1. Although picky-eating in young children is not unusual, warning signs of ARFID include such “pickiness” leading to a failure to gain weight as expected or the necessity of administering nutritional supplements in order to avoid experiencing a nutritional deficiency. ARFID may negatively affect family functioning, especially around mealtime1. Related psychological conditions include anxiety disorders, autism spectrum disorder, obsessive-compulsive disorder, and attention deficit-hyperactivity disorder.
Eating Disorder Not Otherwise Specified (ED-NOS) or Feeding or Eating Disorders Not Elsewhere Classified (FED-NEC)
- Characterized by disturbances in eating behavior that don’t
fit exactly with the disorders described above (1)
- Behaviors may be less frequent or qualitatively different than those seen in the primary eating disorder, but are just as distressing
- Examples include:
-Restrictive eating resulting in substantial weight loss despite normal weight status (atypical AN)
-Binge eating and compensatory behaviors occurring less frequently than required for a diagnosis of BN (subthreshold BN)
-Purging without binge eating (purging disorder)
-Recurrent episodes of night eating, defined by eating after awakening from sleep or excessive food consumption after the evening meal (night eating syndrome)
- Most common eating disorder diagnosis; affects ~4-5% of the population (17)
- ~4:1 female to male ratio (17)
- Typical age of onset is adolescence or young adulthood (18)
- Related medical and psychological conditions are similar to those
for the other eating disorders
- These complications are just as severe for those with ED-NOS as for those with full-syndrome eating disorders (19)
- Warning signs are similar to those for related eating disorder diagnoses
- ~70% of individuals with ED-NOS recover over time, with the best outcomes observed for individuals with high social support (7)
- Some data suggest an increased risk of death in ED-NOS (10), but more research is needed on this understudied group
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