Eating Disorders:
The Myths

Most likely, you know something about eating disorders. Most likely, you have a friend or an acquaintance with an eating disorder—even if you don’t know it.

Some of your education about eating disorders has probably come from the media.

Much of that information may be wrong.

• Eating disorders do NOT only affect white, young, wealthy females.
• Eating disorders are NOT simply caused by Western cultural values of thinness.
• Eating disorders are NOT passing fads or phases.

The Facts

What are Eating Disorders?
Eating disorders can be recognized by a persistent pattern of unhealthy eating or dieting behavior that can cause health problems and/or emotional and social distress. Eating disorders do not discriminate on the basis of gender, age or race. They can be found in both genders, all age groups and across a wide variety of races and ethnic backgrounds.

The three recognized eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. Although there are formal guidelines that health care professionals use to diagnose eating disorders [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Text Revision (DSM-IV-TR)(American Psychiatric Association, 2000)], unhealthy eating behaviors exist on a continuum. Even if a person does not meet the formal criteria for an eating disorder, she or he may be experiencing unhealthy eating behaviors that cause substantial distress and may be damaging to both physical and psychological health.

What is Anorexia Nervosa?
Individuals with anorexia nervosa do not maintain or have a body weight that is normal or expected for his/her age and height. Typically, this means that a person is less than 85 percent of their expected weight. For a woman who is 5’5” with a medium frame, that means weighing less than 113 lbs. Even when underweight, individuals with anorexia continue to be fearful of weight gain. Their thoughts and feelings about their size and shape have profound impact on their sense of self and their self-esteem as well as their relationships. They often do not recognize or admit the seriousness of their weight loss and deny that it may have permanent adverse health consequences. Women with anorexia nervosa often stop having their periods.

There are two subtypes of anorexia nervosa. In the restricting subtype, people maintain their low body weight purely by restricting food intake and, sometimes, by exercise. Individuals with the binge-eating/purging type also restrict their food intake, but regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics or enemas. Many people move back and forth between subtypes during the course of their illness.

What is Bulimia Nervosa?
Individuals with bulimia nervosa experience binge-eating episodes that are marked by eating an unusually large amount of food, usually within a couple of hours, and feeling out of control while doing so. The sense of being out of control is what distinguished binge-eating from regular overeating. For example, during a binge, an individual may feel compelled to eat, and find it extremely difficult, if not “impossible” to stop eating. In people suffering from bulimia nervosa, binge eating is followed by attempts to ”undo” the consequences of the binge by using unhealthy behaviors such as self-induced vomiting, misuse of laxatives, enemas, diuretics, severe caloric restriction or excessive exercising.

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What is Binge Eating Disorder?
Individuals with binge eating disorder (BED) engage in binge eating, but do not regularly use inappropriate or unhealthy weight control behaviors such as fasting or purging to counteract the binges. Binge eating is defined in the above section on bulimia nervosa. Binge Eating Disorder is more common among individuals who are overweight or obese. Previous terms used to describe these problems included compulsive overeating, emotional eating, or food addiction. Binge eating disorder is not an officially recognized eating disorder, but is included in the DSM category titled Eating Disorder Not Otherwise Specified.

What about people who only have some symptoms of anorexia nervosa, bulimia nervosa or binge eating disorder?
There are many types of eating disorders that do not fall under the specific heading of anorexia, bulimia nervosa or binge eating disorder. In fact, many people with eating disorders meet some, but not all of the symptoms of these disorders. This group is considered to have an eating disorder not otherwise specified (EDNOS). Just because someone doesn’t have classic anorexia or bulimia nervosa does not mean that they do not need treatment.

Burden

• Eating disorders are among the top four leading causes of burden of disease in terms of life lost through disability or death.
• Up to 10 percent of women with anorexia nervosa may die due to anorexia-related causes.
• Risk of death among individuals with anorexia is 12 times greater than their same age peers without anorexia.
• Health consequences such as osteoporosis (brittle bones), gastrointestinal complications and dental problems are significant health and financial burdens throughout life.

How Common Are Eating Disorders?

• Between 0.3-1 percent of young women have anorexia nervosa, which makes anorexia as common as autism
• Around 1-3 percent of young women have bulimia nervosa
• Around 3 percent of the population has binge eating disorder
• Many more suffer from some, but not all, of the symptoms of anorexia nervosa or bulimia nervosa. Between 4 percent and 20 percent of young women practice unhealthy patterns of dieting, purging, and binge-eating.
• Eating disorders are more common in women, but they do occur in men. Rates of binge eating disorder are similar in females and males.
• Athletes in certain sports are particularly high risk for eating disorders. Female gymnasts, ice skaters, dancers, and swimmers, to name a few, have been found to have higher rates of eating disorders. In a study of Division 1 NCAA athletes, more than one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa.
• Male athletes are also at increased risk— especially those in sports such as wrestling, bodybuilding, crew, running, cycling, and football.
• Although white females may be more likely to suffer from anorexia nervosa, African-American girls may be especially vulnerable to developing eating disorders that involve binge eating. Body dissatisfaction in young girls has been shown in White, African-American, Hispanic and Asian girls.

Federal Funding

• Eating disorders research has been hampered by very low federal funding levels (approximately $28 million/year), compared to other conditions.
• Alcoholism: 18 x more funding ($505 million)
• Schizophrenia: 13 x more funding ($352 million)
• Depression: 12 x more funding ($328 million)
• Food safety: 12 x more funding ($333 million)
• Sleep disorders: 7 x more funding ($187 million)
• ADHD: 4 x more funding ($105 million

Treatment

• A review of research studies concluded that bulimia nervosa can be treated effectively with cognitive behavioral therapy—a type of psychotherapy that addresses an individual’s thoughts and feelings to make changes in her behavior. Improvement in symptoms over a short period of time are also seen with the only FDA approved medication for bulimia nervosa—fluoxetine (i.e., Prozac).
• The critical first step in treatment of anorexia nervosa is re-nutrition (carefully monitored feeding, often with the assistance of a medical team) and weight restoration back to the healthy weight range. There is no consensus on the best approaches to treating anorexia nervosa, but family therapy appears to be helpful for younger patients who have recently developed an eating disorder. Cognitive-behavioral therapy may be helpful after weight restoration.
• Binge eating disorder also responds to cognitive-behavioral therapy and a variety of medications (e.g., selective serotonin reuptake inhibitors, tricyclic antidepressants) have also been shown to lead to improvement.
• Getting treatment early is associated with a better chance of recovery.
• If you think you might have an eating disorder, or would like to find help for a friend, please contact a treatment professional.

 Recovery

• Over a 10-year period, about half of people with anorexia nervosa recover fully, a small percentage continues to suffer from anorexia nervosa, and the rest develop other eating disorders. Even among those individuals who recover from an eating disorder, it is common for them to continue to maintain a low body weight and experience depression.
• More than half of individuals treated for bulimia nervosa no longer have the disorder at follow-up.

 The Bottom Line

• Eating Disorders are serious illnesses. Help a friend, help yourself. Don’t look the other way.
• There is hope. Good, clinically tested treatment and early intervention can make a world of difference.