There are many people who develop unusual eating behaviors and beliefs about food such as eating very few calories per day or overeating and then vomiting.  These abnormal eating behaviors and beliefs, over time, threaten their well-being, and in some extreme cases, their lives.  An individual diagnosed with an Eating Disorder has an illness which involves distorted attitudes or behaviors in regards to one’s eating habits, body image, or body weight. Sadly, the overwhelming majority of individuals with Eating Disorders are teenage girls and young adult females.  It has been reported that, in their lifetime, about 0.5% to 3.7% of females will suffer from anorexia, and roughly 1.1% to 4.2% will suffer from bulimia.  Although girls are most commonly diagnosed with Eating Disorder, some males and older women also suffer from Eating Disorders.  In fact, there has been a recent increase in Eating Disorders among males possibly due to changes in social norms conveyed in the media.  Males with Eating Disorders are often adversely affected by unhealthy expectations in certain sports (e.g. wrestlers, jockeys).

Currently, there are three major types of Eating Disorders: anorexia nervosa, bulimia nervosa, andbinge-eating disorder. Anorexia nervosa is characterized by a distorted body image which causes one to restrict one’s eating behaviors; anorexics may also develop unusual eating habits (e.g., they may refuse to eat in front of other people) which can lead to extreme weight loss or death. In contrast, bulimia is characterized by binges (i.e., periods of excessive overeating) which are then followed by the use of vomiting, enemas, laxatives, or diuretics in an attempt to rid the body of the food/calories consumed. Similarly, binge-eating disorder involves ingesting a disproportionate amount of food; however, binge-eaters do not purge their body of the food. Some other types of Eating Disorders are eating disorder not otherwise specified (EDNOS) andnight eating syndrome (NES).

Disordered eating (dysorexias) refers to eating behaviors that are atypical.  Beyond just being “picky,” some children, teens, and adults are so selective in their eating habits that their health may be at risk. Types of disordered eating habits include not eating an entire food group (e.g. fruits or vegetables), eating only certain foods (e.g. pizza), only eating foods at a certain time of day, excluding foods with a certain texture, etc.  While these atypical behaviors may not be easily detected as other Eating Disorders, they still warrant attention and treatment.  Disordered eating is often found among children with autistic spectrum disorders. A potentially medically dangerous form of unusual eating behavior is the eating of non-food items (e.g. dirt, pencil erasers).  Swallowing hair leading to serious medical complications is sometimes found among those with Trichotillomania, a hair-pulling disorder.

Although no one can say for certain how Eating Disorders are caused, certain factors have been associated with them. For example, many anorexics tend to be perfectionists whereas bulimics tend to be impulsive; in addition, many people who suffer from Eating Disorders experience feelings of helplessness, have low self-esteem, and/or may be dissatisfied with the way they look. Though some research has suggested that society’s pressure to be thin has led to the development of many Eating Disorders, most researchers agree that Eating Disorders come about through the interplay of cultural, social, familial, genetic, and psychological factors.

Eating Disorders can be detrimental in a number of ways. For instance, different Eating Disorders have been associated with osteoporosis, osteopinea, anemia, tooth decay, palpitations, irregular heartbeat, hair loss, diabetes, high blood pressure, and amenorrhea (the absence of menstruation). In addition to the physical problems associated with Eating Disorders, people with Eating Disorders tend to have higher rates of other psychological disorders; Anxiety Disorders, substance abuse, and depression are common among those who suffer from Eating Disorders.

Over the years, there have been many Obsessive Compulsive symptoms noted among individuals with Eating Disorders.  These include ruminative thinking about body image, thinness, binge eating, food, and diet, as well as ritualistic eating and exercising behaviors, checking of weight, and binging and purging behavior.  Symmetry obsessions, ordering and arranging compulsions, and perfectionism were also frequently reported obsessive-compulsive symptoms among patients with Eating Disorders. In fact, Obsessive Compulsive Disorder (OCD) is a very common comorbid condition among individuals with Eating Disorders (10 to 60% in anorexia nervosa, 0 to 40% in bulimia nervosa).  Both Anorexia Nervosa and Bulimia Nervosa fall within the Obsessive-Compulsive Spectrum Conditions.  It is no surprise that there is much neurobiological overlap between these two conditions.  Individuals with OCD and those with Eating Disorders may share common brain-behavior pathways (specifically, frontal-subcortical circuitry).   Both groups of people have serotonin dysfunction; individuals with either condition may respond to medicines known as selective serotonin reuptake inhibitors.

Psychological treatments for Eating Disorders include Cognitive Behavioral Therapy (CBT). CBT emphasizes challenging the thoughts and behaviors that serve to maintain unhealthy and self-defeating eating behaviors.  It is hypothesized that individuals with Eating Disorders have core irrational beliefs that then influence their behavior and emotions.  For example, in the case of Bulimia Nervosa, these individuals have beliefs that overemphasize body weight largely based on societal pressures and/or cultural norms.  These beliefs in turn lead to restricting food intake which then places them at risk for later overconsumption of food and subsequent purging.  This cycle results in negative emotions which then lead to more binge eating.  Treatment for Eating Disorders emphasizes the development of more adaptive eating behaviors, exposure and response prevention (for example, exposure to the urge to purge food while preventing vomiting), skills training for high risk situations, cognitive therapy to modify irrational beliefs, and relapse prevention.  Along with family therapy and support groups, CBT can be an effective treatment for many kinds of eating problems.  Unfortunately, some Eating Disorders are so severe that there is no other option than residential or hospital-based treatment.