There are three types of eating disorders:

All eating disorders involve a strong concern with body size and dieting, and all involve using food to cope with life. People with these disorders often have low self-esteem and feel out of control. Both females and males of all ages experience eating disorders.

• Anorexia Nervosa involves the loss of at least 15% of original body weight or maintenance of body weight at least 15% below a normal weight for the individual. It is accompanied by an extreme fear of becoming overweight and a perception that the body is very large. This often requires stringent dieting and/or exercise to manage the fear. As more and more of life is devoted to this pursuit, isolation from others increases. Also, symptoms of starvation appear, such as increased sensitivity to cold, slowed heart rate, slowed metabolism, decreased concentration, brittle hair and nails, and dry skin. Depression and problems sleeping often appear. It becomes very difficult to think of anything besides food and weight.

• Bulimia Nervosa often develops after a period of intense dieting. May begin with a “binge” – an episode of excessive eating in a short amount of time. Eventually, the individual may attempt to rid the body of this food or its effects by vomiting, fasting, excessive exercise, the use of laxatives, or diuretics. Initially, these methods appear to be a wonderful discovery. It is only later when a destructive cycle of “bingeing and purging” has been established that the trap is revealed. As it progresses, mood swings and depression increase. The binge-purge cycle is normally accompanied by self-criticism and awareness that the eating behavior is abnormal and out of control. For some, this cycle remains an occasional activity, but for others it can escalate into many times a day. The shame and guilt associated with bulimia lead to secretiveness. Protecting the secret may mean not letting any other person find out, leading gradually to social withdrawal. Because this disorder is very secretive and the person often appears to be in the normal weight range, others may not realize that anything is wrong.

• Eating Disorder Not Otherwise Specified (EDNOS) is the diagnosis used when individuals do not meet all criteria for anorexia or bulimia but nonetheless are in need of treatment. Binge-eating disorder (e.g. bingeing without purging or other compensatory behaviors) is included here.

What to look for in a good treatment program…

Eating disorders are complicated and are caused by a combination of factors; good treatment should address all of these factors.

• Psychotherapy is necessary to help the person eliminate eating-related symptoms as well as to address underlying emotional concerns. Psychotherapy may be individual, in groups, or with the person’s family.
• Involvement of a physician is very important because there can be many serious physical effects of starvation, bingeing, and purging. Physicians can also help address depression by prescribing medications when necessary.
• Nutritional counseling from a registered dietitian can also be very helpful since people with eating disorders may not understand what constitutes healthy eating.
• Most treatment can occur on an outpatient basis. Hospitalization becomes necessary, however, when the individual is at risk medically or is at risk of suicide. It is best to choose a hospital that has a specific eating disorders program.
• Individuals and their families should ask if hospital staff or outpatient professionals have specific training in treating eating disorders. Membership in the Academy for Eating Disorders is also a plus.

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