en españolTrastornos de la alimentación
Eating disorders are so common in America that 1 or 2 out of every 100 students will struggle with one. Each year, thousands of teens develop eating disorders, or problems with weight, eating, or body image.
Eating disorders are more than just going on a diet to lose weight or trying to exercise every day. They represent extremes in eating behavior and ways of thinking about eating — the diet that never ends and gradually gets more restrictive, for example. Or the person who can't go out with friends because he or she thinks it's more important to go running to work off a snack eaten earlier.
The most common eating disorders are anorexia nervosa and bulimia nervosa (usually called simply "anorexia" and "bulimia"). But other food-related disorders, like avoidant/restrictive food intake disorder, binge eating, body image disorders, and food phobias, are becoming more and more commonly identified.
People with anorexia have a real fear of weight gain and a distorted view of their body size and shape. As a result, they eat very little and can become dangerously underweight. Many teens with anorexia restrict their food intake by dieting, fasting, or excessive exercise. They hardly eat at all — and the small amount of food they do eat becomes an obsession in terms of calorie counting or trying to eat as little as possible.
Others with anorexia may start binge eating and purging — eating a lot of food and then trying to get rid of the calories by making themselves throw up, using some type of medication or laxatives, or exercising excessively, or some combination of these.
Bulimia is similar to anorexia. With bulimia, people might binge eat (eat to excess) and then try to compensate in extreme ways, such as making themselves throw up or exercising all the time, to prevent weight gain. Over time, these steps can be dangerous — both physically and emotionally. They can also lead to compulsive behaviors (ones that are hard to stop).
To have bulimia, a person must be binging and purging regularly, at least once a week for a couple of months. Binge eating is different from going to a party and "pigging out" on pizza, then deciding to go to the gym the next day and eat more healthfully
People with bulimia eat a large amount of food (often junk food) at once, usually in secret. Sometimes they eat food that is not cooked or might be still frozen, or retrieve food from the trash. They typically feel powerless to stop the eating and can only stop once they're too full to eat any more, or they may have to go to extreme measures (like pouring salt all over a dessert to make it inedible) in order to get themselves to stop eating. Most people with bulimia then purge by vomiting, but also may use laxatives or excessive exercise.
Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight, but those with bulimia may be an average weight or can be overweight.
Binge Eating Disorder
This eating disorder is similar to anorexia and bulimia because a person binges regularly on food (at least once a week, but typically more often). But, unlike the other eating disorders, a person with binge eating disorder does not try to "compensate" by purging the food.
Anorexia, bulimia, and binge eating disorder all involve unhealthy eating patterns that begin gradually and build to the point where a person feels unable to control them.
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is a new term that some people think just means "picky eating," but a number of other eating issues can also cause it. People with ARFID don't have anorexia or bulimia, but they still struggle with eating and as a result don't eat enough to keep a healthy body weight.
Types of eating problems that might be considered ARFID include:
- difficulty digesting certain foods
- avoiding certain colors or textures of food
- eating only very small portions
- having no appetite
- being afraid to eat after a frightening episode of choking or vomiting
Because they don't get enough nutrition in their diet, people with ARFID lose weight, or, if they're younger kids, they may not gain weight or grow as expected. Many people with ARFID need supplements each day to get the right amount of nutrition and calories.
People with ARFID also might have issues in their day-to-day lives, at school, or with their friends because of their eating problems. For example, they might avoid going out to eat or eating lunch at school, or it might take so long to eat that they're late for school or don't have time to do their homework.
Some people with ARFID may go on to develop another eating disorder, such as anorexia or bulimia.
Signs of Anorexia and Bulimia
Sometimes a person with anorexia or bulimia starts out just trying to lose some weight or hoping to get in shape. But the urge to eat less or to purge or over-exercise gets "addictive" and becomes too hard to stop.
Teens with anorexia or bulimia often feel intense fear of being fat or think that they're fat when they are not. Those with anorexia may weigh food before eating it or compulsively count the calories of everything. People to whom this seems "normal" or "cool" or who wish that others would leave them alone so they can just diet and be thin might have a serious problem.
How do you know for sure that someone is struggling with anorexia or bulimia? You can't tell just by looking — a person who loses a lot of weight might have another health condition or could be losing weight through healthy eating and exercise.
But there are some signs to watch for that might indicate a person has anorexia or bulimia.
Someone with anorexia might:
- become very thin, frail, or emaciated
- be obsessed with eating, food, and weight control
- weigh herself or himself repeatedly
- deliberately "water load" when going to see a health professional to get weighed
- count or portion food carefully
- only eat certain foods, avoiding foods like dairy, meat, wheat, etc. (of course, lots of people who are allergic to a particular food or are vegetarians avoid certain foods)
- exercise excessively
- feel fat
- withdraw from social activities, especially meals and celebrations involving food
- be depressed, lethargic (lacking in energy), and feel cold a lot
Someone with bulimia might:
- fear weight gain
- be intensely unhappy with body size, shape, and weight
- make excuses to go to the bathroom immediately after meals
- only eat diet or low-fat foods (except during binges)
- regularly buy laxatives, diuretics, or enemas
- spend most of his or her time working out or trying to work off calories
- withdraw from social activities, especially meals and celebrations involving food
What Causes Eating Disorders?
No one is really sure what causes eating disorders, although there are many theories about it. Many people who develop an eating disorder are between 13 and 17 years old. This is a time of emotional and physical changes, academic pressures, and a greater degree of peer pressure.
Although there is a sense of greater independence during the teen years, teens might feel that they are not in control of their personal freedom and, sometimes, of their bodies. This can be especially true during puberty.
For girls, even though it's completely normal (and necessary) to gain some additional body fat during puberty, some respond to this change by becoming very fearful of their new weight. They might mistakenly feel compelled to get rid of it any way they can.
When you combine the pressure to be like celebrity role models with the fact that bodies grow and change during puberty, it's not hard to see why some teens develop a negative view of themselves. Celebrity teens and athletes conform to the "Hollywood ideal" — girls are petite and skinny, and guys are athletic and muscular, and these body types are popular not only in Hollywood but also in high school.
Many people with eating disorders also can be depressed or anxious, or have other mental health problems such as obsessive-compulsive disorder (OCD). There is also evidence that eating disorders may run in families. Although part of this may be genetics, it's also because we learn our values and behaviors from our families.
Sports and Eating Disorders
Athletes and dancers are particularly vulnerable to developing eating disorders around the time of puberty, as they may want to stop or suppress growth (both height and weight).
Coaches, family members, and others may encourage teens in certain sports — such as gymnastics, ice skating, and ballet — to be as thin as possible. Some athletes and runners are also encouraged to weigh less or shed body fat at a time when they are biologically destined to gain it.
Effects of Eating Disorders
Eating disorders are serious medical illnesses. They often go along with other problems such as stress, anxiety, depression, and substance use. Eating disorders can lead to the development of serious physical health problems, such as heart conditions or kidney failure.
Someone whose body weight is at least 15% less than the average weight for that person's height may not have enough body fat to keep organs and other body parts healthy. In severe cases, eating disorders can lead to severe malnutrition and even death.
With anorexia, the body goes into starvation mode, and the lack of nutrition can affect the body in many ways:
- a drop in blood pressure, pulse, and breathing rate
- hair loss and fingernail breakage
- loss of periods
- lanugo hair — a soft hair that can grow all over the skin
- lightheadedness and inability to concentrate
- swollen joints
- brittle bones
With bulimia, constant vomiting and lack of nutrients can cause these problems:
- constant stomach pain
- damage to the stomach and kidneys
- tooth decay (from exposure to stomach acids)
- "chipmunk cheeks," when the salivary glands permanently expand from throwing up so often
- loss of periods
- loss of the mineral potassium (this can contribute to heart problems and even death)
A person with binge eating disorder who gains a lot of weight is at risk of developing diabetes, heart disease, and some of the other diseases associated with being overweight.
The emotional pain of an eating disorder can take its toll, too. When someone becomes obsessed with weight, it's hard to concentrate on much else. It can be exhausting and overwhelming to monitor food intake and exercise, and be in a constant state of stress about food and how your body looks. It's easy to see why when you develop an eating disorder you could become withdrawn and less social. It gets too hard to join in on snacks and meals with friends or families, or too hard to stop the addictive exercising or working out to have fun.
Having an eating disorder also can use up a lot of mental energy planning what to eat, how to avoid food, planning a binge, getting money to buy food or laxatives or other medications, making up reasons to use the bathroom after meals, or figuring out how to tell people around you that you want to be alone after a meal.
Treatment for Eating Disorders
Fortunately, eating disorders can be treated. People with eating disorders can get well and gradually learn to eat well and more like their family and friends again. Eating disorders involve both the mind and body. So medical doctors, mental health professionals, and dietitians will often be involved in a person's treatment and recovery.
Therapy or counseling is a very important part of getting better — in many cases, family therapy is one of the keys to eating healthily again. Parents and other family members are important in supporting people who have to regain weight that they are afraid of, or to learn to accept the body shape that their culture, genes, and lifestyle allows for.
If you want to talk to someone about eating disorders but are unable or not ready to talk to a parent or close family member, try reaching out to a friend, teacher, school nurse or counselor, coach, neighbor, your doctor, or another trusted adult.
Remember that eating disorders are very common among teens. Treatment options depend on each person and their families, but many treatments incorporate journaling, talking to therapists, and working with dietitians and other professionals.
Learning to be comfortable at your healthy weight is a process. It takes time to unlearn some behaviors and relearn others. Be patient, you can learn to like your body, understand your eating behaviors, and figure out the relationship between feelings and eating — all the tools you need to feel in control and to like and accept yourself for who you are.
This post is from the Eating Disorders, Compulsions and Addictions Service (EDCAS) of the William Alanson White Institute in recognition of National Eating Disorders Awareness Week (February 23th through March 1th).
By Carrie Gottlieb, Ph.D.
It’s pretty easy to diagnose a full-blown eating disorder like Anorexia or Bulimia Nervosa. But more subtle forms of disordered eating are difficult to pinpoint. In our culture there is an obsession with size and weight, diet and exercise--the pervasiveness of disordered eating is astounding. Research suggests that up to 50% of the population demonstrate problematic or disordered relationships with food, body, and exercise. Rates of clinical eating disorders are much lower, estimated from 1% to 3% of the general population.
There are four diagnoses of eating disorders in The Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V), Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Eating Disorder Not Otherwise Specified. Specific diagnostic criteria are listed for each of the four diagnoses. However, falling short of meeting these criteria does not mean a person is maintaining a healthy relationship with food and weight. Individuals who demonstrate disordered eating may still be at risk both physically and emotionally.
Defining and recognizing disordered eating is a complicated issue. What are the signs and symptoms of disordered eating? How do you distinguish disordered eating from an actual eating disorder or even from more normative dieting behaviors? And what can be done to treat these behaviors once they become a problem?
Signs and Symptoms of Disordered Eating
Symptoms of disordered eating may include behavior commonly associated with eating disorders, such as food restriction, binge eating, purging (via self induced vomiting or excessive exercise, and use of diet pills and/ or laxatives). However, disordered eating might also include:
- Self worth or self esteem based highly or even exclusively on body shape and weight
- A disturbance in the way one experiences their body i.e. a person who falls in a healthy weight range, but continues to feel that they are overweight
- Excessive or rigid exercise routine
- Obsessive calorie counting
- Anxiety about certain foods or food groups
- A rigid approach to eating, such as only eating certain foods, inflexible meal times, refusal to eat in restaurants or outside of one’s own home
Disordered Eating vs. Eating Disorders
What distinguishes disordered eating from a full-blown eating disorder? It is all about degree. An individual with disordered eating is often engaged in some of the same behavior as those with eating disorders, but at a lesser frequency or lower level of severity. However, disordered eating is problematic and to be taken seriously, though the symptoms might not be as extreme as those of a diagnosable eating disorder. Individuals with disordered eating may be at risk for developing a full-blown eating disorder and are more likely to have a history of depression and/ or anxiety, or be at risk for anxiety and depression at some point in the future.
Understanding and Assessing The Risk of Disordered Eating
As with other mental health issues, it is important to explore how and to what extent disordered eating is affecting an individual’s daily functioning. Issues to consider include the following:
- Concentration and ability to focus-- do thoughts about food, body and exercise prevent concentration or impede performance at work or school?
- Social life--is socializing restricted because it might require eating in a restaurant, consumption of foods that are scary or uncomfortable, or disruption of exercise routine?
- Coping skills-- Is food consumption and/ or restriction used as way to manage life’s problems or cope with stressors?
- Discomfort or anxiety-- How much discomfort do thoughts of food and body cause? Are these thoughts hard to shake and anxiety provoking?
A mental health professional can help to distinguish between disordered eating, eating disorders, and more normative diet and exercise patterns and determine whether you might be at risk.
Preventing and Managing Disordered Eating
Here are some things you can do to prevent or manage disordered eating:
- Avoid fad or crash diet--many diets are both too restrictive in terms of both quantity and variety. This can cause a feeling of deprivation and possibly lead to binge eating. It is healthier to adopt a more inclusive meal plan in which all foods are incorporated in moderation.
- Set healthy limits on exercise and focus on physical activities that are enjoyable. For example, it’s preferable to take a yoga class instead of staying on the elliptical machine until you burn a certain number of calories.
- Stop negative body talk--be mindful of overly critical talk about yourself or your body.
- Throw away the scale--people with disordered eating often weight themselves daily or multiple times per day.
Treating Disordered Eating
The relationship we have with our bodies, as well as how we experience our size and shape is complex emotionally and physically. Difficulties with self-esteem and body image are common among those with and without eating disorders. Psychotherapy can help people understand these complex relationships, achieve body acceptance, and explore the relationship patterns and other psychological issues that contribute to the disordered eating. In addition, a nutritionist, who specializes in eating disorders and adopts a non-diet approach to food and exercise, can also be a good resource, particularly with respect to increasing attention to the body’s natural hunger/fullness cues.
Dr. Gottlieb is a clinical psychologist specializing in the treatment of eating disorders. She is trained in cognitive behavioral, interpersonal, relapse prevention and DBT therapies and adopts an integrative approach to psychotherapy with her patients. Dr. Gottlieb is currently on the steering committee of the William Alanson White Institute Eating Disorders, Compulsions, and Addictions program (EDCAS). She is in private practice in New York City. firstname.lastname@example.org.