What are Bulimia, Anorexia, & Eating Disorders?
Eating disorders are serious psychiatric conditions that are characterized by severe disturbances in eating, thoughts, and behaviors. At least 30 million people in the United States suffer from eating disorders of all types. Eating disorders do not discriminate. They can affect people of all races, ages, and genders. 1
Eating disorders can be life-threatening if not identified and treated appropriately. In fact, eating disorders have the highest mortality rate of any mental illness. More people die of eating disorders each year than of depression, bipolar disorder, and psychotic disorders.1
Types of Eating Disorders
The major types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder. Here is an in-depth look at these eating disorders, including the symptoms and risk factors.
Anorexia is perhaps one of the most well-known eating disorders. It is characterized by excessive weight-loss from self-starvation. People with this disorder have an intense fear of gaining weight and a distorted self-image. They perceive themselves as being overweight in spite of overwhelming evidence to the contrary. Here are some of the most common symptoms of anorexia: 2
- A distorted body image
- An intense fear about gaining weight
- Anxiety especially around meal times
- Low self-esteem
- Trouble concentrating
- Sensitivity to comments about body image, weight or size
- Unable to maintain a normal sized body weight
- Feeling cold a lot of the time
- Absence of a menstrual period in girls over the age of 12
- Dizziness or fainting
- Low energy or fatigue
- Difficulty sleeping
- Fine hair all over the body
- Preoccupation with food
- Significant changes in food preferences (a sudden dislike of foods that they previously enjoyed)
- Obsessive rituals around food prep and eating (taking elaborate steps to prepare food, eating very slowly)
- Compulsive or excessive exercising (spending hours at the gym each day)
- Self-harm or suicidal thoughts or behaviors
Bulimia is another common eating disorder that is characterized by a cycle of binge eating and compensatory behaviors designed to undo the binge. During a binge, a person with bulimia will eat an extremely large amount of food in a short time. For instance, they may eat up to 11,000 calories over a period of just a couple of hours. The person experiences a loss of control during the binge. People with bulimia often feel like they can’t stop eating once they binge. After binging, the person will attempt to compensate for the binge by vomiting, using laxatives, fasting or other behaviors, such as excessive exercise. It is a myth that all people with eating disorders are thin. People with bulimia are often normal to overweight. Here are some of the symptoms of bulimia. 3
- Having a distorted body image
- Feelings of self-loathing
- A preoccupation with food
- Feeling preoccupied with weight and size
- An obsessive need to control
- Irritability or depression
- Secrecy surrounding food and meal times
- Frequent weight loss or weight gain
- Damage to the teeth
- Bad breath
- Puffy cheeks
- Feeling tired or fatigued
- Trouble sleeping
- Gastrointestinal problems related to laxative use
- Vomiting or laxative use
- Excessive exercise
- Frequent dieting
- Obsessively counting calories, weighing food, etc.
- Frequent trips to the bathroom right after meals
- Insistence on eating alone
- Secrecy surrounding eating
You might not have heard of orthorexia. However, this eating disorder is increasing in the United States. Part of the reason for the increase may be due to the emphasis in social media on “clean eating” and other extremely restrictive diets. Family and friends may never know that a person has it because they appear to eat very healthy.
Orthorexia is listed under the avoidant restrictive food intake disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which professionals use to diagnose people with eating disorders.6 People with this disorder have very restrictive eating habits. They may eat only raw food or foods that are “clean.” People with orthorexia may avoid eating entire groups of foods. They may avoid gluten or artificial purposes.
So, you might be wondering “what is the difference between healthy eating and orthorexia?” Orthorexia goes well beyond healthy eating. People with orthorexia have an unhealthy obsession with food. They develop obsessive rituals about food and have no medical reason for intake restriction. Orthorexia sufferers may develop significant anxiety if they cannot control what they eat. They will experience shame, panic or guilt if they do not follow their “diet.” Thoughts about food and eating often consume them and impact their daily functioning.7
- Severe anxiety over food choices and health concerns, such as diabetes, asthma or digestive issues
- Feelings of guilt when deviating from food preferences
- Thinking critical thoughts about “unhealthy foods”
- A person with orthorexia may seem exceptionally healthy
- Avoidance of foods with GMOs, pesticides, dairy, animal products, fat, sugar, salt and other ingredients considered to be unhealthy
- A drastic reduction in the types of foods eaten
- Noticeable increase in the intake of supplements, herbal remedies, and vitamins
- Irrational fear of food prepared by others
Binge Eating Disorder
Binge eating disorder is an illness that is characterized by episodes of binge eating. Unlike people with bulimia, those binge-eating disorders do not use compensatory behaviors to negate the consumption. As a result, many people with binge-eating disorder are overweight or obese. Binge eating disorder affects both females and males at a similar rate. Binge eating disorder includes the following signs and symptoms. 4
- Feelings of guilt, embarrassment, and self-disgust related to binges.
- Poor self-image
- A preoccupation with food and eating
- Bloating and stomach ache
- Not sleeping well
- Eating large quantities of food even when full
- Eating when full
- Frequent dieting with no weight loss
- Hoarding food
- Hiding food wrappers and boxes
Risk Factors For Eating Disorders
Eating disorders affect people of all ages, races, and genders. Risk factors for eating disorders include a range of psychological, biological and environmental factors. Here are some of the most common: 7
- Having a close relative with an eating disorder
- Having a close relative with another mental disorder
- Body image dissatisfaction
- History of trauma
- History of being bullied
- Depression and other mental health issues
Diagnosis Of Eating Disorders
Eating disorders are serious mental disorders that should be diagnosed by an eating disorder therapist or specialist. The first step in getting a diagnosis is to visit your doctor. They will perform a physical exam and ask you about your eating behaviors. Then, they will most likely refer you to an eating disorder therapist.
Treatment For Eating Disorders
Eating disorders are not just a matter of dieting or self-control. They have far deeper roots than that and require specialized treatment to address both the distorted thoughts and harmful behaviors.
Additionally, eating disorders frequently occur with other mental illnesses, such as depression, anxiety disorders, and substance abuse. Professional treatment usually addresses all of these issues. Here are some of the most common treatments for eating disorders. 8
A commonly-used type of psychotherapy for treating eating disorders is cognitive behavioral therapy (CBT). CBT involves teaching a person to notice their negative or distorted thoughts and self-talk. In learning to catch your destructive thoughts, you will then learn strategies for challenging and changing them. This does not mean putting an unnecessarily positive view onto your life but instead aims to teach people to see themselves more realistically.
The goal of psychotherapy is to help people with eating disorders live a relatively normal life, free from harmful behaviors. Another important goal is self-acceptance. Through therapy, a person with an eating disorder can learn to develop a more healthy mindset.
People with eating disorders may require inpatient hospitalization if the disorder is severe. Generally, an eating disorder specialist can recommend inpatient treatment when it is needed.
After inpatient treatment, many people with eating disorders participate in residential treatment for a period of time. This is a long-term treatment that provides 24-hour care in a non-medical setting.
Although there are no medications that are specifically used to treat eating disorders, medications are often used to treat co-occurring conditions, such as anxiety and depression, as these frequently occur in people with eating disorders.
Self Help Tips
For many people struggling with eating disorders, self-care can be difficult. However, part of recovery involves learning to practice self-care. Here are some tips:
- Meditation and mindfulness – Practicing meditation and mindfulness during recovery can help you learn to calm. There are plenty of apps for meditation. One of our favorites is Calm.
- Social media breaks – Taking a break from social media is a great way to practice self-care during eating disorder recovery. Social media can be a helpful tool to find compassion and support from others. However, it can also encourage eating disorder behaviors. It is important to recognize when social media is negatively impacting your thoughts and behaviors and take breaks, as needed.
- Feel the music – Listen to uplifting music. Dance like nobody’s watching.
How to Find Help For Eating Disorders
If you or someone that you love has signs of an eating disorder, it is important to seek treatment from a therapist with experience in eating disorders. They will be the most effective at giving you the guidance you need to manage eating disorder symptoms and develop healthier behaviors. To find an eating disorder therapist near you, search the TherapyTribe directory.
- National Association of Anorexia Nervosa and Associated Disorders (2019). Eating Disorder Statistics. Retrieved from: https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/
- National Eating Disorders Association (2018). Anorexia Warning Signs and Symptoms. Retrieved from: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia/warning-signs-symptoms
- National Eating Disorders Association (2018). Bulimia Nervosa. Retrieved from: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia
- National Eating Disorders Association (2018). Binge Eating Disorder. Retrieved from: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
- National Eating Disorders Association (2018). Orthorexia. Retrieved from: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia
- National Eating Disorders Association (2018). Risk Factors. Retrieved from: https://www.nationaleatingdisorders.org/risk-factors
- National Eating Disorders Association (2018). Treatment. Retrieved from: https://www.nationaleatingdisorders.org/treatment