EATING U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 07-4901 DISORDERS Revised 2007 NATIONAL INSTITUTE OF MENTAL HEALTH EATING DISORDERS NATIONAL INSTITUTE OF MENTAL HEALTH TABLE OF CONTENTS TWO wHAT ARE EATING DISORDERS ? FIVE ANOREXIA NERVOSA NINE BULIMIA NERVOSA TWELVE BINGE-EATING DISORDER FOURTEEn HOW ARE MEN AND BOYS AFFECTED ? FIFTEEn HOW ARE WE WORKING TO BETTER UNDERSTAND AND TREAT EATING DISORDERS ? W HAT ARE EATING DISOR DERS? AN EATING DISORDER A person with an eating disorder is marked by extremes. It is pres- may have started out just eating ent when a person experiences smaller or larger amounts of severe disturbances in eating food than usual, but at some behavior, such as extreme reduc- point, the urge to eat less or tion of food intake or extreme more spirals out of control. overeating, or feelings of extreme Eating disorders are very distress or concern about body complex, and despite scientific weight or shape. research to understand them, the biological, behavioral and social underpinnings of these illnesses remain elusive. TWO The two main types of eating Eating disorders frequently disorders are anorexia nervosa appear during adolescence or and bulimia nervosa. A third young adulthood, but some category is “eating disorders not reports indicate that they can otherwise specified (EDNOS),” develop during childhood or later which includes several variations in adulthood. Women and girls of eating disorders. Most of these are much more likely than males disorders are similar to anorexia to develop an eating disorder. or bulimia but with slightly Men and boys account for an different characteristics. Binge- estimated 5 to 15 percent of eating disorder, which has re- patients with anorexia or bulimia ceived increasing research and and an estimated 35 percent of media attention in recent years, those with binge-eating disorder. is one type of EDNOS. Eating disorders are real, treat- able medical illnesses with complex underlying psychological and biological causes. They frequently co-exist with other psychiatric disorders such as depression, substance abuse, or anxiety disorders. People with eating disorders also can suffer from numerous other physical health complications, such as heart conditions or kidney failure, which can lead to death. Eating disorders are treatable diseases. Psychological and medicinal In these cases, treatment plans treatments are effective for many often are tailored to the eating disorders. However, in patient’s individual needs that more chronic cases, specific may include medical care treatments have not yet been and monitoring; medications; identified. nutritional counseling; and individual, group and/or family psychotherapy. Some patients may also need to be hospitalized to treat malnutrition or to gain weight, or for other reasons. FOUR ANOREXIA NERVOSA ANOREXIA NERVOSA is Many people with anorexia see characterized by emaciation, themselves as overweight, even a relentless pursuit of thinness when they are starved or are and unwillingness to maintain clearly malnourished. Eating, food a normal or healthy weight, a and weight control become ob- distortion of body image and sessions. A person with anorexia intense fear of gaining weight, typically weighs herself or himself a lack of menstruation among repeatedly, portions food care- girls and women, and extremely fully, and eats only very small disturbed eating behavior. Some quantities of only certain foods. people with anorexia lose weight Some who have anorexia re- by dieting and exercising exces- cover with treatment after only sively; others lose weight by one episode. Others get well but self-induced vomiting, or misusing have relapses. Still others have a laxatives, diuretics or enemas. more chronic form of anorexia, in which their health deteriorates over many years as they battle the illness. According to some studies, Many people with anorexia people with anorexia are up also have coexisting psychiatric to ten times more likely to and physical illnesses, including die as a result of their illness depression, anxiety, obsessive compared to those without behavior, substance abuse, the disorder. The most common cardiovascular and neurological complications that lead to death complications, and impaired are cardiac arrest, and electro- physical development. lyte and fluid imbalances. Suicide also can result. OTHER SYMPTOMS MAY DEVELOP OVER TIME, INCLUDING: • thinning of the bones (osteopenia or osteoporosis) • brittle hair and nails • dry and yellowish skin • growth of fine hair over body (e.g., lanugo) • mild anemia, and muscle weakness and loss • severe constipation • low blood pressure, slowed breathing and pulse • drop in internal body temperature, causing a person to feel cold all the time • lethargy SIX MTREATING ANOREXIA involves three components : 1. restoring the person to a healthy weight; 2. treating the psychological issues related to the eating disorder; and 3. reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse. Some research suggests that Different forms of psychotherapy, the use of medications, such as including individual, group and antidepressants, antipsychotics family-based, can help address or mood stabilizers, may be the psychological reasons for the modestly effective in treating illness. Some studies suggest that patients with anorexia by helping family-based therapies in which to resolve mood and anxiety parents assume responsibility symptoms that often co-exist for feeding their afflicted adoles- with anorexia. Recent studies, cent are the most effective in however, have suggested that helping a person with anorexia antidepressants may not be gain weight and improve eating effective in preventing some habits and moods. Shown to patients with anorexia from be effective in case studies and relapsing. In addition, no medica- clinical trials, this particular tion has shown to be effective approach is discussed in some during the critical first phase guidelines and studies for treat- of restoring a patient to healthy ing eating disorders in younger, weight. Overall, it is unclear if nonchronic patients. and how medications can help patients conquer anorexia, but research is ongoing. Others have noted that a combined approach of medical attention and supportive psychotherapy designed spe- cifically for anorexia patients is more effective than just psychotherapy. But the effective- ness of a treatment depends on the person involved and his or her situation. Unfortunately, no specific psychotherapy ap- pears to be consistently effective for treating adults with anorexia. However, research into novel treatment and prevention approaches is showing some promise. One study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder. EIGHT BULIMIA NERVOSA BULIMIA NERVOSA is charac- and are intensely unhappy with terized by recurrent and frequent their body size and shape. episodes of eating unusually Usually, bulimic behavior is done large amounts of food (e.g., secretly, because it is often binge-eating), and feeling a lack accompanied by feelings of of control over the eating. This disgust or shame. The binging binge-eating is followed by a type and purging cycle usually repeats of behavior that compensates several times a week. for the binge, such as purging Similar to anorexia, people with (e.g., vomiting, excessive use of bulimia often have coexisting laxatives or diuretics), fasting psychological illnesses, such as and/or excessive exercise. depression, anxiety and/or Unlike anorexia, people with substance abuse problems. Many bulimia can fall within the normal physical conditions result from range for their age and weight. the purging aspect of the illness, But like people with anorexia, including electrolyte imbalances, they often fear gaining weight, gastrointestinal problems, and want desperately to lose weight, oral and tooth-related problems. OTHER SYMPTOMS INCLUDE: • chronically inflamed and sore throat • swollen glands in the neck and below the jaw • worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids • gastroesophageal reflux disorder • intestinal distress and irritation from laxative abuse • kidney problems from diuretic abuse • severe dehydration from purging of fluids TEN As with anorexia, TREATMENT FOR BULIMIA often involves a combination of options and depends on the needs of the individual. To reduce or eliminate binge CBT that has been tailored and purge behavior, a patient to treat bulimia also has shown may undergo nutritional counsel- to be effective in changing ing and psychotherapy, especially binging and purging behavior, cognitive behavioral therapy and eating attitudes. Therapy (CBT), or be prescribed medica- may be individually oriented tion. Some antidepressants, such or group-based. as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration for treating bulimia, may help patients who also have depression and/or anxiety. It also appears to help reduce binge-eating and purging behavior, reduces the chance of relapse, and improves eating attitudes. BINGE-EATING DISORDER BINGE-EATING DISORDER Obese people with binge-eating is characterized by recurrent disorder often have coexisting binge-eating episodes during psychological illnesses including which a person feels a loss of anxiety, depression, and personal- control over his or her