Eating Disorders

Remember

Eating disorders can cause lots of medical symptoms.
Treatment with nutrition, mental health, and medical professionals can help address the eating disorder.
If you think you may have an eating disorder, get help! Talk with your health care provider or another trusted adult.

Eating disorders affect millions of teens and young women worldwide and are more common in cultures that focus on weight loss and body image. Intense focus on thinness can lead to negative body image and unhealthy eating behaviors in young women. Sometimes, these unhealthy eating behaviors lead to eating disorders such as anorexia nervosa, bulimia, binge eating disorder or eating disorders not otherwise specified (ED-NOS). If you are reading this guide, perhaps you are worried about your health or the health of someone you know. This guide was created to help young women understand eating disorders, and realize that treatment and recovery are possible.

What are eating disorders?

There are four types of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and ED-NOS (Eating Disorders Not Otherwise Specified). Young women with these disorders often have a negative and distorted body image, and intense emotions and behaviors surrounding food. The phrase "body image" means the thoughts and feelings people have about their physical appearance. Young women with eating disorders may start to eat less because they are afraid of gaining weight. Sometimes they binge (overeat, consuming very large quantities of food) and sometimes purge (by making themselves vomit, over-exercising, or using laxatives). Eating disorders affect a person's physical and emotional health. They are very dangerous illnesses and can be fatal if they are not treated.

What is anorexia nervosa?

Anorexia nervosa is an illness that involves having an extreme desire to be thin. The key elements of anorexia nervosa are: a refusal to keep body weight at a healthy level, an intense fear of being fat, a distorted body image. Many teens who have anorexia stop having their periods or don’t get it on a regular schedule.

Symptoms of Anorexia Nervosa
Physical	Emotional
Dramatic weight loss	Depression
Slow heart rate	Anxiety or nervousness
Low blood pressure	Distorted body image
Low body temperature	Intense fear of weight gain
Brittle hair and finger nails	Low self-esteem
Hair loss	Withdrawal from friends & activities
Dry skin & dehydration	Thinking about food most of the time
Growth of lanugo (soft furry hair on face, back & arms)
Amenorrhea (menstrual period stops)
Slow or stunted growth

If you have any of these symptoms you may be at risk for serious health problems and you should call or make an appointment with your health care provider as soon as possible.

What is bulimia nervosa?

Bulimia nervosa is an eating disorder that involves frequent bingeing and purging, as well as a distorted body image. Bingeing means eating a lot of food at one time even when you’re not hungry. Following a binge, young women with bulimia will try to get rid of food by vomiting, taking laxatives or by excessively exercising. People with bulimia may hide what they eat from others and feel afraid or ashamed of their behavior.

What are some of the health problems that girls with bulimia face?

Bulimia is hard to detect from looking at a person since the health problems a teen may suffer from are not as obvious as with anorexia. For example, someone may have a normal weight, but still have bulimia. Also, they may be secretive about their eating habits so that even their family and friends are not aware that they have a problem. Bulimia is serious and can cause permanent damage to the teeth, stomach, digestive track, and heart.

Symptoms of Bulimia Nervosa
Physical	Emotional
Electrolyte problems	Depression
Irregular menstrual periods	Shame or guilt
Dehydration	Anxiety
Swollen face (fluid retention)	Fear of weight gain
Sore throat	Withdrawal from friends
Tooth decay/loss
Dry, flakey skin
Heart arrhythmias (due to potassium loss from vomiting)
Constipation
Body weight is typically normal

If you have these symptoms you are at risk for serious health problems and you should contact a health care provider immediately.

What is Binge Eating Disorder?

Binge eating disorder, or compulsive eating disorder, involves eating large amounts of food in short periods of time without purging. Often, people with binge eating disorder will skip meals or eat small portions when they are around others and then eat large amounts when they are alone. Young women with binge eating disorder often suffer from anxiety, depression, loneliness, shame and/or self-hatred. Their body weight can vary from normal to obese.

What is EDNOS (Eating Disorder Not Otherwise Specified)?

EDNOS is short for Eating Disorder Not Otherwise Specified. People with EDNOS have some, but not all, of the symptoms of either anorexia, bulimia, or binge eating disorder. For example, young women struggling with EDNOS may have periods of restrictive eating (days or months) followed by periods of overeating or binge eating, or they may be at a very low weight, but not have anorexia because they still get their menstrual period. Young women with EDNOS may also maintain a stable weight that is within a medically safe range, but still have many of the other symptoms and medical complications of eating disorders.

What causes eating disorders?

There are many different theories regarding the causes of eating disorders. Eating disorders are likely caused by a combination of social, psychological, family, genetic, and environmental factors.

Society’s intense focus on thinness and appearance influences how young women view their bodies and their self-esteem. While this focus may not cause eating disorders, it can contribute to their development.

An individual may have a family history of emotional disorders such as depression or anxiety. Eating disorders are often associated with feelings of helplessness, sadness, anxiety, and the need to be perfect. This can cause a person to use dieting or weight loss to provide a sense of control.

Teens who participate in competitive sports that emphasize thinness or artistic activities, such as ballet, running, gymnastics, or skating, are more likely to develop an eating disorder.

Family stress of any kind can also contribute to the development of these illnesses. Dealing with difficult transitions, loss, or teasing about weight from friends or family may trigger eating disorders.

What do I do if I think my friend has an eating disorder?

It can be hard to talk to a friend who you think has an eating disorder. People who have eating disorders are often in denial and do not want to talk about their problems. They may get defensive or upset with the people in their lives who try to get them help. Do not let these reactions prevent you from trying to help someone you care about.

Remember, you can make a difference by helping a friend face her illness and her get treatment. Many people who get treatment for anorexia or bulimia are able to do so because of the support from others in their lives. It is often very hard for people with this illness to make a phone call or come in for their appointments. They often need friends and family to take the first steps for them.

Before talking to your friend, think about how to approach her. If you feel that you can't approach her yourself, share the information with a trusted adult and have them get help for your friend. You may want to talk with someone first such as an adult or another friend to find out more information, as it is helpful to have names and numbers of eating disorder resources (see Related Links below) to give your friend so she can take the steps to get help.

You may need to give your friend some time after you confront her about your concerns. Do not expect that she will immediately be able to understand you or accept help right away. Dealing with eating disorders can be challenging and may take a long time. Being honest and patient with your friend will make it easier for you to support her. But most importantly, remember to tell an adult such as a parent or teacher if you are worried about a friend.

How are eating disorders treated?

Eating disorders are medical and psychological problems. Treatment usually includes working with a team of specialists: a therapist, a nutritionist, and a doctor or nurse practitioner. Treatment is individualized to fit a teen's specific needs.

What does a medical doctor do to treat an eating disorder?

A doctor keeps track of a person's medical health by checking height, weight, blood pressure, pulse, and temperature. It may be necessary to draw blood for lab tests, to make sure the chemicals in the body called electrolytes are stable. Electrolytes are the sodium, potassium, chloride, and carbon dioxide levels in your body. They keep the heart and body working properly. The doctor may recommend that a person stay in the hospital for a few days if her medical condition is dangerous.

The doctor may also order special tests such as an EKG to monitor heart rhythm or a bone density test (DEXA) to see if osteoporosis is present. The doctor will likely discuss treatments such as healthy eating, weight stabilization, calcium and vitamin supplements, exercise, hormone replacement, and possibly medication for anxiety or depression. Also, a doctor will usually recommend talking with a nutritionist and therapist as part of the treatment plan.

What does a therapist do to treat an eating disorder?

The goals for a young woman with an eating disorder are to improve her body image and self-esteem and to address other emotional issues. If you have an eating disorder, you may discover that you have other problems in your life such as depression, obsessive-compulsive disorder, or substance abuse. You may explore feelings of sadness, anxiety, or anger with your therapist. Therapy provides the time and space where you can confidentially discuss your needs, your goals, and your understanding of the eating problem. Therapy helps to explore eating disordered thinking and behaviors and learn strategies to become healthy. Families often need a therapist or a group for support and education surrounding eating problems.

Family therapy can be an important part of getting well if family tensions, difficult relationships, or poor communication exist. In the family treatment meeting, the family members can talk about problems and work on solutions and coping skills with the help and guidance of a trained therapist.

Group therapy can also be an effective treatment option. Many people find that talking with other people who have had an eating disorder is helpful, because they can share stories, feelings and coping strategies.

Can medication help an eating disorder?

Medications are often prescribed as part of the treatment for an eating disorder, or for other conditions that people with eating disorders may have such as: depression, anxiety, and obsessive compulsive disorder. A doctor will prescribe and monitor the medicine.

Can a nutritionist help to treat an eating disorder?

A nutritionist can help you to create a safe eating plan and answer questions about food. In a culture obsessed with dieting, and striving for the "perfect" body, people get many mixed messages about food and health. A nutritionist can discuss the harmful myths about food and diet and help guide you to healthy eating and healthy living! It is very important to work with a nutritionist who has experience working with teens and young women with eating disorders.

I'm worried about developing an eating disorder—What can I do?

Having a positive self-image, eating a healthy diet, and exercising for fitness and enjoyment will help you to maintain a healthy balance in your life and decrease your risk of developing an eating disorder. The following tips are good ways to stay healthy, build a good body image, and feel better about who you are.

Identify and respect everything about yourself- the inside and the outside.
Be yourself. Don’t try to look like models in magazines.
Try not to think or talk about weight, calories, and food.
Try to make eating a positive experience: eating fuels both your body and mind!
Don't diet! Try to eat mostly healthy foods.
Work on ways to cope with negative feelings, such as talking to friends or family, listening to music, playing a sport, or doing crafts. Practicing healthy ways to deal with stress may help you avoid using food to deal with emotions.

What do I do if I think I may have an eating disorder?

If you think that you may have an eating disorder, it is very important that you talk to your health care provider immediately. If you are too nervous or scared to contact your health care provider on your own, try talking to an adult you trust such as a parent, teacher, relative, or family friend. They can help you to make sure that you receive the help you need. Even if it is scary to get help for an eating disorder, your life may depend on it! The sooner you get help, the sooner you will feel relief from some of your eating disorder symptoms.

What can we do as a society to prevent eating disorders?

It is important for us to look at our attitudes and behaviors in our own lives to help us understand how we can prevent eating disorders in our culture. Teasing and harassment about weight and body shape often leads young women to develop eating disordered behaviors. Conversations and activities that focus only on thinness, weight, and dieting can be harmful.

Magazines and movies promote unrealistic role models for beauty and weight. Often, we are presented with an image that is unnaturally thin and unlike most women. It is important to realize that we are all meant to be different shapes and sizes and that pictures in magazines are airbrushed.

The dieting industry also may push us to try and change our bodies into something we are not. Most young women have come to accept dieting as a part of growing up; yet dieting and restricting calories can cause serious psychological and physiological consequences such as the inability to focus at school, tiredness, and depression. Girls who diet actually are more likely to gain weight then those who don't diet.

Accepting these unreasonable standards to measure bodies may create disordered thinking and behaviors and generally low self-esteem. It is very difficult to avoid or fight back against the industry that places these ideas in our head, but we can try. Together we can reverse the social environment and mind-set that creates eating disorders!

What are some of the advances in eating disorders treatment and prevention?

Many researchers are working to figure out how to treat eating disorders. New therapies and medications to prevent osteoporosis, mood and hormonal problems associated with eating disorders are being studied. Many schools are using a curriculum that promotes awareness around eating disorders as well as healthy attitudes about body image. In addition, there is a national effort to offer screening to adolescents and young adults for eating disorders in community health centers and schools so they can get help early. Many health professionals and researchers are working hard to prevent eating disorders and to find new treatments.

Where can I learn more?