The term “eating disorder” is used loosely nowadays in the media and amongst young people. But if you or someone you know may be suffering from any degree of a real struggle with body image or an eating disorder, it can be life threatening.

The earlier an eating disorder is recognized and treated, the more likely the sufferer can go on to lead a normal, healthy life and even help others. Don’t wait seventeen years like I did to seek treatment. It was a mistake that nearly killed me, and to this day I struggle with emotional and physical side effects related to my disorder having gone on so long untreated.

According to the National Eating Disorders Association, there are clear and important clues to look for to know if you or someone you know may be at risk for bulimia, anorexia, binge eating, or other types of eating disorders.

“Anorexia Nervosa

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.

Symptoms

Resistance to maintaining body weight at or above a minimally normal weight for age and height.

Intense fear of weight gain or being “fat,” even though underweight.

Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight.

Loss of menstrual periods in girls and women post-puberty.

Eating disorders experts have found that prompt intensive treatment significantly improves the chances of recovery. Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.

Warning Signs

Dramatic weight loss.

Preoccupation with weight, food, calories, fat grams, and dieting.

Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).

Frequent comments about feeling “fat” or overweight despite weight loss.

Anxiety about gaining weight or being “fat.”

Denial of hunger.

Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).

Consistent excuses to avoid mealtimes or situations involving food.

Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.

Withdrawal from usual friends and activities.

In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health Consequences of Anorexia Nervosa

Anorexia nervosa involves self-starvation.; The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences:

Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower.

Reduction of bone density (osteoporosis), which results in dry, brittle bones.

Muscle loss and weakness.

Severe dehydration, which can result in kidney failure.

Fainting, fatigue, and overall weakness.

Dry hair and skin, hair loss is common.

Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

About Anorexia Nervosa

Approximately 90-95% of anorexia nervosa sufferers are girls and women.

Between 0.5–1% of American women suffer from anorexia nervosa.

Anorexia nervosa is one of the most common psychiatric diagnoses in young women.

Between 5-20% of individuals struggling with anorexia nervosa will die. The probabilities of death increases within that range depending on the length of the condition.

Anorexia nervosa has one of the highest death rates of any mental health condition.

Anorexia nervosa typically appears in early to mid-adolescence.

Bulimia Nervosa

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Symptoms

Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.

Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.

Extreme concern with body weight and shape.

The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

Warning Signs of Bulimia Nervosa

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.

Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.

Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.

Unusual swelling of the cheeks or jaw area.

Calluses on the back of the hands and knuckles from self-induced vomiting.

Discoloration or staining of the teeth.

Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.

Withdrawal from usual friends and activities.

In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Continued exercise despite injury; overuse injuries.

Health Consequences of Bulimia Nervosa

Bulimia nervosa can be extremely harmful to the body. The recurrent binge-and-purge cycles can damage the entire digestive system and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the health consequences of bulimia nervosa include:

Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death.

Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.

Inflammation and possible rupture of the esophagus from frequent vomiting.

Tooth decay and staining from stomach acids released during frequent vomiting.

Chronic irregular bowel movements and constipation as a result of laxative abuse.

Gastric rupture is an uncommon but possible side effect of binge eating.

About Bulimia Nervosa

Bulimia nervosa affects 1-2% of adolescent and young adult women.

Approximately 80% of bulimia nervosa patients are female.

People struggling with bulimia nervosa usually appear to be of average body weight.

Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.

Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.

Risk of death from suicide or medical complications is markedly increased for eating disorders.

Binge Eating Disorder

Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

Symptoms

Frequent episodes of eating large quantities of food in short periods of time.

Feeling out of control over eating behavior during the episode.

Feeling depressed, guilty, or disgusted by the behavior.

There are also several behavioral indicators of BED including eating when not hungry, eating alone because of embarrassment over quantities consumed, eating until uncomfortably full.

Health Consequences of Binge Eating Disorder

The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:

High blood pressure

High cholesterol levels

Heart disease

Diabetes mellitus

Gallbladder disease

Musculoskeletal problems

About Binge Eating Disorder

The prevalence of BED is estimated to be approximately 1-5% of the general population.

Binge eating disorder affects women slightly more often than men–estimates indicate that about 60% of people struggling with binge eating disorder are female, 40% are male.

People who struggle with binge eating disorder can be of normal or heavier than average weight.

BED is often associated with symptoms of depression.

People struggling with binge eating disorder often express distress, shame, and guilt over their eating behaviors.

People with binge eating disorder report a lower quality of life than non-binge eating disorder.

Other Specified Feeding or Eating Disorder (OSFED) previously known as Eating Disorders Not Otherwise Specified (EDNOS)

Eating disorders such as anorexia and bulimia include extreme emotions, attitudes, and behaviors surrounding weight and food issues. They are serious disorders and can have life-threatening consequences. The same is true for a category of eating disorders known as Other Specified Feeding or Eating Disorder, or OSFED, which used to be classified as Eating Disorders not Otherwise Specified or EDNOS. These serious eating disorders can include any combination of signs and symptoms typical of anorexia and bulimia, so it may be helpful to first look at anorexia and bulimia.
Symptoms associated with anorexia nervosa include:

Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level.

Intense fear of weight gain or being “fat”

Feeling “fat” or overweight despite dramatic weight loss

Loss of menstrual periods

Extreme concern with body weight and shape

Symptoms associated with bulimia nervosa include:

Repeated episodes of binging and purging

Feeling out of control during a binge and eating beyond the point of comfortable fullness

Purging after a binge, (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting)

Frequent dieting

Extreme concern with body weight and shape

The following are some common examples of eating disorders not otherwise specified, but your experience may be different. If you are concerned about your eating and exercise habits and your thoughts and emotions concerning food, activity and body image, we urge you to consult an ED expert.

Examples of OSFED (EDNOS)

Menstruation is still occurring despite meeting all other criteria for anorexia nervosa.

All conditions are present to qualify for anorexia nervosa except the individual’s current weight is in the normal range or above.

Purging or other compensatory behaviors are not occurring at a frequency less than the strict criteria for bulimia nervosa

Purging without Binging—sometimes known as purging disorder

Chewing and spitting out large amounts of food but not swallowing

The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school or relationships. If something does not seem right, but your experience does not fall into a clear category, you still deserve attention.

Diabulimia

Diabulimia is an eating disorder which may affect those with Type 1 Diabetes. Diabulimia is the reduction of insulin intake to lose weight. Diabulimia is considered a dual diagnosis disorder: where one has diabetes as well as an eating disorder. While diabulimia is generally associated with use of insulin, an individual with diabetes may also suffer from another eating disorder as well.

Health Risks of Diabulimia

High glucose levels

Glucose in the urine

Exhaustion

Thirst

Inability to think clearly

Severe dehydration

Muscle loss

Diabetic Ketoacidosis (unsafe levels of ketones in the blood)

High Cholesterol

Bacterial skin infections

Yeast infections

Menstrual disruption

Staph infections

Retinopathy

Neuropathy

Peripheral Arterial Disease

Atherosclerosis (a fattening of the arterial walls)

Steatohepatitis (a type of liver disease)

Stroke

Coma

Death

Possible signs of Diabulimia can include:

Hemoglobin level of 9.0 or higher on a continuous basis.

Unexplained weight loss.

Persistent thirst/frequent urination.

Preoccupation with body image.

Blood sugar records that do not match Hemoglobin A1c results.

Depression, mood swings and/or fatigue.

Secrecy about blood sugars, shots and or eating.

Repeated bladder and yeast infections.

Low sodium/potassium.

Increased appetite especially in sugary foods.

Cancelled doctors’ appointments.

Orthorexia Nervosa

By Karin Kratina, PhD, RD, LD/N

Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.” Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake.
Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating. Eventually, the obsession with healthy eating can crowd out other activities and interests, impair relationships, and become physically dangerous.

Is Orthorexia An Eating Disorder?

Orthorexia is a term coined by Steven Bratman, MD to describe his own experience with food and eating. It is not an officially recognized disorder, but is similar to other eating disorders – those with anorexia nervosa or bulimia nervosa obsess about calories and weight while orthorexics obsess about healthy eating (not about being “thin” and losing weight).

Why Does Someone Get Orthorexia?
Orthorexia appears to be motivated by health, but there are underlying motivations, which can include safety from poor health, compulsion for complete control, escape from fears, wanting to be thin, improving self-esteem, searching for spirituality through food, and using food to create an identity.

Do I Have Orthorexia?

Consider the following questions. The more questions you respond “yes” to, the more likely you are dealing with orthorexia.
Do you wish that occasionally you could just eat and not worry about food quality?
Do you ever wish you could spend less time on food and more time living and loving?
Does it seem beyond your ability to eat a meal prepared with love by someone else – one single meal – and not try to control what is served?
Are you constantly looking for ways foods are unhealthy for you?
Do love, joy, play and creativity take a back seat to following the perfect diet?
Do you feel guilt or self-loathing when you stray from your diet?
Do you feel in control when you stick to the “correct” diet?
Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?

So What’s The Big Deal?

The diet of orthorexics can actually be unhealthy, with nutritional deficits specific to the diet they have imposed upon themselves. These nutritional issues may not always be apparent. Social problems are more obvious. Orthorexics may be socially isolated, often because they plan their life around food. They may have little room in life for anything other than thinking about and planning food intake. Orthorexics lose the ability to eat intuitively – to know when they are hungry, how much they need, and when they are full. Instead of eating naturally they are destined to keep “falling off the wagon,” resulting in a feeling of failure familiar to followers of any diet.

When Orthorexia Becomes All Consuming

Dr. Bratman, who recovered from orthorexia, states “I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed. … I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life’s meaning had been transferred inexorably to food, and I could not reclaim it.” (Source: www.orthorexia.com)

Are You Telling Me it is Unhealthy to Follow a Healthy Diet?
Following a healthy diet does not mean you are orthorexic, and nothing is wrong with eating healthfully. Unless, however, 1) it is taking up an inordinate amount of time and attention in your life; 2) deviating from that diet is met with guilt and self-loathing; and/or 3) it is used to avoid life issues and leaves you separate and alone.

What Is The Treatment for Orthorexia?

Society pushes healthy eating and thinness, so it is easy for many to not realize how problematic this behavior can become. Even more difficult is that the person doing the healthy eating can hide behind the thought that they are simply eating well (and that others are not). Further complicating treatment is the fact that motivation behind orthorexia is multi-faceted. First, the orthorexic must admit there is a problem, then identify what caused the obsession. She or he must also become more flexible and less dogmatic about eating. Working through underlying emotional issues will make the transition to normal eating easier.
While orthorexia is not a condition your doctor will diagnose, recovery can require professional help. A practitioner skilled at treating eating disorders is the best choice. This handout can be used to help the professional understand orthorexia.

Recovery

Recovered orthorexics will still eat healthfully, but there will be a different understanding of what healthy eating is. They will realize that food will not make them a better person and that basing their self-esteem on the quality of their diet is irrational. Their identity will shift from “the person who eats health food” to a broader definition of who they are – a person who loves, who works, who is fun. They will find that while food is important, it is one small aspect of life, and that often other things are more important!”