Do you or someone you know have an eating disorder?
What are the most common types of eating disorders?
What are the treatments available for eating disorders?
This post will concentrate on the three most prominent eating disorders. These include
- Anorexia nervosa (AN)
- Bulimia nervosa (BN)
- Binge eating disorder (BED
We will explore these disorders one at a time. The most important thing to remember is that getting professional help is crucial if you suffer from any of these conditions. All of these disorders can progress to death if not treated.
Anorexia Nervosa (AN)
Anorexia is probably the most well-known eating disorder. Although estimates vary based on the study, it is estimated that the lifetime prevalence rate of AN is 0.8%.1
It is important to note that eating disorders are often underreported in the literature because many with these conditions do not seek treatment.
Patients with anorexia have significantly low body weight in relation to age, sex, and physical health. These individuals have an intense fear of gaining weight and becoming fat. They also underestimate the seriousness of their low body weight and have a distorted view of their body shape. There are two types of anorexia.
- Restricting type – The patient has not regularly engaged in binge eating or purging in the last three months.
- Binge eating/purging type – The patient has regularly engaged in binge eating or purging in the last three months.
Signs and Symptoms of Anorexia
The signs and symptoms of anorexia can be split into three specific categories, as follows:3
Psychiatric symptoms:
- Preoccupation with food, cooking, and nutrition
- Fear of weight gain
- Restlessness
- Social isolation and withdrawal
- Ritualistic behaviors
- Irritability
Many of these patients also suffer from other psychiatric disorders such as depression, anxiety, or obsessive-compulsive disorder.
Eating Behaviors:
- Water loading.
- Vegan and vegetarian diet.
- Skipping meals.
- Calorie restriction.
- Cutting food into small pieces.
Physical Signs:
- Underweight, emaciated
- Constipation, abdominal pain
- Lethargy
- Dry skin, brittle nails
- Yellowish skin
- Electrolyte imbalances
- Hypoglycemia
- Infertility, premature births
- Bradycardia, hypotension, cardiac arrhythmias
- Osteoporosis
Risk Factors for Developing Anorexia
Genetic factors – Some studies suggest genetics may be a factor in the development of anorexia.
- Diabetes
- Emotional Stress – There is a link between emotional stressors such as the death of a loved one or divorce of parents and the development of AN.
- Parental pressure regarding achievement and appearance.
- Participation in sports that are associated with thinness, such as ballet, wrestling, or running.
- Peer pressure and social media – Young teens are often bombarded with perceived success based on unrealistic body images.
- Age – Peak onset is early to mid-adolescence.
- Gender – Lifetime prevalence in females is 0.9% and only 0.3% in females.4
Treatment of Anorexia Nervosa
Treating anorexia should be accomplished using a team approach. Physicians, nurses, dietitians, therapists, and other health professionals with experience treating eating disorders should be employed.
A dietician should provide nutritional rehabilitation to avoid refeeding syndrome. This is done by slowly increasing the patient’s weight.
The most effective treatment for anorexia in adolescents and young adults is family-based psychotherapy.
The use of medications in the treatment of AN is controversial and should not be started until the patient has gained sufficient weight in most cases. These may include:
- Multivitamins
- Agents for constipation, abdominal pain and bloating.
- Calcium supplements for osteopenia.
Medications used to treat co-existing conditions such as depression, OCD, and anxiety may also be initiated when it is safe to do so.
In severe cases, hospitalization may be necessary to correct dehydration, electrolyte imbalances, cardiac arrhythmias, or severe malnutrition.
One final comment about AN. Many people are unaware that this disorder has a high mortality rate. In fact, a meta-review of all-cause and suicide mortality in mental disorders came to the following conclusion:
Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa.5
Bulimia Nervosa (BN)
Bulemia Nervosa (BN) is an emotional disorder that involves an obsessive desire to lose weight. BN is characterized by extreme overeating followed by depression and inappropriate compensatory behaviors to prevent weight gain, such as:
- Excessive exercise.
- Misuse of laxatives, diuretics, or enemas.
- Self-induced vomiting or purging.
The severity of BN can be categorized according to the frequency of these inappropriate behaviors:
- Mild – Average of 1-3 episodes weekly.
- Moderate – Average of 4-7 episodes weekly.
- Severe – Average of 8-13 episodes weekly.
- Extreme – Average of more than 13 episodes weekly.
Signs and Symptoms of Bulimia
As with anorexia, the signs and symptoms of BN can be split into categories.
Psychiatric Symptoms:
- Substance use disorders
- Anxiety disorders
- Impulsivity
- Depression
- Mood fluctuations
Behaviors:
- Preoccupation with food and eating
- Laxative or diuretic abuse
- Compulsive exercise
- Poor self-image
- Self-induced vomiting or purging
These patients often lose control over food intake. They eat large quantities of high-calorie foods such as cake and ice cream, often attempting to combat dysphoric mood states. Binging helps with anxiety and dysphoria in the short term but makes them feel guilty. Patients with BN often conceal their binging, plan it, and eat until they are uncomfortable.
Physical Signs:
- Normal to slightly overweight
- Loss of tooth enamel from purging
- Increase in dental cavities
- Lethargy
- Electrolyte imbalances
- Amenorrhea
- Hypotension, bradycardia, prolonged QTc interval
- Osteopenia, osteoporosis
Risk Factors for Developing Bulimia
- There is a strong genetic predisposition, according to studies.
- Physical and sexual abuse victims are more prone to BN.
- Emotional stress.
- Participation in sports that are associated with thinness, such as ballet, wrestling, or running.
- Peer pressure and social media – Young teens are often bombarded with perceived success based on unrealistic body images.
- Those who are impulsive.
- Those who have inadequate stress coping skills.
- Gender: Incidence is reported to be 2.6% in females and 0.5% in males.
The peak age of onset for bulimia is 16-20 years.
The mortality rate is about 1%.
Early detection is a critical factor in recovery.
Treatment of Bulimia Nervosa
As with anorexia, the treatment of bulimia should involve a multidisciplinary team of professionals.
Psychotherapy has the best efficacy for this disorder. This process can take 4 to 5 months to complete.
SSRI’s such as fluoxetine are also used to reduce binge-purge episodes.
Dietitians can be instrumental in creating nutritional plans for these patients as adequate meals can decrease food craving.
Some organizations can help get bulimia patients the help they need. Two great options are:
Overeaters Anonymous: www.oa.org
Bulimia.com to help locate support groups: www.bulimia.com
Binge Eating Disorder (BED)
Binge eating disorder (BED) is a condition in which the patient eats a more considerable amount of food than most people would in a similar time period. Unlike bulimia, these individuals do not regularly employ compensatory measures such as purging to counter the binge eating. They often eat rapidly until they are uncomfortable. Binge eaters often eat even when they are not hungry and eat alone due to embarrassment. They often feel depressed or guilty after eating.
To be diagnosed with BED, binge eating must occur at least once per week for at least three months.
The severity of BED can be classified as follows:
Mild – Average of 1-3 episodes weekly.
Moderate – Average of 4-7 episodes weekly.
Severe – Average of 8-13 episodes weekly.
Extreme – 14 or more episodes per week.
Signs and Symptoms of Binge Eating Disorder
The signs and symptoms of BED are as follows:
- Slightly overweight to obese.
- High level of emotional stress.
- High incidence of GERD.
- Presence of stretch marks due to weight changes.
- Gallbladder disease.
- Poor impulse control.
- Feelings of guilt.
- Comorbid anxiety or depressive disorders.
- Cardiovascular disease.
- Hyperlipidemia
- Hyperglycemia – prone to diabetes.
Risk Factors for Developing Binge Eating Disorder
There seems to be a genetic component with BED. Family and twin studies have shown a 57% heritability.
Females have a higher incidence (3%) than males (2%).
The age of onset peaks at 18-20 years of age, but this disorder may occur later in life.
Many of these patients have a history of “yo-yo” dieting. They have large fluctuations in body weight over time.
There is a strong correlation between binge eating and obesity. About 50% of obese individuals report binge eating as one of their problems.
Treatment of Binge Eating Disorder
As with the above eating disorders, a multidisciplinary team of professionals should be employed in the treatment of BED. Psychotherapy has the most significant effect on BED, but drugs may be added. Some examples of adjunctive medications include:
- Lisdexamphetamine is the only medication FDA approved for BED. It has been shown to decrease binge eating days, binge eating cessation, and global improvement compared to placebo.6
- Topiramte
- Zonisamide
- SSRI’s (fluoxetine, sertraline, citalopram, fluvoxamine, escitalopram)
- Orlistat
- Bupropion/naltrexone
Eating disorders can cause endless problems for patients who suffer from them and the families involved. Our society has caused our young citizens to believe that they need to look a certain way to be popular or successful. Social media has amplified this lie! The truth is, we all have a special gift to give, and it has very little to do with our weight or body shape.
I urge every person reading this to begin to love yourself as you are. Determine your “gift” and take steps to develop it to share this gift with those who will benefit.
Our body shape is something that we are born with. We can’t all have the body type of the stars. The best thing you can do for yourself is:
- Eat whole, healthy foods.
- Drink plenty of water.
- Exercise 5 days per week for at least 30 minutes.
- Get enough sleep.
If you think you may have an eating disorder, GET HELP!
There are many sources of help available. Here is one example:
https://www.eatingrecoverycenter.com/
I hope you have learned something from this post. Remember, eating disorders are serious and can be deadly if not treated.
Have a great week, and stay safe out there.
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.
- Udo T, Grilo CM: Prevalence and Correlates of DSM-5-Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. Biol Psychiatry. 2018;84(5):345–354. 10.1016/j.biopsych.2018.03.014 [PMC free article] [PubMed]
- Smink FR, van Hoeken D, Hoek HW: Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14(4):406–14. 10.1007/s11920-012-0282-y [PMC free article] [PubMed]
- Traci Turner, Pharm D., Psychiatric Pharmacotherapy Review, Chapter 9. Personality Disorders and Eating Disorders, CPNP, 2018-2019.
- https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2012/spotlight-on-eating-disorders.shtml - visited 10/27/2020
- Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014;13(2):153-160. doi:10.1002/wps.20128
- McElroy SL, Hudson JI, Mitchell JE, Wilfley D, Ferreira-Cornwell MC, Gao J, Wang J, Whitaker T, Jonas J, Gasior M. Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder: a randomized clinical trial. JAMA Psychiatry. 2015 Mar;72(3):235-46. doi: 10.1001/jamapsychiatry.2014.2162. PMID: 25587645.
