1.

Binge Eating Disorder

Walker's room is his oasis. It's where he listens to music, does his homework, plays online games, and chats with friends. It looks like a
typical bedroom — except for what's under the bed. That's where Walker keeps his secret stash of snacks and tosses the empty candy
wrappers, chip bags, and cookie boxes.

Walker has just eaten a large packet of cookies and a family-sized bag of chips — and he hasn't even finished his homework yet. He's
searching for more chips to eat while he does his math. He hates that he's overweight, but he can't seem to stop binge eating. In the back
of his mind, he knows that in an hour or so he's going to feel guilty and disgusted with himself, but right now it feels like he just can't
stop himself.

Understanding Binge Eating

If you gorged on chocolate during Halloween or ate so much pumpkin pie at Thanksgiving that you felt uncomfortable, you know what it
feels like to overeat. It's not unusual to overeat from time to time. Most people do.

During our teens, the body demands extra nutrients to support growth of muscle and bone. So if you go through phases where you feel
like eating more sometimes, that's usually why.

But binge eating is different from typical appetite increases or overeating during the holidays. People with a binge eating problem
regularly eat much more food than they need. They often eat quickly, eat when they are stressed or upset (instead of just when they are
hungry), and do other things while they eat (like watch TV or do homework). They don't stop eating when they're full.

People who binge eat are usually overweight because they take in so many more calories than their bodies can use. As a result, they may
feel bad about themselves, feel that they lack self-control, and be unhappy about their weight, shape or body image.

Binge eating involves more than just eating a lot. People with this problem don't want to be overweight. They wish they could be slim
and healthy. Many times people who binge eat feel misunderstood. It's not as easy as others might think to just stop eating. With
bingeing, a person feels out of control and powerless to stop eating while doing it. That's why binge eating is also called compulsive
overeating.

Emotions often play a role. People with a binge eating problem may overeat when they feel stressed, upset, hurt, or angry. Many find it
comforting and soothing to eat. But after a binge, people might feel guilty and sad about the out-of-control eating.

Binge eating is often a mixed-up way of dealing with or avoiding difficult emotions. Usually, people who binge eat aren't aware of
what's driving them to overeat.

Why Do Some People Binge Eat?

Most experts believe that it takes a combination of things to develop an eating disorder — including a person's genes, emotions, and
behaviors (such as eating patterns) learned during childhood.

Some people may be more prone to overeating for biological reasons. For example, the hypothalamus (the part of the brain that controls
appetite) may fail to send proper messages about hunger and fullness. And serotonin, a normal brain chemical that affects mood and
some compulsive behaviors, may also play a role in binge eating.

In most cases, the unhealthy overeating habits that develop into binge eating start during childhood. These habits might be a result of
eating behaviors learned in the family.

It's normal to associate food with nurturing and love, but sometimes food is used too much as a way to soothe or comfort. When this is
the case, kids may grow up with a habit of overeating to soothe themselves when they feel pressured. They do this because they may not
have learned other ways to deal with stress.
Some kids may grow up believing that unhappy or upsetting feelings should be suppressed and may use food to quiet these emotions.
Some people feel that the amount they eat is the only thing they have control over when life seems difficult or traumatic.

It's hard to know just how many teens may have a binge eating problem. Both guys and girls can have binge eating disorder. But because
people often feel guilty or embarrassed about out-of-control eating, many don't talk about it or seek help. People can also be overweight
without having a binge eating problem.

Signs of a Binge Eating Problem

People with a binge eating problem might:

 binge eat at least once a week for 3 months

 eat much more quickly than other people do
 eat until they feel uncomfortably full
 eat large amounts of food even when they're not physically hungry
 eat alone because they're embarrassed by what or how much they're eating
 feel upset about their binge eating (e.g., ashamed or guilty)

Getting Help

It may be hard for many people with binge eating problems to reach out for help because of how society thinks about overeating and
being overweight. Many people don't get treatment for binge eating until they're adults trying to lose weight. But getting professional
help as a teen can really help people develop great stress management techniques and lower the risk of long-term health problems.

People with eating disorders need professional help because problems like binge eating can be caused by brain chemistry and other
things that seem beyond someone's control. Doctors, counselors, and nutrition experts often work together to help those with eating
disorders manage their eating, weight, and feelings.

Part of dealing with a binge eating disorder is learning how to have a healthy relationship with food. Nutrition specialists or dietitians can
help teens and their families learn about healthy eating, nutritional needs, portion sizes, metabolism, and exercise. They also can help
design an eating plan that's specially designed for someone's needs and help the person stick with it and make progress.

Psychologists and other therapists can help teens and families learn healthy ways of coping with emotions, thoughts, stress, and other
things that might contribute to someone's eating problem.

Depending on what's behind someone's binge eating, doctors may prescribe medications along with therapy and nutrition advice.

People with binge eating disorder may find it helpful to surround themselves with supportive family members and friends. It's best to
avoid people who make negative comments about eating or weight because they can add to someone's feelings of self-criticism, making
matters worse.

Sometimes other family members or friends are not ready to deal with their own eating problems. They may worry about a teen who is
eating healthier or exercising more. It is important for someone with binge eating disorder to feel supported in their decision to live a
healthier lifestyle.

Another thing that can help build self-confidence and take a person's mind off eating is trying a new extracurricular activity or hobby.
Finding a way to express feelings, such as through music, art, dance, or writing, also can help a person develop new, healthier habits and
stress management techniques.

It can take a while to get back on a healthier track with eating but it’s worth the investment in your long-term physical and emotional
health. Just like getting better in any other skill, sometimes you need the support of a therapist, coach, trainer, and family or friends to get
you where you need to be.

Reviewed by: Michelle J. New, PhD

Date reviewed: October 2014
 2. Eating Disorders
What Are Eating Disorders?

Eating disorders are problems with the way people eat. They can harm a person's health, emotions, and relationships. There are several
types of eating disorders. 

What Are the Different Types of Eating Disorders?

Common types of eating disorders are anorexia, bulimia, binge eating, and avoidant/restrictive food intake disorder (ARFID).

Anorexia. People with anorexia:

 eat very little on purpose. This leads to a very low body weight.
 have an intense fear of weight gain. They fear looking fat.
 have a distorted body image. They see themselves as fat even when they are very thin.

People with anorexia are very strict about what and how much they will eat. They may think about food or calories almost all the time.

To lose weight, some people with anorexia fast or exercise too much. Others may use laxatives, diuretics (water pills), or enemas.

Bulimia. People with bulimia:

 overeat and feel out of control to stop. This is called binge eating.

 do things to make up make up for overeating. They may make themselves throw up on purpose after they overeat. This is
called purging. To prevent weight gain they may use laxatives, diuretics, weight loss pills, fast, or exercise a lot.
 judge themselves based on body shape and weight

People with bulimia eat much more (during a set period of time) than most people would. If a person regularly binges and purges, it may
be a sign of bulimia. Unlike people with anorexia who are very low weight, people with bulimia may be thin, average weight, or
overweight. People with bulimia often hide their eating and purging from others.

Binge eating. People with binge eating disorder:

 overeat and feel out of control to stop. This is called binge eating.
 eat large amounts even when they are not hungry
 may feel upset or guilty after binge eating
 often gain weight, and may become very overweight

Many people with binge eating disorder eat faster than normal. They may eat alone so others don't see how much they are eating. Unlike
people with bulimia, those with binge eating disorder do not make themselves throw up, use laxatives, or exercise a lot to make up for
binge eating. If a person binge eats at least once a week for 3 months, it may be a sign of binge eating disorder.

ARFID. People with avoidant/restrictive food intake disorder (ARFID):

 are not interested in food or avoid foods

 lose weight, or don't gain expected amount of weight
 are not afraid of gaining weight
 don't have a poor body image
People with ARFID don't eat because they are turned off by the smell, taste, texture, or color of food. They may be afraid that they will
choke or vomit. They don't have anorexia, bulimia, or another medical problem that would explain their eating behaviors.

How Do Eating Disorders Affect Health and Emotions?

Eating disorders can cause serious problems throughout the body.

Anorexia can lead to health problems caused by undernutrition and low body weight, such as:

 low blood pressure

 slow or irregular heartbeats
 feeling tired, weak, dizzy, or faint
 constipation and bloating
 irregular periods
 weak bones
 delayed puberty and slow growth

People with anorexia may find it hard to focus and have trouble remembering things. Mood changes and emotional problems include:

 feeling alone, sad, or depressed

 anxiety and fears about gaining weight
 thoughts of hurting themselves

Bulimia can lead to health problems caused by vomiting, laxatives, and diuretics, such as:

 low blood pressure

 irregular heartbeats
 feeling tired, weak, dizzy, or faint
 blood in vomit or stool (poop)
 tooth erosion and cavities
 swollen cheeks (salivary glands)

People with bulimia may have these emotional problems:

 low self-esteem, anxiety, and depression

 alcohol or drug problems
 thoughts of hurting themselves

Binge eating can lead to weight-related health problems, such as:

 diabetes
 high blood pressure
 high cholesterol and triglycerides
 fatty liver
 sleep apnea

People with binge eating disorder may:

 have low self-esteem, anxiety, or depression

 feel alone, out of control, angry, or helpless
 have trouble coping with strong emotions or stressful events

ARFID may lead to health problems that stem from poor nutrition, similar to anorexia. People with ARFID may:
  not get enough vitamins, minerals, and protein
 need tube feeding and nutrition supplements
 grow poorly

People with ARFID are more likely to have:

 anxiety or obsessive-compulsive disorder (OCD)

 autism spectrum disorder or attention deficit disorder (ADHD)
 problems at home and school because of eating behavior

What Causes Eating Disorders?

There's no single cause for eating disorders. Genes, environment, and stressful events all play a role. Some things can increase a person's
chance of having an eating disorder, such as:

 poor body image

 too much focus on weight or looks
 dieting at a young age
 playing sports that focus on weight (gymnastics, ballet, ice skating, and wrestling)
 having a family member with an eating disorder
 mental health problems such as anxiety, depression, or OCD

How Are Eating Disorders Diagnosed?

Health care providers and mental health professionals diagnose eating disorders based on history, symptoms, thought patterns, eating
behaviors, and an exam.

The doctor will check weight and height and compare these to previous measurements on growth charts. The doctor may order tests to
see if there is another reason for the eating problems and to check for problems caused by the eating disorder.

How Are Eating Disorders Treated?

Eating disorders are best treated by a team that includes a doctor, dietitian, and therapist. Treatment includes nutrition counseling,
medical care, and talk therapy (individual, group, and family therapy). The doctor might prescribe medicine to treat binge eating,
anxiety, depression, or other mental health concerns.

The details of the treatment depend on the type of eating disorder and how severe it is. Some people are hospitalized because of extreme
weight loss and medical complications. 

What if I Have an Eating Disorder?

If you think you may have an eating disorder:

Tell someone. Tell a parent, teacher, counselor, or an adult you trust. Let them know what you're going through. Ask them to help.

Get help early. When an eating disorder is caught early, a person has a better chance of recovery. Make an appointment with your
doctor or an eating disorders specialist.

Go to all appointments. Treatment takes time and effort. Work hard to learn about yourself and your emotions. Ask questions any time
you have them.

Be patient with yourself. There's so much to learn, and change happens a little at a time. Take care of yourself and be with people who
support you.
Reviewed by: D'Arcy Lyness, PhD
Date reviewed: January 2019
 3. Anorexia
       

Anorexia is an eating disorder that causes people lose more weight than is considered healthy for their age and
height.

People with this disorder may have an intense fear of weight gain, even when they are underweight. They may
diet or exercise too much or use other ways to lose weight.

Causes
The exact causes of anorexia are not known. Many factors may be involved. Genes and hormones may play a
role. Social attitudes that promote very thin body types may also be involved.

Risk factors for anorexia include:

 Being more worried about, or paying more attention to, weight and shape

 Having an anxiety disorder as a child

 Having a negative self-image

 Having eating problems during infancy or early childhood

 Having certain social or cultural ideas about health and beauty

 Trying to be perfect or overly focused on rules

Anorexia often begins during the pre-teen or teen years or young adulthood. It is more common in females, but
may also be seen in males.

Symptoms
A person with anorexia usually:

 Has an intense fear of gaining weight or becoming fat, even when underweight.

 Refuses to keep weight at what is considered normal for their age and height (15% or more below the
normal weight).

 Has a body image that is very distorted, be very focused on body weight or shape, and refuse to admit
the danger of weight loss.

People with anorexia may severely limit the amount of food they eat. Or they eat and then make themselves
throw up. Other behaviors include:

 Cutting food into small pieces or moving them around the plate instead of eating
 Exercising all the time, even when the weather is bad, they are hurt, or their schedule is busy

 Going to the bathroom right after meals

 Refusing to eat around other people

 Using pills to make themselves urinate (water pills, or diuretics), have a bowel movement (enemas
and laxatives), or decrease their appetite (diet pills)

Other symptoms of anorexia may include:

 Blotchy or yellow skin that is dry and covered with fine hair

 Confused or slow thinking, along with poor memory or judgment

 Depression
 Dry mouth

 Extreme sensitivity to cold (wearing several layers of clothing to stay warm)

 Thinning of the bones (osteoporosis)

 Wasting away of muscle and loss of body fat

Exams and Tests

Tests should be done to help find the cause of weight loss, or see what damage the weight loss has caused.
Many of these tests will be repeated over time to monitor the person.

These tests may include:

 Albumin
 Bone density test to check for thin bones (osteoporosis)
 CBC
 Electrocardiogram (ECG)
 Electrolytes
 Kidney function tests
 Liver function tests
 Total protein
 Thyroid function tests
 Urinalysis
Treatment
The biggest challenge in treating anorexia nervosa is helping the person recognize that they have an illness.
Most people with anorexia deny that they have an eating disorder. They often seek treatment only when their
condition is serious.

Goals of treatment are to restore normal body weight and eating habits. A weight gain of 1 to 3 pounds (lb) or
0.5 to 1.5 kilograms (kg) per week is considered a safe goal.
 Different programs have been designed to treat anorexia. These may include any of the following measures:

 Increasing social activity

 Reducing the amount of physical activity

 Using schedules for eating

To start, a short hospital stay may be recommended. This is followed by a day treatment program.

A longer hospital stay may be needed if:

 The person has lost a lot of weight (being below 70% of their ideal body weight for their age and
height). For severe and life-threatening malnutrition, the person may need to be fed through a vein or stomach
tube.
 Weight loss continues, even with treatment

 Medical complications, such as heart problems, confusion, or low potassium levels develop

 The person has severe depression or thinks about committing suicide

Care providers who are usually involved in these programs include:

 Nurse practitioners

 Physicians

 Physician assistants

 Dietitians

 Mental health care providers

Treatment is often very difficult. People and their families must work hard. Many therapies may be tried until
the disorder is under control.

People may drop out of programs if they have unrealistic hopes of being "cured" with therapy alone.

Different kinds of talk therapy are used to treat people with anorexia:

 Cognitive behavioral therapy (a type of talk therapy), group therapy, and family therapy have all been
successful.

 Goal of therapy is to change person's thoughts or behavior to encourage them to eat in a healthier way.
This kind of therapy is more useful for treating younger people who have not had anorexia for a long time.
 If the person is young, therapy may involve the whole family. The family is seen as a part of the
solution, instead of the cause of the eating disorder.

 Support groups may also be a part of treatment. In support groups, patients and families meet and
share what they have been through.

Medicines such as antidepressants, antipsychotics, and mood stabilizers may help some people when given as
part of a complete treatment program. These medicines can help treat depression or anxiety. Although
medicines may help, none has been proven to decrease the desire to lose weight.

Support Groups
The stress of illness can be eased by joining a support group. Sharing with others who have common
experiences and problems can help you not feel alone.
Outlook (Prognosis)
Anorexia is a serious condition that can be life threatening. Treatment programs can help people with the
condition return to a normal weight. But it is common for the disease to return.

Women who develop this eating disorder at an early age have a better chance of recovering completely. Most
people with anorexia will continue to prefer a lower body weight and be very focused on food and calories.

Weight management may be hard. Long-term treatment may be needed to stay at a healthy weight.

Possible Complications
Anorexia can be dangerous. It may lead to serious health problems over time, including:

 Bone weakening

 Decrease in white blood cells, which leads to increased risk of infection

 A low potassium level in the blood, which may cause dangerous heart rhythms

 Severe lack of water and fluids in the body (dehydration)

 Lack of protein, vitamins, minerals, and other important nutrients in the body (malnutrition)
 Seizures due to fluid or sodium loss from repeated diarrhea or vomiting
 Thyroid gland problems

 Tooth decay

When to Contact a Medical Professional

Talk to your health care provider if someone you care about is:

 Too focused on weight

 Over-exercising

 Limiting the food he or she eats

 Very underweight

Getting medical help right away can make an eating disorder less severe.

Alternative Names
Eating disorder - anorexia nervosa

Images

 myPlate
References
American Psychiatric Association. Feeding and eating disorders. In: American Psychiatric
Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American
Psychiatric Publishing. 2013;329-345.
Kreipe RE. Eating disorders. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of
Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 28.
Lock J, La Via MC; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality
Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with eating
disorders. J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-425. PMID
25901778 www.ncbi.nlm.nih.gov/pubmed/25901778.
Tanofsky-Kraff M. Eating disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed.
Philadelphia, PA: Elsevier Saunders; 2016:chap 219.
Thomas JJ, Mickley DW, Derenne JL, Klibanski A, Murray HB, Eddy KT. Eating disorders: evaluation and
management. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital
Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 37.
Review Date 3/26/2018
Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla,
CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and
the A.D.A.M. Editorial team.
 4. Binge eating disorder
       

Binge eating is an eating disorder in which a person regularly eats unusually large amounts of food. During
binge eating, the person also feels a loss of control and is not able to stop eating.

Causes
The exact cause of binge eating is unknown. Things that may lead to this disorder include:

 Genes, such as having close relatives who also have an eating disorder

 Changes in brain chemicals

 Depression or other emotions, such as feeling upset or stressed

 Unhealthy dieting, such as not eating enough nutritious food or skipping meals

In the United States, binge eating is the most common eating disorder. More women than men have it. Women
are affected as young adults while men are affected in middle age.

Symptoms
A person with binge eating disorder:

 Eats large amounts of food in a short period, for example, every 2 hours.

 Is not able to control overeating, for example is unable to stop eating or control the amount of food.

 Eats food very fast each time.

 Keeps eating even when full (gorging) or until uncomfortably full.

 Eats even though not hungry.

 Eats alone (in secret).

 Feels guilty, disgusted, ashamed, or depressed after eating so much

About two thirds of persons who have binge eating disorder are obese.

Binge eating may occur on its own or with another eating disorder, such as bulimia. People with bulimia eat
large amounts of high-calorie foods, often in secret. After this binge eating, they often force themselves to
vomit or take laxatives, or exercise vigorously.

Exams and Tests

The health care provider will perform a physical exam and ask about your eating patterns and symptoms.
 Blood tests may be done.

Treatment
The overall goals of treatment are to help you:

 Lessen and then be able to stop the bingeing incidents.

 Get to and stay at a healthy weight.

 Get treated for any emotional problems, including overcoming feelings and managing situations that
trigger binge eating.

Eating disorders, such as binge eating, are often treated with psychological and nutrition counseling.

Psychological counseling is also called talk therapy. It involves talking with a mental health provider, or
therapist, who understands the problems of persons who binge eat. The therapist helps you recognize the
feelings and thoughts that cause you to binge eat. Then the therapist teaches you how to change these into
helpful thoughts and healthy actions.

Nutrition counseling is also important for recovery. It helps you develop structured meal plans, healthy eating,
and weight management goals.

The health care provider may prescribe antidepressants if you are anxious or depressed. Medicines to help with
weight loss may also be prescribed.

Support Groups
The stress of illness can be eased by joining a support group. Sharing with others who have common
experiences and problems can help you not feel alone.

Outlook (Prognosis)
Binge eating is a treatable disorder. Long-term talk therapy seems to help the most.

Possible Complications
With binge eating, a person often eats unhealthy foods that are high in sugar and fat, and low in nutrients and
protein. This can lead to health problems such as high cholesterol, type 2 diabetes, or gallbladder disease.

Other possible health problems may include:

 Heart disease

 High blood pressure

 Joint pain

 Menstrual problems 
When to Contact a Medical Professional
Call your provider if you think you, or someone you care for, might have a pattern of binge eating or bulimia.

Alternative Names
Eating disorder - binge eating; Eating - binge; Overeating - compulsive; Compulsive overeating

References
American Psychiatric Association. Feeding and eating disorder. In: American Psychiatric
Association.  Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American
Psychiatric Publishing. 2013;329-345.
Kreipe RE. Eating disorders. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of
Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 28.
Lock J, La Via MC; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality
Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with eating
disorders. J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-425. PMID:
25901778 www.ncbi.nlm.nih.gov/pubmed/25901778.
Tanofsky-Kraff, M. Eating disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed.
Philadelphia, PA: Elsevier Saunders; 2016:chap 219.
Thomas JJ, Mickley DW, Derenne JL, Klibanski A, Murray HB, Eddy KT. Eating disorders. In: Stern TA,
Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry.
2nd ed. Philadelphia, PA: Elsevier; 2016:chap 37.
Review Date 3/26/2018
Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla,
CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and
the A.D.A.M. Editorial team.
 5. Bulimia
       

Bulimia is an eating disorder in which a person has regular episodes of eating a very large amount of food
(bingeing) during which the person feels a loss of control over eating. The person then uses different ways,
such as vomiting or laxatives (purging), to prevent weight gain.

Many people with bulimia also have anorexia.

Causes
Many more women than men have bulimia. The disorder is most common in teenage girls and young women.
The person usually knows that her eating pattern is abnormal. She may feel fear or guilt with the binge-purge
episodes.

The exact cause of bulimia is unknown. Genetic, psychological, family, society, or cultural factors may play a
role. Bulimia is likely due to more than one factor.

Symptoms
With bulimia, eating binges may occur as often as several times a day for many months. The person often eats
large amounts of high-calorie foods, usually in secret. During these episodes, the person feels a lack of control
over the eating.

Binges lead to self-disgust, which causes purging to prevent weight gain. Purging may include:

 Forcing oneself to vomit

 Excessive exercise

 Using laxatives, enemas, or diuretics (water pills)

Purging often brings a sense of relief.

People with bulimia are often at a normal weight, but they may see themselves as being overweight. Because
the person's weight is often normal, other people may not notice this eating disorder.

Symptoms that other people can see include:

 Spending a lot of time exercising

 Suddenly eating large amounts of food or buying large amounts of food that disappear right away

 Regularly going to the bathroom right after meals

 Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
 Exams and Tests
A dental exam may show cavities or gum infections (such as gingivitis). The enamel of the teeth may be worn
away or pitted because of too much exposure to the acid in vomit.
A physical exam may also show:

 Broken blood vessels in the eyes (from the strain of vomiting)

 Dry mouth

 Pouch-like look to the cheeks

 Rashes and pimples

 Small cuts and calluses across the tops of the finger joints from forcing oneself to vomit

Blood tests may show an electrolyte imbalance (such as low potassium level) or dehydration.
Treatment
People with bulimia rarely have to go to the hospital, unless they:

 Have anorexia

 Have major depression
 Need medicines to help them stop purging

Most often, a stepped approach is used to treat bulimia. Treatment depends on how severe the bulimia is, and
the person's response to treatments:

 Support groups may be helpful for mild bulimia without other health problems.

 Counseling, such as talk therapy and nutritional therapy are the first treatments for bulimia that does
not respond to support groups.

 Medicines that also treat depression, known as selective serotonin-reuptake inhibitors (SSRIs) are
often used for bulimia. Combining talk therapy with SSRIs may help, if talk therapy alone does not work.

People may drop out of programs if they have unrealistic hopes of being "cured" by therapy alone. Before a
program begins, people should know that:

 Different therapies will likely be needed to manage this disorder.

 It is common for bulimia to return (relapse), and this is no cause for despair.

 The process is painful, and the person and their family will need to work hard.

Support Groups
The stress of illness can be eased by joining a support group. Sharing with others who have common
experiences and problems can help you not feel alone.
 Outlook (Prognosis)
Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.

People with fewer medical complications of bulimia and those willing and able to take part in therapy have a
better chance of recovery.

Possible Complications
Bulimia can be dangerous. It may lead to serious health problems over time. For example, vomiting over and
over can cause:

 Stomach acid in the esophagus (the tube that moves food from the mouth to the stomach). This can
lead to permanent damage of this area.

 Tears in the esophagus.

 Dental cavities.

 Swelling of the throat.

Vomiting and overuse of enemas or laxatives can lead to:

 Your body not having as much water and fluid as it should

 Low level of potassium in the blood, which may lead to dangerous heart rhythm problems
 Hard stools or constipation
 Hemorrhoids
 Damage of the pancreas
When to Contact a Medical Professional
Call for an appointment with your health care provider if you or your child has symptoms of an eating
disorder.

Alternative Names
Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia

Images

 Upper gastrointestinal system

References
American Psychiatric Association. Feeding and eating disorders. In: Diagnostic and Statistical Manual of
Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:329-354.
Kreipe RE. Eating disorders. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of
Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 28.
Lock J, La Via MC; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality
Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with eating
disorders. J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-425. PMID:
25901778 www.ncbi.nlm.nih.gov/pubmed/25901778.
Tanofsky-Kraff, M. Eating disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed.
Philadelphia, PA: Elsevier Saunders; 2016:chap 219.
Thomas JJ, Mickley DW, Derenne JL, Klibanski A, Murray HB, Eddy KT. Eating disorders: evaluation and
management. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital
Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 37.
Review Date 3/26/2018
Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla,
CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and
the A.D.A.M. Editorial team.
Anorexia nervosa
Anorexia nervosa is an eating disorder. Find out why some
people get anorexia
Reviewed by John Powell

11/05/2015

What is anorexia nervosa?

Anorexia nervosa is an eating disorder. People with anorexia nervosa keep

their body weight very low. They often have a distorted image of their own
bodies. It mainly affects girls or women, although boys or men can also suffer
from anorexia nervosa. It usually starts in the teenage years.

It is difficult to estimate how common anorexia nervosa is, but surveys

suggest that up to 1 per cent of young women have anorexia nervosa. This
may be an underestimate. 

What are the symptoms of anorexia nervosa?

 The main symptom is deliberate weight loss. People with anorexia

nervosa maintain a body weight at least 15 per cent below what is
expected for their age, sex and height.
 This self-induced weight loss is caused by avoiding fattening foods and
sometimes by taking excessive exercise, or by using laxatives or
diuretics (medicines that make you urinate more). Sometimes people
make themselves sick to lose weight.
 People with anorexia nervosa have a strong, almost overwhelming fear
of putting on weight, with sufferers preoccupied with the shape or size
of their bodies.
 Rules may be invented regarding how much food is allowed and how
much exercise is needed after eating certain amounts of food.
 Those with anorexia nervosa pursue a very low 'ideal' weight.
 The weight loss may cause hormonal disturbances and women with
anorexia nervosa may stop having periods or have delayed
development in puberty.
 Other effects include tiredness, feeling cold, constipation and stomach
ache.

Why do some people get anorexia?

The cause of anorexia nervosa is unknown, although it's likely that both
inherent biological factors and factors in the person's social environment play
a part.

Anorexia nervosa is mainly encountered in the Western world and is more

common among women in certain professions, such as models and ballet
dancers.

Puberty, relationship problems, bullying, abuse, and other life stresses are all
believed to be potential triggers of anorexia.

There may also be peer pressure to lose weight, nasty comments from others
about weight that trigger dieting or an unrealistic expectation of what a normal
body weight should be.

Certain personality traits make some people more vulnerable to developiong

anorexia.

These include a tendency to depression and anxiety, a poor reaction

to stress, perfectionism, inhibition and obsessional or compulsive feelings.

How long can anorexia last?

The sooner the treatment is started, the better the chance of recovery.

However, anorexia may last for months or years, and it can take many more
years before normal weight is regained.

Severe anorexia

 People with severe anorexia may become chronically ill or even die.
 Long spells without an adequate diet can cause osteoporosis (fragile
bones) and damage to the heart, liver, kidneys and brain.
 Anorexia can impede growth in the young and cause difficulties in
concentration.
 People with anorexia nervosa may also experience mental health
problems, such as low self-esteem, depression, anxiety, and an
increased risk of self-harm and suicide.

How is anorexia treated?

Treatment will vary depending on the individual circumstances and will
usually involve a combination of psychological help and help with diet and
gaining weight. Initial assessment will usually be by a person's GP.

Other healthcare professionals who are likely to be involved include clinical

psychologists, psychiatrists, specialist nurses and dieticians.

There's no one single treatment that has proven to be effective in all cases.

Psychological treatment for anorexia nervosa include cognitive analytic

therapy (CAT), cognitive behaviour therapy (CBT), interpersonal
psychotherapy (IPT), focal psychodynamic therapy and family interventions
focused explicitly on eating disorders.

Professionals will also monitor the person's physical health and help them to
plan how to eat a healthy diet and gain weight safely, and how to maintain
this weight gain.

In some cases, medication is additionally used to treat mental health

problems such as depression or obsessive compulsive symptoms.

Occasionally, if the excessive weight loss becomes a risk to physical health,

admission to hospital may be required.

What can people suffering from anorexia do to help themselves?

Anorexia nervosa is a potentially life-threatening illness and should be treated

as soon as possible. People with anorexia nervosa should seek help, or be
encouraged to do so.

The National Institute for Health and Care Excellence has published  guidance
on eating disorders.

The charity Beat is the UK's leading eating disorder charity and has a
telephone helpline service and online support forums.

Full details are on their website. There are also self-help books available.

Based on a text by Dr René Støving, Dr Kirsten Hørder, Dr Paul Klenerman

Last updated 10.05.2015