Eating Disorders

Researchers estimate eating disorders affect 1-2% of the general population, up to 30% of college students experience eating disorder symptoms during their college years.The development of anorexia or bulimia is not simply the result of a desire to be thin, but the manifestation of deeper emotional and psychological problems. Most notably, people with eating disorders have low self-esteem and lack effective coping mechanisms for dealing with such a distorted self-image. Eating disorders can provide a sense of control and escape, allowing sufferers to temporarily forget depression, anxiety, stress, anger, and guilt. Low self-esteem also plays a role in eating disorders. Anorexics and bulimics often have high expectations of themselves. If they fall short of these expectations, they experience low self-esteem. 

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Anorexia Nervosa

Anorexia is an eating disorder where the individual becomes preoccupied with an unhealthy pursuit of weight loss that eventually leads to distortion in body image. No matter how thin they may become, anorexics continue to believe they need to lose weight. To accomplish this desire, they starve themselves, maintain rigorous exercise regimes, and sometimes purge by vomiting, laxatives, or diuretics. 

Most anorexics desire a sense of control, especially if they experience changes in their lives over which they have no power. Changes that can trigger anorexia may include divorce of one’s parents, receiving unexpectedly low grades, rejection in a peer relationship, having a sports injury, and entering a new school.

Who is at risk for developing anorexia?

Anorexia usually develops in girls between 12 and 25 years old. Factors that influence the development of anorexia include family life, genetics, personality, relationship problems, and traumatic experiences. Girls who are more likely to develop this eating disorder tend to be conscientious, eager to please, and hard working – traits that also contribute to academic success. They are perfectionists who do not cope well with change, even the natural change their bodies undergo during puberty. Usually low self-esteem promotes the anorexic’s belief that she is unworthy of love and attention. This, in turn, fuels a desire for validation. Anorexics often lack the communication skills to express painful feelings, such as a need for attention, fear of growing up, or desire for independence. Controlling food intake is a way to cope with such troubling emotions.

What causes anorexia?

The causes underlying each case of anorexia can vary widely, but certain patterns have emerged. It’s probably safe to say there is never one single cause – anorexia is the result of a combination of many factors.

  • Certain personality traits, such as obsessive-compulsive and sensitive-avoidant
  • Genetic factors that predispose people to developing anxiety, perfectionism, and obsessive-compulsive thoughts
  • Eating disorders. Once an individual has developed unhealthy eating patterns, they are likely to continue and worsen because both undereating and overeating can cause brain chemicals to provide a sense of peace and euphoria.
  • Low self-esteem, lack of identity. Anorexics frequently lack a firm understanding of themselves; they hope to gain attention and respect through achievements, including having an admired exterior, rather than cultivating their natural personality.
  • Overprotective, rigid families. These families do not invite open communication, especially concerning emotional issues. Mothers are emotionally cool while fathers are physically or emotionally absent.
  • Media. Studies have shown that women who watch TV three or more nights a week, influenced by the ubiquitous images of thin women, are more likely to develop anorexia.
  • Event triggers. Certain memorable incidents, from teasing to rape, can set the ball rolling for individuals who are already vulnerable.
  • Athletics. Involvement in a sport that demands thinness encourages anorexia.

What are the signs and symptoms of anorexia?

  • Starvation and restriction of food
  • Obsession with food, calories, recipes (cooking for others, but not eating anything themselves)
  • Obsessive exercise
  • Purging by vomiting, or using diet pills, laxatives, or diuretics
  • Eating junk food, particularly candy, and drinking a lot of coffee or tea, and/or smoking
  • Unusual eating habits (e.g. picking at food, spreading it around the plate, cutting food into tiny pieces)
  • Excuses to avoid eating (e.g. “I already ate,“ “I’m not feeling well“)
  • Hiding food they claimed to have eaten
  • Suddenly becoming vegan or vegetarian to avoid certain foods
  • Social withdrawal
  • Wearing baggy clothes to hide weight loss and keep warm
  • Weight loss
  • Fatigue, muscle weakness
  • Always being cold
  • Irregular menstruation or amenorrhea (loss of period)
  • Fainting spells, dizziness
  • Headaches
  • Pale complexion
  • Persistent concern with body image; complaining of being fat, even when thin
  • Depression, irritability, mood swings
  • Perfectionist attitude


Bulimia involves binge eating followed by purging or fasting. Someone who is bulimic eats an abnormally large amount of food in a short period of time and then fasts or purges using laxatives, diuretics, or self-induced vomiting because he or she feels overwhelmed with guilt and shame. Another method bulimics use to cope with such emotion is excessive exercise. Through purging, fasting, and exercise, bulimics hope to regain a sense of control they lacked while bingeing, but unfortunately they end up suffering such hunger that their cravings for food will take hold once again, making binge eating more likely. In contrast to anorexics, bulimics tend to be around average weight and realize they have a problem. The most dangerous health risk posed by bulimia is cardiac arrest or heart attack due to an electrolyte imbalance of the mineral potassium. Individuals who abuse laxatives will find they can no longer have natural bowel movements, resulting in constipation.

Like other eating disorders, bulimia is a symptom of psychological problems. In order to effectively treat the disorder, one must address the underlying emotional causes. Bulimics do not have effective coping skills to deal with life’s pressures and seek escape through food. As they binge, bulimics ignore natural feelings of hunger and fullness, not even paying attention to the taste of the food. Pizza, cookies, and ice cream provide short-term relief from feelings of depression, anxiety, or anger.

Who is at risk for developing bulimia?

It is impossible to pin down an exact description of an individual likely to develop bulimia, but certain events and personality traits are common among bulimic patients. Sufferers often have problems with anxiety, depression, and impulse control. For example, they have been found to engage in risky behaviors like shoplifting, casual sex, and alcohol and drug abuse. Because bulimics have difficulty trusting people, they have few or no satisfying relationships, and lacking proper coping mechanisms, they do not handle stress gracefully.

What are the signs and symptoms of bulimia?

  • Binge eating
  • Secretive eating
  • Going to the bathroom after meals
  • Vomiting
  • Laxative, diet pill, or diuretic abuse
  • Intense exercise regimen
  • Fasting
  • Red, puffy face and watery eyes (from vomiting)
  • Weight fluctuations (usually between 10 and 15 lbs.)
  • Swollen glands
  • Fatigue, muscle weakness
  • Tooth decay
  • Irregular heartbeats
  • Chronic sore throat
  • Mood swings
  • Depression
  • Low self-esteem
  • Persistent concern with body image
  • Feelings of guilt and shame

What are the medical complications of anorexia and bulimia?

  • Fatigue
  • Dizziness, fainting spells, seizures
  • Headaches
  • Dehydration
  • Loss of bone mass, osteoporosis
  • Insomnia
  • Anemia, malnutrition.
  • Disruption of body’s fluid/mineral balance.
  • Weakened immune system
  • Skin problems – dry, blotchy skin with unhealthy gray or yellow cast
  • Hair loss
  • Edema (fluid retention)
  • Lanugo (fine, downy hair)
Digestive system
  • Bloating
  • Constipation and diarrhea
  • Stomach pain and bloating
  • Chronic sore throat
  • Ruptured esophagus
  • Erosion of teeth enamel
  • Decreased metabolic rate
  • Kidney and liver damage
  • Development of peptic ulcers and pancreatitis
Circulatory system
  • Irregular heartbeats, chest pains
  • Cold hands and feet
  • Low blood pressure
  • Cardiac arrest and death
Respiratory System
  • Shortness of breath
Reproductive System
  • Amenorrhea, infertility

Binge Eating Disorder

Binge eating disorder is similar to bulimia, but doesn’t involve purging, or other compensatory behavior. Patients feel out of control as they ingest large quantities of food without regard to hunger or fullness. Like bulimics, they feel ashamed, disgusted, and guilty afterwards. Binge eating disorder may be difficult to detect because sufferers prefer to eat alone due to embarrassment and guilt. Without behavior to compensate for the calories consumed during an episode of bingeing, patients become overweight, suffering health complications similar to those of obesity. In fact, about 25% of obese individuals experience binge eating disorder, which affects slightly more women than men.

The best treatment for binge eating disorder involves cognitive-behavioral therapy that teaches an individual to keep track of the food he/she eats and how to react in difficult situations without relying on food to cope. A therapist may also help the patient analyze and improve relationships with friends and family.

What are the signs and symptoms of binge eating disorder?

  • hiding food
  • going on many different diets
  • secretive eating patterns
  • avoidance of social situations where food will be present
  • weight gain
  • fluctuations in weight
  • feeling out of control over eating
  • low self-esteem
  • depression
  • anxiety
  • loss of sexual desire
  • feelings of guilt and shame
  • disgusted with self
  • suicidal thoughts

Compulsive Eating

When an individual no longer eats food for nutrition or enjoyment, but for emotional reasons ranging from happiness to depression, he or she probably suffers from compulsive eating. Similar to victims of other eating disorders, compulsive eaters use eating habits to cope with difficult emotions, or even to celebrate joyful events. They frequently suffer from low self-esteem and depression, hoping food will fill the void, or at least help them escape from feelings of stress, anxiety, and anger. Compulsive eating involves addictive behavior with food.

Parenting is a major factor in the development of compulsive eating. If friends and family members offer comfort in the form of food, children will be less likely to develop more effective coping mechanisms. Learning to associate food with emotion initiates a tragic cycle in which the individual turns to food for comfort, but then feels ashamed for gaining weight and not being “good enough.“ The more weight that’s gained, the more a victim will try to diet, which unfortunately causes hunger that will lead to another bingeing episode. This cycle of dieting and bingeing can go on forever unless the emotional attachment to food is broken.

What are the medical complications of binge eating disorder and compulsive eating?

  • obesity
  • menstrual irregularities
  • diabetes
  • high blood pressure
  • high cholesterol
  • decreased mobility
  • shortness of breath
  • heart disease, as a result of high triglyceride levels
  • gallbladder disease
  • cardiac arrest and/or death 

Compulsive Exercising

Compulsive exercising is not a formally recognized disorder because it is usually a symptom of anorexia nervosa, bulimia, or obsessive-compulsive disorder. People who suffer from compulsive exercising spend about 2 to 5 hours exercising everyday, often compromising other areas of their life to maintain extremely high levels of physical activity. Like patients with other eating disorders, compulsive exercisers are motivated by psychological factors. Their goal is not simply good physical appearance and performance, but control and self-respect. They seek to rid themselves of negative feelings and emotions through exercise, even if that means running with an injured ankle or through the snow. Other symptoms include lying about the amount of time spent in the gym, skipping work or school to exercise, continually increasing the intensity and frequency of workouts, and continuing with exercise despite injury. Compulsive exercisers are in danger of dehydration, stress fractures, osteoporosis, heart problems, kidney failure, and other risks associated with low body fat.

Helping a Friend

Plan to approach your friend directly. Pick a time when both of you are feeling calm and have plenty of time to sit down and chat. Accusations, confrontations, or pleas to change will only result in closing any potential lines of communication. Be sure to tell your friend why you suspect there’s a problem, using “I“ statements to point out specific eating and exercise patterns that worry you. Helping a friend with an eating disorder requires a lot of patience because the person is not going to change their behavior over night. However, just talking with your friend and being supportive is an important first step. If you start to get frustrated, ask if you can continue the conversation at another time. Try to anticipate what kind of response your friend is likely to give. It may be one of relief and admission of the problem, but it could be defensive and angry.

Do not ignore symptoms of bingeing, such as open containers and empty food wrappers. Although bulimics and binge eaters eat secretly, they frequently leave clues about their unhealthy habits, kind of like a cry for help.

It’s important to understand that eating disorders stem from a variety of psychological and emotional issues, and that recovery means far more than breaking habits of starving, bingeing, compulsive exercise, and purging. Sufferers must not only learn how to eat healthy, but also discover and correct the underlying problems that contributed to the development of an eating disorder. Complete recovery can only be achieved with the help of professional doctors and therapists, but you can play an important role as a supportive and encouraging friend.

Reach out and let your friend know that you are concerned, and that there are better ways to deal with life’s problems than stuffing and starving. Encourage professional help, but expect denial and resistance. Don’t dwell on weight or appearance, but discuss health, relationships, and mood. Your friend likely has a distorted body image and will not be persuaded to find help by comments that suggest they are too thin (in fact, they may celebrate such a remark). Be a good listener, don’t give advice unless it is asked for, and be prepared to suggest where your friend may go for help if they want it.