Understanding Anorexia Nervosa: Symptoms, Causes and Treatments

Hi, I'm Dr. Leslie Sim, a clinical psychologist with Mayo Clinic. Throughout life, we all experience moments of concern about our body shape and weight. But when these thoughts cause dangerous weight-loss or dieting, it may be due to an eating disorder called anorexia nervosa. Anorexia nervosa is an eating disorder characterized by fear of weight gain. This fear drives people to restrict their eating, leading to dangerous weight-loss or failure to make expected weight gain. Restrictive eating and anorexia nervosa can take many forms. It might involve skipping meals, eating smaller portion sizes, or eliminating snacks and specific foods from a person's diet. People with anorexia nervosa can present at any weight or shape. People in larger bodies and smaller bodies experience similar medical and psychological complications.

Some people with anorexia may not explicitly state or even be aware that they are afraid to gain weight. On some occasions, people with anorexia will deny fear of weight gain and instead describe a preoccupation with eating healthy. However, when this pursuit leads to dangerous consequences and undermines their health, this is a characteristic of anorexia nervosa. The exact cause of anorexia nervosa is still unknown, but biological, psychological, and social factors increase the risk for the condition. Situations that lead to weight loss can also place people at risk, for example anxiety, weight-loss for any reason, medical conditions or medications that interfere with appetite. Low appetite, or fear of vomiting can put people at risk for anorexia nervosa. Many of the psychological and physical complications of anorexia are related to starvation. They may be difficult to notice because people with anorexia often disguise their thinness, eating habits, or physical problems. Associated symptoms may include depression, suicidal behavior, or appetite. Focus on pain or fatigue, preoccupation with food, and fear of weight gain.

Anorexia nervosa is a serious, life-threatening condition that has one of the highest mortality rates of any mental illness. Anorexia affects every organ system in the body, including impairments in bone growth and heart problems. Depression is frequently a consequence of restrictive eating and weight loss. Notably, anorexia is associated with a very poor quality of life, with many deaths due to suicide. Anorexia is often difficult to diagnose, as many individuals will lack insight into the seriousness of their low weight. The fear of weight gain leads them to under-report their symptoms and attribute their weight-loss to low appetite, abdominal pain, or other factors.

Anorexia nervosa often goes undetected in people with higher weights, which commonly contributes to delays in their diagnosis. The good news is that anorexia is very treatable, particularly if caught early. The first and necessary goals are to restore eating and weight. Weight has to be fully restored to have a full recovery. For those in larger bodies weight restoration may have to be higher than they want it to be in order to recover. Because of the fear of weight gain and lack of insight, people with anorexia need family support and assistance with meals to improve their eating and weight. If you have a loved one you're worried about, urge him or her to talk to a doctor. They are not alone and treatment does help. Learn more about anorexia nervosa by visiting mayoclinic.org. We wish you well.

Understanding Bulimia Nervosa Symptoms, Causes and Treatments

Hi, I'm Dr. Leslie Sim, a clinical psychologist with Mayo Clinic. From time to time, people can overeat, especially during celebrations and the holidays. But when episodes of overeating are associated with a loss of control and are followed by behaviors to get rid of the calories consumed, it may be due to an eating disorder called bulimia nervosa.

Bulimia nervosa is a serious, potentially life threatening eating disorder. People with bulimia struggle with significant and overwhelming concerns about their body shape and weight. They may secretly binge, eat a large amount of food with a loss of control over their eating, and then purge, trying to get rid of the calories in an unhealthy way. Bulimia is characterized by recurrent binge-eating and purging at least once per week for at least three months. Binges can include eating extremely fast, eating to the point of nausea, and eating when not hungry. They also occur in secret and are followed by strong feelings of guilt or shame. Binges also have accompanying experiences of loss of control. People will describe this feeling as if they can't stop eating even when they want to.

When diagnosing a binge episode, there is strong evidence that the feeling of losing control is more important than the amount of food consumed. Purging includes anything that individuals do to get rid of the food and calories consumed during the binge. This can include self induced vomiting, abusive laxatives, or diuretics. People with bulimia may also use other ways to offset the calories consumed during binge-eating, like fasting or excessive exercise, or abusing medications, such as stimulants, diet pills or other prescription medications that have appetite suppressant side effects. These behaviors occur immediately following a binge or at any other time. In bulimia, dieting drives a dangerous cycle. Individuals with the condition restrict their diet, leading to increased psychological and physiological pressures to eat. Ultimately, this leads to a binge episode, which is followed by purging, which is followed by further shame and distress. This leads to increased pressure to restrict, which restarts the cycle.

The exact cause of bulimia is unknown. Many factors play a role in the development of eating disorders, including genetics, biology, psychological factors, and social expectations. According to the national surveys, the median age of onset is 18 years old. There are some risk factors that increase a person's chance of developing bulimia nervosa. These include dieting or losing weight for any reason, diabetes, medical conditions or medications that interfere with appetite, a history of yo-yo dieting, being bullied or shamed for one's weight, and traumatic experiences. In contrast to what is commonly thought, bulimia can affect people of all body types. Sometimes individuals with bulimia are weight suppressed, meaning they weigh less than they should based on their personal history.

The most serious consequences of bulimia nervosa include electrolyte imbalances that can lead to heart attacks or seizures. Individuals with the condition are five times more likely to have a heart attack. Inducing vomiting also causes significant damage to dental enamel and cause sores in the mouth and the tongue. Bulimia is associated with high rates of depression, anxiety, feelings of hopelessness, increased suicidality, or self-harm.

The good news is that bulimia is very treatable. Individual therapy, like cognitive behavior therapy enhanced and integrative cognitive affective therapy can help break the cycle. For adolescents with the condition, treatment includes family-based interventions where parents or guardians help normalize their child's eating and eliminate bulimic behaviors. Some individuals may need to go to a treatment center to break the cycle of binge eating and purging. If you have a loved one you're worried about, urge him or her to talk to a doctor. They're not alone. And treatment does help. Learn more about bulimia nervosa by visiting mayoclinic.org. We wish you well.

Understanding Binge-Eating Disorder: Symptoms, Causes and Treatments

Hi, I'm Dr. Jocelyn Lebow, a clinical psychologist with Mayo Clinic, here with you to talk about binge-eating disorder. Almost everyone over eats on occasion, like having a second or third helping of a holiday meal. But for some people, regular excessive eating can cross the line to binge-eating.

Binge-eating disorder is when a person frequently consumes unusually large amounts of food and feels unable to stop. This disorder is characterized by recurrent binge-eating at least once a week for at least three months. Binges can include eating extremely fast, eating to the point of nausea, and eating when not hungry. They also often occur in secret and can be followed by strong feelings of guilt or shame. People who binge-eat also experienced a loss of control. People will describe this feeling as if they can't stop eating, even if they want to. When diagnosing a binge episode. There's strong evidence that the feeling of losing control is more important than the amount of food consumed. Binge eating disorder is a dangerous cycle. Individuals restrict their diet, leading to increase psychological and physiological pressures to eat. Ultimately, this leads to a binge episode, which is often followed by shame and distress. This in turn leads to increased pressure to restrict, again, restarting the cycle. If an individual goes through this cycle of restriction in binge-eating enough times, it can impact metabolism causing weight gain, which further perpetuates the cycle.

The exact cause of binge-eating disorder is unknown, but many factors play a role in the development of eating disorders, including genetics, biology, psychological factors, and long-term diet. According to national surveys, the median age of onset for binge-eating is 21 years old. There are some risk factors that increase a person's chance of developing binge-eating disorder. These include dieting or losing weight for any reason, diabetes, medical conditions or medications that interfere with appetite. Athletes who do not increase their calories during their sports season. A history of yo-yo dieting, being bullied or shamed for weight and traumatic experiences.

Binge-eating disorder is associated with high rates of obesity, depression, anxiety, feelings of hopelessness, and increased self-harm. People with binge-eating disorder also often report lower quality of life. In contrast to common thought, binge-eating disorder can affect people of all body types. You do not have to be overweight to have binge-eating disorder.

The good news is that binge-eating disorder is very treatable. Though it seems counter-intuitive, the first step to addressing binge-eating behaviors is to normalize eating, meaning eliminating all dieting and restrictive behavior through evidence-based therapy. Individual therapies including enhanced cognitive behavioral therapy and integrative cognitive affective therapy, or a combination of group and individual therapy such as dialectical behavioral therapy. Some individuals may need to go to a treatment center to break the cycle of binge-eating. If you have a friend or loved one you're worried about, urge them to talk to a doctor. They are not alone and treatment does help. Learn more about binge-eating disorder at mayoclinic.org. We wish you well.