Anorexia nervosa Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. People with anorexia nervosa typically weigh themselves many times every day, are very strict with how much food they eat, and eat very small amounts of only certain foods. Some people with anorexia nervosa also may eat too much food and then go on a very strict diet afterwards, exercise too much, make themselves vomit, or misuse of laxatives, diuretics, or enemas.
Symptoms of anorexia nervosa include:
Extremely low body weight
Severe food restriction
Pursuit of thinness and unwillingness to maintain a normal or healthy weight
Intense fear of gaining weight
Distorted body image and self-esteem
Denial of the seriousness of low body weight
Lack of menstruation among girls and women.
Some who have anorexia nervosa recover with treatment after only one episode. Others get well but then get sick again. Still others have a more long-lasting, form of anorexia nervosa, in which their health gets worse as they battle the illness.
Other symptoms and medical complications may develop over time, including:
Thinning of the bones (osteopenia or osteoporosis)
Brittle hair and nails
Dry and yellowish skin
Growth of fine hair all over the body (lanugo)
Low blood count, muscle wasting, and weakness
Severe constipation
Low blood pressure, or slowed breathing and pulse
Damage to the heart
Brain damage
Multi-organ damage
Drop in internal body temperature, causing a person to feel cold all the time
Feeling tired all the time
Inability to get pregnant
Bulimia nervosa People with bulimia nervosa have frequent episodes of eating unusually large amounts of food and feel a lack of control over these episodes. This binge eating is followed by behavior that makes up for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, too much exercise, or a combination of these behaviors.
Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are very unhappy with their body size and shape. Usually, bulimic behavior is done secretly because of feelings of disgust or shame. The binge eating and purging cycle can happen anywhere from several times a week to many times a day.
Other symptoms include:
Always having a sore throat
Swollen salivary glands in the neck and jaw area
Worn tooth enamel, and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
Acid reflux disorder and other gastrointestinal problems
Intestinal distress and irritation from laxative abuse
Severe dehydration from purging of fluids
Electrolyte imbalance—too low or too high levels of sodium, calcium, potassium, and other minerals that can lead to a heart attack or stroke.
Binge-eating disorder People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa, periods of binge eating are not followed by behaviors like vomiting, too much exercise, or not eating. As a result, people with binge-eating disorder often are overweight or obese. People with binge-eating disorder who are obese are more likely to get sick with heart disease and high blood pressure. They also experience guilt and shame about their binge eating, which can lead to more binge eating.
Treatment goals usually include getting proper nutrition, bringing weight to a healthy level, reducing excessive exercise, and stopping binging and purging behaviors. Specific forms of psychotherapy, or talk therapy—including a family-based therapy called the Maudsley approach and cognitive behavioral approaches—have been shown to be useful for treating specific eating disorders. Evidence also suggests that antidepressant medications approved by the U.S. Food and Drug Administration may help for bulimia nervosa and also may be effective for treating co-occurring anxiety or depression for other eating disorders.
Treatment plans often are tailored to individual needs and may include one or more of the following:
Individual, group, or family psychotherapy
Medical care
Nutritional counseling
Medications
Some patients also may need to be hospitalized to treat problems caused by poor nutrition or to make they eat enough if they are very underweight. Complete recovery is possible.
