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Eating Disorders

Up to 8 percent of Americans suffer from an eating disorder. Body dysmorphic disorder, anorexia nervosa, bulimia nervosa and binge eating disorder are serious, life-threatening illnesses that require medical attention.

Addiction is four times more common in those with eating disorders.

Eating disorders are not a choice. They are diseases that affect men and women of all ages, races and backgrounds. According to the National Institute of Mental Health, women are 2.5 times more likely than men to suffer from an eating disorder, but men are not immune. Eating disorders are closely linked to anxiety, as two-thirds of people with eating disorders are diagnosed with a co-occurring anxiety disorder.

Woman measuring her waist in the mirror

Body Dysmorphic Disorder

People with BDD think certain aspects of their bodies are flawed and may obsess over these imperfections to an unhealthy degree. The flaw is either completely imagined or its reality is exaggerated so that extreme measures are taken to “hide” it.

Symptoms and Signs of Body Dysmorphic Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM) puts BDD in the same category as obsessive-compulsive disorder because the attention paid to the flaw borders on obsession. For example, someone may spend an inordinate amount of time looking in a mirror, examining their skin for blemishes.

People with BDD often attribute natural physiological sensations with the perceived flaw. “I’m hungry because I’m so fat. I’m not going to eat this meal,” is a thought someone with this disorder may have. When this thought is recurrent, it can lead to an eating disorder.

Other signs of body dysmorphic disorder include:

Because BDD isn’t only about weight, it is not an eating disorder in and of itself. However, when BDD and an eating disorder are present, they are both diagnosed.

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Anorexia Nervosa

A term often used too loosely to describe anyone who is thin, anorexia nervosa is a serious disease with the highest mortality rate of all mental disorders. Anorexia affects 4 percent of women and 1 percent of men worldwide. It is the most common psychiatric diagnoses among young women.

Anorexia is more than just severely restricting food intake. Those suffering from anorexia might also binge and purge, exercise excessively or use laxatives to keep weight down. Suicide rates are more common among women with anorexia than among those with other mental disorders.

Signs and Symptoms of Anorexia

Those with anorexia may appear skinny to the point of being emaciated and will avoid situations that involve eating. They will consider themselves fat regardless of their weight, unfairly compare their weight to that of others and maintain a strict diet even in cases of extreme malnourishment.

Some indicators of anorexia nervosa include:

Women also may stop menstruating, a condition called amenorrhea. Their hair becomes brittle and falls out, and their skin becomes dry and yellow. In extreme cases, heart problems, brain damage or death by starvation may occur.

Anorexia also produces emotional symptoms. Individuals with anorexia exhibit mood swings, social withdrawal and irritability. They often lack emotion, appear depressed and fear eating in public.


Bulimia occurs when a person ingests too many calories in one sitting (binging) and immediately rids the body of the calories consumed (purging). This results in a normal body weight but severely poor nutrition.

Young woman eating two cheesburgers

Signs and Symptoms

The first sign of bulimia is overeating. This is usually done in private, but in the early stages of bulimia, it may happen in public, and the individual typically senses a loss of control over the binging. The second stage of bulimia is purging the food from the body. While purging is traditionally thought of as vomiting, other ways food can be purged is by over-exercising, taking laxatives or diuretics or refusing food for days after a binge.

Signs of bulimia nervosa:

Physical side effects include bad breath, poor teeth, acid reflux or lesions in the mouth and throat from vomiting. Emotional side effects may include low self-esteem, feelings of guilt and shame about eating, and social isolation.

Other side effects could include:

Binge-Eating Disorder

Not as well-known as anorexia or bulimia, binge eating disorder (BED) is the most common eating disorder in America and affects up to 5 percent of the general population — 3.5 percent of women, 2 percent of men, and 1.6 percent of adolescents.

BED is characterized as binging — eating more than the average person’s food intake or lacking the control to stop eating — without the subsequent purge.

Signs and Symptoms

People with BED shy away from eating in front of others, preferring to binge in private. The disorder is frequently accompanied by feelings of guilt and shame. Depression and anxiety are also characteristic of the eating disorder.

More indicators of binge-eating disorder:

It’s important to note that having larger meals on occasion, eating outside of established eating times or consuming too much for dinner isn’t indicative of binge-eating disorder. BED occurs when an individual frequently consumes an inordinate amount of food over a period of time.

40% - 60% of high school girls diet graphic

Eating Disorders and Young People

Young people are particularly susceptible to eating disorders. They often face societal pressure to be thin and participate in activities that value leanness, such as sports. The National Institute of Mental Health says 3 percent of U.S. adolescents are affected by an eating disorder, most of whom do not receive treatment.

The pressures of looking good and fitting in never go away, but the spotlight of popularity shines brightest in high school and college. This is why eating disorders disproportionately affect young people. During a 13-year period, eating disorders increased on one college campus from 7.9 percent to 25 percent in males and 23.4 percent to 32.6 percent in females.

In 1996, the town of Nadroga, Fiji, got its first access to television. The town’s only channel played mostly American, British and Australian shows. In 1998, it was reported that 15 percent of girls, averaging age 17, admitted to vomiting to control weight, and 74 percent of the girls reported feeling “too big and fat” sometimes. This illustrates how the media’s portrayal of “the perfect body” affects young people.

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Eating Disorders and Athletes

Being an athlete requires the body to be at peak physical condition at all times. Unfortunately, the path many athletes, especially young athletes, take to get into condition involves disordered eating.

In a study that included more than 200 college athletes from 17 sports, 2 percent were diagnosed with eating disorders, and 25.5 percent exhibited symptoms of an eating disorder without formal diagnosis.

A study published in the Clinical Journal of Sports Medicine found that elite athletes are more likely than the general population to develop an eating disorder. The prevalence of these disorders is higher among female athletes than male athletes.

Eating disorders are more common among athletes in weight-dependent sports, such as boxing or wrestling, than in other sports, the study found.

Man eating a hamburger

Men and Eating Disorders

Men are overwhelmingly underrepresented when it comes to eating disorders, and tests designed to study eating disorders often leave them out.

Part of the reason for this is that men don’t report it. The stigma men face by having a “woman’s disease” prevents them from admitting their problem. But, according to the nonprofit National Eating Disorders Association, studies suggest males have a higher risk of mortality from an eating disorder than females do.

Men and women develop eating disorders for similar reasons. Men see professional athletes and male celebrities and feel bad about their bodies. Society puts pressure on them to be “a real man” and to be strong and fit in order to appeal to women. The need to be muscular overrides the need to have a healthy body. An eating disorder may manifest in men cutting out fat and building a disproportionate amount of muscle to look powerful and strong.

30% - 35% of those with eating disorders also suffer from addiction

Eating Disorders and the Prevalence of Drug Abuse

The connection between eating disorders and drug abuse starts with the drugs themselves. Drugs such as nicotine, heroin and certain prescription pills have a side effect of weight loss. The drugs also contribute positive feelings that may substitute for food.

“We’ve had students who would use stimulants as part of their eating disorders,” Dr. Thomas Hall, director of substance abuse prevention treatment and recovery at the University of Central Florida, told

Drugs such as cocaine and Ritalin have been a problem for students with eating disorders at UCF. Hall said that many of these students are female, and they often suffer from anorexia and bulimia.

This problem isn’t specific to Orlando. A 2015 study published in the journal Psychiatry Research evaluated comorbidity among men and women with eating disorders. The results indicated that nearly one in 10 ED patients had a substance use disorder.

According to the study, about one-third of men suffering from bouts of binge or purge eating met the criteria for alcohol dependence, compared to 7 percent of women with similar problems. More than 13 percent of individuals with bulimia nervosa had a substance use disorder.

Woman looking in the mirror after purging her food

Eating Disorders: Thoughts, Feelings and Emotions

Eating disorders are debilitating diseases that not only affect physical health, but psychological health as well. Often, individuals with eating disorders grapple with feelings of guilt, shame and self-loathing.

Joyce was a 23-year-old bulimic who had a nice apartment, good job and loving boyfriend. However, her constant binging and vomiting resulted in a swirl of conflicting emotions. She constantly felt isolated, frightened and insecure. At times, she was overcome with anxiety and discomfort.

“I have this perpetual knot in my stomach. I was never even aware of it before. It comes from worrying about ‘them,’” Joyce told the authors of “Surviving an Eating Disorder,” which features strategies for overcoming these diseases. “I don’t know who ‘they’ are — but I’m worried they will see me for what I really am; not the mature adult, but the insecure kid.”

Eating disorders are debilitating diseases that not only affect physical health, but psychological health as well.

Joyce said she feels most uncomfortable with herself when she binges. She is far from alone.

Jennie was a 20-year-old college student who exhibited symptoms of BDD. She felt unlovable and undesirable and often avoided social situations. She attributed any disappointment in life to her weight.

“Sometimes I think I stay fat because everything that is wrong in my life can be attributed to that. This way, if someone doesn’t like me, I can always blame it on my weight,” said Jennie.

Negative feelings and emotions are common among people with eating disorders. Thomas Hall says feelings of guilt and shame overwhelm many UCF students with eating disorders.

“The shame is significant,” Thomas Hall said. “There’s a sense of ‘I am who people think I am.’”

Erin Hall, who plans substance-free social events at UCF, agrees. She says people with eating disorders often grapple with shame, guilt and fear. They also deal with isolation, which makes getting help more difficult.

She also noted the sense of control these individuals possess: They can control their eating, sometimes through binging and purging.

“The thought of giving up the control is terrifying,” Erin Hall told “When you give up control, you feel vulnerable.”

She called anorexia and bulimia a 24/7 job that can be psychologically taxing. She said people with eating disorders often keep tabs on their calorie intake, and they go to great lengths to hide these disorders.

“It takes a lot of work,” she said.

Doctor diagnosing woman with disorder

Treating Eating Disorders

Treating a person with an eating disorder follows the same principles as treating someone who has a substance abuse problem. The goal of treatment is to change the behaviors around the eating disorder.

The Success of CBT for Eating Disorders

The treatment that has shown the most promise is cognitive behavioral therapy (CBT). Cognitive behavioral therapy is the practice of changing behavior by increasing awareness of negative thoughts that affect behavior. For eating disorder patients, it’s changing the way the patient perceives food, themselves and how they are viewed by others.

Studies show people who have CBT treatments have a smaller risk of relapse than those who receive other types of treatment or no treatment at all. A 2003 study showed patients who used CBT dropped out of therapy only 22 percent of the time, versus general therapy dropout rates of 73 percent. The study also found their “good” outcome was achieved by 44 percent of the CBT patients, whereas only seven percent reached a “good” outcome using other treatments.

Getting Help

If you think someone has an eating disorder, talk to them. If help is needed, get in contact with a guidance counselor or counseling center at school, a professional psychiatrist or a treatment center. Eating disorders may damage the body temporarily, but overcoming one can lead to a long and healthy life.

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Eating Disorder Resources

A number of programs and initiatives provide education, support and outreach to people suffering from eating disorders.

View Sources

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