Anorexia Nervosa is primarily defined by extreme weight loss and caloric restriction. Sufferers are often plagued by a fear of weight gain, a distorted perception of their body, and an obsessive need to control their food intake and weight. They usually spend a large amount of time weighing themselves and portioning their food, and they only eat very small quantities of food at a time. Because of these behaviors and perceptions they are unable to maintain a healthy body weight.
Broadly speaking, there are two major types of anorexia. Restrictive type anorexia is when the individual essentially starves his/herself by restricting food intake well below caloric needs. Binge/purge type anorexia is when the individual not only restricts food intake but also engages in binges (uncontrolled eating of an unusually large amount of food) and/or purging behaviors like over-exercise, vomiting, or laxative abuse.
One big misconception about anorexia is that the individual has to be extremely thin. This is not the case – people with a healthy body weight, and even those in larger bodies can and do struggle with anorexia. In fact, many formerly overweight patients who lose a significant amount of weight end up developing anorexia nervosa.
Many physical symptoms of anorexia nervosa include, but are not limited to:
- extreme weight loss
- thin appearance
- abnormal blood counts
- elevated liver enzymes
- dizziness or fainting
- brittle nails
- hair that thins, breaks or falls out
- absence of menstruation (amenorrhea)
- development of fine hair on the extremities (lanugo)
- dry skin
- intolerance of cold
- irregular heart rhythms
- low blood pressure
- osteoporosis, the loss of bone calcium, which may result in broken bones
Bulimia nervosa is characterized by recurrent and frequent episodes of binging and purging. Binging is when an individual eats a large amount of food very quickly in one sitting, even to the point of physical discomfort. Binges may be planned or unplanned but regardless lead to a sense of uncontrolled intake of this food. These episodes of eating often trigger shame and self disgust; they are followed by the need to purge in order to rid the body of the food that has been consumed. Purging behaviors include forced vomiting, excessive use of laxatives or diuretics, excessive exercising, fasting, etc.
Like anorexia, bulimia involves a distorted vision of the body and an obsession with food intake. Sufferers often withdraw from friends and activities, creating an alternative schedule around binges, purges, or long exercise sessions.
Many physical symptoms of bulimia nervosa are linked to self-induced vomiting such as:
- Damaged teeth and gums
- Swollen salivary glands in the cheeks (chipmunk cheeks)
- Persistent sores in the throat and mouth
- Sores, scars or calluses on the knuckles or hands caused by self-induced vomiting
- Scratchy or raspy voice quality
Other symptoms include, but are not limited to:
- Abnormal bowel functioning
- Dry skin
- Irregular heartbeat
- Menstrual irregularities or loss of menstruation (amenorrhea)
- Tingling in the hands or feet
Individuals with binge eating disorders eat excessive amounts of food at one time. During a binge, the sufferer might eat rapidly and uncontrollably even to the point of physical discomfort. Like sufferers of bulimia, these episodes often trigger shame and self disgust; however, individuals with binge eating disorder do not purge. Binge-eating can be related to severe caloric restrictions that lead to uncontrollable hunger, or it can emerge as a self-soothing behavior.
While one in five obese people engage in binge eating, many individuals with the disorder maintain a normal weight.
The most severe symptoms are psychological and include, but are not limited to:
- Lack of control once one begins to eat
- Disgust or self-hatred about eating behaviors
OSFED (Other Specified Feeding or Eating Disorder)
Not all eating disorder sufferers have symptoms that neatly fit into one of the above-listed categories. OSFED encompasses a range or mixture of behaviors and symptoms for individuals who do not meet the specific diagnostic criteria for other disorders. This does not mean it is less serious than the other disorders. Around 30% of people who seek treatment for an eating disorder have OSFED.