Amenorrhea is defined as having missed at least three consecutive menstrual cycles, or having failed to begin menstruation by age 16. In the context of eating disorders, it results from the hormonal changes associated with low body weight. It also may occur in normal-weight athletes who exercise excessively, and have too little body fat to menstruate. However, all individuals will menstruate in slightly different hormonal conditions; thus, someone with an eating disorder may still menstruate, and someone without an eating disorder may not.
Anemia occurs when the red blood cell count is low, meaning not enough oxygen is being transported to the bones and tissues. Anemia is often found in people who suffer from eating disorders, as it can result both from inadequate nutrition and excessive exercise. Symptoms of anemia include fatigue, dizziness, headaches, and an unusually fast heart rate or shortness of breath while exercising.
Although anorexia is often perceived as self-induced starvation, it is a misconception that anorectics do not eat. Anorectics do eat, but in a way that still leaves them undernourished. Anorectics severely limit both the types and the quantity of food that they consume. In addition, they often employ compensatory behaviors whenever food is consumed, such as excessive exercise, purging, and laxative abuse. Anorectics maintain a body weight that is well below the healthy range, yet struggle with an intense fear of gaining weight.
It is helpful to differentiate this disorder from anorexia itself, because both warning signs and treatment may be different. Anorexia athletica is often found in athletes, such as dancers, runners, wrestlers, and figure skaters –people for whom size and shape bear a direction correlation to personal performance. This disorder is characterized by consuming insufficient nutrients for the amount of physical activity performed daily. They may perceive weight loss as necessary to improving performance. Women who suffer from anorexia athletica are especially susceptible to what is called the Female Athlete Triad, which is characterized by a loss of bone density (osteoporosis), loss of menstrual cycle (amenorrhea), and disordered eating.
Binge eating disorder is characterized by frequent episodes of overeating without the compensatory behaviors employed by bulimics. Many binge eaters are overweight or obese, and express the feeling that they are not in control while eating. The desire to binge may arise from malnutrition; skimping on nutrient-dense food leads to overeating on innutritious food. It also may result from chemical dependence on the effect of certain foods. Certain combinations of salt, fat, and sugar, can elicit drug-like reactions. Like other eating disorders, however, BED has both physiological and psychological components.
Bradycardia is one of the most common heart conditions in people with eating disorders, defined as a resting heart rate of under about 60 beats per minute. Bradycardia results from an electrolyte imbalance associated with dehydration and starvation, and it especially dangerous when combined with the intense exercise, purging, and drug consumption that are associated with eating disorders.
Bulimia is characterized by episodes of overeating, or binging, following by purging. Despite often being of a normal or above-normal weight, bulimics do not receive adequate nourishment. Because they do not fully absorb the nutrients from food before purging it, their bodies demand more food – and this uncontrollable desire to eat is then followed by a psychological compulsion to purge. Exercise bulimia is different from typical bulimia insofar as the “purging” of food is achieved through intense and prolonged exercise, rather than forcing oneself to throw up.
EDNOS (Eating Disorder Not Otherwise Specified) describes an eating disorder that does not meet the diagnostic criteria of anorexia, bulimia, or binge eating disorder. This term may be used for an anorectic that still menstruates, for example, or a bulimic who binges less frequently than twice per week. EDNOS is the most commonly diagnosed eating disorder.
Although it is not formally recognized by the DSM, orthorexia is a real subcategory of disordered eating with many of the risks associated with anorexia. Orthorexia is characterized by the elimination of “bad” foods and obsession with consuming only “good,” “clean,” or “safe” foods. Orthorexics may eliminate entire food groups (like meat or dairy) or ways of preparing food (e.g., eating only raw food or non-processed food). They may obsessively track their consumption of micro- and macronutrients, as well as adopt a strict exercise regimen. Orthorexia can place extreme stress on the body as well as interfere with other aspects of one’s life, as the consumption of “safe” food and the avoidance of anything “unsafe” is all-consuming.
Osteoporosis, or a loss of bone density, may occur at an early age in people who suffer from eating disorders. This is partly because bone structure and strength are still developing in the teenage years, when many anorectics or bulimics are not providing their bodies with adequate nutrition to carry out normal growth processes.
Potential Signs of an Eating Disorder
- Rapid weight loss in a short period of time, or failure to gain weight at the expected rate
- Loss of menstrual period or failure to develop it by age 16
- Soft hair all over the skin, the body’s attempt to warm itself when there is insufficient body fat
- Frequently feeling cold
- Blue or purple-tinted hands and feet
- Slow or irregular heartbeat
- Weakness and dizziness
- Withdrawal from or disinterest in social situations in which food is involved
- Excessive concern for nutritional content of anything consumed, despite being at a normal or below-normal weight
- Does not perceive themselves as underweight, and does not perceive losing more weight as undesirable
- Feels uncomfortably full, sick, or bloated after small or normal quantities of food
- Scars, callouses, or markings on the fingers, especially the knuckles, due to repeatedly sticking them down the throat
- Discolored teeth, due to their frequent exposure to stomach acid
- Frequent and noticeable fluctuations in weight
- Weakness and dizziness caused by inadequate nutrition
- Leaving immediately after meals or eating – not necessarily to the bathroom, but to anywhere that is private enough to purge
- Losing weight or maintaining a normal weight despite seeming to eat large quantities of food
- Disappearance of large amounts of food
The most noticeable physical sign that someone is suffering from BED is weight gain and obesity. However, obesity itself is not an eating disorder and gaining weight does not necessarily indicate disordered eating. Thus, in BED, behavioral signs offer the best indication.
- Eating in private. Does the person seem to be gaining weight despite eating normally or even less-than-normal in the presence of others?
- Frequent crash or yo-yo dieting followed by “falling off the wagon” with a binge
- Uncomfortable in the presence of food (saying things like, “don’t let me see those brownies unless you want them to disappear!”)
Eating Disorder FAQ
What is the difference between eating disorders and disordered eating?
There are specific diagnostic criteria that must be met in order for a person to be diagnosed with anorexia, bulimia, binge eating disorder, or EDNOS. However, many more people embody the behavior associated with eating disorders, only less frequently, or to a smaller magnitude. Countless women have tried purging, diet pills, laxatives, detoxes, and eliminating food groups or macronutrients (e.g., low-carb, low-fat, etc.) in an attempt to lose weight. Disordered eating can affect both physiological and psychological wellness, as well as interfere with one’s social life and productivity.
What causes eating disorders?
Although no one knows exactly what causes anorexia, many professionals have agreed that “genes load the gun and environment pulls the trigger.” Eating disorders are more common in people with a family history of eating disorders, depression, anxiety, and other compulsive behavior. However, given a supportive and healthy environment, the risk of developing an eating disorder can be reduced.
What is the difference between binge eating and overeating?
Everyone overeats from time to time, yet not everyone describes the experience of overeating as a “loss of control” or a compulsion. Most people overeat due to the addictive quality of modern foods, which are low in nutrients while combining salt, fat, and sugar to an enticing effect. Binge eaters, however, express more defenselessness in the face of food, perceiving weekly or even daily binges as both inevitable and out of their control. There is thus thought to be both a psychological and a physiological component to binge eating that exists less, if at all, in typical overeating.
How can I tell if I am just on a diet, or if I am developing disordered eating behavior?
A person with an eating disorder is not simply someone on a diet with a lot of self-control. Normal dieters begin at an unhealthy weight. The diet is “over” when they have achieved a weight that is healthy, comfortable and sustainable. Even those who transform a diet into a lifestyle change do so hoping to maintain that loss, not to lose weight indefinitely. A diet can lead to disordered eating when the dieter becomes addicted to the process of losing weight, and terrified of gaining weight back. A disordered eater will never be satisfied with their present weight; the continuation of the disorder depends on dissatisfaction with their weight.
Can someone have an eating disorder without being underweight?
(Or, have binge eating disorder without being overweight?) Yes. In fact, most people who suffer from eating disorders are not underweight. Some may meet all of the diagnostic criteria for anorexia besides a body weight that is 15% below ideal; and yet, the psychological and behavioral components to the disease still desperately need treatment. Many bulimics are at a normal or above-normal weight, as their body is able to glean a portion of the nutrition in the process of binging and purging. In addition, many people with BED or EDNOS suffer in silence. A BED may counter their binges by going days without a proper meal, and thus maintain a normal weight.
Can men have eating disorders?
Absolutely. The long-cited statistic with regard to men and eating disorders is that up to 10% of total eating disorders occur in men. However, this statistic could easily be too low, as the diagnostic criteria for eating disorders have been written largely with respect to women, and are only recently being reviewed. Amenorrhea, a long-held criterion for anorexia, is clearly a non-issue in men. In addition, the cultural ideal for men prizes muscularity over thinness. Thus, an anorexic man may be at a normal body weight and yet still be restricting food intake and putting his body through undo stress.