The three primary eating disorders include anorexia, bulimia nervosa, and binge eating disorder. Each come with their own physical consequences and prognosis. Anorexia nervosa is the restriction of behaviors that promote healthy body weight. Bulimia Nervosa is repeated episodes of binge-eating and repeated compensatory behaviors to prevent weight gain such as purging (vomiting), fasting, excessive exercise, and the use of laxatives and/or diuretics. Binge eating disorder is repeated binge eating disorders that occur at least once a week for at least 3 months.
Anorexia nervosa is the restriction of behaviors that promote healthy body weight. Typically, body weight is significantly below normal for a person’s age and height. It involves a strong fear of weight gain or behavior that interferes with weight gain and distorted body image or sense of body shape. Weight loss is typically achieved through dieting but can also occur through purging and excessive exercise. The fear of gaining weight is not reduced by weight loss as the person believes there is no such thing as “too thin.” Even when emancipated, those with anorexia nervosa may believe they are overweight and will. They will overestimate their body and will chose a thin figure as ideal. Severity ratings are based on Body Mass Index (BMI) and is associated with significant stigma. Subtyping of anorexia nervosa includes restricting type which is weight loss is achieved by severely limiting food intake and binge-eating/purging type where the person has also regularly engaged in binge eating and purging. Longitudinal research suggests limited validity of subtypes yet may have some clinical utility. The onset is early to middle teenage years and is usually triggered by dieting and stress. At least 3 more frequent in women than men. In men, focus may be more on muscularity in addition to lean body shape.
Bulimia Nervosa is repeated episodes of binge-eating and repeated compensatory behaviors to prevent weight gain such as purging (vomiting), fasting, excessive exercise, and the use of laxatives and/or diuretics. Body shape and weight are extremely important for self-evaluation. A binge episode includes an excessive amount of food consumed in a short period of time and a feeling of losing control over-eating. It typically occurs in secret. Bulimia Nervosa may be triggered by stress, negative emotions, or negative social interactions. Typical food choices in cakes, cookies, ice cream, and other easily consumed high-calories foods. Avoiding a craved food can later increase likelihood of binge. There are reports of losing awareness or dissociations with shame and remorse often following. Feelings of discomfort, disgust, and fear of weight gain lead to inappropriate compensatory behavior of attempting to undo the caloric effects of the binge. Vomiting, laxative, and diuretic abuse, fasting, excessive exercise are used to prevent weight gain. Binge/purge episode must occur at least once a week for 3 months. Onset occurs in late adolescence or early adulthood with 90% of women with bulimia nervosa being women. The prevalence among women is 1-2%. People are typically overweight before onset and symptoms begin while dieting. It is comorbid with depression, personality disorders, anxiety, substance use disorders, and conduct disorder. Suicide rates are higher than in general population but are much lower than in anorexia nervosa.
Binge eating disorder is repeated binge eating disorders that occur at least once a week for at least 3 months. The binge eating episodes must include several features such as eating fast, eating even if not hungry, eating past feeling full, and feeling bad about eating so much. No compensatory behavior is present. It is typically associated with obesity and history of dieting with a BMI over 30 but only 2-25% of obese people meet criteria for Binge Eating Disorder. It is often comorbid with mood disorders, anxiety disorders, conduct disorder, and substance use disorders. Rick factors include childhood obesity, critical comments about being overweight, weight-loss attempts in childhood, low self-concept, depression, and childhood physical or sexual abuse. It is more prevalent in women and more prevalent than anorexia or bulimia. It is equally prevalent among Euro-, African-, Asian-, and Hispanic-Americans.