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Eating disorders are about 10 times more common in women than in men.
About 85% of eating disorders begin during adolescence. The most serious of these are:
- Anorexia nervosa ('anorexia').
- Bulimia nervosa ('bulimia').
Many more women have less severe eating problems, called 'EDNOS' for 'Eating Disorders Not Otherwise Specified'), such as Binge Eating Disorder.
Health risks
Some of the health risks of Anorexia and Bulimia may include:
- Difficulty maintaining blood pressure.
- Low body temperature.
- Abnormalities of blood electrolytes.
- Abnormalities of heart rhythm which may result in sudden death.
- Disordered hormone levels in the body.
- Delay in onset of menstruation, or established menses may cease.
- Impairment of normal adolescent bone growth and strengthening possible long term problems with weak bones.
- Some evidence suggests that changes in brain structure and function may occur in Anorexia, and may not be reversible.
- Acid from recurrent vomiting in bulimia can damage teeth and throat.
Early warning signs
Early warning signs of eating disorders may include:
- A constant focus on dieting, exercise or food.
- Cooking for others but not eating.
- Insisting on having different meals to the rest of the family.
- Avoidance of eating in public.
- Food rituals.
- Frequent weighing.
- Visits to the bathroom after eating.
Eating disorders often start insidiously with the young person initially seen to be following a 'healthy diet'.
While few young people who diet develop an eating disorder, the presence of dieting is recognised as a risk factor.
Risk factors
Research has shown that some genetic factors contribute to eating disorders.
Depression is also a risk factor for the development of an eating disorder. However, eating disorders are known to bring on depression, thought to be as a result of starvation.
Effects
Eating disorders in adolescents negatively affect health in both the short and long term. They also impact seriously on family functioning.
Early diagnosis and intervention are crucial to achieving a good long term outcome.
Management and treatment
Weight restoration is a primary goal in adolescents to prevent problems with future growth and bone strength.
Treatment needs to be comprehensive.
Young people should be given time alone to talk with their doctor during their consultation.
One health professional should be the recognised co-ordinator of the treatment team, for example:
- A medical practitioner.
- A mental health professional.
- A nutritionist/dietician.
Management usually addresses the following areas:
- Physical.
- Psychosocial.
- Family.
- Educational.
Family therapy can be especially effective in younger adolescents.
Eating disorder support groups are very helpful for some families.
Medication for eating disorders
There is some evidence that Fluoxetine, an SSRI medication may help reduce binging and purging behaviours and may help decrease relapse rate in anorexic patients following weight restoration.
Calcium and vitamin D supplements are often recommended to help bone development.
If you are concerned about an eating disorder
- Seek help from your doctor.
- Focus on increasing healthy physical activity, especially as part of a team sport.
- Help and education may be needed regarding a healthier approach to eating.
- Depression and anxiety need to be considered, recognised and treated if present. They significantly increase the risk of a young person developing an eating disorder.
Note: Young people of normal weight who are dieting should be strongly discouraged from doing do.
Diagnostic criteria for anorexia nervosa*
- Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to maintenance of body weight <85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight <85% of that expected).
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
- In postmenarchal females, amenorrhea, i.e. the absence of at least three consecutive menstrual cycles. A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.
Two types of anorexia nervosa:
Restricting type: During the episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behaviour (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas).
Binge eating/purging type: During the episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behaviour (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
* Source: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Washington, DC, American Psychiatric Association, 1994 (DSM-IV - a manual of diagnostic criteria for a wide range of disorders).
Diagnostic criteria for bulimia nervosa*
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g. within any two hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
- A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
- Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives or diuretics, enemas, or other medications, fasting, or excessive exercise.
- The binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
Two types of bulimia nervosa:
Purging type: During the current episode of bulimia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Non-purging type: During the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviors such as fasting or excessive exercise but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
* Source: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Washington, DC, American Psychiatric Association, 1994 (DSM-IV - a manual of diagnostic criteria for a wide range of disorders).
More information
Eating Disorder Association of New Zealand.
Eating Disorder Association of NSW in Australia.
The NSW centre for Eating and Dieting Disorders. For guidelines and information on recognising excessive exercise and extreme dieting.
The Royal Children's Hospital (Melbourne, Australia) Centre for Adolescent Health Centre of Excellence in Eating Disorders - mainly for professionals but provides information, personal stories, a reading list, and glossary.
ISIS - Centre for Women's Action on Eating Issues Inc. This website was developed by a group called SISTA (ongoing support and social action group).
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