Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight.

Eating disorders frequently develop during adolescence or early adulthood, but can occur during childhood or later in adulthood.

Three eating disorders, anorexia nervosa, bulimia, and binge eating disorder are on the increase among teenage girls and young women and often run in families.

Anorexia nervosa
Anorexia and bulimia affect nearly 10 million women and one million men (primarily teens and young adults) in reported cases in the U.S. and can be fatal. 
Anorexia nervosa has the highest premature fatality rate of any mental illness.
The average age of sufferers is dropping rapidly (as young as elementary school), with peak onset among girls ages 11-13.

It's estimated that another 25 million people suffer from binge eating disorder.

Anorexia nervosa is characterized by self-starvation and excessive weight loss.  The diagnosis of anorexia is made when the anorexic either loses fifteen percent (15%) of their weight or when the growing child fails to acquire eighty-five percent (85%) of the minimal weight for their particular age and height.

Symptoms of anorexia include:

• Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level
• Intense fear of weight gain or being “fat”
• Feeling “fat” or overweight despite dramatic weight loss
• Loss of menstrual periods
• Extreme concern with body weight and shape
•  Sore throat and painless swelling of the cheeks from vomiting  

A teenager with anorexia nervosa is typically a perfectionist and a high achiever in school.  At the same time, she suffers from low self-esteem, irrationally believing she is fat regardless of how thin she becomes.  Desperately needing a feeling of mastery over her life, the teenager with anorexia nervosa experiences a sense of control only when she says "no" to the normal food demands of her body.  In a relentless pursuit to be thin, the girl starves herself.  This often reaches the point of serious damage to the body and, in a small number of cases, may lead to death.

Bulimia nervosa
Bulimia nervosa is characterized by a secretive cycle of binge eating followed by purging.  Bulimia includes eating large amounts of food -- more than most people would eat in one meal -- in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising.

It is difficult to detect bulimia.  Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day.  Dieting heavily between episodes of bingeing and purging is also common.  Eventually, half of those with anorexia will develop bulimia.

Symptoms of bulimia include:

• Repeated episodes of bingeing on high-caloric food
• Feeling out of control during a binge and eating beyond the point of comfortable fullness
• Purging after a binge (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting)
• Frequent dieting, with binges alternating with severe diets
• Extreme concern with body weight and shape
• Hiding the signs of throwing up by running water while spending long periods of time in the bathroom
• Sore throat and painless swelling of the cheeks from vomiting  

The purging of bulimia presents a serious threat to the patient's physical health, including dehydration, hormonal imbalance, the depletion of important minerals, and damage to vital organs.

Binge Eating Disorder
Binge eating disorder (also known as Compulsive Overeating) is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full.

Symptoms of binge eating are:

• Eating large amounts of food when not physically hungry
• Rapid eating
• Eating until uncomfortably full
• Eating alone out of embarrassment at the quantity of food being eaten
• Hiding of food because the person feels embarrassed about how much he or she is eating
• Feelings of disgust, depression, or guilt with overeating  

This disorder is different from bulimia because people with binge eating disorder usually do not purge afterward by vomiting or using laxatives.

While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge.

People who binge disparage their bodies and feel self-conscious about their body size and/or shape.  However, not everyone who has binge eating disorder is overweight.  Although body weight may vary from normal to mild, moderate, or severe obesity, most people with binge eating disorder are obese (more than 20 percent above a healthy body weight).

Up to half of all people with binge eating disorder have a history of depression. Whether depression is a cause or effect of binge eating disorder is unclear.

Many people report that anger, sadness, boredom, anxiety or other negative emotions can trigger a binge episode.

Impulsive behavior and certain other psychological problems (such as obsessive-compulsive behavior, substance abuse, and personality disorders) may be more common in people with binge eating disorder.

Unhealthy weight gain due to poor diet, lack of exercise, and bingeing is responsible for over 300,000 deaths each year. The annual cost to society for obesity is estimated at nearly $100 billion.

Eating Disorders is a Serious Mental Health Issue
Recognition of eating disorders as real and treatable diseases is critically important.  The consequences of eating disorders can be severe.  For example, one in ten cases of anorexia nervosa leads to death from starvation, cardiac arrest, kidney failure, other medical complications, or suicide.

Without treatment, up to twenty percent (20%) of people with serious eating disorders die. However, early identification and treatment leads to more favorable outcomes.  With treatment, the mortality rate falls to two to three percent (2-3%).

Getting Help
Parents who notice symptoms of an eating disorder in their teenagers should ask their family physician or pediatrician for a referral to a child and adolescent mental health professional.

With comprehensive treatment, most teenagers can be relieved of the symptoms or helped to control eating disorders.  Mental health professionals that specialize in working with children and adolescents are trained to evaluate, diagnose, and treat these psychiatric disorders.  Eating disorders frequently co-occur with depression, alcohol abuse, substance abuse, and anxiety disorders, and  it is important to recognize and get appropriate treatment for these problems as well.

Treatment for eating disorders usually requires a team approach; including individual therapy, family therapy, working with a primary care physician, and working with a nutritionist.

Treatment usually begins in an outpatient setting, but residential treatment may be necessary if symptoms are severe.

Hospitalization may be necessary if there is:

• significant weight loss
• low blood pressure
• cardiac dysfunctions
• fluid retention
• dehydration
• electrolyte disturbances
• inability to function at home, school, and the community
• severe depression
• thoughts of suicide 

If the hospital is not exclusive to the treatment of eating disorders, the individual should then be transferred to an residential treatment center specializing in eating disorders that addresses underlying psychological issues and provides a safe, secure, loving, and supportive environment.
  
Information from the National Eating Disorders Association, the American Academy of Child & Adolescent Psychiatry, and Anorexia Nervosa and Related Eating Disorders, Inc.

Anorexia nervosa  -  Bulimia  -  Binge Eating
Help and Support  -  More Information on Eating Disorders

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