APA Expert Opinion
An APA expert answers common questions about Eating Disorders

Pauline S. Powers, M.D., APA Member, is President of the National Eating Disorders Association and Professor of Psychiatry and Behavioral Medicine at University of South Florida, Health Sciences Center

What exactly is an "eating disorder?"

Eating disorders are serious, but treatable, medical illnesses. Those suffering from eating disorders typically become obsessed with food and their body weight. Eating disorders affect some several million people at any given time, most often women between the ages of 12 and 35. There are two main types of eating disorders, anorexia nervosa and bulimia nervosa; a third disorder, binge eating disorder, is still being examined.

Anorexia nervosa afflicts as many as one in every 100 girls and young women. It is usually diagnosed when patients weigh at least 15 percent less than the normal healthy weight expected for their height. People with anorexia nervosa don't maintain a normal weight because they refuse to eat enough, often exercise obsessively, and sometimes force themselves to vomit or use laxatives to lose weight. Girls and women with anorexia nervosa usually lose their menstrual periods.

Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa can be slightly underweight, normal weight, overweight or even obese. But, they are never as underweight as anorexia nervosa sufferers. Patients with bulimia nervosa binge eat frequently, and during these times sufferers may eat an astounding amount of food in a short time, often consuming thousands of calories that are high in carbohydrates and fat. They can eat very rapidly, sometimes gulping down food without even tasting it. Their binges often end only when they are interrupted by another person, they fall asleep, or their stomach hurts from being stretched beyond normal capacity. During an eating binge, sufferers feel out of control. After a binge, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative. This cycle is usually repeated at least several times a week or, in serious cases, several times a day.

Can eating disorders be cured?

Although many people with eating disorders are not completely "cured," many people who are treated early in the course of their illness can have a full and lasting recovery with appropriate treatment. Even among those who do not completely recover, there are very effective treatment programs that can help people suffering from an eating disorder return to healthy eating patterns and lead productive lives. Each treatment plan should be tailored to the individual patient, but most often treatment involves a combination of psychotherapy, a nutritional plan and possibly even medication. The biggest step is getting someone who has one of these disorders to admit it and get them to seek help.

The first step in treating anorexia nervosa is to assist patients with regaining weight to a healthy level; for patients with bulimia nervosa interrupting the binge-purge cycle is key. For patients with binge eating disorder it is important to help them interrupt and stop binges.

Do eating disorders only affect women?

No. Eating disorder can affect both women and men. While it's true that they are more commonly diagnosed in women, more and more cases are being seen in male patients.

One of my friends makes herself vomit after meals, but only before big events. She says she doesn't do it all the time, should I be concerned?

In a word, yes. Anyone who feels they need to either starve themselves or force themselves to purge food they have already eaten in order to feel better about their body has an unhealthy attitude about their physical appearance. This doesn't necessarily mean they have a diagnosable eating disorder, but you should approach your friend about these concerns. If they deny the problem or get defensive, it might be helpful to have information for them about what eating disorders actually are. You can download a fact sheet on anorexia nervosa and bulimia nervosa here.

My daughter exercises excessively, sometimes up to 3 and 4 hours a day. Is this considered to be a sign of an eating disorder?

If the compulsion is driven by a desire to lose weight, despite being within a normal weight range, or if the compulsion is driven by guilt due to binging, then, yes, this compulsion to exercise is a dimension of an eating disorder. Talk to your daughter about the reasons she exercises so much. If you are concerned about her weight or the rationale behind her excessive exercise regime, seek help.

Where can someone suffering from an eating disorder find help?

It is important to let the person know that they are not alone. There are many other people who feel negatively about their bodies and go to extreme measures to feel better about themselves. But seeking help is imperative, especially for those who are losing weight rapidly or are already severely underweight.

You can receive a referral for a treatment provider through the American Psychiatric Association by clicking here.

The National Eating Disorders Association also provides referrals here.

If you are seeking help for your own symptoms, it can be helpful to have questions prepared for the healthcare provider. Review a sample list of questions here.

To locate a psychiatrist in your area, visit www.psych.org and click on "District Branches & State Associations" to contact your local APA District Branch. You may also visit www.MentalHealthScreening.org to locate a depression screening site near you.

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