According to the Center of Excellence for Eating Disorders at the University of North Carolina at Chapel Hill (UNC CEED), eating disorders include the following diagnoses:
- Anorexia nervosa (AN): The disorder is marked by a very low body weight and malnutrition (less than 85% of expected), a fear of gaining weight, and an inability to restore weight.
- Bulimia nervosa (BN): The disorder is marked by eating binges with a loss of control including over eating and compensatory behavior (such as vomiting or excessive exercise).
- Binge eating disorder (BED): The disorder is marked by eating binges with a loss of control and does not include compensatory behaviors in response to the eating binge.
Eating disorders often begin in adolescence although they may also affect children and older adults. They affect both genders and people from diverse socioeconomic, racial, and ethnic backgrounds. While no specific data for NC residents are available, national lifetime prevalence varies by gender, with eating disorders affecting females more frequently than males.
|Binge Eating Disorder||3.5%||2.0%||2.8%|
BED is more common than AN and BN combined, with many being overweight or obese. People with bulimia usually maintain what is considered a healthy or relatively normal weight.
One of the contributing factors to eating disorders is the sociocultural idealization of thinness. Research has indicated that 40-60% of elementary school girls are concerned about their weight or becoming too fat. Up to 40% of overweight girls and 37% of overweight boys are teased about their weight by peers or family members. Weight teasing predicts weight gain, binge eating, and extreme weight control measures. Overweight students generally have lower levels of physical activity, negative attitudes about sports, and lower participation in physical activity. Weight stigma affects both genders and poses a significant threat to psychological and physical health and is a risk factor for depression, low self-esteem, and body dissatisfaction.
Dieting has been shown to be a predictor of a developing eating disorder. In a study of 14-15-year old girls, those who dieted moderately were 5 times more likely to develop an eating disorder, and those who practiced extreme restriction were 18 times more likely to develop an eating disorder than those who did not diet. Another study showed that over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, self-induced vomiting, and taking diet pills or laxatives. Overweight girls are more likely than normal weight girls to engage in such extreme dieting. Girls who diet frequently are 12 times as likely to binge as girls who don’t diet. Multiple studies have found that dieting was associated with greater weight gain and increased rates of binge eating in both boys and girls.
Teenage girls from low-income families are 153% more likely to be bulimic than girls from wealthy families. Black adolescents are 50% more likely than white teenagers to exhibit bulimic behavior, such as binging and purging. Hispanic teens were significantly more likely to suffer from BN than their non-Hispanic peers. The researchers also reported a trend towards a higher prevalence of BED in all minority groups. Despite similar rates of eating disorders among non-Hispanic Whites, Hispanics, African-Americans, and Asians, people of color are significantly less likely to receive help for their eating issues.
Social media has also played a role, enhanced by the growing availability of internet-enabled mobile devices. Tweens ages 8-12 average 6 hours a day while teens ages 13-18 average 9 hours a day on non-school-related social media. In a study on social media, 95% of the girls say they see the onslaught of negative beauty critiques on social media posts, comments, photos, and videos, with 72% seeing them at least once a week. Another study of teen girls found that social media users were significantly more likely than non-social media users to have internalized a drive for thinness and to engage in body surveillance. Yet another study indicated that about 70% of girls and women reported a decline in body confidence and an increase in beauty and appearance anxiety, which resulted from advertising’s unrealistic standard of beauty.
High school and college athletes who engage in sports that emphasize appearance, size, and weight are at greater risk for eating disorders than their peers. Among female high school athletes in aesthetic sports (e.g., gymnastics, swimming, diving), 41.5% reported disordered eating. In addition, they were twice as likely to incur a musculoskeletal injury than athletes in aesthetic sports who did not report disordered eating. A study found that 35% of female and 10% of male college athletes were at risk for AN and 58% of female and 38% of male college athletes were at risk for BN.
Being LGBTQ may have an effect on eating disorders as well. The unique stressors that they experience, such as coming out, bullying, harassment, or physical or sexual violence can contribute to anxiety, depression, low self-esteem, and unhealthy coping mechanisms such as substance abuse. These factors may play a role in the development of an eating disorder and are common co-occurring conditions. Beginning as early as age 12, gay, lesbian, and bisexual teens may be at higher risk of binge eating and purging than their heterosexual peers. Elevated rates of binge eating and purging by vomiting or laxative abuse were found for both males and females who identified as gay, lesbian, bisexual, or “mostly heterosexual” in comparison to their heterosexual peers. Transgender individuals experienced eating disorders at rates significantly higher than cisgender individuals. A Trevor Project-sponsored study of 1034 individuals ages 13 to 24 found that the majority of of LGBTQ youth with a diagnosed eating disorder said they had considered suicide:
- 96% of those who have been diagnosed with bulimia nervosa have considered suicide.
- 92% of those who have been diagnosed with anorexia nervosa have considered suicide.
- 86% of those who have been diagnosed with binge eating disorder have considered suicide.
Eating disorders are not restricted to teens and young adults. A 2014 study found that rates of disordered eating have increased across all demographic sectors, but at a faster rate in male, lower socioeconomic, and older participants. Hospitalizations involving eating disorders have also increased for all age groups, but hospitalizations for patients ages 45-65 have increased the most, by 88%, with people over the age of 45 accounting for 25% of eating disorder-related hospitalizations. Low self-esteem is a common characteristic of individuals who have eating disorders. Psychiatric disorders were also common, where a study of more than 2400 individuals hospitalized for an eating disorder found that 97% had one or more co-occurring conditions, including:
- 94% had co-occurring mood disorders, mostly major depression
- 56% were diagnosed with anxiety disorders
- 20% had obsessive-compulsive disorder
- 22% had post-traumatic stress disorder
- 22% had a substance use disorder
AN has the highest death rate of any mental disorder. Individuals with AN had a six-fold increase in mortality compared to the general population. Reasons for death included starvation, substance abuse, and suicide, but there was also an increased rate of death from natural causes (e.g., cancer).
Suicide is the second leading cause of death among individuals with AN, and suicidal behavior is greater for those with BN and BED in comparison to the general population. Approximately one-quarter to one-third of people with AN, BN, or BED have thought about suicide, and one-quarter to one-third of people with AN and BN have attempted suicide. Relative to gender and age-matched comparison groups, individuals with AN are 18 times more likely to die by suicide, and individuals with BN are 7 times more likely to die by suicide.
- UNC Center of Excellence for Eating Disorders: https://www.med.unc.edu/psych/eatingdisorders
- National Institute on Mental Health: https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
- Eating Disorders Myths Busted (a video series by Cynthia Bulik, Ph.D., a NIMH grantee at the University of North Carolina). The video debunks nine myths about eating disorders and is available at https://www.nimh.nih.gov/news/science-news/2014/9-eating-disorders-myths-busted.shtml.
- National Eating Disorders Association: http://www.nationaleatingdisorders.org
- American Psychiatric Association Steering Committee on Practice Guidelines. Practice Guideline for the Treatment of People with Eating Disorders. Third Edition. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/eatingdisorders.pdf
- org: Suicide Prevention, Awareness, and Support (eating disorders and suicide): http://suicide.org/eating-disorders-and-suicide.html