Eating disorders comprise a group of serious psychiatric illnesses. In the condition known as anorexia nervosa, patients starve themselves, sometimes to the point of serious medical risk or death. In bulimia nervosa, they engage in “binges” (episodes of consumption of large amounts of food, often eaten quickly and to the point of physical discomfort and/or nausea even in the absence of hunger), followed by compensating behaviors such as purging (deliberate vomiting), fasting, strenuous exercise, or laxative abuse. (Some anorexia patients also engage in binge-purge cycles.) Although there are additional eating disorders, this article primarily addresses issues associated with anorexia and bulimia.
Not all patients who undereat have actual eating disorders. For example, reduced food intake can be a symptom of depression or of unusual phobias that some patients develop about eating (different from the fears of weight gain that do typify eating-disordered patients). There are a number of metabolic or other medical factors that also can cause disordered eating. Therefore, medical assessment and monitoring of patients who exhibit eating-disorder symptoms is essential, both for diagnostic reasons and for medical safety because of the fact that self-starvation, binge-eating, and purging (as well as laxative abuse) are practices that carry serious medical risks.
Patients with severe anorexia sometimes require hospitalization, which is often prompted by weight loss to a medically unsafe range. In such cases, a “re-feeding” program may be employed to bring them back to a safe weight. Although such treatment may overcome an immediate crisis, it is important to understand that the disorder itself, which resides in abnormal meanings and feelings that are attached to food, eating and body image, will not be cured merely by compulsory return to a normal-range weight.
Eating disorders often coexist with significant mood or personality disorders, which also need to be diagnosed and treated. As with all serious psychiatric conditions, competent assessment and treatment is not only necessary but may be literally life-saving for individuals with these difficulties. If you or someone close to you struggles with eating-disorder behaviors, by all means consult with your family doctor or other primary care provider for referral to an appropriate mental health specialist qualified to diagnose and treat eating disorders and their related problems.
Dr. Stone, a clinical psychologist, is an Assistant Professor of Psychology in Clinical Psychiatry at Weill Medical College of Cornell University, and Director of the Dialectical Behavior Therapy Program for Self-Injuring Adolescents at the Westchester Division of New York-Presbyterian Hospital in White Plains, New York. He resides in Pawling with his wife, Susan, and their family.