Eating Disorders

Anorexia Nervosa

Anorexia nervosa is the most serious and life-threatening eating disorder, with an estimated mortality rate of 10%, and affects approximately 1% of all females. The onset of this disorder is usually in adolescence. According to the Diagnostic and Statistical Manual, Fourth Edition-Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000), anorexia nervosa is diagnosed if the following characteristics are present:

• A refusal to maintain minimal normal body weight for age
• An intense fear of gaining weight or becoming fat
• Feeling fat even when obviously underweight
• Amenorrhea (i.e., cessation of the menstrual cycle)

The DSM-IV-TR distinguishes between two subtypes of anorexia nervosa: the restricting type and the binge eating-purging type. Individuals diagnosed with anorexia nervosa-restricted type limit and/or avoid eating foods (e.g., foods containing fat) and may exercise excessively to lose weight. Those diagnosed with the binge eating-purging type exhibit the same bingeing and purging behaviors as bulimics; they consume [Page 184]large amounts of food in one sitting and then purge to avoid weight gain. These individuals differ from those diagnosed with bulimia nervosa because their initial diagnosis is anorexia nervosa-restricted type.

Health consequences of anorexia nervosa include slow heart rate, osteoporosis, muscle loss and weakness, severe dehydration, kidney failure, excessive weight loss, fainting, fatigue and overall weakness, dry hair and skin, hair loss, and a growth of layer of hair over the body for warmth (Hughes & colleagues, 2001). People with anorexia nervosa may display a depressed mood, somatic dysfunction (i.e., impaired or altered functioning of the body), or sexual dysfunction in which they lose interest in sexual behavior. They may also display guilt or an obsessive and/or anxious, fearful, or dependent personality (Guide to Recovery, 2002).

Bulimia Nervosa

Bulimia nervosa may co-occur with anorexia nervosa, but this is not always the case. Thirty to 80% of people with bulimia nervosa have a history of anorexia nervosa. It is often hard to diagnose bulimia nervosa because those with the disorder tend to be normal or slightly overweight (Levine & Smotak, 2002). Bulimia nervosa usually occurs in adolescence or early adulthood. As many as 17% of college-age women engage in bulimic behaviors, which are distinguished in the DSM-IV-TR by recurrent episodes of binge eating followed by purging.

People with bulimia nervosa may also engage in recurrent inappropriate compensatory behavior to prevent weight gain. This behavior includes self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. To be classified as having bulimia nervosa, binge eating and inappropriate compensatory behavior must occur, on average, two times per week for three months (Hughes & colleagues, 2001). People with bulimia nervosa evaluate themselves based on their body weight and shape. The health consequences of bulimia nervosa

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