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Public Mental Health

Eating Disorders

People with eating disorders experience serious disturbances in their eating patterns, such as a severe and unhealthy reduction in their food intake or overeating, as well as extreme concern about body shape or weight. Eating disorders usually develop during adolescence or early adulthood. Eating disorders are not due to weak willpower or bad behavior; rather, they are real, treatable illnesses. The two main types of eating disorders are anorexia nervosa and bulimia nervosa.

Who has eating disorders?

  • Women are much more likely than men to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia are male.
  • An estimated 0.5 to 3.7 percent of women suffer from anorexia nervosa in their lifetime. Research suggests that about 1 percent of female adolescents have anorexia.
  • An estimated 1.1 to 4.2 percent of women have bulimia nervosa in their lifetime.
  • About 50 percent of people who have had anorexia develop bulimia or bulimic patterns.

What are the signs and symptoms?

Anorexia Nervosa - Extreme weight loss and believing that one is fat despite excessive thinness are key features of anorexia. The following behaviors are signs that a person may have anorexia:

  • Skips meals, takes tiny portions, will not eat in front of others, or eats in ritualistic ways
  • Always has an excuse not to eat
  • Will only eat a few "safe," low-calorie, low-fat foods
  • Loses hair, looks pale or malnourished, wears baggy clothes to hide thinness
  • Loses weight yet fears obesity and complains of being fat despite excessive thinness
  • Detests all or specific parts of the body, insists she or he cannot feel good about self unless thin
  • Exercises excessively and compulsively
  • Holds to rigid, perfectionist standards for self and others
  • Withdraws into self and feelings, becoming socially isolated
  • Has trouble talking about feelings, especially anger

Bulimia Nervosa - People who have bulimia regularly binge-eat and then attempt to prevent gaining weight from their binge through purging (e.g., vomiting, abusing laxatives, exercising excessively). The following are signs of bulimia:

  • Binges, usually in secret, and empties cupboards and refrigerator
  • Buys "binge food" (usually junk food or food high in calories, carbohydrates and sugar)
  • Leaves clues that suggest discovery is desired: empty food packages; foul-smelling bathrooms; running water to cover sounds of vomiting; use of breath fresheners; poorly hidden containers of vomit
  • Uses laxatives, diet pills, water pills or "natural" products to promote weight loss
  • Abuses alcohol or street drugs to deaden appetite or escape emotional pain
  • Displays a lack of impulse control that can lead to rash and regrettable decisions about sex, money, commitments, careers, etc.

What causes eating disorders?

As with most mental illnesses, eating disorders are not caused by just one factor but by a combination of sociocultural, psychological and biological factors.

Sociocultural and psychological factors:

  • Low self-esteem>
  • Pressures to be thin (i.e., pressure to lose weight from family and friends)
  • Cultural norms of attractiveness as promoted by magazines and popular culture
  • Use of food as way of coping with negative emotions
  • Rigid, "black or white" thinking (e.g., "being fat is bad" and "being thin is good")
  • Over-controlling parents who do not allow expression of emotion
  • History of sexual abuse

Biological factors:

  • Genetic predisposition to eating disorders, depression, and anxiety
  • Certain personality styles, for example obsessive-compulsive personality type
  • Deficiency or excess of certain brain chemicals called neurotransmitters, especially serotonin

What other mental illnesses commonly "co-occur" with eating disorders?

Mental illnesses such as depression, anxiety and alcohol/drug addiction are sometimes found in people with eating disorders. Some of these disorders may influence the development of an eating disorder, and some are consequences of it. Many times, eating and co-occurring disorders reinforce each other, creating a vicious cycle.

What are the long-term effects of eating disorders?

Left untreated, eating disorders may lead to malnutrition; muscle atrophy; dry skin, hair, and nails; dental problems; insomnia or chronic fatigue; ulcers; low blood pressure; diabetes; anemia; kidney, liver, and pancreas failure; osteoporosis and arthritis; infertility; seizures; heart attack; and death:

  • The most common causes of death are complications of the disorders, including suicide.
  • The mortality rate among people with anorexia is 12 times higher than the death rate among females ages 15 to 24 from all other causes.

What treatments are available?

Eating disorders are treatable. The sooner they are diagnosed and treated, the better the outcomes are likely to be. Eating disorders require a comprehensive, long-term treatment plan that usually involves individual or family therapy, and that may include medication and even immediate hospitalization. Unfortunately, many people with eating disorders will not admit they are ill and refuse treatment. Support from family and friends is vital to successful treatment and recovery.

For more information about the National Mental Health Association or additional resources, please call 1-800-969-NMHA(6642) or visit our website our resource center.

  1. The National Institute of Mental Health: "Eating Disorders: Facts About Eating Disorders and the Search for Solutions." Pub No. 01-4901. Accessed Feb. 2002. Website:
  2. Anorexia Nervosa and Related Eating Disorders, Inc. website. Accessed Feb. 2002. Website:
  3. Nolen-Hoeksema, Susan. Abnormal Psychology, 2nd Edition. McGraw Hill, Boston: 2001.
  4. Something Fishy Music and Publishing: Something Fishy Website. Accessed Feb. 2002. Website:

Eating Disorders: Organizations and Resources

National Eating Disorders Association (NEDA)
603 Stewart Street, Suite 803
Seattle, WA 98101
Tel: (800) 931-2237
NEDA is the largest non-profit organization in the United States dedicated to eliminating eating disorders and body dissatisfaction. NEDA aims to accomplish its goals by promoting positive body image and self-esteem. Services NEDA offers include prevention programs, the distribution of educational materials, research and a referral line.

Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED)
ANRED's mission is to provide easily accessible information on anorexia nervosa, bulimia nervosa, binge-eating and other food and weight disorders. ANDRED, a non-profit organization, distributes materials on topics such as self-help, prevention and recovery.

National Association of Anorexia Nervosa and Associated Disorders (ANAD)
PO Box 7
Highland Park, IL 60035
Tel: (847) 831-3438
ANAD is a non-profit organization dedicated to helping people with eating disorders and their families. In addition to its hotline counseling, ANAD operates an international network of support groups and offers referrals to health care professionals who treat eating disorders, across the U.S. and in fifteen other countries. ANAD publishes a national quarterly newsletter, and will mail information packets customized to individual needs upon request. It also provides educational speakers, programs and presentations for schools, colleges, public health agencies and community groups.

Screening for Mental Health, Inc. (SMH)
One Washington Street, Suite 304
Wellesley, MA 02481-1706
Tel: (781) 239-0071
SMH is a non-profit organization that coordinates mental health screening programs nationwide, including the National Eating Disorders Screening Program (NEDSP), a large-scale screening for eating disorders, and an Interactive Telephone Screening Programs. NEDSP includes an educational presentation on eating disorders, body image, and nutrition, a written screening test and the opportunity to meet one-on-one with a health professional.

Soy Unica! Soy Latina!
An excellent bilingual website for young Latinas with a good section on eating disorders.

Eating Disorder Information and Referral Center
This website is a resource for information and treatment options for all forms of eating disorders. It includes referrals to local treatment centers nationwide.

Harvard Eating Disorders Center (HEDC)
WACC 725
15 Parkman Street
Boston, MA 02114
Tel: (617) 236-7766
The Harvard Eating Disorders Center is a national non-profit organization dedicated to research and education, and gaining new knowledge of eating disorders, their detection, treatment and prevention to share with the community-at-large. The web site includes information about eating disorders, help for family and friends, resources and a listing of events and programs.

Overeaters Anonymous (OA)
World Service Office
PO Box 44020
Rio Rancho, NM 87174-4020
Tel: (505) 891-2664
OA is a non-profit international organization that provides volunteer support groups worldwide. Modeled after the 12-step Alcoholics Anonymous program, the OA recovery program addresses physical, emotional and spiritual recovery aspects of compulsive overeating. Members are encouraged to seek professional help for individual diet and nutrition plans and for any emotional or physical problems.

The Renfrew Center Foundation
475 Spring Lane
Philadelphia, PA 19128
Tel: 1-800-RENFREW
The Renfrew Center Foundation is a tax-exempt, non-profit organization promoting the education, prevention, treatment and research of eating disorders. The Renfrew Center Foundation is funded by private donations and by the Renfrew Center, the nation's first freestanding facility committed to the treatment of eating disorders.

For more information about the National Mental Health Association or additional resources, please call 1-800-969-NMHA(6642) or visit our website our resource center.

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