Eating Disorders Health Center

Anorexia Nervosa

Anorexia nervosa is characterized by:

• extreme thinness (emaciation)
• a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• intense fear of gaining weight
• distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
• lack of menstruation among girls and women
• extremely restricted eating

Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. People with anorexia nervosa typically weigh themselves repeatedly, portion food carefully, and eat very small quantities of only certain foods. Some people with anorexia nervosa may also engage in binge-eating followed by extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of laxatives, diuretics, or enemas.

Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness.

Other symptoms may develop over time, including:

• thinning of the bones (osteopenia or osteoporosis)
• brittle hair and nails
• dry and yellowish skin
• growth of fine hair all over the body (lanugo)
• mild anemia and muscle wasting and weakness
• severe constipation
• low blood pressure, slowed breathing and pulse
• damage to the structure and function of the heart
• brain damage
• multiorgan failure
• drop in internal body temperature, causing a person to feel cold all the time
• lethargy, sluggishness, or feeling tired all the time
• infertility

Bulimia Nervosa

Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge-eating and purging cycle happens anywhere from several times a week to many times a day.

Other symptoms include:

• chronically inflamed and sore throat
• swollen salivary glands in the neck and jaw area
• worn tooth enamel, increasingly sensitive and decaying teeth as a result of exposure to stomach acid
• acid reflux disorder and other gastrointestinal problems
• intestinal distress and irritation from laxative abuse
• severe dehydration from purging of fluids
• electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack

Binge-Eating Disorder

With binge-eating disorder a person loses control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, peoplewith binge-eating disorder often are over-weight or obese. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure.9 They also experience guilt, shame, and distress about their binge-eating, which can lead to more binge-eating.