How common are eating disorders?
The eating disorders anorexia nervosa and bulimia nervosa, respectively, affect 0.5 percent and 2-3 percent of women over their lifetime. The most common age of onset is between 12-25. Although much more common in females, 10 percent of cases detected are in males.
Are certain personality traits more common in individuals with eating disorders?
Women with eating disorders tend to be perfectionistic, eager to please others, sensitive to criticism, and self-doubting. They often have difficulty adapting to change and are future- oriented. A smaller group of patients with eating disorders have a more extroverted temperament and are often novelty-seeking and impulsive with difficulty maintaining stable relationships.
What is the difference between anorexia nervosa and bulimia?
Both anorexia nervosa and bulimia are characterized by an overvalued drive for thinness and a disturbance in eating behavior. The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patient with bulimia nervosa are, by definition, at normal weight or above.
Bulimia is characterized by a cycle of dieting, binge-eating and compensatory purging behavior to prevent weight gain. Purging behavior includes vomiting, diuretic or laxative abuse. When underweight individuals with anorexia nervosa also engage in bingeing and purging behavior the diagnosis of anorexia nervosa supercedes that of bulimia.
What causes an eating disorder?
Eating disorders are believed to result from a combination of biological vulnerability, environmental, and social factors. Once an eating disorder develops, physiological changes play a role in sustaining the behaviors and irrational patterns of thinking involved. For example, starvation increases preoccupation with food and the risk of binge-eating. For underweight patients, achievement of a low normal weight is therefore a priority for successful treatment.
What forms of treatment are effective for anorexia nervosa?
Treatment of anorexia nervosa involves behavioral monitoring and nutritional rehabilitation to normalize weight. Psychotherapy is aimed at correcting irrational preoccupations with weight and shape and preventing relapse. Interventions include monitoring weight gain, prescribing an adequate diet, and admitting patients who fail to gain weight to a specialty inpatient or partial hospitalization program. Specialty programs combining close behavioral monitoring with psychological therapy are generally very effective in achieving weight gain in patients unable to gain weight in outpatient settings. The fear of fatness and body dissatisfaction characteristic of the disorder tend to extinguish gradually over several months if target weight is maintained, and 50-75% of patients eventually recover. No medications have been shown to facilitate weight gain. In the case of patients under 18 years of age, family therapy has been found to be more effective than individual therapy alone.
What forms of treatment are effective for bulimia nervosa?
Most uncomplicated cases of bulimia nervosa can be treated on an outpatient basis although inpatient treatment is occasionally indicated. The most well-validated psychological treatment is cognitive-behavioral therapy, which involves self-monitoring of thoughts, feelings, and behaviors related to the eating disorder. Therapy is focused on normalizing eating behavior and identifying environmental triggers and irrational thoughts or feeling states that precipitate bingeing or purging. Patients are taught to challenge irrational beliefs about weight and self-esteem. Antidepressants have also been shown to be effective in decreasing bingeing and purging behaviors in bulimia.
Is there a biological basis to eating disorders?
Social pressure for thinness is believed to influence dieting behavior. However, it is not a sufficient explanation for why only four percent of women and girls develop a full-blown eating disorder since the majority of women in the United States diet at some time in their life. Additional vulnerability factors must characterize the affected population. Family and twin studies suggest that genes predispose to an eating disorder and genetic studies are currently underway to attempt to isolate genes involved in the development of eating disorders. Abnormalities in the brain's serotonergic system are thought to play a role in the cause and or maintenance of eating disorders. Taken together these studies suggest that there may be an inborn vulnerability to eating disorders in at-risk individuals, and that once dieting behavior starts it leads to biological changes that help sustain eating disordered behavior.
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Please read the information provided on this website. If you think you may have an eating disorder, consult your doctor, therapist, or school counselor and request a referral to the Eating Disorders Program at The Johns Hopkins Hospital. For more information about the Inpatient and Partial Hospitalization (Day Hospital) Programs, please contact the Eating Disorders Admission Coordinator at 410-502-5467. For more information about the Outpatient and Consultation services, please contact the Eating Disorders Clinic at 410-955-3836. For referring physicians, please contact Dr. Guarda by email aguarda@jhmi.edu or call the Hopkins Access Line at 800-765-JHHS.
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