The Johns Hopkins Eating Disorders Program treats patients with a wide variety of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder and other specified eating disorders as well as any co-occurring psychiatric or medical conditions. We are located within the Johns Hopkins Hospital and are a nationally recognized comprehensive program for the treatment of eating disorders with over 40 years of experience in helping patients achieve recovery.
Anorexia nervosa is a form of self-starvation and a very serious psychiatric disorder with elevated mortality and risk of long-term medical consequences. Affected people continue to view themselves as needing to lose weight or fear gaining weight despite being very underweight. Signs and symptoms may include:
- A decrease in variety and amount of food eaten resulting in low body weight
- Excessive preoccupation with food, weight and shape
- Anxiety associated with eating foods high in calorie density
- Behaviors that interfere with reaching a normal weight including any of the following:
- Skipping meals and avoiding eating food with, or prepared by others
- Excessive exercise
- Self-induced vomiting or chewing and spitting out food
- Misuse of laxatives, enemas, diuretics or diet pills
Other signs and symptoms associated with anorexia nervosa are due to its serious health consequences: depressed mood, menstrual irregularities and infertility, gastrointestinal symptoms, bone fractures and heart problems.
There are two subtypes of anorexia nervosa, anorexia nervosa restricting type and anorexia nervosa binge-eating/purging type. In the former, individuals diet and may also excessively exercise whereas in the latter, they additionally engage in binge-eating and/or purging behavior (self-induced vomiting and/or misuse of laxatives, diuretics or enemas).
Bulimia nervosa is characterized by intermittent binge eating or the consumption of large quantities of food associated with a sense of loss of control over eating. Binges are followed by unhealthy compensatory behaviors intended to prevent weight gain. Unlike in anorexia nervosa, affected persons are usually normal weight or may be overweight. Warning signs and symptoms include:
- Rapidly eating large amounts of food, often alone or secretively (binge eating)
- A sense of loss of control over eating
- Excessive dissatisfaction and concern with body shape and weight
- Feelings of guilt, shame and secrecy concerning bulimic behaviors
- Self-induced vomiting or intermittent starvation
- Excessive exercise
- Misuse of laxatives, enemas, diuretics, or diet pills
Binge Eating Disorder
Binge eating disorder, like bulimia, is associated with the rapid consumption of large quantities of food and with a sense of loss of control over eating but does not include the compensatory behaviors (such as vomiting, excessive exercise or abuse of laxatives, enemas, diuretics, or diet pills) to prevent weight gain typical of bulimia nervosa. Symptoms include:
- Fear of loss of control over eating
- Binge eating
- Feelings of shame and self-loathing
- Poor self-esteem and body dissatisfaction
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is an eating disorder that is characterized by restriction of food intake resulting in marked impairment in function and either significant weight loss, nutritional deficiency or dependence on tube feeding that is not fully explained by a concurrent medical condition, or by the presence of another mental disorder, and is not associated with the body dissatisfaction and fear of weight gain typical of AN and BN. ARFID is often characterized by extremely picky eating or ritualized eating behavior. Symptoms of ARFID may be related to lack of interest in food or poor appetitive drive, to anxiety or fears of eating (e.g. fear of swallowing or choking, or worries about gastrointestinal consequences of eating certain foods e.g. nausea, abdominal pain or bloating) or feelings of disgust.
Other Specified Feeding and Eating Disorders (OSFED)
The category of Other Specified Feeding and Eating Disorders includes behavioral feeding and eating disorders that cause distress and impairment but do not meet the full criteria for any of the disorders mentioned above. Examples include:
- Atypical Anorexia Nervosa: these individuals meet all criteria for anorexia nervosa except being underweight. Often they have lost weight rapidly but their baseline weight was above average such that despite losing an equivalent amount of weight and having similar behaviors and cognitions to patients with anorexia nervosa they may be normal or above normal weight. This disorder can be associated with serious medical and psychiatric complications similar to those seen in patients with anorexia nervosa.
- Purging Disorder: Individuals with purging disorder are not underweight and therefore do not have anorexia nervosa. They engage in recurrent purging behaviors but do not regularly binge eat.