1. Tammy Danks Azusa Pacific University March 16, 2012
Eating Disorders
Tammy Danks
Azusa Pacific University
March 16, 2012

2. General Definition
Eating disorders involve extreme emotions, attitudes, and behaviors surrounding weight and food issues.
Eating disorders are psychiatric disorders that can have serious and even life- threatening physical consequences.
The key to the diagnosis of an eating disorder is not weight, but attitudes and behaviors.
Eating disorders are one of the most fatal of all psychiatric disorders.
It is really the attitudes, beliefs, and behaviors surrounding food that are the root of problem, not the person’s weight.

3. Disordered Eating
Behaviors that are highly correlated to developing an eating disorder
Obsessive calorie counting
Anxiety about foods or food groups
Rigid approach to eating
Inflexible meal times
Not wanting to eat outside your home
Self-worth based highly on body shape & weight
Calorie (food) restriction prior to drinking alcohol to increase rate of intoxication

4. Anorexia Nervosa
Anorexia Nervosa is characterized by self-starvation and excessive weight loss. People with anorexia generally:
Are underweight
Have extreme fear of gaining weight or being “fat”
Have a distorted view of their bodies
It is important to note that early on in the disorder, not all anorexics are underweight. It is the mindset of being fat, the fear of gaining weight, and a clearly distorted body image that is most indicative of a developing problem. As the disorder progresses, the person will begin to lose more and more weight.

5. Warning Signs of Anorexia
Dramatic weight loss
Obsession with weight, food, calories, fat grams, exercising, etc.
Development of food rituals, like having to eat food in a certain order, rearranging food on the plate, etc.
Consistent excuses to avoid eating and mealtimes
Interestingly, many people with anorexia develop food rituals. I once worked with a patient who absolutely refused to touch any kind of food with her hands, and would not allow her lips to touch her fork. Rearranging food on the plate is common, as it may give the appearance that the person is eating the food, when in reality, they are not.

6. No Anorexia Campaign
This is Isabelle Caro, a French model and actress. Isabelle told reporters that she had become ill with anorexia at age 13 after a traumatic childhood in which her mother would constantly measure her because she was afraid Isabelle would grow. Isabelle was hospitalized for the first time at age 20. This photo was taken for a controversial No Anorexia campaign in 2007 and was banned in Italy. Isabelle Caro died in 2010 at the age of 28.

7. An Anorexia True Story
Isabelle said she was willing to pose nude in order to warn people of the dangers of fad diets and the demands of the fashion industry. It is said that she weighed approximately 60 pounds at the time of this photo shoot.

8. Bulimia Nervosa
Bulimia Nervosa is characterized by a cycle of bingeing followed by behaviors designed to compensate for or undo the bingeing, such as vomiting, fasting, using laxitives, or extreme exercise. These behaviors are collectively known as purging. People with bulimia may be underweight, average weight, or overweight.
Purging is more than just vomiting; it is any action performed with the intention of undoing the caloric intake of the meal or binge. Bulimia has a wide range of behaviors. Some bulimics restrict food completely for days at a time, then binge and purge immediately after, while others binge and purge multiple times per day. Other bulimics do not vomit at all, but abuse laxatives or utilize other methods to attempt to rid themselves of calories.

9. Warning Signs of Bulimia
Evidence of binge eating, including disappearance of large quantities of food in a short time
Evidence of purging, such as frequent trips to the restroom after meals, signs or smells of vomiting
Excessive, rigid exercise regimen
Extreme concern with body size and shape
Many bulimics are capable of ingesting extremely large quantities of food. I once worked with a patient who would eat an entire large pizza, vomit, then eat a gallon of ice cream, vomit, and so on.
Exercise is often used excessively as a way to purge. Exercise is a good and healthy thing, but when it reaches the point of compulsion—if the inability to complete an exercise regimen causes extreme anxiety—it has become unhealthy and an eating disorder is likely present.
As with anorexia, bulimia involves unhealthy mindsets regarding food and weight.

10. Russell’s Sign
Russell’s sign is caused by contact of the skin with the incisor teeth during self-induced vomiting. It is important to note that not all bulimia sufferers have this sign, as many utilize another object to stimulate the gag reflex, and some have grown so conditioned to purging that they do not need to use anything at all. I have witnessed patients simply lean over and vomit, silently and with complete control.

11. Binge Eating Disorder
Binge Eating Disorder is characterized by eating large quantities of food in a short period of time, feeling out of control over eating, and feeling shame or disgust by eating behaviors. Binges are not followed by purging.
Binge Eating Disorder sufferers often are overweight, but may be of normal weight.
Binge eating disorder is similar to bulimia in some ways, but people with this disorder do not attempt to purge themselves of the calories consumed. Key points for diagnosis are feeling out of control while eating, eating while not hungry, eating until uncomfortably full, shame and disgust over eating behaviors, and unwillingness or inability to eat in from of other people for fear of losing control.

12. Nutrition and the Body
Carbohydrates, proteins, lipids, vitamins, and minerals are essential for the body to promote normal growth, maintenance, and repair.
At least 45 and possibly 50 molecules, called essential nutrients, cannot be made by the body and must be provided by the diet.
When the body is deprived of nutrients, such as in an eating disorder, EVERY body system is affected.
Scientists agree that there is no set timeframe that a person can go without food or without water, as it varies depending on many factors. However, all scientists and doctors agree that adequate nutrition and hydration is essential to maintaining life and health. Essential nutrients must come from the diet, and when we do not provide our bodies with these nutrients, there are dire consequences.

13. Effects of ED’s: Cognitive Functioning
Difficulty concentrating or focusing
Difficulty regulating moods
Poor nutrition can lead to or worsen depression, anxiety, obsessive compulsive disorder (OCD), and substance abuse problems
The brain is a high maintenance organ, requiring much of the body’s glucose supplies, blood supply, and other energy sources. When the body is not receiving adequate nutrition, the brain suffers and as a result, concentration and moods are affected.

14. Effects of ED’s: Cardiovascular
Slow heart rate and low blood pressure
Dizziness or fainting
Shortness of breath
Chest pain
Arrhythmias (irregular heartbeat) or even cardiac arrest resulting from decreased potassium levels or other electrolyte imbalances
The heart requires fluids and electrolytes such as sodium and potassium to pump blood throughout the body. When the body does not get enough fluids and nutrients, it is forced to slow down the cardiovascular system, resulting in low blood pressure, slow heart rate, dizziness, fainting, chest pain, and irregular heartbeats. These effects can be fatal.

15. Effects of ED’s: Musculoskeletal
Muscle weakness
Decreased bone density leading to osteoporosis and stress fractures
Stunted growth in children and adolescents
When the body is not receiving adequate nutrition, muscles are not able to contract effectively and the body cannot grow as it needs to. Children with eating disorders are at risk for stunted growth. Eating disorder sufferers of all ages are at risk for bone loss, because without adequate intake, the bloodstream cannot maintain the proper amount of calcium and minerals, so the body takes those from the bones.

16. Bone Loss
This is a picture illustrating the weakness that occurs in osteoporosis. Osteoporosis is a disease that typically affects older adults, but can affect anyone who is suffering from severe malnutrition, such as in anorexia. Osteoporosis causes weakness and fragility of the bones, which often leads to fractures.

17. Effects of ED’s: Mouth and Teeth
Erosion of tooth enamel
Loss of teeth
“Chipmunk Cheeks:” swelling of the salivary glands due to frequent vomiting
Gum disease
Sore throat due to presence of stomach acid
Effects of eating disorders on the mouth and teeth are due to the continual presence of stomach acid in the mouth due to repeated vomiting. The esophagus and mouth are not designed for stomach acid, and the extreme acidity of stomach acid—which is about the same pH as battery acid—damages everything it comes into contact with.

18. Enamel Erosion
This is an example of erosion of tooth enamel caused by stomach acid in a bulimia patient.

19. Enamel Erosion
Notice the clear areas at the bottom of the teeth where the structure of the tooth has been worn away by the acid.

20. Effects of ED’s: Endocrine and Reproductive
Thyroid abnormalities
Low energy and fatigue
Cold intolerance and low body temperature
Loss of hair on scalp
Development of fine body hair, called lanugo, all over the body, including the face
Loss of menstrual period; indicates inability to bear children (women)
Reduced thyroid function can sometimes result from the body’s response to prolonged malnutrition.
Low energy, fatigue, and loss of hair are related to the body’s adjustment in metabolic rate in an attempt to survive the malnourishment.
Lanugo grows in severely underweight patients in an attempt to keep the body warm, as there are no longer adequate fat stores to accomplish this.

21. No Period, No Babies!
The female body will cease to menstruate in malnourished states. This is called amenorrhea. Ovulation does not occur, so a female with amenorrhea is not fertile at that point. Long term fertility may also be damaged by a chronic eating disorder; however, many times once the patient is in recovery and a healthy weight has been achieved, fertility is restored.

22. Effects of ED’s: Gastrointestinal
Peptic ulcers
Pancreatitis and gastritis
Gastroesophageal Reflux Disease (GERD)
Gastric rupture from excessive bingeing and vomiting (has 80% fatality rate)
Chronic constipation
Ulcers are erosions in the lining of the stomach that occur due to excess acid production in bulimia, and lack of food intake in anorexia. If a person does not eat, the stomach acid sits in the stomach and has nothing to digest, so it often destroys areas of the stomach lining.
Pancreatitis and gastritis are inflammatory disorders of the pancreas and stomach that may occur due to several complicated mechanisms in people with eating disorders.
Repeated vomiting can cause the lower esophageal sphincter to fail to close properly, causing acid reflux (GERD).
Chronic constipation occurs because the colon gets “lazy.” When food is restricted or purged, it does not pass through the colon, and as a result activity of the colon slows. Abuse of laxatives also results in constipation. Some people become dependent on laxatives to have a bowel movement.

23. Esophageal Erosion
Esophageal erosions are painful.

24. Peptic (Stomach) Ulcer
Stomach ulcers are also painful. They can be caused by a variety of other problems, in addition to being a result of an eating disorder.

25. Gastric (Stomach) Rupture
A gastric rupture is a severe complication of bingeing and purging. It is an emergency and has an 80% mortality rate. As you can see, there is a lot of blood, and patients with this complication often bleed to death.

26. Effects of ED’s: Urinary and Renal
Kidney Stones
Kidney damage and kidney failure (usually results from severe dehydration)
Electrolyte imbalances such as loss of potassium, sodium, and chloride which can lead to heart arrhythmias and death
Dehydration that occurs with both anorexia and bulimia causes many complications in the urinary system, including kidney stones, damage, and failure. Urinary stasis, which is the term for when urine just sits in the bladder because the person is not urinating enough (such as that which occurs in a dehydrated person), can sometimes cause painful urinary tract infections as well.
The kidneys help regulate electrolyte levels, but when the body is severely dehydrated and malnourished, the kidneys can no longer regulate these ions. The resulting electrolyte imbalances can have fatal consequences for the heart.

27. What Causes Eating Disorders?
Eating disorders are very complex. There is almost never a single cause. Some things researchers think may contribute:
Low self esteem
Troubled upbringing and/or trauma
Other emotional problems, especially depression and anxiety
Cultural pressure, such as images in the media
Biologic factors (genetics)

28. True Story of an Exercise Addict

29. What I Have Noticed
A history of sexual abuse is almost always present in Anorexics, and often in Bulimics
Many people with eating disorders are not able to freely express their emotions
Many eating disorder sufferers come from chaotic backgrounds, and the disorder is a method of control in an otherwise out- of-control life
Sexual trauma sometimes results in eating disorders. One reason for this is because when a person is sexually violated, they sometimes stop eating in an attempt to suppress sexual characteristics. Anorexics lose their breasts, their periods, and their pubic hair, so in a sense, they become like little children again. For many, that is the only state in which they feel safe. For others, sexual abuse results in an extreme hatred of their bodies, and an eating disorder develops as an attempt to punish or to fix the perceived ugliness.
Some therapists believe that pushing down and refusing to work through negative feelings can result in eating disorders. Specifically in bulimia, purging is an attempt to rid the person of troubling emotions.
Many eating disorders are about control. The person with an eating disorder feels a false sense of control because they can control what goes in and what comes out. A drive for perfection is present in most anorexics, and this relates to control as well.

30. Case Study: Giselle
Giselle’s dad abused her mom, often in front of her, until her mom left him. After that, her dad had no contact with the children. Giselle had a brain injury at a young age, and learned that being sick was the only way to get her busy mom’s attention. Giselle, feeling rejected by her dad and abandoned by her mom, now refuses to eat and weights 85 pounds.
Giselle has discovered that having an identity as a sick person has a payoff. When she is ill, she receives attention from her mother that she does not otherwise get. Giselle also has a deep hatred for her body and feels that everyone else is prettier than she is. Much of this stems from her Dad abandoning her at a young age. Giselle believes that she is not worthy of love and is ugly because if she was not, her dad would not have left her.

31. Case Study: Kendra
Kendra grew up in a normal family. A boy teased her about being fat in front of her whole class in 8th grade. Kendra now alternates between compulsively eating and vomiting and not eating at all. She is unable to admit that she does not have it all together. Last week, Kendra lost a tooth while brushing because her teeth have been so damaged by her vomiting.
Kendra was not able to deal with her emotions, because in her family, it was not ok to be upset. Kendra learned early on that it was expected of her to be ok, so she has mastered the art of putting on a good front, while she secretly binges. When she is finished, she feels ashamed and disgusted with herself, so she vomits and then starves herself for an extended period of time. Even though her body is beginning to break down, Kendra is not yet able to be completely honest and truly acknowledge that she is not ok and that she does not have it all together.

32. Eating Disorder Myth #1
Eating disorders are a choice. All the person needs to do is just eat!
An eating disorder is NOT a choice, and it is not under conscious control of the person suffering from it. Eating disorders are complex, serious psychiatric illnesses. It is not as simple as telling the person to eat. When someone is entrenched in an eating disorder, they are not physically or psychologically able to eat normally. Any attempt to force the person to eat can result in extreme anxiety and even panic attacks. The treatment of an eating disorder should not be attempted by anyone other than specially trained professionals.

33. Eating Disorder Myth #2 Eating disorders only occur in females.
Eating disorders occur in men too. Statistics are showing that men are currently suffering from eating disorders in higher numbers than ever before. Eating disorders are not just a female problem.

34. Men Suffer Too
This is a man suffering from anorexia.

35. Eating Disorder Myth #3
You can tell if a person has an eating disorder simply by their appearance.
Not all underweight people suffer from anorexia, not all bulimics are under or overweight, and many people with eating disorders appear perfectly normal. Taking statistics into account, it is likely that at least one person you know suffers from an eating disorder, and it is certain that several people hearing this presentation are currently suffering from an eating disorder.

36. Appearances Are Deceiving
Actress Demi Lovato has recently gone public with her battle with bulimia and self harm. Her honestly and dedication to decreasing the stigma associated with these disorders are admirable.

37. Eating Disorder Myth #4
Eating Disorders are all about appearance and beauty, and the media with their unrealistic images have caused this problem. People with eating disorders are vain.
While the experts agree that the unrealistic images in the media can be harmful to young audiences, it is clear that not all people exposed to these images develop eating disorders. More research is needed on this topic. Eating disorders are much more complex than a simple reaction to the cultural media and expectations.

38. The Miracle of Airbrushing
While media is not solely responsible for eating disorders, it is important to understand that most, if not all, of the images displayed today are not reality. Airbrushing is the rule, not the exception, and it is important to have realistic and healthy expectations. This picture is a great example of how the media is selling unattainable standards to our society.

39. Eating Disorder Myth #5
Achieving a healthy weight means Anorexia is cured.
As we have learned, mindsets are much more important than weight when it comes to eating disorders. A person can completely restrain from alcohol for a season, but not have addressed any of the issues and behaviors that make that person an alcoholic. This is what is known as a dry alcoholic. The same rule applies to eating disorders. Many underweight ED sufferers enter treatment, achieve a healthy weight, go home and immediately relapse. Why? Because recovery is not about weight, it is about mental and emotional health, and correcting those incorrect mindsets.

40. Eating Disorder Myth #6 Purging helps a person lose weight.
Purging further damages weight loss and health efforts because it negatively alters metabolism. One study measured calories in and calories out and found that among the best and most experienced purgers, only 50% of the calories taken in were vomited, even when purging occurred immediately after a meal. This is because the body begins absorbing nutrients right away when a person is eating. So purging is not only harmful to your body, but it doesn’t work.

41. Getting Help
If you or someone you know is struggling with an eating disorder, tell an adult you trust immediately.
EDs CAN be treated and recovery IS possible!
When choosing a treatment method, it is imperative to choose a counselor, therapist, or treatment center that has documented experience in treating eating disorders.
School guidance counselors like Mr. White are great resources!

42. References
Copstead, L. C., & Banasik, J. L. (2010). Pathophysiology: fourth edition. St. Louis, MO: Saunders Elsevier, Inc.
Marieb, E. N. (2004). Human anatomy and physiology: sixth edition. San Francisco, CA: Pearson Education, Inc.
National association of anorexia nervosa and associated disorders. (2012). Retrieved from
National eating disorders association. (2012). Retrieved from