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Eating disorders are substantial disturbances in eating or behavior related to eating. They may be associated with medical and psychiatric complications, impaired functioning, and decreased quality of life. People with eating disorders have higher death rates than then general population. Eating disorders affect 2% to 5% of people during their lifetimes and are more common among females than males. Risk factors include a family history of an eating disorder and experiencing harm during childhood such as emotional, physical, or sexual abuse. Activities such as gymnastics, ballet, or modeling that emphasize body shape or weight are associated with increased risk of eating disorders. Depression, bipolar disorder, anxiety, obsessive-compulsive disorder, and alcohol or stimulant use disorder are also associated with eating disorders.

The three most common eating disorders are:

• Anorexia nervosa involves restricted calorie intake, resulting in low body weight and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of less than 18.5 for adults (healthy BMI is 18.5-24.9). Those with anorexia nervosa may exercise excessively and are typically preoccupied with body weight and shape. Females with it may stop menstruating completely or have irregular periods. Anorexia nervosa can lead to osteoporosis, anemia, heart problems, decreased white blood count, and low levels of essential minerals (sodium, potassium, phosphate, and magnesium) and is associated with an increased risk of suicide.
• Bulimia nervosa involves overeating or binge eating and purging (self-induced vomiting); misuse of diuretics, laxatives, or weight-loss medication; or excessive exercise. Frequent vomiting exposes teeth to stomach acid, which can lead to enamel loss and dental erosion. Purging can cause chronic dehydration, which may lead to fluid retention and mineral imbalances.
• Binge-eating disorder involves overeating, including eating until uncomfortably full, eating more rapidly than normal, and eating alone because of embarrassment over the amount of food eaten. Binge eating is associated with overweight, obesity, and development of type 2 dia­betes.

No effective medications are available to treat anorexia nervosa. Treatment focuses on achieving individualized targets for calorie intake and weight gain. Youths with anorexia nervosa may benefit from family-based therapy with parents overseeing eating patterns. Individuals with anorexia nervosa should be hospitalized if they have serious medical or psychiatric complications such as low heart rate or suicidal thoughts. Fluoxetine (Prozac) and other antidepressants decrease binge-eating episodes among those with bulimia nervosa regardless of whether they have depression. Antidepressants and the central nervous system stimulant lisdexamfetamine (Vyvanse and Elvanse, used to treat ADHD) reduce the frequency of binges in binge-eating disorder. Behaviorally focused therapies, particularly cognitive behavior therapy, improve symptoms for patients with bulimia nervosa and binge-eating disorder.

For more information, go to the website of the National Institute of Mental Health at www.nimh.nih.gov

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