Eating Disorder Definitions

Keep in mind that you can still suffer from any of these eating disorders even if one of the signs listed below is not present. If you think you have an eating disorder, it's dangerous to read the diagnostic criteria and think "I don't have one of the symptoms, so I must not be Anorexic, Bulimic or a Compulsive Overeater or Exerciser".

Anorexia Nervosa: the relentless pursuit of thinness and an attempt to maintain strict control over food intake.

The defining features of this eating disorder are (a) an intense and irrational fear of body fat and weight gain, (b) an iron determination to become thinner and thinner, and (c) a misperception of body weight and shape to the extent that the person may feel or see "fat" even when emaciation is clear to others.

These psychological characteristics contribute to drastic weight loss and defiant refusal to maintain a healthy weight for height and age. Food, calories, weight, and weight management dominate the person's life, and they become angry or defensive when someone tries to disrupt this private system.

• Person refuses to maintain normal body weight for age and height
• Weighs 85% or less than what is expected for age and height
• Is terrified of becoming fat
• Person denies the dangers of low weight
• Is terrified of gaining weight even though she/he is markedly underweight
• Reports feeling fat even when very thin
• In women, loss of three consecutive menstrual periods
• Young girls do not begin to menstruate at the appropriate age
• In men, reduced libido
• In addition to the above, anorexia nervosa often includes depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories

Anorexia and Bulimia may coexist. Many bulimia nervosa patients have a history of anorexia nervosa; others may subsequently lose weight and become anorexic. Approximately half of anorexia nervosa patients engage in binging and purging behaviors associated with bulimia.

Specific Type:

Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Binge-Eating - Purging Type: During the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Bulimia Nervosa: the diet-binge-purge disorder

This eating disorder is characterized by self-perpetuating and self-defeating cycles of binge-eating and purging. During a "binge," the person consumes a large amount of food in a rapid, automatic, and helpless fashion. This may anesthetize hunger, anger, and other feelings, but it eventually creates physical discomfort and anxiety about weight gain. Thus, the person "purges" the food eaten, usually by inducing vomiting and by resorting to some combination of restrictive dieting, excessive exercising, laxatives, and diuretics.

As with anorexics, bulimics may have a distorted body image, an intense fear of fat, and the conviction that a slender body shape is absolutely crucial for self-acceptance.

• Person binge eats
• Feels out of control while eating
• Vomits, misuses laxatives, exercises, or fasts to get rid of the calories
• Diets when not bingeing. Becomes hungry and binges again
• Believes self-worth requires being thin
• May shoplift, be promiscuous, and abuse alcohol, drugs, and credit cards
• Weight may be normal or near normal unless anorexia is also present

Like anorexia, bulimia can kill. Even though the person puts up a cheerful front, she/he is often depressed, lonely, ashamed, and empty inside. Friends of bulimics may describe them as competent and fun to be with, but underneath, where they hide their guilty secrets, they are hurting. Feeling unworthy, they have great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger.

Binge eating disorder: sometimes called compulsive eating

Compulsive overeating is characterized primarily by periods of impulsive gorging or continuous eating. While there is no purging, there may be sporadic fasts or repetitive diets. Body weight may vary from normal to mild, moderate, or severe obesity.

• The person binge eats frequently and repeatedly
• Feels out of control and unable to stop eating during binges
• May eat rapidly and secretly, or may snack and nibble all day long
• Feels guilty and ashamed of binge eating
• Has a history of diet failures
• Tends to be depressed and obese

People who have binge eating disorder do not regularly vomit, overexercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which at present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger. Or they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. In fact, diets almost always make matters worse.

Compulsive Exercising

Compulsive exercising is not a recognized diagnosis as are anorexia, bulimia, and binge eating disorder. We include it here because many people who are preoccupied with food and weight, exercise compulsively in attempts to control weight. The real issues are not weight and performance excellence, but rather power, control, and self-respect.

• The person repeatedly exercises beyond the requirements for good health
• May be a fanatic about weight and diet
• Steals time to exercise from work, school, and relationships
• Focuses on challenge. Forgets that physical activity can be fun
• Defines self-worth in terms of performance
• Is rarely or never satisfied with athletic achievements
• Does not savor victory. Pushes on to the next challenge immediately
• Justifies excessive behavior by defining self as a "special" elite athlete

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