Eating Disorders

Action Signs*:

• Anse fear of gaining weight
• A distorted body image
• Amenorrhea (absence of at least three consecutive menstrual cycles when they are otherwise expected to occur)

In addition to the classic pattern of restrictive eating, some people will also engage in recurrent binge eating and purging episodes. Starvation, weight loss, and related medical complications are quite serious and can result in death.  People who have an ongoing preoccupation with food and weight even when they are thin would benefit from exploring their thoughts and relationships with a therapist. The term anorexia literally means loss of appetite, but this is a misnomer. In fact, people with anorexia nervosa ignore hunger and thus control their desire to eat. This desire is frequently sublimated through cooking for others or hiding food that they will not eat in their personal space. Obsessive exercise may accompany the starving behavior and cause others to assume the person must be healthy.

Bulimia nervosa is a serious eating disorder marked by a destructive pattern of binge eating and recurrent inappropriate behavior to control one's weight. It can occur together with other psychiatric disorders such as depression, obsessive-compulsive disorder, substance dependence, or self-injurious behavior. Binge eating is defined as the consumption of excessively large amounts of food within a short period of time. The food is often sweet, high in calories, and has a texture that makes it easy to eat fast.  For those who binge, sometimes any amount of food, even a salad or half an apple, is perceived as a binge and is vomited. 

Inappropriate compensatory behavior to control one's weight may include:

• Purging behaviors
• Self-induced vomiting
• Abuse of laxatives, diuretics, or enemas
• Non-purging behaviors
• Fasting
• Excessive exercise

People with bulimia nervosa often feel a lack of control during their eating binges. Their food is usually eaten secretly and gobbled down rapidly with little chewing. A binge is usually ended by abdominal discomfort. When the binge is over, the person with bulimia feels guilty and purges to rid his or her body of the excess calories. To be diagnosed with bulimia, a person must have had, on average, a minimum of two binge-eating episodes a week for at least three months. The first problem with any eating disorder is constant concern with food and weight to the exclusion of almost all other personal concerns.

* The Action Signs Project Peter Jensen, MD et al, REACH Institute

Clinical Guidelines:

This is the current release of the guideline.

AAP Policy Statement contains screening questions and possible findings on physical examination in children and adolescents with eating disorders

Parent information and handouts: