Eating Disorders: Anorexia Nervosa & Bulimia Nervosa

People with anorexia nervosa obsess about their weight and the food they eat and attempt to maintain their weight far below normal.  They may starve themselves to prevent weight gain or to continue losing weight. People with bulimia nervosa eat large amounts of food all at one time and then try to get rid of the extra calories by vomiting or excessive exercise. The disorders make the person preoccupied with weight and body shape, to judge themselves severely and harshly for  self-perceived flaws. With treatment, people with anorexia and/or  bulimia nervosa return to healthier eating habits and reverse some of the serious complications of the disorder.


Complications of Anorexia Nervosa:

  • Abnormal blood counts and anemia
  • Fatigue
  • Insomnia
  • Dizziness or fainting
  • A bluish discoloration of the fingers
  • Brittle nails
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Reduced interest in sex
  • Absence of menstruation in women
  • Constipation
  • Dry skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Osteoporosis
  • Swelling of arms or legs
  • Heart problems,  abnormal heart rhythms and heart failure
  • Bone loss, increasing risk of fractures later in life
  • Gastrointestinal problems, such as constipation, bloating or nausea
  • Electrolyte abnormalities, such as low blood potassium, sodium and chloride
  • Kidney problems
  • Death due to any or all of the above

Complications of Bulimia Nervosa:

  • Abnormal bowel functioning
  • Damaged teeth and gums
  • Swollen salivary glands in the cheeks
  • Sores in the throat and mouth
  • Dehydration
  • Irregular heartbeat
  • Sores, scars or calluses on the knuckles or hands (due to abrasions while inducing vomiting)
  • Menstrual irregularities or loss of menstruation (amenorrhea) in women
  • Depression
  • Anxiety
  • Heart problems, such as an irregular heartbeat and heart failure
  • Digestive problems, and possibly a dependence on laxatives to have bowel movements
  • Drug and alcohol abuse
  • Death


  • Genetic. Eating disorders may run in families Studies of twins also support that idea. An area on chromosome 1 that appears to be associated with an increased susceptibility to anorexia nervosa. Some people have genetic tendency toward perfectionism, sensitivity and perseverance, all traits associated with anorexia.

  • Biological: Serotonin — one of the brain chemicals involved in depression — may play a role in anorexia.

  • Psychological. People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, obsessive-compulsive personality traits,   impulsive behavior, anger management difficulties, family conflicts and troubled relationships.
  • Sociocultural. Modern culture often cultivates and reinforces a desire for thinness. The media portrays images of thin models and actors. Attractiveness, success and worth are often equated with being thin. Peer pressure may cultivate the desire to be thin, particularly among young girls.

Symptoms - Anorexia Nervosa:

  • Preoccupation with food (calorie counting), and weight (repeatedly checking weight)
  • Extreme weight loss with thin appearance
  • Complaining about being fat with frequent checking in the mirror for weight gain in spite of weight loss
  • Refusal to eat, skipping meals, making excuses for not eating, or refusing to eat in public
  • Eating only a few certain “safe” foods, usually those low in fat and calories
  • Denial of hunger
  • Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
  • Excessive exercise
  • Flat or depressed mood, or lack of emotion
  • Social withdrawal
  • Irritability

Symptoms - Bulimia Nervosa:

  • Inability to control eating behavior
  • Eating until the point of discomfort or pain
  • Eating much more food at a time than in a normal meal or snack
  • Forcing yourself to vomit after eating
  • Preoccupation with body shape and weight
  • Going to the bathroom to vomit after eating or during meals
  • Exercising excessively
  • Using laxatives, diuretics or enemas to lose weight
  • Having a distorted, excessively negative body image


Medication: Antidepressants or other psychiatric medications can help control the obsessive preoccupation, and the associated depression, and help reduce the symptoms.

Psycho-therapy: Talking through and challenging beliefs and thought patterns in a structured manner helps identify and recognize unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones, gain a healthier self-esteem and learn positive ways to cope with distress and other strong feelings.

Weight restoration :
The first goal of treatment is to restore the person to a normal weight for height. This is done through nutrition education and  an eating plan that can help instill normal-eating habits and achieve a weight restoration goal.

evere forms of the disorder may require treatment in a hospital.

See also Eating Disorders, Body Image

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