disorder believes he is always too small. This believe is
maintained even when the person is clearly well
muscled. Abnormal eating patterns are less of a prob-
lem in people with muscle dysmorphic disorder than
damage from compulsive exercising (even when
injured) and the abuse of muscle-building drugs such
as anabolic steroids.
Orthorexia nervosa is a term coined by Steven
Bratman, a Colorado physician, to describe ‘‘a patho-
logical fixation on eating ‘proper,’ ‘pure,’ or ‘superior’
foods.’’ People with orthorexia allow their fixation
with eating the correct amount of properly prepared
healthy foods at the correct time of day to take over
their lives. This obsession interferes with relationships
and daily activities. For example, they may be unwill-
ing to eat at restaurants or friends’ homes because the
food is impure or improperly prepared. The limita-
tions they put on what they will eat can cause serious
vitamin and mineral imbalances. Orthorectics are
judgmental about what other people eat to the point
where it interferes with personal relationships. They
justify their fixation by claiming that their way of
eating is healthy. Some experts believe orthorexia
may be a variation of obsessive-compulsive disorder.
Rumination syndrome occurs when an individual,
either voluntarily or involuntarily, regurgitates food
almost immediately after swallowing it, chews it, and
then either swallows it or spits it out. Regurgitation
syndrome is the human equivalent of a cow chewing its
cud. The behavior often lasts up to two hours after
eating. It must continue for at least one month to be
considered a disorder. Occasionally the behavior sim-
ply stops on its own, but it can last for years.
Pica is eating of non-food substances by people
developmentally past the stage where this is normal
(usually around age 2). Earth and clay are the most
common non-foods eaten, although people have been
known to eat hair, feces, lead, laundry starch chalk,
burnt matches, cigarette butts, light bulbs, and other
equally bizarre non-foods. This disorder has been
known to the medical community for years, and in
some cultures (mainly tribes living in equatorial
Africa) is considered normal. Pica is most common
among people with mental retardation and develop-
mental delays. It only rises to the level of a disorder
when health complications require medical treatment.
Prader-Willi syndrome is a genetic defect that
spontaneously arises in chromosome 15. It causes
low muscle tone, short stature, incomplete sexual
development, mental retardation, and an uncontrol-
lable urge to eat. People with Prader-Willi syndrome
never feel full. The only way to stop them from eating
themselves to death is to keep them in environments
where food is locked up and not available. Prader-
Willi syndrome is a rare disease, and although it is
caused by a genetic defect, tends not to run in families,
but rather is an accident of development. Only 12,000–
15,000 people in the United States have Prader-Willi
syndrome.Demographics
In general, more women have eating disorders
than men. About 90% of people with anorexia and
bulimia nervosa are female. Almost as many men as
women develop binge-eating disorder. Anorexia ath-
letica, muscle dysmorphic disorder, and orthorexia
nervosa tend to be more common in men. Rumina-
tion, pica, and Prader-Willi syndrome affect men and
women equally.
Anorexia nervosa begins primarily between the
ages of 14 and 18 and affects mainly white girls. Buli-
mia usually develops slightly later in the late teens and
early twenties. Binge-eating disorder is a problem of
middle age and affects blacks and whites equally.
Prader-Willi syndrome begins in the toddler years.
Not enough is known about the other disorders to
determine when they are most likely to develop or
which races or ethnic groups are most likely to be at
risk.
Depression, low self-worth, and anxiety disorders
are all common among people with eating disorders.
Some disorders have obsessive-compulsive elements.
The association between these psychiatric disorders
and eating disorders is strong, but the cause and effect
relationship is still unclear.Causes and symptoms
Eating disorders have multiple causes. There appears
to be a genetic predisposition in some people toward
developing an eating disorder. Biochemistry also seems
to play a role. Neurotransmitters in the brain, such as
serotonin, play a role in regulating appetite. Abnormal-
ities in the amount of some neurotransmitters are thought
to play a role in anorexia, bulimia, and binge-eatingKEY TERMS
Fast—a period of at least 24 hours in which a
person eats nothing and drinks only water.
Type 2 diabetes—sometime called adult-onset dia-
betes, this disease prevents the body from properly
using glucose (sugar).Eating disorders