recognize that their behavior is abnormal. Often they
are ashamed and feel guilty about their behavior and
will go to great lengths to hide their binge/purge cycles
from their family and friends. People with bulimia are
often of normal weight. Although their behavior
results in negative health consequences, because they
are less likely to be ultra-thin, these consequences are
less likely to be life-threatening.
The APA does not formally recognize binge eat-
ing as an eating disorder. Binge eating is quite com-
mon, but it only rises to the level of a disorder only
when bingeing occurs at least twice a week for three
months or more. People with binge-eating disorder
may eat thousands of calories in an hour or two.
While they are eating, they feel out of control and
may continue to eat long after they feel full. Binge
eaters do not purge or exercise to get rid of the calories
they have eaten. As a result, many, but not all, people
with binge-eating disorder, are obese, although not all
obese people are binge eaters.
Binge eaters are usually ashamed of their behavior
and try to hide it by eating in secret and hording food
for future binges. After a binge, they usually feel dis-
gusted with themselves and guilty about their eating
behavior. They often promise themselves that they will
never binge again, but are unable to keep this promise.
Binge-eating disorder often takes the form of an end-
less cycle—rigorous dieting followed by an eating
binge followed by guilt and rigorous dieting, followed
by another eating binge. The main health consequen-ces of binge eating are the development of obesity-
related diseases such as type 2 diabetes, sleep apnea,
stroke, and heart attack.Lesser-known eating disorders
Quite a few eating problems are called disorders
even though they do not have formal diagnostic cri-
teria. They fall under the APA definition of eating
disorders not otherwise specified. Many have only
recently come to the attention of researchers and
have been the subject of only a few small studies.
Some have been known to the medical community
for years but are rare.
Purge disorder is thought by some experts to be a
separate disorder from bulimia. It is distinguished
from bulimia by the fact that the individual maintains
a normal or near normal weight despite purging by
vomiting or laxative, enema, or diuretic abuse.
Anorexia athletica is a disorder of compulsive
exercising. The individual places exercise above
work, school, or relationships and defines his or her
self-worth in terms of athletic performance. People
with anorexia athletica also tend to be obsessed less
with body weight than with maintaining an abnor-
mally low percentage of body fat. This disorder is
common among elite athletes.
Muscle dysmorphic disorder is the opposite of
anorexia nervosa. Where the anorectic thinks she is
always too fat, the person with muscle dysmorphicSymptoms of eating disordersAnorexia nervosa Bulimia nervosa Binge-eating disorder
Resistance to maintaining body weight at
or above a minimally normal weight for age
and height
Intense fear of gaining weight or becoming
fat, even though underweight
Disturbance in the way in which one's body
weight or shape is experienced, undue
influence of body weight or shape on self-
evaluation, or denial of the seriousness of
the current low body weight
Infrequent or absent menstrual periods
(in females who have reached puberty)Recurrent episodes of binge eating, characterized
by eating an excessive amount of food within a
discrete period of time and by a sense of lack of
control over eating during the episode
Recurrent inappropriate compensatory behavior in
order to prevent weight gain, such as self-induced
vomiting or misuse of laxatives, diuretics, enemas,
or other medications (purging); fasting; or
excessive exercise
The binge eating and inappropriate compensatory
behaviors both occur, on average, at least twice
week for 3 months
Self-evaluation is unduly influenced by body shape
and weightRecurrent episodes of binge eating, characterized by
eating an excessive amount of food within a discrete
period of time and by a sense of lack of control over
eating during the episode
The binge-eating episodes are associated with at least
3 of the following: eating much more rapidly than
normal; eating until feeling uncomfortably full; eating
large amounts of food when not feeling physically
hungry; eating alone because of being embarrassed
by how much one is eating; feeling disgusted with
oneself, depressed, or very guilty after overeating
Marked distress about the binge-eating behavior
The binge eating occurs, on average, at least 2 days a
week for 6 months
The binge eating is not associated with the regular
use of inappropriate compensatory behaviors (e.g.,
purging, fasting, excessive exercise)
SOURCE: National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services(Illustration by GGS Information Services/Thomson Gale.)Eating disorders