Student Counseling Services - Special Issues
An eating disorder is marked by extremes. It is present when a person experiences severe disturbances in eating behavior, such as extreme reduction of food intake or extreme overeating, or feelings of extreme distress or concern about body weight or shape. A person with an eating disorder may have started just eating smaller or larger amounts of food than usual, but at some point, the urge to eat less or more spirals out of control. Eating disorders are very complex, and despite scientific research to understand them, the biological, behavioral, and social underpinnings of these illnesses remain elusive.
Eating disorders frequently appear during adolescence or young adulthood, but some reports indicate that they can develop during childhood or later in adulthood.
Eating disorders affect cisgender women and girls, boys and men as well as genderqueer and transgender individuals. One in four preadolescent cases of anorexia occurs in cisgender boys. Binge-eating disorder affects females and males about equally. Genderqueer individuals experience a higher incidence of eating concerns relative to cisgender men and women and transgender individuals are four times as likely to experience an eating disorder.
Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with a real or imagined defect in one’s physical appearance.
Individuals with BDD have a distorted or exaggerated view of how they look and are overly concerned with actual physical characteristics or perceived flaws, such as a certain facial feature or imperfections of the skin. They frequently think of themselves as ugly or disfigured. People with BDD often have recurring negative thoughts about their appearance, even when reassured by others that they look fine and that the minor or perceived flaws aren't noticeable or excessive.
The signs and symptoms of BDD include:
- Frequently comparing appearance with that of others
- Repeatedly checking the appearance of the specific body part in mirrors or other reflective surfaces
- Refusing to have pictures taken
- Wearing excessive clothing, makeup, and hats to camouflage the perceived flaw
- Using hands or posture to hide the imagined defect
- Frequently touching the perceived flaw
- Picking at one's skin
- Frequently measuring the imagined or exaggerated defect
- Elaborate grooming rituals
- Excessive researching about the perceived defective body part
- Seeking surgery or other medical treatment despite contrary opinions or medical recommendations
- Seeking reassurance about the perceived defect or trying to convince others that it's abnormal or excessive
- Avoiding social situations in which the perceived flaw might be noticed
- Feeling anxious and self-conscious around others (social phobia) because of the imagined defect
BDD is a type of somatoform disorder which is characterized by physical symptoms that suggest a medical condition. However, a thorough medical evaluation doesn't reveal any underlying medical cause for the physical symptoms.
The cause of BDD is unclear, but it is likely that multiple factors may be involved and that they can occur together, including:
- A chemical imbalance in the brain. An insufficient level of serotonin, one of your brain's neurotransmitters (chemical messengers) involved in mood and pain, may contribute to BDD. This type of imbalance is possibly linked with any number of mental health issues and while it is presently unexplained, it may be hereditary.
- Obsessive-compulsive disorder. BDD often co-occurs with obsessive-compulsive disorder, in which a person experiences uncontrollable thoughts over and over and engages in uncontrollable ritual behaviors trying to reduce the thoughts. A history of or genetic predisposition to obsessive-compulsive disorder may make you more susceptible to BDD.
- An eating disorder. BDD may also occur with an eating disorder, such as anorexia nervosa or bulimia nervosa, especially if it involves a weight-related part of the body, such as the waist, hips, or thighs.
- Generalized anxiety disorder. BDD may accompany generalized anxiety disorder, a condition involving excessive worrying resulting in exaggerated or unrealistic anxiety about life circumstances, which could include a perceived flaw or defect in appearance, as in BDD. A history of or genetic predisposition to generalized anxiety disorder may make you more susceptible to BDD.
- Psychological, behavioral, or cultural factors. Someone who feels that they must live up to unobtainable or unrealistically high expectations for personal appearance and success, which may be established by their family or the society/culture surrounding them, may be more prone to BDD.
Doctors often use a combination of medications and talk therapy (psychotherapy) to help people overcome BDD. Treatment may include:
- Antidepressants. A specific type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may help lessen or alleviate the signs and symptoms of BDD. Depending on the severity of symptoms, your doctor may wish to consider using other medications as well.
- Cognitive behavior therapy. This type of talk therapy identifies unhealthy, negative beliefs and behaviors and replaces them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — influence how you behave. The premise is that even if an unwanted situation hasn't changed, you can change the way you think and thus behave in a different way. Cognitive behavior therapy can be effective in learning to manage the effects of BDD. Careful attention to your thoughts may be coupled with certain behavioral assignments, such as reducing the amount of time you check your appearance in the mirror, or increased exposure, such as going out in public more often.
When to seek help
Feelings of shame and/or embarrassment may keep you from seeking treatment for BDD. Even if your anxiety and rituals are deeply ingrained, treatment can help. If you suspect you have BDD, visit or call Student Counseling Services at 516-463-6745 to speak with someone and get more information.
Taylor, C.B., Bryson, S., Luce, K.H., Cunning, D., Doyle, A.C., Abascal, L.B., Rockwell, R., Dev, P., Winzelberg, A.J., Wilfley, D.E. (2006). Prevention of eating disorders in at-risk college-age women. Archive of General Psychiatry, 63 (8): 881-8.
Mayo Clinic Staff (10/30/2006). Body Dysmorphic Disorder. Retrieved 7/25/2008, from http://www.mayoclinic.com/health/body-dysmorphic-disorder/DS00559.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Test Revision. Washington, D.C.: American Psychiatric Association.
Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense fear of gaining weight, a lack of menstruation among girls and women, and extremely disturbed eating behavior. Some people with anorexia lose weight by dieting and exercising excessively; others lose weight by self-induced vomiting, or misusing laxatives, diuretics, or enemas.
Many people with anorexia see themselves as overweight, even when they are starved or are clearly malnourished. Eating, food, and weight control become obsessions. A person with anorexia typically measures their weight repeatedly, portions food carefully, and eats only very small quantities of only certain foods.
Some who have anorexia recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic form of anorexia, in which their health deteriorates over many years as they battle the illness. According to some studies, people with anorexia are up to 10 times more likely to die as a result of their illness compared to those without the disorder. The most common complications that lead to death are cardiac arrest, and electrolyte and fluid imbalances. Suicide also can result.
Other symptoms may develop over time, including:
- thinning of the bones (osteopenia or osteoporosis)
- brittle hair and nails
- dry and yellowish skin
- growth of fine hair over body (e.g., lanugo)
- mild anemia, and muscle weakness and loss
- severe constipation
- low blood pressure, slowed breathing and pulse
- drop in internal body temperature, causing a person to feel cold all the time
Treating anorexia involves three components:
- Restoring the person to a healthy weight.
- Treating the psychological issues related to the eating disorder.
- Reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse.
Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (i.e., binge-eating) and feeling a lack of control over the eating. This binge-eating is followed by a type of behavior that compensates for the binge, such as purging (e.g., vomiting, excessive use of laxatives or diuretics), fasting and/or excessive exercise.
Unlike anorexia, people with bulimia can fall within the normal range for their age and weight. But like people with anorexia, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binging and purging cycle usually repeats several times a week.
Similar to anorexia, people with bulimia often have coexisting psychological illnesses, such as depression, anxiety and/or substance abuse problems. Many physical conditions result from the purging aspect of the illness, including electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems.
Other symptoms include:
- chronically inflamed and sore throat
- swollen glands in the neck and below the jaw
- worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids
- gastroesophageal reflux disorder
- intestinal distress and irritation from laxative abuse
- kidney problems from diuretic abuse
- severe dehydration from purging of fluids
Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over their eating. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise or fasting. As a result, people with binge-eating disorder are often overweight or obese. They also experience guilt, shame and/or distress about the binge eating, which can lead to more binge-eating episodes. Obese people with binge-eating disorder often have coexisting psychological illnesses including anxiety, depression, and personality disorders. In addition, links between obesity and cardiovascular disease and hypertension are well documented.
Psychological and medicinal treatments are effective for many eating disorders. However, in chronic cases, specific treatments have not yet been identified. In these cases, treatments are often tailored to the patient's individual needs and may include medical care and monitoring; medications; nutritional counseling; and individual, group, and/or family psychotherapy. Some patients may also need to be hospitalized to treat malnutrition or to gain weight, or for other reasons.