What is an Eating Disorder and How do I know if I have One?


The incidence of eating disorders has increased over the last 30-40 years. It is estimated that approximately 5% of women and girls have a diagnosable eating disorder. At any given time, 10% 15% of women have symptoms of these disorders. These women may not meet the diagnostic criteria eating disorders, but experience serious symptoms associated with them. It’s important to view eating behavior on a continuum. A person does not either eat normally, or have an eating disorder. There is a gray area on this continuum between normal eating and a diagnosable eating disorder. (See Eating Disorders Continuum).


What is Normal Eating?


Results from a 2003 study at Duke indicate that 23% of women and 5% of men at Duke experience disordered eating (Staples B., Bravender T., 2003). Where is the line between normal eating and disordered eating?


An individual has disordered eating, when her behaviors, attitudes or emotions about food, weight, body shape, and/or exercise have a negative impact on her quality of life.


Normal eating can be:

· Eating when you are hungry and stopping when you are full.

· Not being concerned about what others think about how much you eat

· Not feeling guilty about what you eat

· Not seeing food as either “good” or “bad”

· Spending time planning meals, but it doesn’t take over your thoughts,

· Having realistic feelings and perceptions about your body weight, shape and size.

· You allow yourself to eat foods that are not always healthy for you, but can enjoy them.

· Not having rules or counting carbs, fat grams, or calories to decide what to eat.

· Bottom Line: normal eating is flexible eating.


What can cause eating disorders?


There is not one cause of an eating disorder, but many risk factors have been identified.

Having one of these risk factors doesn’t mean that someone will have an eating disorder.

However, the more risk factors someone has, the more at risk the person is for developing an eating disorder.


Eating disorders and disordered eating are usually not about food. Usually, it’s a way to control something in your life (what you eat and/or how much you exercise), when you feel like you don’t have control over another part of your life. For example, a person may feel stressed or depressed because of a recent breakup and failing grades. These are things that a person may not be able to control. However, she can control how much she eats and how much she exercises. This person may lose 5 pounds, get complements, and continue to feel depressed because the social and academic parts of her life are not going well. She may think, “If I could only lose 5 more pounds my life would be okay.” Unfortunately, no matter how much weight someone loses or how little food someone eats, these other parts of life won’t improve. This can be a start of disordered eating. In addition to being something we think we can control, restricting intake, binging,  exercising, and self-induced vomiting is thought to actually change someone’s brain chemistry. These behaviors can relax a stressed out brain. Disordered eating may start as a way to lose a little weight, but become a coping mechanism to deal with stress.


Risk Factors For Eating Disorders:

· 1 st degree relative has a mental illness, including alcoholism

· Perfectionist personality

· Participation in a sport that emphasizes weight – ie. gymnastics, wrestling, track

· Exposure to media

· A life changing event – divorce or death

· Career emphasizing thinness – model

· Homosexuality (in men)

· Female gender

· Higher socioeconomic status

· Early puberty in girls

· Appearance-obsessed peers


Warning Signs of Disordered Eating:


One cannot tell if someone has an eating disorder just by looking at them. A person may lose or gain weight when they have disordered eating, but they also may not. A person’s behaviors may change, they may become withdrawn.

Below is a list of warning signs:

· significant weight loss or gain

· avoid eating food in front of you

· become withdrawn

· categorize food into “good” or “bad”

· calculate number of fat grams/calories/carbs

· talk/worry about size and shape

· weight herself often

· exercise out of guilt or to lose weight instead of for health/enjoyment

· OVERALL: relationship with food negatively impacting quality of life.

Health Consequences of Eating Disorders


Why are people so concerned about eating disorders? In addition to the psychological toll an eating disorder can have on an individual, there are also severe physical health consequences. An individual with disordered eating may be at risk for a combination of these health consequences. Many women with eating disorders or disordered eating will stop having periods, because they do not have enough body weight to support regular cycles. Amenorrhea, or lack of periods, can cause loss of bone mass and can lead to osteoporosis. This is because estrogen, as part of a women’s monthly menstrual cycle, plays an important roll in building bone mass and preventing the breakdown of bone. Amenorrhea can, of course, also contribute to infertility. This can be temporary or permanent.


Health Consequences Associated with Disordered Eating:

· Loss of bone mass – can lead to osteoporosis

· Dehydration – can result in kidney failure

· Heart failure – from the break down of heart tissue and electrolyte imbalances

· Infertility

· Tooth decay

· Gastric/esophageal rupture

· Obesity

· High blood pressure

· High cholesterol

· Heart disease

· Diabetes

· Gallbladder disease

· Increased mortality rate due to risk factors

            à Extreme cases can be fatal




Don’t Worry,

There’s Help.


Duke OnCampus EBIC (Eating and Body Image Concerns) Resources:

1. Medical evaluations – Duke Student Health – appointments available by calling 919-681-WELL, ask to be scheduled with Dr. Dev Sangvai.

 2. Nutritional counseling – Duke Student Health – Student Health dietitians can be reached at 919-681-WELL for an appointment with Toni Apadula, R.D. at the East Campus Wellness Clinic or Anna M. Lutz, MPH, R.D. at the Duke Student Health Center. Franca Alphin, MPH, R.D., 919-613-7486, takes new appointments by referral only and sees patients at the Wilson Recreation Center.

 3. CAPS – Counseling and Psychological Services – consultations, short-term psychotherapy and group therapy. Contact Stacie CAPS at 919-660-1000 for an appointment.

4. Information – Talk with a dietitian or health educator at Student Health or an ESTEEM peer educator. Ask for books, brochures, and educational packets on eating disorders, disordered eating, how to help a friend, and body image. Call 919-681-WELL and ask for a dietitian or health educator.

 5. ESTEEM – Educating Students To Eliminate Eating Misconceptions – student led peer education group addressing eating and body image concerns through outreach. For more information contact Anna Lutz at 684-2757 or anna.lutz@duke.edu. ESTEEM is also available to help you plan a strategy for approaching a friend you think might be struggling.