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Eating Issues

Warning Signs of an Eating Disorder:
  1. An intense preoccupation with food, weight, and body image
  2. A significant increase or decrease in weight (that is not related to a medical condition)
  3. Abnormal eating habits including severe dieting, preference for strange foods, withdrawn or ritualized behavior at mealtimes, or bingeing in secret
  4. Exercising excessively or compulsively
  5. Self-induced vomiting, periods of fasting, or abuse of diet pills, laxatives or diuretics
  6. Depressive, isolative or irritable feelings

(Eating Disorders Awareness and Prevention, Inc., 1998)

What is Anorexia Nervosa?

The central characteristics of anorexia include:

  • Psychological factors lead to severe weight loss and a refusal to maintain a minimally normal body weight for age and height
  • An intense fear of weight gain or becoming fat, even though underweight
  • Misconception of body weight and shape (feeling “fat”, but appears emaciated to others) denial of seriousness of low body weight, and undue influence of body weight and shape on self-evaluation
  • In females, absence of at least 3 consecutive menstrual cycles (when otherwise expected to occur)
Types of Anorexia:
  • Binge-Eating/Purging Type: During the episode of Anorexia Nervosa, the person engages in recurrent episodes of binge eating or purging
  • Restricting Type: During the episode of Anorexia Nervosa, the person does not engage in recurrent episodes of binge eating or purging
What is the difference between thinness and anorexia?

The central difference is the way in which the anorexic individual experiences his/her body shape and size. An anorexic individual is terrified of becoming fat or gaining weight, has stopped menstruating because her body fat has dropped below a certain level, and has a distorted sense of body size and shape (feels “fat” even though s/he isn’t).

Warning Signs of Anorexia:
  1. Preoccupation with food, calories, and weight
  2. Weight loss in which the individual becomes increasingly thinner and loses 15% or more of his/her ideal body weight for age and height
  3. Dieting and food restriction even though s/he is not overweight
  4. Distorted body image: feeling “fat” even though s/he is thin; frequently weighing self
  5. Denial of hunger
  6. Excessive exercise
  7. Hair loss or thinning hair
  8. Sensitivity to cool or cold temperatures
Medical Complications of Anorexia:
  • Amenorrhea (loss of menstrual cycle)
  • Electrolyte imbalance which can produce life threatening complications
  • Cardiac irregularities
  • Insomnia, difficulty falling and staying asleep
  • Low tolerance for cold
  • Anemia
  • Growth of baby fine body hair
  • Reduced bone mass making individuals vulnerable to fractures (adolescents and young women may be prone to fractures years after their recovery)
  • Osteoporosis (an irreversible condition): predisposes individuals to an increased risk of fractures during everyday activities such as walking
  • Gastrointestinal complications
  • An increase in cholesterol levels despite the state of starvation
  • Elevated carotene levels which leads to a yellowish discoloration of the skin
  • Cataracts, atrophy of the optic nerve (which can cause blindness), and retinal degeneration may also accompany malnutrition

Anorexia is the leading cause of death in young women. At least 5 to 20% of all anorexic individuals will eventually die from the disorder. Common causes of death among anorexics are starvation, electrolyte imbalance (causing heart failure), and suicide (Barnhill et al., 1998) .

What is Bulimia Nervosa?

  • The central characteristics of bulimia include:
  • Cycles of binge-eating and purging (self-induced vomiting, misuse of laxatives, diuretics or enemas)
  • During a binge, an individual consumes large amounts of food in a rapid, automatic, and subjectively out of control manner
  • Bingeing may serve to numb hunger, anger, and other feelings, but eventually creates physical discomfort and anxiety about weight gain
  • Undue influence of body weight and shape on self-evaluations
  • See this website for more information www.bulimiaguide.org
Types of Bulimia:
  • Purging Type: An individual regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
  • Nonpurging Type: An individual uses dieting, fasting or excessive exercise, but does not regularly engage in purging behaviors
Warning Signs of Bulimia:
  1. Overeats in times of emotional stress
  2. Engages in binge eating
  3. Frequently uses the bathroom after meals
  4. Obsesses about weight and food
  5. Feels out of control
  6. Feels guilty or ashamed about eating
  7. Experiences frequent fluctuations in weight
  8. Experiences depressive moods
  9. In females, menstrual irregularities
When does exercise become “excessive”?

Characteristics of excessive exercise include:

  • Exercising more frequently and intensely than is required for good health or performance excellence
  • Never being satisfied with one’s performance
  • Defining oneself in terms of one’s performance
  • Devoting increasingly more time to exercise while taking more time away from school, work or relationships
  • Obsession with weight and diet
Medical Complications of Bulimia:
  • Electrolyte abnormalities which can lead to cardiac complications
  • Electrolyte disturbances can cause symptoms including: weakness, confusion, memory and thinking impairment, and emotional liability
  • Damage to the heart and other muscle tissue from the use of ipecac or other purgatives
  • Dental Problems: acid causes erosion of the enamel of the teeth, creates gum abscesses, obstructs the salivary glands, creates a propensity for cavities and the loss of fillings, ulcers on the lips, and halitosis
  • Jitteriness, anxiety and irritability can be the result of an excessive consumption of coffee, cola, and tea which is common among individuals with eating disorders
  • Dehydration (which can cause lowered blood pressure)
  • Low potassium, sodium, chloride and magnesium levels caused by self-induced vomiting, laxative and diuretic abuse are serious problems that can lead to cardiac arrest and kidney failure
  • Purging may cause fluid retention in a rebound manner causing edema of the hands and legs
  • Abnormalities in the menstrual cycle (among approximately 30% of bulimic females)
  • Peptic ulcers and pancreatitis (inflammation of the pancreas) occur at a higher frequency among bulimic individuals (pancreatitis is a potentially life threatening consequence of bulimia)
  • Yellowish skin and hair loss from chronic protein malnutrition
  • Epileptic seizures from electrolyte imbalance and malnutrition, as well as abnormalities in the electroencephalogram (EEG)
  • Anemias
  • Vitamin deficiencies may be the result of repeated bingeing and purging

Mortality rates for bulimic individuals are unclear. However, some experts assert that the death rate is as high or higher than for individuals with anorexia (Barnhill et al., 1998).

Binge Eating Disorder (formerly referred to as compulsive eating):

Central characteristics include:

  • Periods of impulsively consuming very large amounts of food in a relatively short period of time, or continuous eating while experiencing feelings of being out of control
  • While there is no purging, there may be sporadic fasts or repetitive diets
  • Body weight may vary from normal to mild, moderate or severe obesity

How do I know if I have an eating disorder?

Take the following True/False Quiz

  1. I often feel fat, even though people keep telling me I’m thin.
  2. The first thing I think about when I wake up in the morning is food.
  3. I feel uneasy about food and eating, but I keep my feelings to myself because no one would understand.
  4. I have dieted to an abnormally low weight because that makes me feel like I’m in
  5. I haven’t had a menstrual period for at least the past three months.
  6. I often eat when I’m not hungry.
  7. My greatest fear is that I’ll gain weight and become fat.
  8. I can’t go through a day without worrying about what I can or cannot eat.
  9. I have had an out of control eating binge at least once during the past year.
  10. I often eat until I’m so full I feel uncomfortable.
  11. I have done one of the following after a binge at least once during the past year:
    made myself vomit; used laxatives, enemas, colonics, or diuretics; fasted;
    exercised excessively.
  12. If I got on the scale tomorrow and found out that I’d gained two pounds, I’d be very
  13. If I can’t exercise to compensate for food I have eaten, I panic.
  14. I push food around my plate so that it looks like I’m eating more than I really am.
  15. Often I eat to make myself feel better emotionally, but then I feel guilty about it.
  16. I prefer to eat little in public; then I binge secretly in private.
  17. I think and talk a lot about food, recipes, weight, diets, restaurants, and other topics
    related to food.
  18. People always seem to be bothering me about what I’m eating or not eating, which
    makes me angry.
  19. I don’t believe I’ll be able to find happiness until I’m thin.
  20. It’s important to me to be thinner than my friends.

If you marked any of the statements above “true” (particularly 4,5,7,8,11,13,16 or 19), you may have an eating problem (Barnhill et al., 1998, p.43-44).

If you would like to talk further about any thing related to issues with eating please contact the University of the Sciences Counseling Center.

Appointments can be scheduled either in person or by phone through the Counseling Center front desk at 215.596.8536. In person - come to the 1st floor of Whitecar Hall.

In the event of an emergency or crises after regular office hours call campus security at 215 596-7000 to initiate emergency procedures.

What Family and Friends Can Do

Communicate your concern to the person; express that you would like to help and that you are ready to listen.

Try to avoid talking about topics related to food, calories, weight, and exercise; try to focus on talking about feelings underneath the eating disordered behaviors. Also, try to avoid engaging in a power struggle with the person about his/her behaviors.

Encourage the person to seek professional help, keep in mind that the decision to seek help is ultimately up to the individual.

Certain situations may necessitate getting immediate help for the person including: bingeing, purging or starving to the point that the person is too weak or sick to function, if the person is unable to keep any food down, and if the person is engaging in self-harm behaviors or is suicidal.


Barnill, J., & Taylor, N. (1998). If You Think You Have an Eating Disorder. New York, NY: Bantam Doubleday Dell Publishing Group, Inc.

Zerbe, Kathryn J. (1995). The Body Betrayed, A Deeper Understanding of Women, Eating Disorders, and Treatment. Gurze Books

Resources in the Philadelphia Area:

AA/BA of Philadelphia (American Anorexia /Bulimia Association) Support groups for individuals with anorexia and bulimia (twice a month); separate support groups for families and friends (twice a month); monthly informational meetings with guest speakers; and referrals for psychological and medical services. For information call the AA/BA of Philadelphia at 215.221.1864

Belmont Center For Comprehensive Treatment 215.581.5489

The Renfrew Center in Philadelphia. Renfrew specializes in the treatment of eating disorders. In addition to the residential, day and intensive outpatient programs, a support group open to the public takes place every Friday and Saturday night for individuals with eating disorders and their families and friends. For information call 1.800.RENFREW or visit www.renfrew.org

The Eating Disorders Program at Friends Hospital 215.831.7845

Eating Disorders Treatment Centers 215.772.3001. 255 S. 17th Street, #1601

University of Pennsylvania Weight and Eating Disorders Program. Penn offers participation in research studying eating disorders including free behavioral and nutritional treatment for those who qualify. For information call 215.898.7314

Recommended Readings:

Surviving an Eating Disorder, Perspectives and Strategies for Family and Friends by Michelle Siegel, Ph.D., Judith Brisman, Ph.D., & Margot Weinshel, Ph.D.

The Body Betrayed, A Deeper Understanding of Women, Eating Disorders, and Treatment by Kathryn J. Zerbe, M.D.

For additional recommended readings visit The Renfrew Center’s website and Gurze books at http://www.gurze.com

If you would like to talk further about any of these resources please contact the University of the Sciences Counseling Center.

Appointments can be scheduled either in person or by phone through the Counseling Center Administrative Assistant, at 215.596.8536. In person - come to Suite 1200 on the first floor of Whitecar Hall.

In the event of an emergency or crises after regular office hours call campus security at 215.596.7000 to initiate emergency procedures.

Scheduling Appointments

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