Anorexia Nervosa
About 0.5 to 1.0% of young women develop anorexia nervosa, and it can affect women of any age. Approximately 5% of people with anorexia are male. Significant weight loss due to self-starvation characterises anorexia, often with serious medical complications. About 10% of people with anorexia may die in the long term. Underlying causes of anorexia will differ between individuals, and will be related to a combination of factors. Many of the symptoms are caused by the "Starvation Syndrome". These symptoms will affect anyone who diets for long enough, but some people, at a vulnerable time of life or who have a biological predisposition, will experience greater physical and mental changes.

These may include chemical imbalances and reduced circulation in the brain which may contribute to body image distortions, rigid and obsessive thinking, and mood disturbance. However reversing starvation alone does not 'cure' anorexia nervosa. The emotional relationship and psychological factors that contributed to the condition need to be addressed. Recovery from the effects of starvation can take a long time, even after weight is stabilised.

Physical Characteristics

• Marked weight loss
• Pallor, unhealthy look
• Skin nail and hair problems
• Sensitivity to cold
• Loss of periods in females, in pre-pubescent girls periods may never start
• Growth of fine body hair (lanugo)
• Constipation or bloating
• Insomnia

Behavioural Characteristics

• Unusually low intake of food
• Odd eating habits / unusual food rituals
• Excessive exercise or activity
• Frequent measuring of body weight
• Obsessive reading of nutritional information on food containers
• Increasing withdrawal from social activities
• Vomiting or using laxatives
• Dressing in layers to hide body shape
• Odd eating habits and strange food combinations
• Avoiding places or occasions where food might be present

Psychological Characteristics

• Insecurity about abilities, regardless of actual performance
• Depression, possible suicidal ideation
• Perfectionism and obsessiveness
• Intense fear of becoming fat even though very thin
• Difficulty concentrating
• Mood swings, irritability
• Mood and sense of self-worth affected by what is or is not eaten

Danger Signs
If someone displays any of the following symptoms, they must be medically assessed as soon as possible:

• rapid weight loss (eg 7 kg in 4 weeks)
• recent loss of greater than 10% of healthy weight
• increase in frequency of vomiting
• overexercising while very underweight
• dizziness, fainting or disorientation
• slow heart rate or chest pain
• rapidly increasing weakness
• severe muscle spasms

Bulimia Nervosa
Bulimia nervosa usually starts with restriction of food intake that leads to uncontrolled consumption of large amounts of food (bingeing). Feelings of guilt and panic can follow, leading to attempts to get rid of the food eaten. This eventually becomes a cycle of food restriction, bingeing and purging. Some studies indicate that behaviours associated with bulimia could be found in as many as 30% of adolescents. Bulimia affects 1-3% of adolescent and young adult females, and about 10 to 20% of sufferers are male.

People with bulimia can have serious problems with self-esteem, and may have clinical depression, relationship problems, health problems and difficulty with day to day life. Some people with bulimia may also have problems with substance abuse. Purging is not only found in bulimia - when associated with significant weight loss, it may indicate anorexia and this combination is very dangerous.

Physical Characteristics

• Near average weight or slightly over or underweight
• Dramatic weight fluctuations with related fluid retention
• Swollen salivary glands (puffy cheeks) and chronic hoarseness
• Forced vomiting can cause blistering, tearing and bleeding of the throat and oesophagus
• Dental decay from stomach acid (erosion of enamel, dental cavities)
• Disturbance of menstrual cycle
• Hair, nail and skin problems
• Constipation (laxative, diuretics and emetics may contribute)
• Gastro-intestinal disorders

Behavioral Characteristics

• Episodes of consuming very large amounts of food
• Restriction of food intake, possible fasting
• Purging behaviours such as abuse of laxatives or diuretics, excessive exercise, vomiting, or fasting
• Secretive behaviour (hiding binge-purge behaviours due to shame)
• Social withdrawal (isolation, spending time on food related activities)

Psychological Characteristics

• Low self-esteem, poor self-image
• An overwhelming fear of becoming fat
• Great importance attached to being slender
• Constant pre-occupation with food
• Feelings of guilt, shame and self-loathing
• Depression and possible suicidal thoughts
• Mood swings and increased irritability
• May hide symptoms successfully for years

Binge eating
Binge eating disorder, also known as compulsive overeating, is very similar to bulimia nervosa, but without the purging behaviours. This kind of eating disorder is characterised by excessive consumption of food when not feeling hungry, usually to the point of feeling overly full and often more rapidly than usual. People with binge eating disorder will often describe a feeling of loss of control over their eating during a binge, followed or preceded by feelings of guilt, shame, disgust and depressed moods.

About 30% of people treated for health problems associated with obesity have binge eating disorder, but binge eating disorder is also found in individuals at "normal" weight. Most people with this disorder developed the problem following attempts at restrictive dieting. The main associated health problems are depression and long-term risks for illnesses associated with obesity.

There are some very practical ways of helping alleviate the urge to binge, which may provide a starting point for further recovery:

• Never skip breakfast (or any other meal). Binge eaters who skip meals may find themselves bingeing later in the day - starvation is a powerful stimulus for bingeing behaviour.
• Many people advocate eating smaller more frequent meals, but the overriding principle is that nourishing your body adequately throughout the day may help prevent or reduce bingeing.
• Some people with binge eating disorder have found distraction techniques (hobbies, going for a walk, talking to someone on the phone) can help delay or even prevent a binge.
• Learn to listen to your body: relearn your internal cues for "fullness" and hunger. Support from a good nutritionist and moderate exercise can help.
• People in the obese weight range or those with cardiac or other health difficulties should always consult with their doctor before starting or changing their exercise patterns.