Medical Conditions

American Academy of Pediatrics

Eating Disorders: Anorexia and Bulimia

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Most people enjoy eating.

But for people with an eating disorder, it brings about very different feelings. They become obsessed with thoughts of eating and have an intense fear of gaining weight. These thoughts disrupt their daily activities.

The 2 most well-known eating disorders are anorexia nervosa and bulimia nervosa.Anorexia is self-starvation. Bulimia is a disorder in which a person eats large amounts of food (binges) and then tries to undo the effects of the binge in some way, usually by ridding the body of the food that was eaten. Some people have symptoms of both anorexia and bulimia. (A quick note about people with binge-eating disorder: they eat large amounts of food in a short time and feel intense guilt afterward, but unlike people with bulimia, they don't purge themselves.)

What causes eating disorders?

There is no single cause of eating disorders. But many factors can lead to an eating disorder. Genetics are now felt to play an important role. Although each person's situation is different, people with eating disorders may share many of the same traits, such as

  • Feeling insecure

  • An excessive desire to be in control

  • A distorted body image (feeling fat even when they're not)

  • A family history of depression or an eating disorder

  • Severe family problems

  • A history of sexual or physical abuse

  • Pressure from activities that place a high value on body size such as running, gymnastics, wrestling, or ballet

What is anorexia?

People with anorexia have a distorted image of their bodies and such an intense fear of becoming fat that they hardly eat and become dangerously thin. Many people with anorexia also vomit and overexercise, and they may abuse diet pills to keep from gaining weight. If the condition gets worse, they can die from suicide, heart problems, or starving to death.

People with anorexia focus all of their energy on staying thin. Much of their time is spent thinking about food. For example, people with anorexia may

  • Eat only a small number of “safe” foods, usually those low in calories and fat.

  • Cut up food into tiny pieces.

  • Spend more time playing with food than eating it.

  • Cook food for others but not eat it.

  • Exercise compulsively.

  • Wear baggy clothes to hide their bodies, or complain that normal clothes are too tight.

  • Spend more time alone and isolated from friends and family.

  • Become more withdrawn and secretive.

  • Seem depressed or anxious.

  • Have a decrease in activities, motivation, or energy level.

  • Do things to keep their minds off their hunger, such as chewing food 30 times before swallowing.

What does anorexia do to the body?

Over time, anorexia can lead to kidney and liver damage, bone damage, and heart problems. When the body is starved of food, many physical changes occur like

  • The constant feeling of being cold because the body has lost the fat and muscle it needs to keep warm. (People with anorexia may exercise even more to try to get warm).

  • Dizziness, fainting, or near-fainting.

  • Bones sticking out and skin shrinking around the bones. The stomach may look like it's sticking out (often causing anorexics to think they're still fat).

  • Hair loss.

  • Brittle hair and fingernails.

  • Dry and rough skin.

  • Menstrual periods stopping (or not starting at all if a girl developed anorexia before her first period). This condition is called amenorrhea.

  • Stomach pain, constipation, and bloating.

  • Stunted growth that could be permanent.

  • Anemia (low red blood cells) causing tiredness, weakness, and dizziness.

  • Loss of sexual function in boys.

Who is at risk of developing anorexia?

Most people with anorexia are girls in their teens or even younger. But boys can be anorexic, too. Teens who develop anorexia usually are good students, even overachievers. They get along well with others, tend to be perfectionists, and don't like to admit they need help with anything. They may appear to be in control. However, they actually are insecure, self-critical, and have low self-esteem. They are very concerned about being liked and focused on pleasing others.

Most people who develop anorexia start by dieting. Dieting becomes more severe and strict over time. They may think that losing weight will make them feel better about themselves. Dieting also might be a response to a major life change like puberty or going away to college. Because people with anorexia have low self-esteem, they have a hard time coping with these changes and feel like they're losing control. Over time, dieting is no longer about losing weight, but a way to feel in control.

When should a person get help?

It's important to know the early signs of anorexia before it's too late. The earlier an eating disorder is recognized, the better chance there is of recovery. If someone is having physical symptoms caused by weight loss or answers “yes” to any of the following, that person should get help right away.

  • “I can't stop dieting, even though I've been told that I've lost too much weight.”

  • “Even though I've lost a lot of weight, when I look in the mirror, I still think I'm fat.”

  • “I can't stop exercising.”

What is bulimia?

Bulimia is another eating disorder that is harmful to a person's physical and mental health. Bulimia and anorexia share some of the same symptoms.

  • As with anorexia, food and staying thin become an obsession, but instead of avoiding food, people with bulimia eat large amounts of food in a short time (binge).

  • Guilt and fear then cause them to get rid of the food (purge) by vomiting or other means such as overexercising.

People with bulimia have a difficult time controlling their eating behavior. They may be afraid to eat in public or with other people because they are afraid they won't be able to control their urges to binge and purge. Their fear may cause them to avoid being around people. They also may

  • Become very secretive about eating food.

  • Spend a lot of time thinking about and planning the next binge, set aside certain times to binge and purge, or avoid social activities to binge and purge.

  • Steal food or hide it in strange places, like under the bed or in closets.

  • Binge on foods with distinct colors to know when the food is later thrown up.

  • Exercise to “purge” their bodies of food consumed.

People with bulimia often suffer from other problems as well, such as

  • Depression and thoughts of suicide

  • Substance abuse

What are bingeing and purging?


  • During a binge, people with bulimia eat large amounts of food, often in less than a few hours.

  • Eating during a binge is almost mindless. They eat without paying attention to what the food tastes like or if they are hungry or full.

  • Binges usually end when there is no more food to eat, their stomachs hurt from eating, or something such as a phone call breaks their concentration on bingeing.


  • After bingeing, people with bulimia feel guilty and are afraid of gaining weight. To ease their guilt and fear, they purge the food from their bodies by vomiting or other means.

  • They also may turn to extreme exercise or strict dieting.

  • This period of “control” lasts until the next binge, and then the cycle starts again. Bulimia becomes an attempt to control 2 very strong impulses—the desire to eat and the desire to be thin.

What does bulimia do to the body?

Like anorexia, bulimia damages the body. For example,

  • Teeth start to decay from contact with stomach acids during vomiting.

  • Weight goes up and down.

  • Menstrual periods become irregular or stop.

  • The face and throat look puffy and swollen.

  • Periods of dizziness and blackouts occur.

  • Dehydration caused by loss of body fluids occurs (treatment in a hospital may be needed).

  • Constant upset stomach, constipation, and sore throat may be present.

  • Damage to vital organs such as the liver and kidneys, heart problems, and death can occur.

Who gets bulimia?

Most people with bulimia are girls in their teens and young adult women. But boys can be bulimic, too. People with bulimia often have a hard time controlling impulses, stress, and anxieties. As with anorexia, people with bulimia aren't happy with their bodies and think they are fat. This leads to dieting. Then in response to anxiety and other emotions or hunger, they give in to their impulses and cravings for food by bingeing. People with bulimia may be underweight, overweight, or of average weight.

How are eating disorders treated?

The earlier an eating disorder is recognized, the higher the chances are of treatment working. Treatment depends on many things, including the person's willingness to make changes, family support, and the stage of the eating disorder.

Successful treatment of eating disorders involves a team approach. The team includes many health care professionals working together, each treating a certain aspect of the disorder. Treatment should begin with a visit to a pediatrician to see how the eating disorder has affected the body. If the effects are severe, the person may need medical treatment or even need to be hospitalized.

In treating anorexia, increasing the person's weight is crucial. If this person refuses to eat, hospitalization may be needed so that adequate nutrition can be ensured. People with bulimia also may need to be hospitalized to treat medical complications, replace needed nutrients in the body, or stop the cycle of bingeing and purging.

Counseling is an important part of treatment. Counseling helps people with eating disorders understand how they use food as a way to deal with problems and feelings. It helps them improve their self-images and develop the confidence to take control of their lives. Family therapy usually is needed to help family members understand the problem, how to be encouraging and supportive, and how to help manage the symptoms. Nutrition counseling with a registered dietitian also is recommended to assist patients and families in returning to healthy eating habits.

Living with an eating disorder is very hard on teens and their families! The wear and tear on the body is tremendous. Without help, a person with an eating disorder can have serious health problems, become very sick, and even die. However, with treatment, a person can get well and go on to lead a healthy life.

Where can I find more information?

  • National Eating Disorders Association


  • 800/931-2237

  • National Association of Anorexia Nervosa and Associated Disorders


  • 847/831-3438

Please note: Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this brochure. Phone numbers and Web site addresses are as current as possible, but may change at any time.

The persons whose photographs are depicted in this publication are professional models. They have no relation to the issues discussed. Any characters they are portraying are fictional.

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