Marin County Psychological Association
Marin County Psychological Association

Eating disorders

Author: Dr. Haleh Kashani

Eating disorders are psychiatric conditions with serious medical and psychological consequences. While eating disorders are progressive in nature and can be potentially life threatening, they are highly treatable with proper and timely treatment.  The main types of eating disorders are Anorexia Nervosa, Bulimia Nervosa and Binge eating disorder.

Eating disorders are often misunderstood as a choice rather than an illness.  For many, eating disorders starts with dieting and a desire to lose weight to be “healthy” or to feel better. Dieting and disordered eating habits such as skipping meals can gradually develop into a preoccupation with food and weight and eventually into an eating disorder.  No one knows why some people develop an eating disorder while others do not. Genetics, emotional issues such as anxiety and low self esteem as well as negative environmental and social influences by family, friends, sports, etc. are some of the variables that can place a person at risk to develop an eating disorder.

While the rate of disordered eating and body dissatisfaction is very high in our society, only 1-3% of the population develops an eating disorder. In America we spend over $40 billion, on dieting and diet-related products each year. 25% of American men and 45% of American women are on a diet on any given day. Most fashion models are thinner than 98% of American women. It therefore, would be no surprise to know that 80% of the American women are dissatisfied with their appearance.

The incidence of anorexia has doubled since the 1960s and incidence of bulimia tripled between 1988 and 1993. National statistics show that 1 in 5 women suffer from an eating disorder or disordered eating.  Up to 60% of college-aged students suffers from disordered eating, while 25% of college students and 11% of high school students are diagnosed with an eating disorder.

One study, at a Marin County high school in 2000, found that incidence of eating disorders is on the rise in our community and is at an alarming rate of nearly twice the national average, with approximately 52% of 9th grade female students suffering from some form of disordered eating, as compared to 28% of 14 year old girls nationally.

While eating disorders are most prevalent among adolescent girls and young women, (90 percent of women with eating disorders are between the ages of 12 and 25), eating disorders are on the rise among children, (ages 8 to 11); boys and men (10 to 15%); and middle-aged women. Rates of eating disorders among minorities are similar to those of white women and girls. Binge eating disorder has higher prevalence rate among men than other kinds of eating disorders ( 60% women and 40% men).

We are currently witnessing the rising tide of eating disorders among elementary school children, which has been very disturbing. This has coincided with the rise in obesity prevention and education. Young children are exposed daily to the dangers of being overweight. Given the concrete nature of a child’s mind, children may respond to this education in unintended ways and develop an intense fear of becoming overweight and an outcast. This fear can potentially lead to an eating disorder as they try to be “good” by avoiding all “bad foods”. Though unintended, such potential consequences need to be addressed and taken into consideration by parents as well as the educators and health professionals promoting obesity prevention education.

It is important to note, however, that despite the rise in incidence of eating disorders in the last 50 years, great strides have been made over the last decades in developing successful treatment approaches with adults, adolescents and children.
Eating disorders are treatable conditions and people can successfully recover, especially when it is detected early and treated during the first 6 months to a year from the onset of the illness.

Unfortunately, national statistics shows that still only one in ten seek and receive mental health care. If you find yourself often preoccupied with thoughts of food and weight, engage in under-eating or overeating and constantly scrutinize and criticize your body and size and shape, you may be struggling with an eating disorder and may benefit from consulting with a mental health professional specializing in treatment of eating disorders.

The followings are signs and symptoms of the three main types of eating disorders:

Signs and symptoms of Anorexia Nervosa:

  • Dramatic weight loss, extreme thinness and unwillingness to maintain healthy weight
  • Intense fear of weight gain and becoming fat despite being significantly underweight
  • Extremely restricted eating and denial of hunger
  • Distorted body image and unable to recognize seriousness of low weight
  • Self worth is based on thinness and maintaining low weight
  • Fear of eating in public, avoiding situations that involve food
  • Excessive, rigid exercise regimen
  • Changes in mood and interests with increased social isolation while becoming more preoccupied with food and exercise
  • Irritability, poor sleep, low energy, anxiety, depression, obsessive compulsive behaviors
  • Abdominal pain, constipation
  • Feeling cold
  • Dry skin
  • Hair loss
  • Low blood pressure and pulse and irregular heart beat
  • Dehydration with potential kidney failure
  • Risk of heart failure as blood pressure and heart rate sinks lower
  • Reduction in bone density and brittle bones (Osteoporosis)
  • Muscle loss and weakness

Signs and Symptoms of Bulimia Nervosa

  • Eating a large amount of food in a short period of time to the point of physical discomfort with feelings of guilt for overeating
  • Compensating for over eating by self induced vomiting, excessive exercise, dieting and fasting or use of laxatives, diuretics and diet pills
  • Distorted and negative body image
  • Excessive focus on body shape and self worth is unduly based on weight and size
  • Typically normal weight or somewhat overweight
  • Low self esteem
  • Feeling out of control with eating and use of bathroom after meals
  • Constant dieting
  • Damaged teeth and gums
  • Swollen salivary glands in the cheeks
  • Sores in the throat, mouth and break outs on the face
  • Menstrual irregularities of loss of menstruation for women
  • Constipation and chronic bowel problems due to laxative abuse
  • Electrolyte imbalance due to dehydration and loss of sodium and potassium with purging behaviors, which can lead to irregular heartbeat and heart failure
  • Inflammation and potential rupture of esophagus from repeated vomiting

Signs and Symptoms of Binge Eating Disorder

  • Eating an excessive amount of food in a short period of time with a sense of loss of control (binge) and continuing to eat long after uncomfortably full
  • Binging or overeating is experienced as pleasurable and an outlet and emotional release followed by a great sense of shame and disgust by the behavior
  • Binging is often kept a secret and is done alone
  • Low self esteem
  • Extremely negative body image and body hatred
  • Typically normal weight or overweight
  • Weight cycling and repeated dieting to lose the excess weight due to binging and regaining the weight
  • Binge eating is often associated with depression
  • Potential health consequences include high blood pressure, high cholesterol, diabetes, gall bladder disease, heart disease and musculoskeletal problems.


A team approach, consisting of trained mental health professional, registered dietitian and a physician is a required standard of care for treatment of eating disorders. Approaches such as cognitive behavior therapy, dialectic behavior therapy as well as specialized forms of family therapy (Family-Based Therapy) and group therapy are found to be highly effective methods of treatment.  Health At Every Size (HAES) is supported by research as the most effective approach to food and weight issues.

Education is essential in recovery from an eating disorder. When you are seeking treatment for an eating disorder for yourself or a family member it is important that you empower yourself by learning as much as possible about the many aspects of this very complex disorder and the recovery process. There are many reliable sources for information, education and support. 

The followings are list of some of the resources where you can learn more about eating disorders and treatment approaches:

Below are MCPA Members with specialties in this area:

Marin County Psychology Association (MCPA) provides this listing service for licensed psychologists who are current association members. The people on the list have entered and have direct control over what is posted. MCPA does not verify this information. We hope this service helps you find an appropriate psychologist to fit your needs.