Information for Patients
What are eating disorders?
Eating disorders are serious mental health disorders. They involve severe problems with your thoughts about food and your eating behaviors. You may eat much less or much more than you need.
Eating disorders are medical conditions; they are not a lifestyle choice. They affect your body's ability to get proper nutrition. This can lead to health issues, such as heart and kidney problems, or sometimes even death. But there are treatments that can help.
What are the types of eating disorders?
Common types of eating disorders include:
- Binge-eating, which is out-of-control eating. People with binge-eating disorder keep eating even after they are full. They often eat until they feel very uncomfortable. Afterward, they usually have feelings of guilt, shame, and distress. Eating too much too often can lead to weight gain and obesity. Binge-eating disorder is the most common eating disorder in the U.S.
- Bulimia nervosa. People with bulimia nervosa also have periods of binge-eating. But afterwards, they purge, by making themselves throw up or using laxatives. They may also over-exercise or fast. People with bulimia nervosa may be slightly underweight, normal weight, or overweight.
- Anorexia nervosa. People with anorexia nervosa avoid food, severely restrict food, or eat very small quantities of only certain foods. They may see themselves as overweight, even when they are dangerously underweight. Anorexia nervosa is the least common of the three eating disorders, but it is often the most serious. It has the highest death rate of any mental disorder.
What causes eating disorders?
The exact cause of eating disorders is unknown. Researchers believe that eating disorders are caused by a complex interaction of factors. These include genetic, biological, behavioral, psychological, and social factors.
Who is at risk for eating disorders?
Anyone can develop an eating disorder, but they are more common in women. Eating disorders frequently appear during the teen years or young adulthood. But people can also develop them during childhood or later in life.
What are the symptoms of eating disorders?
The symptoms of eating disorders vary, depending on the disorder:
The symptoms of binge-eating include:
- Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
- Eating even when you're full or not hungry
- Eating fast during binge episodes
- Eating until you're uncomfortably full
- Eating alone or in secret to avoid embarrassment
- Feeling distressed, ashamed, or guilty about your eating
- Frequently dieting, possibly without weight loss
The symptoms of bulimia nervosa include the same symptoms as binge-eating, plus trying to get rid of the food or weight after binging by:
- Purging, making yourself throw up or using laxatives or enemas to speed up the movement of food through your body
- Doing intensive and excessive exercise
Over time, bulimia nervosa can cause health problems such as:
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel and increasingly sensitive and decaying teeth. This is caused by the exposure to stomach acid every time you throw up.
- GERD (acid reflux) and other gastrointestinal problems
- Severe dehydration from purging
- Electrolyte imbalance, which could be too low or too high levels of sodium, calcium, potassium and other minerals. This can lead to a stroke or heart attack.
The symptoms of anorexia nervosa include:
- Eating very little, to the point of starving yourself
- Intensive and excessive exercise
- Extreme thinness
- Intense fear of gaining weight
- Distorted body image - seeing yourself as overweight even when you are severely underweight
Over time, anorexia nervosa can cause health problems such as:
- Thinning of the bones (osteopenia or osteoporosis)
- Mild anemia
- Muscle wasting and weakness
- Thin, brittle hair and nails
- Dry, blotchy, or yellowish skin
- Growth of fine hair all over the body
- Severe constipation
- Low blood pressure
- Slowed breathing and pulse
- Feeling cold all the time because of a drop in internal body temperature
- Feeling faint, dizzy, or weak
- Feeling tired all the time
- Damage to the structure and function of the heart
- Brain damage
- Multiorgan failure
Anorexia nervosa can be fatal. Some people with this disorder die of complications from starvation, and others die of suicide.
Some people with eating disorders may also have other mental disorders (such as depression or anxiety) or problems with substance use.
How is eating disorders diagnosed?
Because eating disorders can be so serious, it is important to seek help if you or a loved one thinks that you might have a problem. Your health care provider may use many tools to make a diagnosis:
- A medical history, which includes asking about your symptoms. It is important to be honest about your eating and exercise behaviors so your provider can help you.
- A physical exam
- Blood or urine tests to rule out other possible causes of your symptoms
- Other tests to see whether you have any other health problems caused by the eating disorder. These can include kidney function tests and an electrocardiogram (EKG or ECG).
What are the treatments for eating disorders?
Treatment plans for eating disorders are tailored to individual needs. You will likely have a team of providers helping you, including doctors, nutritionists, nurses, and therapists. The treatments may include:
- Individual, group, and/or family psychotherapy. Individual therapy may include cognitive behavioral approaches, which help you to identify and change negative and unhelpful thoughts. It also helps you build coping skills and change behavioral patterns.
- Medical care and monitoring, including care for the complications that eating disorders can cause
- Nutrition counseling. Doctors, nurses, and counselors will help you eat healthy to reach and maintain a healthy weight.
- Medicines, such as antidepressants, antipsychotics, or mood stabilizers, may help treat some eating disorders. The medicines can also help with the depression and anxiety symptoms that often go along with eating disorders.
Some people with serious eating disorders may need to be in a hospital or in a residential treatment program. Residential treatment programs combine housing and treatment services.
NIH: National Institute of Mental Health
General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.
Index of Diseases and Injuries Definitions
- And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
- Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
- Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
- Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
- Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
- NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
- See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
- See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
- 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
- With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.