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Pediatric Eating Disorders

What are eating disorders?

The term eating disorders refers to a variety of conditions that involve abnormal eating behaviors. Eating disorders are serious mental health problems that can be life-threatening, so they require clinical care by a physician or other healthcare professional. Two of the most common eating disorders among adolescents and young adults are anorexia nervosa and bulimia nervosa.

What is anorexia nervosa?

Anorexia nervosa, also known as simply anorexia, is an eating disorder that involves self-starvation. Anorexia is characterized by the following main symptoms:

  • Low body weight (less than 85 percent of normal weight for height and age)
  • Distorted body image
  • Amenorrhea (absence of at least three consecutive menstrual cycles)
  • Intense fear of gaining weight

What is bulimia nervosa?

Bulimia nervosa, usually referred to as bulimia, is defined as uncontrolled episodes of overeating (bingeing) usually followed by purging (self-induced vomiting); misuse of laxatives, enemas, or medications that cause increased production of urine; fasting; or excessive exercise to control weight. 

In the case of bulimia, binging means eating much larger than normal amounts of food in a short period of time (usually less than two hours). Eating binges occur at least twice a week for three months and may happen several times a day.

Who gets anorexia and bulimia?

One out of every 100 females between the ages of 16 and 18 years old suffers from anorexia, and five to 10 percent of teens diagnosed with anorexia are males. Anorexia is found in across all socioeconomic groups and a variety of ethnic profiles.
The majority of bulimics are female, adolescent, and from a high socioeconomic group. Bulimia has been found in all westernized industrial countries, and it is estimated that 1 to 4 percent of females in the United States have bulimia.

Adolescents who develop bulimia are more likely to come from families with a history of:

  • Eating disorders
  • Physical illness
  • other mental health problems (ie., mood disorders or substance abuse)

In addition, teens with bulimia often have other mental health problems, such as anxiety or mood disorders. 

What are the dangers of anorexia?

Medical complications that may result from anorexia include, but are not limited to, the following:

Cardiovascular (heart)

While it is difficult to predict which anorexic patients might have life-threatening heart problems resulting from their illness, the majority of hospitalized anorexic patients have been found to have low heart rates. Myocardial (heart muscle) damage that can occur as a result of malnutrition or repeated vomiting may be life threatening. Common cardiac complications include the following:

  • arrhythmias (a fast, slow, or irregular heartbeat)
  • bradycardia (slow heartbeat)
  • hypotension (low blood pressure)

Hematological (blood)

An estimated one-third of anorexic patients have mild anemia (low red blood cell count), and leukopenia (low white blood cell count) occurs in up to 50 percent of anorexic patients.

Gastrointestinal (stomach and intestines)

Normal movement in the intestinal tract often slows down with very restricted eating and severe weight loss. Gaining weight and certain medications can help restore normal intestinal function.

Renal (kidney)

The dehydration often associated with anorexia results in highly concentrated urine. Polyuria (increased production of urine) may also develop in anorexic patients when the kidneys' ability to concentrate urine decreases. Renal changes usually return to normal when the patient returns to their normal weight.

Endocrine (hormones) 

In females, amenorrhea (cessation of the menstrual cycle for at least three consecutive months when otherwise expected) is one of the hallmark symptoms of anorexia. Amenorrhea often precedes severe weight loss and continues after normal weight is restored. In addition, some anorexic patients have reduced levels of growth hormones, which can help explain growth retardation. Normal nutrition usually restores normal growth.

Skeletal (bones)

Persons with anorexia are at an increased risk for skeletal fractures and broken bones. In addition, if the anorexic symptoms start before the patient has achieved peak bone formation (usually mid to late teens), the risk of osteopenia (decreased bone tissue) and/or osteoporosis (bone loss) increases. Anorexia patients often have low bone density and low calcium intake and absorption.

Can eating disorders be prevented?

Specific procedures or programs for preventing anorexia and bulimia have not been identified at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the adolescent's normal growth and development, and improve the quality of life. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful. 



Children's Team

Children's Team


Brooke Bokor

Brooke Bokor

Director, Adolescent Medicine Fellowship
Director, Student and Resident Education
Adolescent Medicine Specialist
Tomas Silber

Tomas Silber

Medical Director, Eating Disorders Clinic
Executive Committee, Ethics Program
Adolescent Medicine Specialist


Eating Disorders Clinic

The Eating Disorders Clinic treats adolescents and teens with eating disorders.

Psychology and Behavioral Health

In the Division of Psychology and Behavioral Health, our child psychologists and other mental health professionals work exclusively with children and teens, emphasizing patient and family-focused care.

Psychiatry and Behavioral Sciences

Psychiatry and Behavioral Sciences at Children’s National offers assessment, diagnosis and care for children and teens with behavioral, emotional and developmental disorders.

Bone Health Program

Orthopaedists at Children’s National offer world-renowned expertise and life-changing care, including surgery, for children at high risk for bone fracture.

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