Dr. Jane Chang, MD

Anorexia nervosa, frequently referred to as anorexia, is a disorder where people severely restrict the types and quantity of food they eat. Those with anorexia have an extreme fear of eating and gaining weight and may repeatedly weigh themselves or engage in harmful behaviors such as excessive exercise or starvation. Those with anorexia often find themselves preoccupied with food, but unable to consume a healthy amount of it. This results in symptoms such as abnormally low BMI, vitamin deficiency, fatigue, fainting, and amenorrhea (lack of menstruation in women). Anorexia may cause bluish discoloration of the hands, brittle and falling out hair, yellowish skin, and lanugo (fine, downy hair). Left untreated, anorexia can lead to organ failure, brain damage, and even death.

Bulimia nervosa, typically called bulimia, is a disorder where people binge (eat large quantities of food) and purge the food that they just consumed by vomiting, laxative abuse, fasting, or excessive exercise. This behavior is usually motivated by a feeling of powerlessness over eating and a fear of weight gain or desire for weight loss. Bulimia can occur in underweight, normal weight, and overweight people. Symptoms of bulimia include acid reflux, intestinal distress, dehydration from purging, amenorrhea, and dental erosion from vomiting. Some people with bulimia have swollen parotid glands (salivary glands near the cheeks) and red scars and marks on the backs of their knuckles. Electrolyte imbalance from bulimia can be particularly severe and may lead to heart attack or stroke.

Binge eating disorder (BED) is the most common eating disorder. People with BED feel that they are unable to control the amount of food they eat and may continue to binge after reaching a point of fullness. BED binges (consuming large amounts of food) are often accompanied by feelings of sadness, guilt, and shame. Symptoms of BED include obesity, acid reflux, weight gain, and dissatisfaction with one's body. People with BED tend to experience cycles of negative emotions and binges. Binges or BED episodes can be provoked by stress, boredom, restrictive dieting, depression, and other triggers.

Other common eating disorders include:

• Pica, eating things that are not food, such as paper, ice, or soil
• Avoidant/Restrictive Food Intake Disorder (ARFID), disinterest in eating and avoidance of food
• Other Specified Feeding or Eating Disorder (OSFED), abnormal eating that does not fall under any disorder

Many people with eating disorders do not consciously develop them, and have difficulty seeking treatment. For this reason, it's important to detect and treat eating disorders as early as possible. Treatment for eating disorders can vary from therapy visits to inpatient treatment, depending on the disorder and its severity. Treatment aims to not only restore physical health and correct negative behaviors, but to also promote psychological well-being and self-confidence.

Healthcare providers are working to provide more inclusive care for people of all sexual orientations and identities. Some choose to address LGBT issues through procedures such as chest reconstruction, facial feminization surgery, masculinization surgery, and glottoplasty (surgery to raise the pitch of one's voice). Sensitive OB-GYN care and hormone therapy may also be options for people with LGBT issues.

LGBT therapy can also help people navigate LGBT issues and mental health problems. LGBT affirmative therapy specializes in creating "affirmative" spaces for people who are LGBT. LGBT affirmative therapists use patients' preferred pronouns, address homophobia and social biases, and act as LGBT advocates in their talk therapy sessions.