Columbia University Health Services

Eating disorders are not about food, but food is what people with eating disorders abuse. 

The term “eating disorders” refers to anorexia nervosa, bulimia nervosa, and binge eating. These syndromes are characterized by extreme disruptions in eating and intense anxiety over body weight and appearance. Sometimes these disorders can overlap. 

Eating disorders are psychological disorders which have physical manifestations. In fact, severe medical complications which can sometimes even be life-threatening occur. 

There are also behavior patterns involving more than one eating disorder, for example, binge eating alternating with periods of food restriction as seen in anorexia. 

People with eating disorders often know the caloric value of foods, read food labels obsessively, and keep records of food intake, often overestimating their daily calories. Many rituals may surround eating, such as cutting foods a specific number of times or eating foods in a particular order. Secrecy and lying are frequently used to shield an eating disorder. Like eating patterns, exercising may become compulsive, with strict adherence to a particular schedule. Severe anxiety results when a schedule or pattern is disrupted. 

The medical evaluation of someone with an eating disorder must be individualized. 

Medical Complications

Disordered eating can result in serious physical consequences: 

Hormones help regulate many functions of the body: 

• In women, irregular periods or no periods can be a warning sign of serious hormonal disturbance. Sometimes “secondary sex characteristics” like an adult distribution of pubic hair and complete breast development can be impaired. Fertility can be reduced.
• Low estrogen affects bone metabolism leading to “osteopenia” (a moderate decrease in bone mass) and “osteoporosis” (severe decrease in bone mass). The normal balance between the breakdown of old bone and the formation of new bone is disrupted. Bones are weak. Stress fractures and other complications follow.
• There is an overall decrease in the body’s metabolism, sometimes reflected in low thyroid hormone levels. 

The Digestive System

With repeated vomiting, stomach acids can erode the lining of the throat and cause ulcerations and, even worse, esophageal rupture. Vomiting can also cause swelling of the salivary glands and erosion of tooth enamel. Changes in the function of the stomach, like delayed stomach emptying can cause feelings of fullness and bloating (often interpreted as “feeling fat”). Constipation is due to not enough food intake and not enough fiber. Laxative abuse can cause alternating constipation and diarrhea, causes alternating constipation and diarrhea, malabsorption of essential nutrients, bowel inflammation, and fluid and electrolyte imbalance. 

Neurological problems

Extreme weight loss and malnutrition can affect how the brain functions causing poor concentration, apathy, slowed processing and what’s known as “semi starvation neurosis”, where one’s perception of the world is distorted. 

The Liver

One third of people with eating disorders will have an enlarged liver. Inflammatory changes can also take place causing some of the enzymes the liver produces to be abnormally elevated in the blood. Normal liver storage supplies of sugar complexes become depleted and severe low blood sugar (hypoglycemia) can result. 

The Kidney

Kidney damage can lead to impaired ability of the body to remove toxins from the blood. Abnormal electrolyte levels can occur which can lead to dehydration.

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Counseling and Psychological Services (CPS) supports the psychological and emotional well-being of the campus community by providing counseling, consultation, and crisis intervention. For more information go to Making Appointments. 

Eating Concerns Support
A group for women with problematic behaviors associated with food. For more information go to Workshops, Groups, and Training.

Primary Care Medical Services (PCMS) provides comprehensive care for routine, urgent, and chronic medical needs for students. Primary Care also provides sexual health, reproductive, and gynecological services, LGBTQ health care, immunizations, and referrals. For more information go to Making Appointments. 

Eating Disorders Team
Students struggling with an eating disorder should contact Health Services at Columbia as a resource. Following national standards for excellent eating disorder care, Health Services at Columbia has for over a decade maintained a multidisciplinary team of experts, comprised of physicians, nurse practitioners, nurses, psychologists, and a registered dietician. The team works together to establish a treatment plan for each student. For more information go to Making Appointments.