Eating disorders are not a choice. They are complex illnesses with biological, psychological, and environmental causes. It is important to seek help as early in the disease process as possible to provide the best opportunity for recovery. CED Clinical Director Amy Pershing and CED Founder and Executive Director Judith Banker participated in a panel discussion on the causes and treatment of eating disorders sponsored by the Bright Nights Community Forum Depression Series of the University of Michigan Depression Center. To view the video online go to www.aadl.org/video/view/1065.   characteristics of Anorexia Nervosa: Individuals with anorexia nervosa are unwilling or unable to maintain a body weight that is normal or expectable for their age and height (most clinicians use 85% of normal weight as a guide). Individuals with anorexia nervosa typically display a pronounced fear of weight gain and a dread of becoming fat although they are dramatically underweight. Concerns and perceptions about their weight have a extremely powerful influence and impact on their self-evaluation. The seriousness of the weight loss and its physical effects is minimized or denied  (women with the diagnosis of anorexia nervosa have missed at least three consecutive menstrual cycles). Diagnostic criteria of anorexia nervosa include two subtypes of the disorder that describe two distinct behavioral patterns. Individuals with the Restricting Type maintain their low body weight purely by restricting food intake and increased activity (i.e. compulsive exercise). Those with the Binge-Eating/Purging Type usually restrict their food intake but also regularly engage in binge eating and/or purging behaviors (i.e. self-induced vomiting or the misuse of laxatives, diuretics or enemas). Binge-Eating/Purging Type of Anorexia Nervosa is also frequently associated with other impulse control problems and mood disorders.  People who suffer from anorexia often have low self-esteem and a tremendous need to control their surroundings and emotions. The eating disorder is often a reaction to external and internal conflicts (i.e. anxiety, stress, and unhappiness can be leading factors).   characteristics of Bulimia Nervosa: Individuals with bulimia nervosa regularly engage in discrete periods of overeating, which are followed by attempts to compensate for overeating and to avoid weight gain. There is variation in the nature of the overeating but the typical episode of overeating involves the consumption of an amount of food that would be considered excessive in normal circumstances. The bulimic is dominated by a sense of a lack of control over the eating. Binge eating is followed by attempts to undo the consequences of the binge though self-induced vomiting, misuse of laxatives, severe caloric restriction, diuretics, enemas, or excessive exercising, etc. The bulimic's self-evaluation is centered on the individual's perceptions of his/her body image. Concerns about weight and shape are characteristic of those with bulimia nervosa. The diagnostic criterion of bulimia nervosa requires that the individual not simultaneously meet criteria for anorexia nervosa. (If an individual simultaneously meets criteria for both anorexia nervosa and bulimia nervosa, only the diagnosis of Anorexia Nervosa, binge-eating/purging type is given.) The formal diagnosis also stipulates minimal frequency and duration cut-offs. The diagnosis requires that individuals must binge eat and engage in inappropriate compensatory behavior at least twice weekly for three months. There are also two subtypes of bulimia nervosa. The Purging Type describes individuals who regularly compensate for the binge eating with self-induced vomiting, laxative abuse, diuretics, or enemas. The Non-Purging Type is used to describe individuals who compensate through dietary fasting or excessive exercising.   characteristics of Binge Eating Disorder: Binge eating disorder is a relatively recently recognized disorder (it is sometimes referred to as compulsive overeating).  Some researchers believe it is the most common of the eating disorders affecting millions of Americans. Similar to bulimia nervosa, those with binge eating disorder frequently consume large amounts of food while feeling a lack of control over their eating. However, this disorder is different from bulimia nervosa because people with binge eating disorder usually do not purge (i.e. vomiting, laxatives, excessive exercise, etc) their bodies of the excess food they consume during a binge episode.    Eating Disorders Not Otherwise Specified (EDNOS): There are variants of disordered eating that do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa. These are still eating disorders requiring necessary treatment. A substantial number of individuals with eating disorders fit into this category. Individuals with eating disordered behaviors that resemble anorexia nervosa or bulimia nervosa but whose eating behaviors do not meet one or more essential diagnostic criteria may be diagnosed with EDNOS. Examples include: individuals who meet criteria for anorexia nervosa but continue to menstruate, individuals who regularly purge but do not binge eat, and individuals who meet criteria for bulimia nervosa, but binge eat less than twice weekly, etc. Being diagnosed as having an "Eating Disorder not Otherwise Specified" does not mean that you are in any less danger or that you suffer any less.   Sources: Eating Disorder Referral and Information Center, www.edreferral.com Academy for Eating Disorders American Psychiatric Association  (1998), Eating Disorders. Dept. of Health and Human Services (1987, 1995). Anorexia Nervosa and Bulimia. Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: American Psychological Association, 1994. Something Fishy Website on Eating Disorders http://www.something-fishy.org, Reprinted with permission