Eating disorders are mental health conditions defined by severe and harmful eating behaviors. Possible symptoms include excessive concern about one's weight or body shape, eating too much or too little, and controlling one's eating patterns.
In the United States, approximately 28.8 million people will experience symptoms of an eating disorder at some point in their lives, but the majority of them do not receive treatment. Eating disorders can affect people of all ages, genders, and weights, although they are more common among those aged 12 - 35, especially women. One in eight people will experience at least one eating disorder before the age of 20.
The complications caused by eating disorders can be severe and even life - threatening. Although many people can fully recover, it often takes a long time. Treatment usually includes psychotherapy and nutritional counseling. Ongoing support is a crucial aspect of recovery and long - term health.
Eating disorders are characterized by significant changes in eating behaviors, but the manifestations vary depending on the type and the individual. Anorexia nervosa, bulimia nervosa, binge eating disorder (BED), and avoidant/restrictive food intake disorder (ARFID) are the most common eating disorders.
Anorexia nervosa, often simply called anorexia, is the most well - known eating disorder and has the highest mortality rate among all mental health disorders. People with anorexia may avoid eating, severely restrict their food intake, or eat only extremely small amounts of food.
There are two subtypes of anorexia:
Restricting: Strictly restricting food intake and sometimes engaging in excessive physical activity.
Binge - Eating/Purging: Severely restricting food intake, as well as binge - eating and purging (eating a large amount of food in a short time and then vomiting or using laxatives, diuretics, or diet pills).
If you have anorexia, you may perceive yourself as overweight (even if you are underweight), weigh yourself frequently, and have an intense fear of weight gain. Other characteristics of anorexia include extremely low body weight, excessive physical activity, excessive focus on food, weight, and thinness, a distorted body image, and behaviors similar to obsessive - compulsive disorder (OCD), such as always using the same cutlery or cutting food into very small pieces.
Due to nutritional deficiencies, anorexia can lead to a series of physical health problems, such as sarcopenia (muscle loss), hypotension (low blood pressure), infertility, brittle hair and nails, and eventually multiple organ failure.
Bulimia nervosa is more common than anorexia nervosa. People with bulimia nervosa (simply called bulimia) may eat a large amount of food at one time and feel unable to control their eating. They may try to avoid weight gain by forcing themselves to vomit, using laxatives or diuretics, fasting, or overexercising.
Many people with bulimia experience symptoms caused by purging behaviors, including a sore and inflamed throat due to self - induced vomiting, swollen salivary glands in the neck and jaw, sensitive or decayed teeth due to vomiting, gastrointestinal problems such as acid reflux, and severe dehydration or electrolyte imbalance. People with bulimia may have different body weights, while those with anorexia are usually underweight.
Binge eating disorder (BED) is the most common eating disorder in the United States. It is characterized by sudden episodes of binge - eating and a lack of control.
Unlike bulimia, people with BED do not try to prevent weight gain by vomiting, exercising, or fasting. Many people with BED have a larger body size and may be overweight or obese. More than one - third of people with BED are male.
Symptoms of BED include eating a large amount of food in a short time, eating even when feeling full or until feeling overly full, feeling out of control during a binge - eating episode, and trying to hide eating habits due to shame or embarrassment.
People with avoidant/restrictive food intake disorder (ARFID) severely limit the variety or amount of food they eat, resulting in weight loss or an inability to maintain the expected weight gain (in children). ARFID most commonly affects children under 7 years old but can persist into adulthood.
ARFID is different from typical childhood picky eating because it leads to significant weight loss and malnutrition. It does not include food restrictions due to religious or other reasons (such as following a vegan diet).
Symptoms of ARFID include a lack of interest in food, loss of appetite, a strong dislike of certain textures, tastes, smells, or colors of food, gradually worsening "picky eating", significant weight loss, and gastrointestinal problems such as nausea or abdominal pain.
Pica and rumination disorder are two other types of eating disorders.
Pica is characterized by a craving to eat non - food items such as dirt, paper, or soap. Many children and pregnant women may have this symptom, but it usually resolves on its own. People with intellectual disabilities may also develop this symptom and it may become chronic.
Rumination disorder is the regurgitation, chewing, and then swallowing or spitting out of food that has already been swallowed. If it occurs in infancy, the symptom usually resolves on its own, but it can also appear in older children and adults.
In addition, some eating disorders fall into the general diagnostic category of "Other Specified Feeding and Eating Disorders (OSFED)", which includes:
Purging Disorder: Trying to control weight by vomiting, overexercising, or using laxatives or diuretics (without binge - eating).
Night Eating Syndrome: Binge - eating after waking up in the middle of the night.
Orthorexia Nervosa: An obsession with "healthy" and "clean eating" (such as avoiding processed foods), including compulsively reading food labels and excluding entire food categories. Currently, orthorexia nervosa has not been officially classified as a separate eating disorder, but research shows that it is often accompanied by obsessive - compulsive disorder.
Everyone's experience is unique, but certain signs may indicate the presence of an eating disorder.
Include dry skin, thinning hair, brittle nails, fine body hair (lanugo), muscle weakness, dizziness, and edema in the feet.
Cover excessive concern about food or weight, refusal to eat certain foods, unusual eating habits (such as strange food combinations, cutting food into small pieces), overexercising, vomiting or using laxatives, diuretics, or diet pills after eating, feeling uncomfortable about one's eating behavior, avoiding eating in social situations, and mood swings.
Although anorexia nervosa is the most common eating disorder, few people with eating disorders meet the criteria of "underweight" (BMI below 18.5). On the contrary, people with a higher BMI have a greater risk of developing an eating disorder and are also more likely to experience weight discrimination in the medical field.
The symptoms of eating disorders vary from person to person, and sometimes healthcare providers may have difficulty identifying them. For example, people from BIPOC (Black, Indigenous, and People of Color) populations are about 50% less likely to be diagnosed with an eating disorder and are also less likely to receive treatment.
If you think you or someone you know may need help, contact a healthcare provider. They can refer you to a mental health provider who specializes in eating disorders, as well as other support professionals such as a registered dietitian (RD).
Body Mass Index (BMI) is a biased and outdated indicator that uses your weight and height to estimate body fat and, consequently, your health status. This indicator has many flaws and does not consider factors such as body composition, ethnicity, gender, race, and age. Despite its limitations, the medical community still uses BMI because it is a cheap and fast method of analyzing health data.
The specific causes of eating disorders are not clear. It seems to be the result of a combination of biological, psychological, and social factors. These may include:
A family history of eating disorders.
Serotonin levels in the brain, which is a hormone that helps regulate appetite and mood.
A history of dieting or a negative energy balance (consuming more calories than ingested, such as during intense exercise training).
Psychological patterns such as perfectionism, impulsivity, neuroticism, inflexibility, and harm avoidance.
Childhood experiences such as bullying and sexual abuse.
Acculturation (assimilating into Western culture, including its social norms).
Exposure to the "thin" social ideal and weight discrimination.
Some people are at a greater risk of developing an eating disorder. For example:
Women are five times more likely to be diagnosed with an eating disorder than men.
Asian American college students are more likely to report food restriction behaviors and body dissatisfaction than non - Asian students.
LGBTQ+ individuals are about three times more likely to develop an eating disorder than heterosexuals.
Transgender college students are four times more likely to be diagnosed with an eating disorder than cisgender students.
People with eating disorders are more likely to have other mental health problems, including mood disorders such as anxiety disorders, obsessive - compulsive disorder, and Attention Deficit Hyperactivity Disorder (ADHD).
Athletes are more likely to overexercise and use eating - related behaviors to lose or maintain weight. However, the fear of stigma and other sport - related barriers may prevent them from seeking treatment.
In addition, weight discrimination can affect a person's self - esteem and body image, leading to disordered eating habits. This can occur in families, among peer groups, and also in the healthcare system. Reducing the emphasis on weight can help encourage people to have a healthier relationship with food.
The goals of treating eating disorders include restoring nutritional levels, reducing excessive physical activity, changing unhealthy eating behaviors, and treating co - occurring mental health conditions and Substance Use Disorders (SUD).
If you suspect that you or a loved one has an eating disorder, it is essential to seek treatment as early as possible to prevent further complications. Treatment of eating disorders usually includes psychotherapy, nutritional counseling, medical care, and medication.
Psychotherapy (talk therapy) or psychobehavioral therapy is the main method for treating eating disorders and related mental health conditions. It is usually conducted in an outpatient (day treatment) setting, but it can also be part of an inpatient (overnight) treatment program.
Mental health professionals may use different types of psychotherapy depending on the patient and their diagnosis, including:
Cognitive Behavioral Therapy (CBT): Focuses on identifying negative or destructive thought patterns and replacing them with more beneficial thoughts and behaviors.
Enhanced Cognitive Behavioral Therapy (CBT - E): A form of CBT that focuses on eliminating the beliefs and behaviors of eating disorders and helping people maintain changes in the long term. CBT - E is usually the main treatment method for all eating disorders.
Family - Based Treatment (FBT): Usually used to treat children and adolescents with anorexia nervosa. The treatment involves the active participation of family members.
Interpersonal Psychotherapy: Focuses on interpersonal relationships and social functioning. It may be used to treat bulimia nervosa or binge eating disorder.
Dialectical Behavior Therapy (DBT): Combines CBT with other elements such as mindfulness and emotion regulation and may also be effective in treating eating disorders.
Nutritional counseling is usually a core part of the treatment of eating disorders. The goals depend on the diagnosis and the individual's situation. For example, for a person with anorexia nervosa, the goals may include gradually increasing weight and restoring vitamins and minerals through a step - by - step refeeding process and monitoring electrolytes.
Combining nutritional counseling with psychotherapy can reduce the risk of relapse. Relapse refers to the recurrence of symptoms after a period of remission, which is quite common in eating disorders.
For severe eating disorders, inpatient treatment may be recommended or required. If an eating disorder leads to severe health complications, a healthcare provider may recommend medical care and monitoring.
Reasons for inpatient medical care may include a weight loss of more than 30%, persistent suicidal thoughts, or no response to outpatient treatment. People with anorexia nervosa most often require medical care. For example, a person with severe anorexia nervosa may need refeeding due to malnutrition, and the refeeding process requires specific strategies and monitoring.
Based on the diagnosis, a healthcare provider may recommend medication. They may also recommend medication to treat other mental health problems, such as antidepressants, antipsychotics, or mood stabilizers. Addressing underlying issues can help in the recovery from eating disorders.
Currently, the antidepressant Prozac (fluoxetine) is the only FDA - approved medication for treating binge eating disorder and bulimia nervosa. Research is still ongoing to evaluate the possible efficacy of this drug for other eating disorders.
If a friend or family member has an eating disorder, your support is crucial for their recovery. Treating eating disorders can be very challenging, which is why a support network is so valuable.
To support someone with an eating disorder, you can:
Learn as much as possible about eating disorders.
Listen with empathy and avoid judgment.
Be clear, honest, and also empathetic, for example, using "I" statements.
Monitor any behaviors that concern you.
Eat together in a supportive and non - judgmental way.
Offer to help them find a treatment provider.
During the support process, it is necessary to respect their boundaries. This can be an emotional experience, but try to focus on the facts and be prepared for some negative reactions.
You can encourage them to seek support, although this may be difficult for someone with an eating disorder. If you are worried that this person's life may be in danger, you may need to tell someone else.
The NEDA website contains information about free and low - cost support options, including groups and mentors. You can also call the SAMHSA Treatment Referral Helpline at 1 - 800 - 662 - HELP (4357) for support.
The risks and complications of eating disorders vary, but they can all have serious health consequences. Possible complications include:
Cardiovascular Diseases: Such as arrhythmia (irregular heartbeat), heart disease, and stroke.
Digestive System Diseases: Such as blood sugar fluctuations, intestinal obstruction, pancreatitis, and infection.
Anemia: A reduction in the number of red blood cells or hemoglobin, which is a protein that helps red blood cells transport oxygen.
Cognitive Deficits: Especially in memory and attention.
Type 2 Diabetes: A disease that occurs when the body cannot use insulin properly.
Eating disorders can delay puberty, cause developmental delays in children and adolescents, lead to amenorrhea (missing three or more consecutive menstrual periods) and osteoporosis (reduced bone density), and affect fertility.
Eating disorders can eventually lead to life - threatening multiple organ failure. Among them, people with anorexia nervosa have the highest risk of death compared to those with other eating disorders due to the risks of starvation and suicide. Therefore, it is essential to seek treatment as early as possible and support the recovery of loved ones.
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 988 or 1 - 800 - 273 - TALK (8255), or text "TALK" to 741 - 741 to reach the Crisis Text Line.
The prevention of eating disorders usually focuses on children and adolescents. Prevention programs (such as those in schools) can help build self - esteem, reduce the pressure to conform to an ideal body image, and change dieting behaviors.
Developing a comprehensive eating habit is crucial for preventing eating disorders, especially for young people. This includes:
Choosing foods rich in a variety of nutrients rather than just focusing on low - calorie foods.
Exercising to build strength and improve cardiovascular health.
Establishing and supporting healthy eating behaviors when eating with family and friends.
Avoiding dieting around children.
Not making fun of others' weight or eating habits.
Intuitive eating is also a useful strategy for developing healthy eating habits. Intuitive eating means listening to the body's hunger and fullness signals, eating nutritious foods that you like, and not restricting any foods. For example, if you are considering eating a piece of cake, you can ask yourself how much you like the cake, how your body will feel after eating it, and how much cake will satisfy you.
Research shows that intuitive eating can reduce eating disorder behaviors, while dieting can increase them.
If you think you or someone you are taking care of may have an eating disorder, contact a healthcare provider. Early treatment of eating disorders is very important to prevent further complications. If you have concerns, talk to your primary care provider about your experience. They can help you contact a mental health provider.
The NEDA website has screening tools for people aged 13 and above and a directory of treatment providers.
Eating disorders encompass a range of mental health conditions that can have serious impacts on health. They are characterized by disordered eating behaviors, but the symptoms vary from person to person.
Psychotherapy and nutritional counseling are key aspects of treatment. In more severe cases, medication may be required. Most people with bulimia nervosa recover within 10 years, but only about half of those with anorexia nervosa recover during this period. Relapse is more common after more than one inpatient admission.
Eating disorders can be fully recovered from, but the prognoses vary, and the recovery process is usually slow. Early treatment and the support of loved ones are crucial for recovery and preventing serious complications.
