Understanding eating disorders
Eating disorders are health conditions that affect someone’s relationship with food, including how you think about eating, weight and body image. These symptoms can impact your physical health, your mental health and ability to function in daily life. There are many types of eating disorders and anyone can develop one. Fortunately, there are many treatment options and with proper care, recovery is possible.
What are eating disorders?
Eating disorders are mental conditions that manifest in how you view food and eating. Symptoms can be different for each person and may be severe enough to become life-threatening. Often, eating disorders co-occur with other conditions, such as depression, anxiety, OCD and substance use disorders.
Most eating disorders involve unsafe eating behaviors, like binging on large amounts of food, restricting food intake or purging food you eat. Since these behaviors can limit the amount of nutrients your body receives, it can be harmful for the heart, digestive system, bones, teeth, mouth and more — which may lead to other diseases.1
An estimated 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime.2 They most often occur in women between the ages of 12 and 35.3 Though evidence suggests that genes and heredity impact why some people are at a higher risk for eating disorders, they can also develop in anyone regardless of family history.4
What are common signs of an eating disorder?
When it comes to recognizing the signs of an eating disorder, it’s important to remember that everyone’s symptoms will look different. And a person might show varying signs, ranging from a few signs to many. Here’s a list of some, but not all, symptoms to look out for if you suspect someone might be experiencing an eating disorder.
Behavioral
- Refusing meals or certain foods, or making excuses to avoid situations that involve eating
- Preoccupation with weight, food, body image, calories, dieting and eating
- Withdrawing from friends and family, becoming more isolated and secretive
- Food rituals, like excessive chewing, eating foods in specific orders, or pushing food around on their plate
- Frequent trips to the bathroom after meals, along with signs of vomiting
- Frequently checking the mirror or body
- Finding hidden food
Physical
- Noticeable fluctuations in weight gain and loss
- Cuts and calluses across the tops of knuckles, which may indicate self-induced vomiting
- Dizziness or fainting
- Stomach and GI issues, like cramps, constipation and acid reflux
- Dental problems
- Fine hair, called lanugo, on the body
- Fatigue
Causes and risk factors for eating disorders
While eating disorders can affect anyone, there are some risk factors that may increase someone’s likelihood of developing one. Some risk factors include having a close relative with an eating disorder or mental health condition, a history of dieting and type 1 diabetes.5 There are also psychological and social risk factors, including:
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Perfectionism
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Impulsivity
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Emotional dysregulation
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Body image issues
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Substance use disorder
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Weight stigmas
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Being teased or bullied
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Loneliness and social isolation
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Past trauma
Types of eating disorders
There are many types of clinically diagnosable eating disorders, as well as disordered eating patterns that do not meet the criteria for diagnosis. Both involve distorted attitudes toward food, weight and appearance, however eating disorders are complex mental illnesses that meet criteria listed in the DSM-5 TR.3
Here are some common eating disorders and their symptoms:
Anorexia is an eating disorder that may involve dramatic weight loss, restricted calorie intake, avoidance of specific foods, fear of gaining weight and distorted body image. It’s important to note that people struggling with anorexia may not appear underweight or thin.
There are two subtypes of anorexia: the restricting type and the binge eating and purging type. People may restrict weight through diet, fasting or excessive exercise — or any combination of behaviors. People that binge and purge might eat large amounts of food, followed by vomiting, taking laxities or excessive exercise. Other signs might be avoiding eating in public, obsessing about food, rigidity, dressing in layers and more. With time, anorexia can lead to thinning bones, infertility, heart or brain damage, organ failure and death.
Like anorexia, bulimia can be potentially life-threatening. It involves a cycle of bingeing — eating a large amount of food in a short period of time — followed by purging to compensate for the calories consumed and to ease discomfort.
Purging can look like forced vomiting, use of laxatives, diuretics and enemas, excessive exercise or another compensatory behavior to ‘undo’ the effects of bingeing.
People with bulimia often feel a sense of lack of control during the binge and symptoms can be very similar to binge eating or the binge and purge subtype of anorexia.
Over time, people may experience esophageal problems, worn tooth enamel and decay, acid reflux, heart problems, electrolyte imbalances, kidney issues and hormonal complications.
BED is usually characterized by rapidly eating large amounts of food in secret until uncomfortably full, despite not feeling hungry. In other words, a loss of control when eating food. Often, feelings of shame, guilt or disgust follow the episode.
People with BED don’t restrict calories or engage in purging, which makes it different from other types of eating disorders. They’re also at a higher risk for developing type 2 diabetes, polycystic ovary syndrome (PCOS), chronic pain, cardiovascular issues and more.
ARFID involves selective eating that’s different from picky eating or lack of food availability. People with AFRID reduce their intake of food due to uninterest, sensory issues, or fears of choking or vomiting. People who have ARFID commonly experience weight loss or poor development, nutritional deficiencies and interruptions to relationships and daily tasks.
Potential risks for someone with ARFID are similar to those with anorexia nervosa, which includes physical symptoms of starvation.
OSFED is used to describe feeding or eating disorders that cause distress, but don’t meet the full criteria for other disorders. Some examples of having OSFED include:
- Atypical anorexia nervosa: a type of anorexia that is often undiagnosed because people with atypical anorexia have a weight that's average or above average for their height
- Sub-threshold bulimia nervosa: bulimia that hasn't lasted as long or symptoms that occur less often, but which still results in a similar degree of distress
- Sub-threshold binge eating disorder: BED with less frequency of symptoms
- Purging disorder: an eating disorder with repeated purging behavior (self-induced vomiting, laxative and/or diuretic abuse) for weight loss, without binge eating
- Night eating syndrome: an eating disorder that involves eating most of your calories in the evening or at night, having difficulty sleeping and often waking up to eat
Pica is an eating disorder that involves eating things that aren’t considered food and provide no nutritional value. This could include things like hair, dirt, ice, paper, cloth and more. It’s important to note that this disorder is different from eating non-food substances as part of someone’s culture or religion.
Pica can affect anyone of any gender, and is often present in people that also live with intellectual disabilities, autism spectrum disorder, schizophrenia and more. People with pica may be at risk for poisoning, infections, GI complications or dental issues.
Rumination disorder is when a person consistently regurgitates food they’ve already chewed and swallowed, re-chewed, re-swallowed or spit out — usually right after a meal. It’s diagnosed if it occurs for at least a month, is not related to a medical condition and the behavior doesn’t happen within the context of another eating disorder.
If the disorder goes untreated, the person can be at risk for dangerous weight loss and severe malnutrition.
Treatment options and recovery
Recovering from an eating disorder can be a long road, sometimes taking months or even years. Treatment may include a combination of options — including psychotherapy, medications or nutritional counseling — with a team of professionals. Psychotherapy, also called talk therapy, can help with improving coping skills. Medications may be used with talk therapy to treat underlying mental health conditions, such as depression. The goal of nutritional counseling may be to work toward a healthy weight and learn healthy eating habits.
Treatment can vary in terms of setting, approach and level of care. Different levels of care include:
- Out-patient therapy — once-a-week counseling
- Intensive outpatient therapy — counseling sessions several times per week
- Inpatient therapy — hospitalization
The length of recovery may depend on the severity and duration of the eating disorder. Recovering from an eating disorder often includes treating medical issues and establishing a plan to help prevent relapse.
Finding support and resources
Looking to speak to someone about concerns for yourself or a loved one? Here are a few helplines that could be helpful:
National Association of Anorexia Nervosa and Associated Disorders (ANAD) helpline
A free eating disorders helpline for:
- Answers to questions
- Peer support
- Treatment referrals
Available Monday-Friday, 9am-9pm CT
National Alliance for Eating Disorders Helpline
A free eating disorders helpline run by licensed, specialized therapists for:
- Professional support
- Treatment referrals
Available Monday-Friday, 9am-9pm CT
Suicide and Crisis Lifeline
Call or text 988
For emotional distress or suicidal thoughts
- Available 24/7
- Confidential
- English and Español
Emergency services
Call 911
For immediate, life-threatening needs, including medical crisis, fire, crime or natural disasters
- Available 24/7
- English and Español