What You Need To Know About Eating Disorders

Types of eating disorders

What is an eating disorder?

Eating disorder refers to prolonged and unhealthy behaviors associated with food, thoughts, and emotions about food. Eating disorders can range in their severity, and these damaging behaviors create a harmful relationship between a person and their body image, eating habits, and exercise routines.

While we all can experience some form of unhealthy eating from time to time, someone with an eating disorder may experience an overwhelming obsession with their weight and food intake. They may tend to talk about food and their body appearance more often and may feel ashamed, guilty, or overly controlling about their eating habits.

The most significant difference between wanting to lose weight or worrying about your weight versus having an eating disorder is what actions you take to achieve that goal. Healthy behaviors would include a long-term plan that is focused on health and wellbeing in a balanced way. This can include recommended sizes, good nutrition, a regular exercise routine, and a healthier mindset. On the other hand, a person with an eating disorder will often go to extremes to achieve weight loss, even if they're of average weight or underweight.

The different types of eating disorders include:

  • Anorexia nervosa

  • Bulimia nervosa

  • Binge eating disorder

  • Pica

  • Rumination disorder

  • Avoidant restrictive food intake disorder (ARFID) 

Anorexia nervosa

A type of eating disorder where a person consumes a dangerously low daily food intake has an extreme fear of gaining weight and has a negative view of their body and appearance. Anorexia nervosa can cause an individual to overeat then immediately purge (such as vomiting, taking laxatives, or excessive exercise), starve themselves by not eating enough, or exercise excessively to burn off more calories than they consume.

Bulimia nervosa

Someone suffering from bulimia experiences cycles of binge-eating in which they consume a large amount of food in a short period of time. This is followed by purging to get rid of the food they've taken in, such as vomiting, taking laxatives, or excessive exercise. These actions are often uncontrollable and connected to intensely negative body image or body dysmorphia where you see your body differently from how it really is. 

Binge eating disorder

As with bulimia, a person with a binge eating disorder consumes a large amount of food in a short period of time, until they're so full that it's uncomfortable. They can also have binging episodes when they're not hungry. Unlikely bulimia, a binge-eater does not take any extreme measures to purge the food they've eaten. This disorder comes with feelings of shame, guilt, and embarrassment. 

Pica

Pica refers to a person’s uncontrollable need to eat non-food items that provide no nutritional value. Common examples include eating clay, soap, hair, pebbles, and metal. The condition must persist longer than a month to be diagnosed as having this disorder.

Rumination disorder

Rumination disorder is an eating disorder in which a person either spits out undigested or partially digested food between 10 and 30 minutes after every meal. They either swallow and regurgitate it, or spit it out instead of swallowing. The cause behind this eating pattern has not yet been identified. 

Avoidant restrictive food intake disorder (ARFID)

A common eating disorder among very picky eaters, ARFID refers to the avoidance of food to the extent that the person cannot meet their nutritional needs. This disorder does not include cultural or religious practices or cases where food availability is low. People with AFRID often struggle with food avoidance due to low appetite, sensory characteristics (look, smell, texture), or extreme fear of what might happen if they eat food (choking, allergy, vomiting).

Symptoms

As each eating disorder has the potential to lead to fatal consequences, it's critical for a person with an eating disorder to seek the right support and treatment as soon as possible. This is important for preventing further damage and correcting disordered habits before they become much more challenging to overcome. With eating disorders, the earlier the intervention the better.

Signs that you or someone you love may have an eating disorder can be identified as physical and psychological symptoms.

Common physical symptoms include:

  • Weight fluctuations

  • Not getting enough sleep

  • Difficulty focusing

  • Weak muscles

  • Fine skin and hair 

  • Dizziness 

  • Gastrointestinal issues (such as stomach cramps, constipation, acid reflux, bloating, and heartburn)

Common psychological symptoms include:

  • Extreme focus on food, weight loss, and body image

  • Extreme change in diet and exercise (such as excessive exercising or under/overeating)

  • Mood swings

  • Obsession with your/their appearance

While many eating disorders share similar symptoms, the following are specific to each disorder:

  • Anorexia — weight loss, dehydration, low blood pressure and body temperature, underweight/very thin, social isolation, headaches, and often feeling cold

  • Bulimia — weight loss, fatigue, bad breath, cavities, constipation, heartburn, self-harm, and sore throat

  • Binge eating — weight gain, overweight/obese, uncontrollable eating, frequent dieting, and extreme feelings of depression, guilt, and upset about eating patterns

  • Pica — nausea, constipation, malnutrition, diarrhea, stomach pains and ulcers, risk of lead poisoning, and dental issues

  • Rumination disorder — unintentional weight loss, bad breath, nausea, feeling full, and involuntary regurgitation (spitting food back up after a meal)

  • ARFID — difficulty gaining weight, extreme food restrictions, delayed growth, malnutrition, unexpected refusal to eat foods eaten in the past, and problems eating with other people

Both physical and mental health are affected by an eating disorder. Eating disorders can cause a sufferer to struggle with anxiety, depression, stress, mood swings, self-harming/suicidal thoughts, and self-esteem issues. Physically, they can experience tooth decay, extreme weight loss/weight gain, dry and yellowish skin, and brittle hair and nails. 

In severe cases, the disorder can even become fatal so it is essential to seek treatment as soon as signs or symptoms develop. According to Good RX,¹ 10% of people with eating disorders will die from their illness, with anorexia having the highest death rate of any mental health condition. If you or someone you know is experiencing any of these symptoms, you should consult your doctor.

Causes

Many risks and factors are at play that can cause a person to develop an eating disorder. Causes include genetics, personality traits such as perfectionism, biological differences in serotonin production, social and cultural pressure to be specific body size, and social media. Other risk factors include age, history of dieting, psychological health, and lifestyle factors such as diet and exercise.

Genetics/family history

According to the U.S. National Library of Medicine,¹ family studies were conducted which found that eating disorders were 7 to 12 times more prevalent among relatives of women who have anorexia and bulimia. The report also saw an increase in similar eating disorder liabilities between twins in a separate twin study, supporting the theory that genetic factors play a role.

Personality traits

Certain personality traits increase a person’s likelihood of developing an eating disorder, such a perfectionism or seeking control. Perfectionists often set very high and unrealistic expectations for themselves, increasing their odds of developing an eating disorder as they try and meet those expectations.

Differences in serotonin production

According to studies reported by Eating Disorder Review,² several studies have linked abnormal serotonin levels in the brain with the development of an eating disorder.

Social and cultural pressure on body image

We can internalize many messages coming from social and cultural influences, and in the media, about what the ideal body looks like. Many people struggle with the expectations to live up to these unrealistic beauty standards and engage in harmful behaviors to try to attain them.

Social media

Many studies, including those reported by Science Direct,³ have shown a strong correlation between social media use and body image issues and eating disorders. We see messages communicated through social media on a daily basis about diet, exercise, and beauty. Both women and men can feel the pressure of living up to altered/photoshopped images, leading to unhealthy comparisons resulting in negative body image.

Age

Eating disorders most commonly appear in adolescence and early adulthood but they can happen at any age.

A history of dieting

People with a history of dieting are more likely to take unhealthy measures to achieve their goals and develop an eating disorder.

Mental health issues

A person with an eating disorder often suffers from other mental health issues like anxiety, depression, and obsessive-compulsive disorders.

Lifestyle

Lifestyle factors, such as professional or amateur sports, can also affect a person’s chances of developing an eating disorder, since they may be required to meet a weight limit or have a specific physique. Studies have shown that athletes report higher rates of excessive exercise⁴ than those who do not participate in sports.

Diagnosis

There are several ways an eating disorder can be diagnosed, but the most common are:

  • Physical exams

  • Tests to rule out other conditions

  • Psychological evaluation

  • Based on the criteria provided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

Treatments

Eating disorder treatments vary by person, conditions, and circumstances. The most common treatment prescribed for eating disorders is psychotherapy with a mental health professional. This can come in the form of family-based treatment (FBT) or cognitive behavioral therapy (CBT).

FBT works with the strong bond and love between family members to offer support and care to someone with an eating disorder to help them recover. CBT is a treatment that consists of 20 sessions with a mental health professional involving goal-setting, evaluations, understanding their disorder, tracking progress, facing their fears, and meal planning.

When identified early, FBT or CBT may be the only treatment a person with an eating disorder needs to recover. However, prolonged and more severe cases may require hospitalization and medication.

Hospitalization is common among people who are severely malnourished and need immediate attention to prevent serious consequences like organ failure or death.

Hospitalization is often followed by medication to help manage symptoms. Medication is also commonly prescribed even if a person has not been hospitalized. Managing symptoms is essential for improving quality of life and guiding someone through the recovery process as easily and comfortably as possible.

Support from family and friends who recognize the signs and stage an intervention can also be valuable. If you notice red flags in a loved one, like obsessive behavior, substantial weight loss/weight gain, health decline, and changes in their mental health and behaviors, make sure to take steps to immediately address the problem.

The first step to recovery is recognizing you have a problem. Make sure to seek support from family and friends. It can also be helpful to include a mental health professional.

Prevention

While eating disorders can't be prevented, developing healthy eating habits from an early age can make a significant difference to whether and to what extent you may develop an eating disorder. Young people are most at risk of developing an eating disorder. They are also more likely to show more severe signs and symptoms. However, eating disorders also commonly develop in adults.

If you have a healthy relationship with food, you are significantly less likely to engage in disordered eating behaviors. On the other hand, if you have been dieting your whole life, you are more likely to go to extremes to achieve better results.

You can help children develop a healthy relationship with food and have a positive body image by:

  • Getting them more involved in meal processes like planning, shopping, and preparation. 

  • Avoiding terms like "good food" and "bad food" when discussing meals. For instance, fruit shouldn't be categorized as "good," while desserts are classified as "bad." This sets the stage for good/bad categorizations that can become obsessive and harmful. 

  • Being a role model by eating a balanced, varied diet, being weight neutral and not complaining about your own weight, and never showing guilt/shame for eating desserts and other foods. 

  • Eating together as a family as often as you can. Family meals create a supportive space where you can develop healthy eating habits. For instance, people tend to eat more mindlessly in front of the TV¹ than with family at a dining table. 

Being a good role model to your children begins with improving your own relationship with food and your body image. More often than not, adults accidentally pass their own insecurities and body image issues onto their children (or other children around them) when they talk or behave negatively around food. Children are very impressionable, making them vulnerable to these insecurities and obsessions.

Some steps you can take to promote a healthier relationship with food and body image include:

  • Limiting social media use

  • Listening to your body and hunger cues (eating when you're hungry and to the point of satisfaction, not overeating or undereating)

  • Allowing yourself to eat

  • Being mindful when you eat

  • Trying a wide variety of foods and expanding your meal options

Awareness

Eating disorders are a serious issue throughout the US, affecting millions of individuals throughout their lifetime. The key to combating eating disorders and reducing fatalities is to raise more awareness and create a safe space for people to speak about their struggles and seek help to recover.

The more we are aware and understand about eating disorders, the more we are equipped to identify and seek treatment for conditions we experience ourselves, as well as help others.

Major campaigns to fight eating disorders include the Dove Campaign For Real Beauty, Cubs For Coping, and the Barefaced & Beautiful Without & Within campaign. These campaigns aim to bring more awareness to the signs and symptoms of eating disorders and the treatments available. They also aim to empower us to have a healthier body image and relationship with food.

The Dove Campaign kicked off in 2004 and has had the most significant positive impact on eating disorder (and associated body image issues) awareness in the US by aiming to redefine beauty and point out harmful body image messaging.

The Cubs For Coping campaign spreads hope by sending teddy bears to eating disorder treatment programs, hospitals, and shelters to help people with eating disorders manage stressful situations. Each teddy bear is different and personalized to the recipient.

The Barefaced & Beauty Without & Within campaign by The Renfrew Center Foundation encourages women throughout the US to go without makeup for a day during National Eating Disorders Week (02/23 – 03/01) to promote inner beauty and healthier body image.

If you or someone you know is or may be struggling with an eating disorder, there are several resources available. National helplines are there when you need them:

  • National Eating Disorders Association Helpline: 1-800-931-2237

  • Hopeline Network: 1-800-442-4673

  • National Association of Anorexia Nervosa and Associated Disorders: 1-630-577-1330

  • Multi-Service Eating Disorders Association: 1-617-558-1881

  • Crisis Text Line: Text CONNECT to 741741

Statistics

Eating disorders are so common with more than 70 million¹ people globally suffering from an eating disorder. About half of all Americans¹ know at least one person with an eating disorder.

In the US, NEDA² reports that the most common eating disorder is binge eating disorder (BED), with 3.5% of women and 2.0% of men having the disorder over their lifetime. The report also found that BED is three times more common than breast cancer, schizophrenia, HIV, and even bulimia and anorexia combined.

While the disorder is more common among girls/women, research shows that males represent at least 25%² of anorexia nervosa cases and often experience more severe and fatal consequences since their diagnoses aren't as easily recognized. Failed diagnoses are especially prevalent among men since it's assumed they don't struggle with, or talk about, eating disorders and body image issues in the same way as women.

Eating disorders have a number of causes. ANAD³ reports the following statistics:

  • Genetics amounts to 28-74% of the risk for developing an eating disorder.

  • White people are more likely to be diagnosed with anorexia, but Black people are prone to experiencing the condition for a longer period.

  • Hispanic people are significantly more likely to suffer from bulimia nervosa than other ethnicities.

  • Women with physical disabilities are more likely to develop eating disorders than able women.

  •  Among adolescent girls, 35-57% admit to fasting, crash dieting, self-induced vomiting, laxatives, or diet pills.

An eight-year community study of women reported by the National Library of Medicine⁴ found that peak onset age for an eating disorder was 19-20 for anorexia, 16-20 for bulimia, and 18-20 for both binge eating and pica. The study also found that youth are the most vulnerable to more intense feelings of functional impairment, distress, and suicidality.

According to the Department of Health,⁵ only 1 in 10 individuals with an eating disorder receives treatment. The report found that inpatient costs are the most common, often costing patients around $30,000. Outpatient treatment is less common which can cost patients up to $100,000 or more for therapy and medical monitoring.

Doctors & specialists

If you or someone you know has any concerns or symptoms associated with an eating disorder, it is critical to seek medical advice from your doctor as soon as possible. Early intervention is the key to a successful recovery to help to prevent long-term damage.

When you are diagnosed with an eating disorder, you will see one or more of the following specialists, depending on the type of disorder, its severity, longevity, and symptoms:

General practitioner/local doctor — your first contact if you have eating disorder concerns. They will direct you as to the next steps and provide additional information. 

Pediatrician — a child's first contact when experiencing an eating disorder is with a doctor specializing in infants, children, and adolescents to discuss suitable treatment options.

Psychologist — provides counseling, conducts assessments, and helps create treatment plans. 

Psychiatrist — assesses and diagnoses your eating disorder, creates a treatment plan, and prescribes/tracks prescriptions. 

Dietitian — for more guidance on nutrition and eating habits, teaching you healthy strategies and recommending dietary plans and actions.

Nutritionist — educates people with eating disorders on the basics of nutritional value, and gives their expert advice on eating plans and making healthier choices.

Mental health nurse — nurses are active in hospitalizations and private practices (outpatient/inpatient practices) that diagnose and treat eating disorders, offering practical medical care while overseeing your mental health.

Eating disorder therapist — therapists specialized in mental health issues can help you address and manage your eating disorder. Re-adapting to your daily routines is essential to recovery, so an eating disorder therapist would be equipped with the knowledge and plans you can implement in your life to improve your quality of life.


Clinical trials for eating disorders

Actively recruiting
Understanding the role of genetics in eating disorders to develop better treatments in the future
AustraliaNew ZealandUnited States
Actively recruiting
Transcranial direct current stimulation for the treatment of anorexia nervosa: A pilot study
VIC (AU)
Actively recruiting
Outcomes of a Skill-Based Program for Eating Disorders
CA, OH (US)