Eating Disorders

What is an Eating Disorder?

An eating disorder is a serious mental illness that causes a person to have an unhealthy relationship with food. It is a complex and devastating medical condition that affects an estimated eight million Americans.

This relationship usually impacts a person’s eating patterns, causing them to starve themselves or overeat, resulting in serious medical complications from heart disease to malnutrition. Eating disorders also affect self-esteem and body image, leading to depression, anxiety disorders, and substance abuse.

Extreme disturbances in eating behaviors characterize eating disorders and may include:

• Binge eating (consuming an excessive amount of food in a short period)
• Self-induced vomiting
• Laxative abuse
• Intense fear of gaining weight or becoming obese, despite being underweight
• Extreme concern with body shape and weight
• Restrictive eating, usually with an obsession over calories or fat grams
• The belief that one cannot stop eating or lose weight

Eating disorders can begin at any age but most commonly begin in adolescence and young adulthood. They may start as dieting behaviors and evolve into more severe forms of disordered eating.

Some people with eating disorders have feelings of self-loathing or lack self-worth because of their size. In some cases, these feelings stem from childhood experiences such as teasing about weight or dieting at an early age. Other teens and young adults may feel increased pressure to look a certain way due to images they regularly see on social media and through advertisements.

What Causes Eating Disorders?

Eating disorders are complex and often misunderstood. There isn’t one specific cause for eating disorders, but rather a combination of biological, psychological, and environmental factors that can lead to their development.

Common causes and risk factors for eating disorders include:

Genetic Predisposition

Some people may be more biologically vulnerable to developing an eating disorder. For example, studies suggest that people with one parent with anorexia or bulimia have a higher risk of developing an eating disorder than those who don’t have this family history. The risk is even higher if both parents have these disorders.

Dysfunctional Family Dynamics or Traumatic Experiences

Problems in the family can play a role in triggering or worsening an eating disorder. Experiencing neglect, abuse, or loss as a child can have lasting effects on mental health and lead to unhealthy coping strategies like food restriction.

Dieting Practices

Dieting for weight loss is common among people with eating disorders and is associated with an increased risk of developing one.

Dieting is often seen as a way to control weight, but it can backfire by triggering an unhealthy relationship between food and body image. It also increases the risk of developing an eating disorder if you’re genetically predisposed to developing one.

Psychological Factors

Many psychological factors have been suggested as causes of eating disorders, including:

• Perfectionism
• Anxiety
• Low self-esteem
• Obsessive-compulsive behavior or obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Substance abuse
• Depression
• Body dissatisfaction

These factors can also make you more vulnerable to disordered eating behaviors such as restrictive dieting or episodes of binge eating.

Types of Eating Disorders

Eating disorders come in many forms, but they all revolve around abnormal eating habits that negatively affect physical or mental health. Eating disorders vary in severity and can range from mild to life-threatening.

Here are the various types of eating disorders.

Anorexia Nervosa

The most common eating disorder is anorexia nervosa, which causes people to restrict their food intake to an extreme degree. People with anorexia may have a distorted body image and believe they are overweight even when they are extremely thin.

Anorexia is one of the deadliest psychiatric conditions next to opioid use disorder. An adult with anorexia typically has a body mass index (BMI) under 18.5. Depending on how far below the normal weight the individual’s BMI is, it can indicate severe malnutrition and may even result in death if not resolved.

Anorexia nervosa can be divided into two subtypes:

• Restrictive: People lose pounds by dieting (either cutting down on calories or not eating anything), fasting, and/or exercising excessively.
• Binge-eating/purging: In this type, some people alternate between periods of binge eating and purging.

Signs and symptoms of anorexia include:

• Amenorrhea (missing three or more menstrual periods in a row)
• Dizziness
• Muscle atrophy (weakening and wasting)
• Heartburn or acid reflux
• Constipation
• Osteoporosis (bone thinning)
• Cold intolerance
• Hair loss/Brittle nails
• Dry skin
• Fatigue
• Depression and anxiety

If you have anorexia, you must seek help from a doctor or mental health professional immediately, as this condition can be life-threatening if left untreated.

Bulimia Nervosa

Cycles of bingeing and purging characterize Bulimia Nervosa as a way to compensate for overeating or to prevent weight gain.

This disorder involves periods of uncontrolled eating during which large amounts of food are consumed in short periods (bingeing). The person then feels compelled to eliminate the extra calories by self-induced vomiting, abusing laxatives, or misusing diuretics. Over time these behaviors can lead to severe health problems.

This disorder may be accompanied by other symptoms such as:

• The urgency to urinate immediately after eating
• Tooth decay
• Laxative and diuretics misuse
• Diarrhea
• Heartburn (acid reflux)
• Serious sore throat
• Dizziness due to dehydration
• Swelling of the parotid salivary glands on either side of the face

Binge-Eating Disorder

Binge-eating disorder refers to recurrent episodes of uncontrolled consumption of large amounts of food accompanied by a feeling of guilt and shame afterward. However, unlike people with bulimia nervosa, the individuals do not engage in other compensatory behaviors such as purging. Instead, binge eating can lead to obesity, diabetes, and other serious health problems.

The binge-eating episodes are associated with at least three of the following:

• Eating much faster than usual
• Eating more than you need, to the point of discomfort
• Eating a lot of food when not physically hungry
• Feeling bad about yourself after you’ve eaten more than usual
• Secretly eating food when binge eating

These episodes occur, on average, at least once a week for three months.

Rumination Disorder

Patients who have this disorder regurgitate food after swallowing it, sometimes more than once per day. The regurgitated material may be re-chewed, re-swallowed, or spit out as saliva. Rumination can lead to malnutrition and other health problems if not treated properly.

To warrant the diagnosis, a person must show behaviors that meet these criteria:

• Reoccurs over at least one month
• Not be caused by a medical or gastrointestinal condition
• It should not occur as part of another behavioral eating disorder
• Other mental disorders may also feature rumination, but the degree of severity must be high enough to merit separate clinical attention

Avoidant Restrictive Food Intake Disorder

Avoidant Restrictive Food Intake Disorder (ARFID) is a rare disorder that causes sufferers to fear eating or not knowing how much to eat. People with ARFID may also be picky eaters who only eat specific foods or avoid certain textures or flavors.

ARFID differs from other eating disorders like anorexia nervosa and bulimia nervosa because it does not involve attempts to lose weight. Instead, ARFID sufferers strongly dislike food and often avoid eating altogether.

In ARFID, an aversion to eating or a limited diet may be caused by one or more factors, such as:

• Eating problems include a lack of appetite or no interest in food
• Fear of choking, vomiting, or becoming ill from food
• Avoidance of certain foods based on texture, color, flavor, or temperature

Some people with ARFID might also have a history of other mental health conditions, such as anxiety disorders or obsessive-compulsive disorder (OCD).

ARFID may be diagnosed when a person’s eating problems are accompanied by one or more of the following symptoms:

• A significant decrease in weight or failure to gain adequate weight
• Severe nutritional deficiency
• The need to have a feeding tube or be dependent on oral nutritional supplements to prevent malnutrition
• Social withdrawal (such as eating alone)

Pica

Pica is a disorder in which a person eats non-food items. This behavior can lead to health problems and gastrointestinal obstruction if not treated immediately.

The items ingested include:

• Clay or charcoal
• Paper
• Soap
• Paint or wax
• Hair
• Cloth or string
• Chalk
• Metal
• Pebbles

Pica is more common among pregnant women and children than adults but can affect anyone. Although it’s unclear what causes pica, studies suggest it may be related to low levels of certain nutrients in the blood.

People who engage in pica may benefit from nutritional testing and intervention and behavioral treatments designed to redirect their attention away from nonfood items.

Eating Disorder Diagnosis

The first step to treating an eating disorder is getting a diagnosis.

How Eating Disorders are Diagnosed

The diagnosis of each eating disorder is based on a set of criteria defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Diagnosis is based on a clinical interview, review of medical records, physical examination, and psychological testing. Tests may also include blood tests to determine nutritional deficiencies or hormone levels.

An evaluation may include the following:

Physical Exam

The doctor may perform a physical exam, including a check of your blood pressure, weight, and height. You may also need to provide information about your eating habits, such as when you last ate and how much. The doctor may also recommend getting lab tests such as thyroid function tests if indicated by your history.

Questionnaires and Interviews

This type of evaluation may include:

Questionnaires

Two common screening tools for eating disorders are the SCOFF (Sick, Control, One, Fat, Food) questionnaire and the EAT-26 (Eating Attitudes Test) questionnaire. The tests will include questions about:

• Your weight
• Dieting behaviors
• Thoughts about food and body shape
• Exercise habits
• Other factors that may contribute to your symptoms

Interviews With Family Members and Friends

In-depth interviews with you and your family members about:

• Your symptoms and thoughts about food, weight, shape, and body image
• Your eating habits
• Any problems with maladaptive behaviors such as over-exercising or binge eating/purging
• Any underlying medical conditions (for example, diabetes) that may affect the severity of your eating disorder
• Treatment history
• Your doctor may also want to know if you have ever been diagnosed with depression or another psychiatric condition

Psychological Testing

A psychologist or psychiatrist will evaluate your mental health to see if any underlying mental health conditions may be contributing to your symptoms. It will also help ensure they don’t complicate an eating disorder treatment.

This process can help doctors get a complete picture of what is going on in your life to make an accurate diagnosis. They may also recommend meeting with a nutritionist who can help develop healthy meal plans that fit your lifestyle and preferences.

Additional Tests

Your doctor may perform or recommend additional testing to ensure the eating disorder is not masking any underlying health problems so you can get the most effective treatment possible.

Eating Disorder Treatment

Eating disorders are serious conditions, and if you or a loved one has one—or thinks you might—it’s important to get treatment as soon as possible. Eating disorders can be life-threatening, but many recover completely with proper treatment and support.

Several eating disorder treatments are available, but the most suitable depends on each individual’s unique needs. It’s important to get treatment as soon as possible if you believe you or a loved one has an eating disorder. Treatment can help you manage your symptoms and feel better overall.

Psychotherapy

Once you have been diagnosed, your doctor may refer you to a therapist trained in treating eating disorders. Two kinds of psychotherapy have proven to be helpful:

• Family-based therapy: Family therapy helps the whole family understand and cope with the illness of one member. It also assists families in finding ways to help their loved ones recover from an eating disorder.
• Cognitive behavioral therapy (CBT): CBT focuses on changing unhealthy behavior by challenging negative thoughts and beliefs. It can help with eating disorders by teaching people to change their thoughts about food and weight, making them feel better about themselves.
• Support groups: Joining a support group that centers around your specific eating disorder can be helpful throughout the healing and recovery process. Support groups provide recovering individuals a safe, empathetic environment to work through their emotions as they regain control over their lives.

Medical Treatments

Eating disorders are medical conditions that need treatment from a team of healthcare professionals, including an eating disorder specialist or psychiatrist. You may need additional treatment if you have other medical problems caused by your eating disorder or if you’re pregnant to protect your unborn child’s growth and development.

Doctors will monitor patients’ physical condition (including blood pressure) throughout their recovery process and provide nutritional counseling as needed.

Nutritional Counseling

Nutritional counseling usually occurs in a doctor’s office or clinic and involves learning about changes in eating habits, food choices, and meal planning. A nutritionist or dietician may also help you learn how to manage stress through healthy eating habits.

Medication

If needed, doctors may prescribe antidepressants, mood stabilizers, and antipsychotic medications as part of your treatment plan. It will help improve your mood or self-esteem while also treating your symptoms of depression or anxiety.

Time To Get Help for Eating Disorders

Eating disorders are serious conditions that can have a huge impact on your health, your life, and your relationships. The good news is that many effective treatment options are available to help you or your loved one manage or overcome an eating disorder.

You don’t have to go through this alone—reaching out for help is the first step toward recovery.

For a list of treatment options in your area, visit SAMHSA’s Substance Abuse Treatment Facility Locator at FindTreatment.gov or call 1-800-662-HELP (4357).