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:
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 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.
Many psychological factors have been suggested as causes of eating disorders, including:
- Low self-esteem
- Obsessive-compulsive behavior or obsessive-compulsive disorder (OCD)
- Posttraumatic stress disorder (PTSD)
- Substance abuse
- 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.
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)
- Muscle atrophy (weakening and wasting)
- Heartburn or acid reflux
- Osteoporosis (bone thinning)
- Cold intolerance
- Hair loss/Brittle nails
- Dry skin
- 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.
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
- 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 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.
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 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
- Paint or wax
- Cloth or string
Pica is more common among pregnant women and children than adults, but it 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 as well as 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:
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 that you get lab tests such as thyroid function tests if indicated by your history.
Questionnaires and Interviews
This type of evaluation may include:
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
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 that 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 that you meet with a nutritionist who can help develop healthy meal plans that fit your lifestyle and preferences.
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 think you might—it’s important to get treatment as soon as possible. An eating disorder can be life-threatening, but many people recover completely with proper treatment and support.
Several eating disorder treatments are available, but what works best 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.
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 very helpful throughout the healing and recovery process. Support groups provide recovering individuals with a safe, empathetic environment to work through their emotions as they regain control over their lives.
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 usually takes place 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.
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 https://www.samhsa.gov/find-treatment or call 1-800-662-HELP (4357).
FAQs About Eating Disorders
What are the common signs of an eating disorder?
An eating disorder is a mental illness that has the potential to result in serious health consequences. Extreme concern with weight, body shape, and an unhealthy relationship with food typically characterizes eating disorders.
Some common signs of an eating disorder include:
- Changes in weight or body shape, such as weight loss or gain, thinning arms and legs (or a swollen stomach), or a thinning appearance
- A feeling that your weight is out of control no matter what you eat
- A change in eating behavior (skipping meals, making excuses not to eat)
- Feeling guilty after eating
- Often eating alone or in secret
- Purging behaviors (such as self-induced vomiting, abuse of laxatives, diuretics, enemas, or diet pills) after eating certain types of food
What are the potential risks of an eating disorder?
Eating disorders can have serious consequences for your health if left untreated. They can lead to:
- Heart problems
- Electrolyte imbalances
- Kidney failure
- Osteoporosis (loss of bone density)
- Death in extreme cases
What causes eating disorders?
People with eating disorders often have distorted thoughts about food and body image. These thoughts are often due to many factors, including:
- Environmental factors such as dieting or media exposure at an early age
- Family dynamics or trauma
- Psychological factors include low self-esteem, anxiety, depression, and other mental health conditions.
What qualifies as an eating disorder?
Eating disorders may be classified by a distorted body image, disturbances in a person’s self-perception, or in how one thinks about food. It affects an individual not only physically but also psychologically and socially. The three most common eating disorders are:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder
What’s the most serious eating disorder?
Anorexia nervosa is the most common eating disorder, with one of the highest mortality rates among mental disorders. It is associated with starvation dieting, excessive exercise, and a strong fear of gaining weight. People with anorexia see themselves as overweight despite having a very low body weight (BMI below 18.5).