Eating Disorders: Types, Signs, and Treatment Options

What Is an Eating Disorder?

Eating disorders (EDs) are serious mental health disorders with severe and life threatening medical and psychological consequences if untreated. They are not issues of willpower or methods of dieting but potentially deadly diseases that require professional medical and therapeutic treatment and support.

• People of all genders and ages may struggle with eating disorders, however, the rate of eating disorders among females is 2.5 times higher as compared to males.
• 9% of the US population will have an eating disorder in their lifetime, according to the National Eating Disorders Association.
• The first signs of an eating disorder are most likely to appear during the teen years or early adulthood but could begin at any time including during childhood, midlife, or older adulthood.

Who Is at Risk for Eating Disorders?

Eating disorders can affect anyone, regardless of age, gender, ethnicity, or socioeconomic background. However, certain factors can increase the risk of developing an eating disorder:

• Genetics: a family history of eating disorders or other mental health conditions can increase the risk.
• Brain chemistry: imbalances in neurotransmitters like serotonin and dopamine, which regulate mood and appetite, may play a role.
• Physical health conditions: certain medical conditions, such as diabetes or gastrointestinal disorders, can increase the risk of developing an eating disorders.

There are a number of issues that can potentially contribute to the development of an eating disorder. Some combination of the following may be potential causes of disordered eating habits:

• Feelings of low self-esteem or self-worth.
• Cultural expectations to remain thin, trim, and often underweight.
• Co-occurring mental health disorders like mood disorders or personality disorders.
• Acute, stressful life events that are life-threatening or result in extreme, unwanted change (e.g., loss of a loved one, divorce, job loss, etc.).
• Family expectations and pressures.

Signs of an Eating Disorder

The signs and symptoms of an eating disorder will vary according to the specific disorder and the individual experiencing the symptoms. In general, however, those who are struggling with an eating disorder often:

• Struggle with maintaining a healthy weight.
• Talk about dieting and calorie management.
• Believe they are fat.
• Struggle with low self-esteem and a distorted self image.
• Struggle with co-occurring disorders, including depression, anxiety, or substance misuse.

Anorexia Nervosa

Anorexia nervosa is a complex eating disorder characterized by an intense fear of gaining weight and a distorted perception of body size. Individuals struggling with anorexia may have a persistent belief that they are overweight, even when they are significantly underweight. They may also express strong opinions about weight and body image, often due to underlying anxieties and insecurities. This can lead to severely restricting their food intake, potentially to the point of malnutrition and serious health complications.

Signs and symptoms of anorexia may include:

• Significant weight loss.
• Changes in eating habits, including skipping meals, avoiding certain food groups, or eating very small portions.
• Preoccupation with food and calories, including obsessive calorie counting or rigid meal planning.
• Physical symptoms of malnutrition including: fatigue, weakness, dizziness, cold intolerance, dry skin, brittle hair and nails, lanugo, and constipate. In women, anorexia can lead to irregular or stopped periods.
• Excessive exercise.
• Intensive fear or gaining weight.
• Distorted body image (individuals may see themselves as overweight even when they are underweight).
• Denial of hunger.
• Social withdrawal (e.g., isolation due to embarrassment or shame about eating habits).
• Mood swings and irritability.
• Secretive behavior around food.

If left untreated, anorexia can have serious consequence, including life-threatening health complications. The impact of the disorder can be significant, and individuals with anorexia may face a higher risk of health issues compared to the general population. Seeking professional help and support is crucial for recovery.

Bulimia Nervosa

Bulimia nervosa is a complex eating disorder characterized by cycles of bing eating, where a person consumes a large amount of food in a short period, often accompanied by feelings of loss of control. Following a binge, individuals with bulimia may engage in “compensatory behaviors” (e.g., self-induced vomiting, misuse of laxatives, excessive exercise, or a combination of these) to try to prevent weight gain or to regain a sense of control.

The frequency and intensity of these cycles can vary among individuals with bulimia. Some may experience daily cycles, while others may have them less frequently. Additionally, bulimia can also co-occur with anorexia.

Unlike individuals with anorexia alone, those with bulimia may maintain a normal weight for their height, be underweight, or overweight.

Signs of bulimia may include:

• Noticeable fluctuations in weight, both up and down.
• Purging unwanted calories ingested during the binge eating session, via self-induced vomiting or misuse of laxatives.
• Use of laxatives, water pills, and/or enemas in an attempt to purge calories before they are absorbed.
• Compulsive exercise in an attempt to burn as many or more calories than ingested.
• Changes in eating patterns, such as large quantities of food disappearing quickly or the presence of numerous empty wrappers or food containers.
• Routinely going to the bathroom right after eating, especially after eating a lot of food.
• Swollen face and puffy eyes and/or broken eye blood vessels.

Additionally, people living with bulimia may have damaged tooth enamel, swollen glands, an inflamed throat, and reflux and/or dehydration.

Binge Eating Disorders

Binge eating disorder (BED) is the one of most commonly diagnosed eating disorder in the United States, affecting 2.7% of women and 1.7% of men across races, social classes, body types, and ethnic backgrounds. It is characterized by consuming a large amount of food within a short period, often accompanied by feelings of loss of control and distress. Binge eating episodes may occur in response to various emotional triggers or after periods of restricting food intake.

Individuals with BED may experience a range of emotions after binge eating, including guilt, shame, and self-disgust. These emotions can create a cycle that perpetuates the disorder. Additionally, BED can lead to weight gain and increase the risk of health conditions such as heart disease, high blood pressure, gallbladder disease, type 2 diabetes, and certain types of cancer.

Some signs and symptoms of binge eating disorder include:

• Consuming an unusually large quantity of food in a short period of time.
• Feeling unable to stop eating or control the amount of types of food consumed.
• Eating even when not hungry, or continuing to eat despite feeling full or physically uncomfortable.
• Eating alone or in secret.
• Preoccupation with food and body weight.
• Frequent dieting without weight loss.
• Digestive problems including bloating, constipation, or diarrhea.

People who struggle with binge eating may also be living with another eating disorder or display other disordered eating habits.

Body Dysmorphic Disorder (BDD)

Body dysmorphic disorder (BDD) is a mental health condition characterized by an obsessive preoccupation with perceived flaws or defects in appearance. These flaws are often minor even unnoticeable to others. However, for individuals with BDD, the perceived flaw causes significant distress and interfere with their daily life.

Common features of BDD include:

• Preoccupation with perceived flaws.
• Distorted body image.
• Repetitive behaviors.
• Social anxiety and isolation.
• Emotional distress.

It’s important to note that BDD is not classified as an eating disorder, but it shares some similarities with eating disorders, especially anorexia. Both conditions involve a distorted body image and can lead to obsessive thoughts and compulsive behaviors related to appearance.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/restrictive food intake disorder (ARFID) is a serious eating disorder where individuals limit the amount and/or types of food that they eat. Unlike other eating disorders, ARFID is not driven by a desire to lose weight or change body shape. Instead, ARFID is root in sensory sensitivities, fear of aversive consequences, and lack of interest in eating.

Common characteristic of ARFID include:

• Limited food intake, especially in varieties of food.
• Avoidance of entire food groups.
• Difficulty digesting certain foods.
• Significant weight loss or failure to gain weight.
• Nutritional deficiencies.
• Impaired psychosocial functioning.

Pica

Pica is an eating disorder characterized by the persistent craving and consumption of non-food items that have no nutritional value, such as clay, dirt, paper, chalk, etc. Pica is most commonly seen in children, pregnant people, and individuals with developmental disabilities or certain medical conditions. However, it can occur in anyone.

Causes of pica can vary and may include:

• Nutritional deficiencies.
• Development or mental health conditions.
• Stress or emotional trauma.
• Learned behavior.

Rumination Disorder

Rumination disorder is an eating disorder characterized by the effortless regurgitation of food shortly after eating, which is then either re-chewed, re-swallowed, or spit out. The exact cause of this disorder is unknown, but it’s thought to involve both physical and psychological factors. It may be triggered by stress, anxiety, or certain medical conditions.

Common signs and symptoms include:

• Regurgitation of food within minutes of eating.
• Re-chewing and re-swallowing or spitting out the regurgitated food.
• Feeling of fullness or pressure in the stomach relieved by regurgitation.
• Bad breath.
• Weight loss (in some cases).
• Stomach aches.
• Indigestion.

Other Specified Feeding or Eating Disorder (OSFED)

is used to diagnose those who are living with a feeding or eating disorder that is intrusive in their lives emotionally and/or physically, causing distress or impairment, but does not fit the diagnostic criteria of anorexia or bulimia. In some cases, the person’s experience may be similar in nature to that of someone living with anorexia or bulimia but vary just enough to be outside the diagnostic parameters for those disorders.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), there are five subtypes of OSFED. These include:

• Atypical anorexia nervosa: Those who meet all the criteria for anorexia but who are maintaining a normal weight are diagnosed with OSFED.
• Bulimia nervosa: Those who purge regularly after eating but engage in the practice less frequently than twice a week, or who have been purging three or more times a week for less than three months will be diagnosed with OSFED rather than bulimia.
• Binge eating disorder: People who engage in binge eating sessions, ingesting large amounts of food but who not do not feel out of control during or after the experience may be diagnosed with OSFED.
• Purging disorder: Those who do not binge before purging (e.g., using laxatives or enemas inappropriately or inducing vomiting) may find that their diagnosis falls into this category.
• Night eating syndrome: Eating after waking in the middle of the night or eating large amounts of food before bed are characteristic of this diagnosis.

In addition, individuals may also experience patterns that, while not meeting the specific criteria for conditions like anorexia or bulimia, still cause significant distress and impairment. These can include:

• Compulsive exercise: Engaging in excessive or rigid exercise routines, often driven by a preoccupation with calorie burning and weight control, even to the point of exhaustion or injury.
• Orthorexia: A fixation on “clean” or healthy eating that becomes overly restrictive, leading to the exclusion of necessary nutrients or insufficient calorie intake.

What Are the Treatment Options for Eating Disorders?

Treatment should offer individuals struggling with EDs access to everything they need to find stability and manage their symptoms. To that end, therapies and treatment should address all the areas of life impacted by an eating disorder, including:

• Medical and health problems.
• Nutritional needs.
• Self-esteem and self-confidence.
• Interpersonal relationships.
• Psychological effects.

People with EDs are encouraged to seek an eating disorder treatment program that is well-rounded in nature at the earliest signs of a disorder. Without treatment, an eating disorder can lead to a range of chronic and acute health issues that diminish quality of life and that can be life-threatening in some cases. Therapy, support from peers and staff, family support, and for some, certain medications can all contribute to the struggling person’s ability to function without returning to disordered eating habits, to get to and maintain a healthy weight, and to create a new life in recovery.

How to Find Treatment for Eating Disorders

Finding the right treatment for EDs is a crucial step toward recovery. Consulting with a healthcare professional such as a doctor, therapist, or registered dietician specializing in eating disorders is a good first step. They can assess your specific needs and recommend the most appropriate level of care.

There are several factors that may play a role in deciding what level of care is appropriate for someone struggling with EDs. These can include:

• Severity of the disorder.
• Individual needs and preferences, such as type of therapies offered, location, and level of structure.
• Financial resources and insurance coverage.

If you need additional resources for finding eating disorder treatment near you, there are several organization that can get you on the road to recovery. These include:

• National Eating Disorder Association (NEDA), which offers a helpline, online screening tool, and treatment locator to help you find resources in your area.
• National Alliance for Eating Disorders (The Alliance), which provides a helpline and resources for finding treatment.
• The Academy for Eating Disorders (AED) offers a directory of eating disorder professionals.

Frequently Asked Questions