What are Eating Disorders?

What is an eating disorder? Eating disorders are serious and complex mental health conditions influenced by biological factors, characterized by extreme disruptions in eating behaviors. Unlike having occasional concerns about weight or appearance, sometimes overeating, or having preferences for certain foods, eating and feeding disorders are characterized by persistent maladaptive eating behaviors that have a significant impact on someone’s life and can cause dangerous nutrition issues. However, with appropriate treatment, full recovery is possible.¹

Types of Eating Disorders

There are 6 types of eating disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders or the DSM-5, the guide that healthcare and mental health clinicians use to diagnose mental health conditions:

Anorexia Nervosa

Anorexia is when someone restricts food intake and loses weight to the point that they are significantly below a healthy body weight. People living with anorexia have a strong fear of gaining weight which is often accompanied by a distorted body image, which drives extremely restrictive eating habits. Most often, others will notice the person is extremely underweight while the individual suffering from anorexia will not. Anorexia is known as one of the most dangerous mental health disorders due to the severe medical complications it causes and the number of people who die from the condition. Anorexia usually starts in adolescence and tends to be more common in people with anxiety and/or people who live and work in places that highly value thinness.^1,2

Avoidant/Restrictive Intake Disorder (ARFID)

Similar to other eating disorders ARFID is characterized by a nutritional deficiency, weight loss, dependence on nutritional supplements, or trouble with psychosocial functioning. Beyond just picky eating habits, a person living with ARFID shows severe disinterest, avoidance, or concern in food because of its texture, color, smell, or taste. This may be due to a sensory disorder or anxiety related to the consequences of eating the food unrelated to its impact on their body weight or shape. This type of eating disorder tends to be more common in people with OCD, ADHD, autism spectrum disorder, and different anxiety disorders and most commonly develops during childhood.³

Bulimia Nervosa

Bulimia nervosa is a condition where someone eats more food than they need and then purges the food in an attempt to prevent weight gain. Purging can be done by intentionally vomiting, using laxatives, excessively exercising, or not eating for a period of time.² People with bulimia may experience stomach problems, a sore throat, or problems with their teeth including pain and worn enamel from vomiting. As with other disorders, people with bulimia often feel a great deal of shame and try to hide their binging and purging. Bulimia most commonly develops during adolescence or early adulthood.

Binge Eating Disorder

People with binge eating disorder eat large amounts of food in a very short period of time. Unlike the more common behavior of occasional overeating, binge eating often includes eating very rapidly, may happen when an individual is not hungry and can lead to feelings of discomfort or sickness due to the large amount of food consumed. They often feel out of control and helpless about their desire to eat, yet they can’t stop. Binge eating disorder often involves eating alone to hide how much one is eating. Often, people who binge eat say they feel guilty or depressed after eating, which may be a result of the behavior but also might promote the behavior.² Binge eating disorders can lead to physical problems such as obesity, high blood pressure and cholesterol, and diabetes if left untreated.

Pica

Pica is when someone regularly eats things that are not food for longer than a month. This can include soap, gum, paint, paper and anything else that is not normally considered food. A variety of serious physical health issues can arise from PICA. Someone with this disorder should always be assessed for the possibility of a GI issue, or nutritional deficiency. The symptoms of PICA are more common during pregnancy and also frequently occur in younger children and people who have intellectual disabilities.²

Rumination Disorder

Rumination disorder is when a person repeatedly regurgitates food after swallowing to re-chew, re-swallow, and/or spit it out. This disordered behavior is not the same as throwing up food after consuming it.² Rumination disorder is most common in babies and toddlers, as well as children with cognitive impairments.

Other Specified Feeding or Eating Disorders

There are other groups of symptoms, somewhat related to the 6 types of eating disorders discussed above, that are not official eating disorders in the DSM-5. However, just as co-dependency is not a diagnosis in the DSM-5 but is a real thing that people deal with and that clinicians help people with, these other patterns of disordered eating may affect people to the point that they should seek professional help. Examples of other feeding or eating disorders include purging disorder, atypical anorexia nervosa, and night eating syndrome.

Orthorexia Nervosa

While not a current diagnosis, Orthorexia will likely be considered for a future addition to the DSM-5. While the symptoms and behaviors may be similar to other eating disorders, orthorexia differs in that it may or may not stem from a desire to lose weight. Rather, the the person’s focus is on the quality or “healthiness” of the food, or the fear of food being bad in certain ways. Orthorexia behaviors can include, spending excessive amounts of time researching ingredients or thinking about food and planning meals, cutting out more and more types of food or ingredients, an unusual focus on what others are eating, and following many social media accounts that focus on body image or lifestyle content.⁵

Eating Disorder Symptoms

While symptoms of eating disorders vary among the different types and from person to person, there are some general symptoms to know and look out for. Importantly, if you notice you’re having obsessive, stressful thoughts about food, weight, or body image it’s best to ask for help. You are not alone, there is nothing to be ashamed of, and there are people ready to help you.

Here are some other typical symptoms of disordered eating to look out for:

• Sudden, rapid, and/or frequent weight gain or loss
• Having rigid rules about food and/or extreme food restriction
• Stockpiling or hiding food
• Obsessive calorie counting
• Vomiting when not ill
• Excessive exercise
• Using laxatives
• Negative body or self-image
• Binge eating or eating until feeling uncomfortable

The health impact of an eating disorder may include:

• Mental and/or physical exhaustion and fatigue
• Menstrual cycle is disrupted or completely stops
• High Blood Pressure and cholesterol
• High or low blood sugar
• Gastrointestinal problems
• Unhealthy skin and hair
• Rotting teeth
• Easily broken bones
• Heart problems
• Diabetes
• Obesity
• Low weight

It is important to consult your doctor or mental health professional right away if you suspect you or someone you love is exhibiting any of these signs or symptoms. Physical deterioration from eating disorders can lead to an emergency health crisis. In some cases, physical symptoms may be the first sign to family or loved ones that an individual is struggling with an eating disorder. While most people receive care before crisis, advanced eating disorders can lead to life-threatening situations including cardiac arrest, coma, organ failure, and suicidal thoughts and behaviors. Detecting feeding and eating disorders as early as possible is a vital step in helping and preventing crises.

Causes of Eating Disorders

What causes eating disorders? Eating disorders are complex illnesses and we do not definitively know what causes them. However, doctors and researchers have developed a few theories.⁶ While genes and biology play a role in our health, things like our emotional health, relationships, culture, and environmental stressors are also factors in the development of a disorder. This is what’s called the biopsychosocial model.⁸

Understanding the potential risk factors associated with eating disorders can help us be prepared to help ourselves or someone we love if and when we start to notice signs that one is developing. People of all different ages, genders, races, ethnicities, and body weights can develop an eating disorder.

Some potential risk factors or causes of eating disorders are:^1,4

• Family history
• Co-occurring mental health issues like trauma, anxiety, OCD, and depression
• Dieting and starvation
• Bullying and abuse
• Environmental stressors and big life transitions
• Unhealthy cultural body image standards and ideals

Eating Disorder Diagnosis

When diagnosing an eating disorder, licensed healthcare and mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a guide to determine if someone meets the criteria for a certain disorder. Clinicians may also conduct physical examinations, lab tests, and other screenings to identify if someone may have an eating disorder and to monitor the physical health of individuals with disordered eating.

Eating Disorders Treatments

Eating disorders are serious conditions that can be scary for the person with the condition and the person’s family. Various evidence-based treatments and therapies are proven to work for treating eating disorders. It’s important to identify potential symptoms and to reach out for support as early as possible.

Because eating disorders are common, there are mental health providers, physicians, crisis lines, peer support groups, and organizations dedicated to providing useful, empathetic, and supportive resources for both patients and their families. Many individuals with eating disorders also require monitoring by their primary care provider or another health professional due to the high risk of developing serious health problems related to these disorders. Healing is possible using trusted therapies and treatments.

CBT and Enhanced Cognitive Behavioral Therapy (CBT-E)

Cognitive Behavioral Therapy (CBT) is an evidence-based psychotherapy that focuses on the connection between our thoughts, feelings, and behaviors. CBT can help people with eating disorders learn new ways of thinking, coping skills, and change unwanted behaviors.

Enhanced Cognitive Behavioral Therapy (CBT-E) was specifically created for eating disorders and helps people change their thinking around food, eating, and weight. It is a time-limited Cognitive Behavioral Therapy designed to identify healthy patterns of eating and address body image. Behavior-focused treatment is most effective because it directly addresses symptoms and helps change eating and behavioral disturbances that accompany eating disorders.⁸

Family-based Treatment (FBT)

Family-based treatment (FBT) is a leading approach for treating eating disorders in teenagers. It focuses on a few key ideas. First, therapists don't try to find the cause of the disorder and avoid being overly controlling. Instead, they see parents as essential to helping their child recover. They also treat the eating disorder as something separate from the child, which helps in the treatment process. Finally, FBT uses practical, solution-focused methods.^9,10

Interpersonal Therapy (IPT)

Interpersonal Therapy (IPT) helps people understand their eating behaviors, as well as how they interact with people in their lives. IPT focuses on how people relate to others and how interpersonal interactions affect health and wellness.¹¹

Nutritional Therapy

Registered dieticians and nutritionists play an important role in the treatment of eating disorders. They help people learn the science behind what food does for the body so they can start to associate food with something that is essential and healthy for the body rather than the enemy. Nutritional management provided by a dietician is an important addition to help patients learn healthy eating.¹

Feeding Therapy

Feeding therapy, which typically involves a team including physicians, mental health specialists, and nutritionists, is generally the recommended intervention for ARFID. Individuals with ARFID benefit not just from medical management and nutritional counseling, but may also require treatment from a speech and language pathologist or difficulties with swallowing or an occupational therapist who can treat underlying sensory disorders that may contribute to this disorder.¹²

Residential Treatment, inpatient Treatment, and Intensive Outpatient Programs

Residential treatment, partial hospitalization, or inpatient care may be helpful for patients whose physical health is compromised and need to be medically stabilized or for individuals who have not made sufficient progress after outpatient treatment alone. Inpatient treatment typically consists of a 30-day stay in a rehabilitation facility specifically focused on treating eating disorders. Intensive outpatient treatment is the next step down from inpatient treatment. After someone completes a 30-day residential inpatient program, it may be recommended that they transition to a 30, 60, or 90-day partial hospitalization and intensive outpatient program (IOP). Usually, the patient lives at home and travels to an outpatient care facility for treatment a couple of days a week.

Peer Recovery Programs

These programs typically involve a combination of therapy including peer support, group therapy, family therapy, psychiatric medication management, and a nutritionist. Group therapies are of great benefit to people going through an eating disorder because it helps them realize they are not alone.

Medication

Some people with eating disorders benefit from medication to help with thoughts and feelings of depression and/or anxiety that often come along with an eating disorder. Medication can help individuals with bulimia or binge-eating disorders however medication should always be used alongside therapy and nutrition-related interventions and treatment.¹³

Coping with an Eating Disorder

Living with an eating disorder can feel scary and isolating. But you are not alone. There are people ready to help you heal right now. A support system that helps you implement structure and maintain a healthy environment and routine is essential to your recovery. Treatment for eating disorders is a journey.

For people in ED recovery, here are healthy coping tips.

• Limit social media and other unhealthy body image influences
• Subscribe to body-positive and recovery-focused newsletters and websites
• Focus on balance and positive behaviors versus weight and numbers
• Ask loved ones to help implement structure and rules around meal times

While eating disorders can impact anyone, research shows that young women who are diagnosed with an eating disorder often live with repetitive, negative thought patterns that impact their self-esteem. However, there are coping mechanisms supported by evidence that can help including the following:

• Mindfulness activities help individuals become aware of their thoughts and feelings without judgment, reducing negative thought patterns.
• Practicing Self-Compassion and treating yourself with kindness and understanding during difficult times to reduce self-criticism and promote a healthier self-image.¹⁴

How to help someone with an eating disorder

Try to connect with the person you are worried about as soon as possible. Talking about these challenges must be done emphatically, compassionately, and kindly, but the seriousness of the conversation must also be clear. A person with an eating disorder often experiences deep embarrassment, shame, guilt, fear, and hopelessness. It’s important for family and/or loved ones be as patient as possible. It often takes time and repeated efforts to successfully discuss concerns. Support and personal connection from family are vital.

It is unrealistic to expect someone to recover from an eating disorder without support. Loved ones can help people with eating disorders recover by helping to structure their environment for pro-health behaviors and by getting them connected with the right professional support. Family and loved ones can support an individual recovering from an eating disorder by attending to their own health and wellness as well. For example, families can adopt balanced, healthy eating and exercise routines together. While caring for an individual with an eating disorder, practicing mindfulness, self-compassion, and other self-care routines can also be helpful.

Summary

Eating disorders are complex mental health conditions that negatively affect both mental and physical health. They can cause serious physical problems, emotional distress, and medical crises. The DSM-5 recognizes six types of eating disorders: Anorexia Nervosa, Avoidant/Restrictive Food Intake Disorder (ARFID), Bulimia Nervosa, Binge Eating Disorder, Pica, and Rumination Disorder, each with distinct symptoms and characteristics.

Eating disorders are influenced by a combination of genetic, psychological, and social factors. Potential risk factors include family history, co-occurring mental health issues, excessive dieting, environmental stressors, experiencing bullying or abuse, and unhealthy cultural body image standards.

If you or a loved one has signs of an eating disorder, it’s important to get help right away. A combination of evidence-based treatment and social support are very effective to help individuals recover from eating disorders.

If you or someone you know is struggling with any of the issues discussed, help is just a phone call away. Please call the National Alliance for Eating Disorder Helpline at 1-866-662-1235.

If you or someone you know is experiencing a mental health crisis, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. If you or someone you know are in immediate danger, call 911.