An overview of eating disorders

Developing a healthy approach to eating is critical for your overall health and well-being. Too much focus on food, body weight, and shape can signal an eating disorder and negatively impact your physical and mental health and your ability to live your best life.

Eating disorders can occur at any age, but they most often develop in the teen and young adult years. Eating disorders are serious, as they can harm the heart, digestive system, bones, and teeth and mouth, and lead to other diseases. They can even be fatal. 

The most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder, which are outlined below along with a less common eating disorder called avoidant restrictive food intake disorder. 

Anorexia nervosa

Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods, due to an intense fear of gaining weight or feeling fat. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight because they have a distorted perception of their own body.

There are two subtypes of anorexia nervosa: a “restrictive” subtype and a “binge-purge” subtype:

• In the restrictive subtype of anorexia nervosa, people severely limit the amount and type of food they consume.
• In the binge-purge subtype of anorexia nervosa, people also greatly restrict the amount and type of food they consume. In addition, they may have binge-eating and purging episodes—eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what was consumed.

Anorexia is up to 10 times more common in women than in men. It most often begins in adolescence or young adulthood, but a second peak seems to occur after age 40.

Anorexia nervosa can be fatal. It has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

Symptoms of anorexia nervosa

• Extremely restricted eating
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia and muscle wasting and weakness
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Severe constipation
• Low blood pressure
• Slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multiorgan failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility

Bulimia nervosa

Bulimia nervosa is a condition where people have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or over overweight.

The disorder is diagnosed when that pattern occurs once a week for at least three months. Bulimia often begins in adolescence, and there is a biological component at play. Risk factors include childhood physical or sexual abuse, stressful events, childhood obesity, early puberty, mental health challenges such as low self-esteem, anxiety, and depression. Shame and secrecy are often enmeshed in bulimia—it’s sometimes referred to as the “secretive syndrome.” People with bulimia tend to have a typical body weight or are overweight. 

Symptoms of bulimia nervosa

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging of fluids
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

The disorder can elicit anxiety and shame, and purging specifically can feel like an addiction that the person finds “unwanted,” “out of control,” or “disgusting.” This shame can prevent people from seeking treatment. Yet treatment is key because bulimia can produce medical complications in addition to deep distress. 

Binge-eating disorder

Binge-eating disorder is a condition where people lose control over their eating and have reoccurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese, but they don’t have to be. Binge-eating disorder is the most common eating disorder in the U.S.

Symptoms of binge-eating disorder

• Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
• Eating even when you’re full or not hungry
• Eating fast during binge episodes
• Eating until you’re uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about your eating
• Frequently dieting, possibly without weight loss

It’s diagnosed when binges occur once a week for at least three months, when binges aren’t followed by purges or laxatives as in the case of bulimia, and when the experience leads to distress in the person’s life. People with binge-eating disorder often struggle with intense shame and self-criticism about it.

Avoidant restrictive food intake disorder

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.

ARFID occurs when someone doesn’t eat enough to get proper energy or nutrition. The disorder often emerges in infancy and childhood. It’s diagnosed when the avoidance can’t be explained by lack of food availability or cultural practice. Someone with ARFID might avoid eating due to sensory characteristics of foods like texture or smell, fear the consequences of eating, or not show interest in eating at all. Weight loss, nutritional deficiencies, and developmental problems can occur as a result. Medical problems, eating disorders, and mental health conditions must also be ruled out. Risk factors for ARFID include anxiety, OCD, and autism as well as gastrointestinal problems.

Symptoms of ARFID

• Dramatic restriction of types or amount of food eaten
• Lack of appetite or interest in food
• Dramatic weight loss
• Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause
• Limited range of preferred foods that becomes even more limited (“picky eating” that gets progressively worse)

People are often confused by the line between picky eating and ARFID. Picky eating verges into a disorder when the person fails to meet their caloric or nutritional needs. They may not be able to gain weight, have an inappropriate weight for their height, or depend on supplements. If it begins to interfere with their functioning on a daily basis, they could have a disorder.

Risk factors

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Researchers are using the latest technology and science to better understand eating disorders.

One approach involves the study of human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

Treatments and therapies

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

• Individual, group, and/or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications

Psychotherapies

Family-based therapy, a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appears to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Medications

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression. The Food and Drug Administration’s (FDA) website has the latest information on medication approvals, warnings, and patient information guides.

Learn more

If you have concerns about your own eating habits or that of your child, contact your provider at Welia Health. 

The Emily Program, located in Minneapolis, is nationally recognized for its compassionate and personalized approach to eating disorder awareness, treatment, and lifetime recovery. The Emily Program website offers extensive resources if you’d like to learn more.

Source: National Institute of Mental Health » Eating Disorders