Eating Disorders

Overview

What is an eating disorder?

An eating disorder is a serious, complex, mental health issue that one’s affects emotional and physical health. People with eating disorders develop an unhealthy relationships with food, their weight or appearance. Anorexia, bulimia and binge eating disorder are all types of eating disorders.

Eating disorders are treatable. People with untreated eating disorders may develop life-threatening problems.

How common are eating disorders?

Approximately 20 million girls and women and 10 million boys and men in America have an eating disorder.

Eating disorders are caused by several complex factors including genetics, brain biology, personality, cultural and social ideals and mental health issues.

What are the types of eating disorders?

There are different types of eating disorders. Some people may have more than one type of eating disorder. Types include:

  • Anorexia nervosa: People with anorexia nervosa greatly restrict food and calories sometimes to the point of self-starvation. You can have anorexia at any body size. It is characterized by an obsessive desire to lose weight and a refusal to eat healthy amounts of food for your body type and activity level.
  • Bulimia nervosa: People diagnosed with bulimia nervosa binge or eat, or perceive they ate, large amounts of food over a short time. Afterward, they may force themselves to purge the calories in some way such as vomiting, using laxatives or exercising excessively to rid their body of the food and calories.
  • Binge eating disorder (BED): Binge eating disorder is characterized by a person experiencing a loss of control over their eating. They eat, or perceive that they have eaten, large amounts of food in a short period of time. However, after binging they don’t purge food or burn off calories with exercise. Instead, they feel uncomfortably full and may struggle with shame, regret, guilt or depression.

Who is at risk for eating disorders?

Eating disorders can develop at any age. They affect all genders, races and ethnicities. It’s a myth that eating disorders mostly affect girls and women. Boys and men are equally at risk. Certain factors may make you more prone to developing an eating disorder, such as:

  • Family history of eating disorders, addiction, or other mental health issues, such as depression.
  • A history of trauma (physical, emotional or sexual).
  • Personal history of anxiety, depression or obsessive-compulsive disorder (OCD).
  • History of dieting.

Other factors include:

  • Diabetes (up to one-fourth of women with Type 1 diabetes develop an eating disorder).
  • Involvement in activities that focus on a slender appearance, such as modeling, gymnastics, swimming, wrestling and running.
  • Major life changes, such as starting a new school or job, a divorce or a move.
  • Perfectionistic tendencies.

Symptoms and Causes

What causes eating disorders?

A mix of genetics, environment and social factors play a role in the development of eating disorders. Some people with eating disorders may use extreme measures to control food when they feel like other aspects of their lives are out of control. An obsession with food becomes an unhealthy way of coping with painful emotions or feelings. Thus, eating disorders are more about finding healthy way to manage your emotions than about food.

What are the symptoms of eating disorders?

You can’t always tell by someone’s appearance that they have an eating disorder. You can have an eating disorder at any body weight or size. Eating disorders often impact the way people think about food or relate to it, which is not reflected in their weight or size.

Specific symptoms of eating disorders vary by type. It may be difficult to spot an eating disorder as it often mimics dieting. Or, a person struggling with an eating disorder may be reluctant to share their eating concerns. If you or a loved one has an eating disorder, you may notice these general changes:

  • Mood swings.
  • Fatigue, fainting or dizziness.
  • Thinning hair or hair loss.
  • Frequent bathroom breaks after eating.
  • Unexplained weight changes or drastic weight loss.
  • Unusual sweating or hot flashes.

Other changes could include:

  • Solo dining or not wanting to eat with other people.
  • Withdrawing from friends or social activities.
  • Hiding food or throwing it away.
  • Fixation on food, calories, exercise or weight loss.
  • Food rituals (chewing food longer than necessary, eating in secret).

Diagnosis and Tests

How is an eating disorder diagnosed?

Healthcare providers, such as physicians and mental health professionals, diagnose eating disorders. Your primary care provider may review symptoms, perform a physical examination and order blood tests. A mental health counselor, such as a psychologist or psychiatrist, conducts a psychological evaluation to learn more about your eating behaviors and beliefs.

Providers use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) to make a diagnosis. The DSM outlines symptoms for each type of eating disorder. You don’t have to have every symptom to receive an eating disorder diagnosis. And even if you don’t have a specific DSM-listed eating disorder, you may still need help overcoming food-related issues.

Management and Treatment

What are the complications of eating disorders?

Eating disorders are the second most lethal psychiatric disorder, followed only by opioid use disorder.

Greatly restricting calories, throwing up or extreme exercise can take a toll on your overall health. An untreated eating disorder places you at risk for serious problems, such as:

How are eating disorders managed or treated?

Treatments for eating disorders vary depending on the type and your specific needs. Even if you don’t have a diagnosed eating disorder, an expert can help you address and manage food-related issues. Treatments include:

  • Psychotherapy: A mental health professional can determine the best psychotherapy for your situation. Many people with eating disorders improve with cognitive behavioral therapy (CBT). This form of therapy helps you understand and change distorted thinking patterns that drive behaviors and emotions.
  • Maudsley approach: This form of family therapy helps parents of teenagers with anorexia. Parents actively guide a child’s eating while they learn healthier habits.
  • Medications: Some people with eating disorders have other conditions, like anxiety or depression. Taking antidepressants or other medications can improve these conditions. As a result, your thoughts about yourself and food improve.
  • Nutrition counseling: A registered dietitian with training in eating disorders can help improve eating habits and develop nutritious meal plans. This specialist can also offer tips for grocery shopping, meal planning and preparation.

The best treatment approach is often a combination of all of these professionals working together to obtain a comprehensive treatment to address the physical, mental and behavioral aspects.

Prevention

How can I prevent an eating disorder?

If eating disorders run in your family, being aware of the warning signs is a good first step to catching the problem early. Prompt treatment can break unhealthy eating patterns before they become harder to overcome. You can also reduce the risks of an eating disorder by getting treatment for problems like depression, anxiety and OCD.

Be a positive role model for your family, eating health food and avoiding talking about food as “good or bad.” Do not diet, talk about dieting or make negative comments about your body.

Outlook / Prognosis

What is the prognosis (outlook) for people who have eating disorders?

People who get treatment for eating disorders often recover and go on to lead healthy lives. It’s helpful to detect a problem early and start treatment right away.

There are different levels of care, including:

  • Outpatient therapy (once a week counseling).
  • Intensive outpatient therapy (therapy several times a week).
  • Inpatient therapy (hospitalization).

Your primary care doctor will work with you to decide what level of treatment would be right for you.

Left untreated, people with eating disorders can develop life-threatening complications. Some people may need to receive medical and mental health care at a hospital or treatment center.

Living With

When should I call the doctor?

You should call your healthcare provider if you have an eating disorder and you:

  • Find that your relationship to food is causing you distress.
  • Find that your relationship to food is getting in the way of your everyday activities.
  • Have chest pain, shortness of breath or heart palpitations.
  • Have dizziness or fainting.
  • Have a severe sore throat or acid reflux.
  • Have slurred speech or blurred vision.

What questions should I ask my doctor?

If you have an eating disorder, you may want to ask your healthcare provider:

  • What type of eating disorder do I have?
  • What is the best treatment for the eating disorder I have?
  • What are the treatment risks and side effects?
  • What type of follow-up care do I need after treatment?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Eating disorders are a serious problem that can affect your mental and physical health. If you think you have an eating disorder, don’t be embarrassed about seeking help. Millions of Americans struggle every day with an eating disorder. With proper medical care and mental health counseling, you can get better. Years of living with an untreated eating disorder can harm your physical health and may lead to life-threatening problems. Take the first step to protecting your well-being by talking to your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 10/07/2020.

References

  • American Psychiatric Association. Accessed 10/21/2020.What Are Eating Disorders? (https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders)
  • National Alliance on Mental Illness. . Accessed 10/21/2020. Eating Disorders (https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders)
  • National Eating Disorders Association. Accessed 10/21/2020.What Are Eating Disorders? (https://www.nationaleatingdisorders.org/what-are-eating-disorders)
  • National Institute of Mental Health. . Accessed 10/20/2020.Eating Disorders (https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml)
  • Rome ES, Strandjord SE. Eating Disorders. Pediatrics in Review 2016;37(8);323-336.
  • Dickstein LP. Franco KN, Rome ES, Auron M. Recognizing, managing medical consequences of eating disorders in primary care. Cleve Clinic J Med 2014;81(4):255-263.

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