Eating Disorders

What is an eating disorder?

An eating disorder is a mental health condition that affects your relationship with food and how you see yourself (body image). Eating disorders affect your physical and emotional health and can be life-threatening.

The symptoms of eating disorders look and feel different for each person and vary based on the type. You may count calories or limit how much and what types of foods you eat. You may eat large amounts of food, eat non-food items or throw up after eating. Eating may make you feel guilty or shameful instead of satisfied.

Food is a necessity to survive. Everyone has their own connection with food — your favorite things to eat (or avoid) are unique to you. It may be difficult to see when an eating disorder is present because you’ve grown accustomed to it.

While you may feel trapped in a cycle of disordered eating, know that treatment is available to help you feel well again when you’re ready.

Types of eating disorders

There are several different types of eating disorders, including:

• Anorexia nervosa: Restricting food and/or caloric intake (self-starvation), fear of gaining weight and a distorted self-image.
• Bulimia nervosa: Eating large amounts of food in a short amount of time (binging) or believing that the food intake was large, followed by getting rid of the food (purging) by vomiting, using laxatives (medications that make you poop) or exercising excessively.
• Binge eating disorder: Eating or thinking that there was a large amount of food intake in a short amount of time (binging) followed by feeling shame, regret, guilt or depression.
• Pica: Compulsively swallowing non-food items (such as chalk, dirt and paint).
• Rumination disorder: Undigested food returns to a person’s mouth after swallowing it. It’s then rechewed, re-swallowed or spit out.
• Avoidant/restrictive food intake disorder (ARFID): Limiting the amount or type of food eaten for reasons unrelated to a distorted self-image or an attempt to lose weight.

It’s possible to have more than one type of eating disorder at the same time.

How common are eating disorders?

Eating disorders are common. Studies show that 28.8 million people in the United States will have an eating disorder in their lifetime.

What are the signs and symptoms of eating disorders?

Signs and symptoms of eating disorders vary based on the type but could include:

• Mood swings.
• Fatigue.
• Fainting or dizziness.
• Thinning hair or hair loss.
• Unexplained weight changes or drastic weight loss.
• Unusual sweating or hot flashes.

Behavioral symptoms of eating disorders may include:

• Restrictive eating.
• Eating a lot in a short amount of time.
• Avoiding food or certain foods.
• Forced vomiting after meals or laxative misuse.
• Compulsive exercising after meals.
• Frequent bathroom breaks after eating.
• Withdrawing from friends or social activities.
• Hiding food or throwing it away.
• Food rituals (chewing food longer than necessary, eating in secret).

It may be difficult to spot an eating disorder in a loved one, as it often mimics dietary or lifestyle changes (adjustments to the things you do to change your overall health). You also can’t tell by looking at someone to know if they have this condition.

What does an eating disorder feel like?

If you have an eating disorder, you may feel that:

• Food is an enemy or it can harm you.
• You did something wrong or shameful after eating food.
• You aren’t at the correct weight or body size.
• You’re “failing” if you don’t meet certain weight or food requirements.
• Other people negatively perceive you.
• What and how you eat is the only thing in your life that you can control.
• You don’t want to spend time with others for fear of judgment.

These feelings aren’t a voluntary choice. Beyond physical health, an eating disorder severely impacts your ability to make decisions, your emotions and your ability to interact with others as expected.

What causes eating disorders?

The exact cause of eating disorders is unknown. But research suggests there are several possible factors that lead to eating disorders, including:

• Genetics: Studies found that anorexia nervosa, bulimia nervosa and binge eating disorder run in families. You can inherit genetic traits from your biological family that make you more likely to develop the condition.
• Brain biology: Dopamine and serotonin are chemicals in your brain. They make you feel things like pleasure and happiness. Research suggests that these chemicals activate during certain eating disorder behaviors.
• Cultural and social ideals: Pressure to “fit in” can affect your mental health and change your patterns of behavior to meet certain, often unrealistic, goals set by others. In the digital era, social media, television and movies may also influence your self-esteem if you feel you don’t look like the people you follow or admire.
• Underlying mental health conditions: You may use extreme measures around food when you feel like other aspects of your life are hard to manage. An obsession with food becomes an unhealthy way of coping with painful emotions or feelings. As a result, some eating disorders happen alongside other mental health conditions.

What are the risk factors for eating disorders?

Anyone at any age can develop an eating disorder. They’re most common among adolescents and teenagers. You may be more at risk if you:

• Have a history of eating disorders or other mental health conditions in your biological family.
• Experienced trauma (physical, emotional or sexual).
• Have an underlying mental health condition like anxiety, depression or obsessive-compulsive disorder.
• Participate in activities where your weight or body size is a factor (like gymnastics, wrestling or swimming).
• Go through a major change like starting a new school or job, a divorce or a move.
• Have Type 1 diabetes. Studies found that up to 25% of women and people assigned female at birth with Type 1 diabetes develop an eating disorder.
• Have a driven personality and strive for perfection (perfectionism).

What are the complications of eating disorders?

Greatly restricting calories, vomiting (throwing up) or extreme exercise can take a toll on your physical health. An untreated eating disorder causes serious complications such as:

• Arrhythmia, heart failure and other heart problems.
• Acid reflux (gastroesophageal reflux disease or GERD).
• Gastrointestinal problems.
• Low blood pressure (hypotension).
• Organ failure and brain damage.
• Osteoporosis.
• Severe dehydration and constipation.
• Stopped menstrual cycles (amenorrhea) and infertility.
• Stroke.
• Tooth damage.

As a mental health condition, your feelings about food or your body image may put you at risk of suicide or thoughts of suicide. If at any time you feel overwhelmed or need someone to talk to, call or text 988 to reach the Suicide and Crisis Lifeline (U.S.). Someone is available to help you 24/7.

How are eating disorders diagnosed?

A healthcare provider will make an eating disorder diagnosis by:

• Performing a physical exam.
• Reviewing your symptoms.
• Learning more about your eating and exercising habits.
• Ordering imaging, blood or urine tests (kidney function test, electrocardiogram) to rule out other possible causes of your symptoms or to determine if you have any complications.

Providers use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5-TR) to make a diagnosis. The DSM-5-TR 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.

Who diagnoses an eating disorder?

Healthcare providers, like 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, like a psychologist or psychiatrist, conducts a psychological evaluation to learn more about your eating behaviors and beliefs.

How are eating disorders treated?

Treatments for eating disorders vary by type but could include:

• Psychotherapy: A mental health professional can determine the best type of therapy for your situation. Options include individual, group and family therapy. Many people with eating disorders choose cognitive behavioral therapy (CBT).
• Medications: You may have other conditions, like anxiety or depression, with an eating disorder. Taking antidepressants, antipsychotics or other medications may improve these conditions.
• 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 approach is often a combination of treatment options. Your care team will work together to create a comprehensive treatment plan to address the physical, mental and behavioral aspects of the condition.

Even if you don’t have a diagnosed eating disorder, a medical expert can help you address and manage food-related issues or other conditions that affect your health.

What are the levels of care for eating disorders?

There are different levels of care for eating disorders, including:

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

Your primary care provider will work with you to determine what level of treatment would be best.

Eating disorder therapy

Therapy can be rewarding and challenging at the same time. You’ll meet regularly with a mental health professional to help you understand and change the thinking patterns that drive your behaviors and emotions.

It isn’t easy to open up and be honest with someone new. It can also be difficult to accept help when you feel in control of the situation. Therapy may make you experience feelings and emotions you may not want to think about.

It’s OK and encouraged to discuss these feelings with your provider. While undergoing treatment, know that your care team is available to help you whenever you need it.

Eating disorder recovery

The good news is that recovery is possible and there’s hope. Eating disorders don’t go away overnight. Treatment takes time. It depends on the severity and length of time you’ve had one. You may notice your symptoms improve after starting a medication or talking with a professional. You may also feel worse before you start to feel better. This is normal.

The best way to achieve recovery is to stick with your healthcare provider’s treatment plan. Discuss any side effects or roadblocks that you face with them. Remain honest and open about your feelings. Your providers can offer personalized guidance to help you get back to wellness sooner.

Can eating disorders be prevented?

There’s no known way to entirely prevent eating disorders.

If eating disorders or mental health conditions run in your biological family, awareness helps you and your care team detect and treat them early. Prompt treatment can break unhealthy behavioral patterns before they become harder to overcome.

How can I lower my risk of eating disorders?

You may be able to reduce your risk of an eating disorder by getting treatment for general health conditions and mental health conditions (like depression, anxiety and obsessive-compulsive disorder) at the first sign of symptoms.

If you’re a parent or caregiver and know that eating disorders run in your biological family, the following may reduce risk among children:

• Be a positive role model.
• Eat healthy foods and avoid talking about food as “good” or “bad.”
• Avoid talking about “dieting” with children.
• Avoid making negative comments about bodies.

What’s the outlook for eating disorders?

Treatment is available for all types of eating disorders. It’s helpful to detect an eating disorder early and start treatment right away for the best outlook. Recovery takes time and you may need lifelong support.

Untreated eating disorders can be life-threatening. If you or a loved one experiences symptoms of an eating disorder, seek treatment from a healthcare provider.

When should I see a healthcare provider?

Contact a healthcare provider if you:

• Find that your relationship with food is causing you distress.
• Notice that your relationship with food is getting in the way of your everyday activities.
• Have chest pain, shortness of breath or heart palpitations.
• Experience frequent dizziness or fainting.
• Have a severe sore throat or acid reflux.

What questions should I ask my healthcare provider?

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

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