Medically ReviewedEating disorders are severe yet treatable mental illnesses that impact people of all ages, genders, ethnicities, and backgrounds. In the United States, 28.8 million people in the current population will experience an eating disorder during their lifetime.
Those affected often have altered perception of food and body image and resort to disordered eating behaviors as a coping mechanism for challenging situations or emotions.
What Are the Types of Eating Disorders?
Someone may transition between eating disorder diagnoses if their symptoms evolve, as there is frequently considerable overlap among various types of eating disorders. The most common eating disorders are:
1. Anorexia Nervosa
Anorexia nervosa, often called anorexia, is a severe mental illness characterized by people limiting their food and drink intake, often setting strict rules about what, when, and where they eat. Those with anorexia lose more weight than is healthy for their age and height, often due to avoidance or severe restriction of food. The disorder is marked by an intense fear of weight gain, leading people to engage in excessive dieting, exercise, or other weight loss methods, even when they are already underweight.Men constitute 5 to 15 percent of people affected by anorexia. It is most prevalent among adolescent females, typically initiating in the mid-teenage years.
There are two subtypes of anorexia:
- Restrictive anorexia: People severely limit food intake.
- Binge-purge anorexia: In addition to restricting food, people also engage in binge-eating episodes followed by purging episodes through vomiting or the use of laxatives or diuretics.
2. Bulimia Nervosa
People with bulimia find themselves trapped in a pattern of bingeing, where they consume large amounts of food, and purging, or attempting to counteract overeating through actions such as vomiting, using laxatives or diuretics, fasting, or engaging in excessive exercise. Such episodes take place, on average, a minimum of once per week for a duration of three months.Story continues below advertisement
In the United States, the estimated prevalence of bulimia is 0.9 percent among adolescents, 1.5 percent among the general female population, and 0.5 percent among the general male population. It is most common in adolescent girls and young women. People with bulimia experience a loss of control when bingeing, often feeling disconnected from their actions.
People with bulimia place significant emphasis on weight and shape, perceiving themselves as heavier than they really are. Bulimia is less noticeable than anorexia, as patients may have a normal weight or be overweight, and they often engage in binge-eating and purging in private. However, despite the absence of noticeable weight changes, bulimia can still lead to severe health complications.
3. Binge-Eating Disorder (BED)
Binge-eating disorder is the most prevalent eating disorder in the United States. It involves repetitive episodes of consuming large quantities of food in a short timeframe. Around 2.7 percent of women, 1.7 percent of men, and 1.3 percent of adolescents experience BED, which typically emerges around the age of 23. The disorder is prevalent across age groups, races, ethnicities, and socioeconomic levels. However, people with BED are typically older and more likely to be male compared to people with anorexia or bulimia.BED is diagnosed when someone engages in binge eating, typically at least once a week for three months. These binges can be highly distressing, with some describing feelings of disconnection during the episodes and difficulty recalling what they ate afterward. Unlike those with bulimia, people with BED do not get rid of the food by purging.
Binge eating urges can be triggered by various emotions such as sadness, boredom, anger, anxiety, happiness, and excitement. In some cases, binge eating episodes may be habitual or planned, involving “special” binge foods. In addition, some people may engage in dietary restrictions or establish rules around food and binge eating.
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Other eating disorders include:
- Avoidant restrictive food intake disorder, where individuals either avoid specific foods or types of food, have restricted overall intake, or exhibit both behaviors.
- Pica, which is characterized by the consumption of non-food substances with no nutritional value, such as paper, soap, or chalk.
- Rumination disorder, which involves repeatedly regurgitating food after eating without experiencing nausea or involuntary retching.
What Are the Symptoms and Early Signs of Eating Disorders?
The signs and symptoms of eating disorders include physical and mental conditions that vary depending on the type of eating disorder and its severity.
Anorexia Nervosa
Anorexia nervosa can have both short- and long-term signs and symptoms.Short-term signs of anorexia include:
- Severely limited food intake.
- Extreme thinness.
- An ongoing quest for thinness with a refusal to maintain a healthy weight.
- An intense fear of gaining weight, often expressed through frequent weigh-ins.
- A distorted perception of one’s body image.
- Reduced bone density.
- Dry and yellowish skin.
- Fine hair growth throughout the body.
- Severe constipation.
- Low blood pressure and heart rate.
- Slow breathing.
- Sensitivity to cold.
- Mild anemia.
- Muscle wasting and weakness.
- Brittle hair and nails.
- Irregular menstruation.
- Multiple organ failure.
Bulimia Nervosa
People with bulimia nervosa experience episodes of binge eating, followed by purging. Self-induced vomiting and other methods of purging can result in symptoms and signs such as:- Chronic throat inflammation.
- Swollen salivary glands.
- Gastrointestinal issues, such as acid reflux.
- Erosion of dental enamel, from repeated vomiting of stomach acid.
- Intestinal irritation, from the misuse of laxatives.
- Severe dehydration, from purging.
- Electrolyte or mineral level imbalances.
In comparison with anorexia patients, people suffering from bulimia exhibit less social isolation and a higher risk of impulsive behavior, drug and alcohol substance abuse, and overt depression. Some may have low self-esteem and thoughts of hurting themselves.
Binge-Eating Disorder
People with BED often consume excessive calories in one sitting. They eat quickly, even when not hungry, snack frequently alongside regular meals, and experience distress about their eating behaviors. BED can result in weight gain, low self-esteem, depression, and anxiety.Story continues below advertisement
About 79 percent of people with BED have at least one psychiatric disorder, and 49 percent have a lifetime history of two or more comorbid disorders, such as anxiety or mood disorders.
What Causes Eating Disorders?
The exact causes of specific eating disorders remain unknown. Scientists believe that they result from the intricate interplay of many genetic, behavioral, psychological, and social factors.
1. Genetics: Researchers have found that eating disorders often exhibit familial patterns. Their current focus is on identifying DNA variations associated with an increased risk of developing eating disorders. Genetic factors may also involve alterations in hormone levels, as well as a family history of eating disorders, depression, or substance misuse.
2. Altered brain structure and function: People with anorexia exhibit changes in brain activity, including deficiencies of the mood regulators dopamine and serotonin.
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Interoceptive function, or the way the brain processes feedback, such as hunger and thirst, may also play a role in the binge-eating behavior of people with eating disorders. Studies have found abnormalities in the brain’s structure and connectivity, specifically in areas related to appetite and taste-reward pathways, in people with anorexia and bulimia.
BED shares similar brain processes with substance use disorder, involving difficulties in reward processing and inhibitory control.
3. Psychological traits: Susceptibility to depression and anxiety, difficulty managing stress, excessive worry about the future, and a fear of being labeled fat or overweight could contribute to eating disorders. One survey revealed increased anxiety and worsened symptoms for people with anorexia, bulimia, and binge-eating disorder during the COVID-19 pandemic.
4. Environmental and social factors: Environmental factors may include academic stressors, experiences of bullying or abuse, criticism related to body shape or eating habits, and challenging family dynamics. Performing a job or pursuing a hobby where a slender physique is perceived as ideal can also contribute.
There are also some cultural norms related to food and appearance. For instance, obesity stigma is well-established in Japan, with Japanese females being particularly susceptible to the risk of developing eating disorders.
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While a single cause of eating disorders has not been identified, researchers believe multiple factors contribute to a person developing an eating disorder. Illustrations by The Epoch Times, Shutterstock
Who Is at Risk of Eating Disorders?
The risk factors for eating disorders include:
- Having a family history of eating disorders: Genetic heritability accounts for 28 to 74 percent of the risk for eating disorders.
- Childhood obesity: BED is linked to an earlier onset of overweight conditions, with around 30 percent of people with BED having experienced childhood obesity. Another related risk factor is the loss of controlled eating in childhood.
- Being female: Over 50 percent of girls in the United States who have not yet reached puberty engage in dieting or employ other methods to manage their weight. These practices may include crash dieting, fasting, self-induced vomiting, and the use of diet pills or laxatives.
- Being young: Eating disorders commonly emerge in adolescence or early adulthood but can also manifest during childhood or later stages of life. A reported 77 percent of young people are dissatisfied with their body image.
- Being LBGT: Research indicates that over 50 percent of LBGT youth are diagnosed with an eating disorder in their lifetime. Gay men are more likely to report purging than straight men. The connection between gender dysphoria, body dissatisfaction, and eating disorders is frequently highlighted in transgender people.
- Experiencing mood disorders: One of the most common mood disorders, major depressive disorder, can sometimes lead to an eating disorder.
- Possessing specific personality traits: These personal traits may include impulsivity and perfectionism.
- Being a survivor of sexual abuse: Sexual abuse has been experienced by 30 percent of people with eating disorders.
- Being of a certain race/ethnicity: Black teenagers are 50 percent more likely than their white peers to show binge-eating, purging, and similar behaviors. Also, Hispanic people have a significantly higher risk of experiencing bulimia than other ethnicities. Asian American college students report higher rates of restriction.
- Larger body size: Larger body size is identified as a risk factor for developing an eating disorder, including bulimia and BED.
- Being an athlete: The occurrence of disordered eating and eating disorders ranges from 0 to 19 percent among male athletes and 6 to 45 percent among female athletes. In addition, athletes report higher rates of excessive exercise than non‐athletes.
- Having experienced a stressful event or trauma: This can increase the risk of having BED. Family conflicts can also increase a person’s risk.
How Are Eating Disorders Diagnosed?
Doctors use physical and psychological evaluations, including diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as well as some lab tests, to diagnose eating disorders. The typical workup involves a comprehensive medical history, including family and social history, medications, psychiatric history, and previous abuse, and a thorough physical exam to find out whether another medical condition is involved.
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Basic lab tests performed to rule out other conditions include:
- Complete blood count (CBC): Also known as a full blood count (FBC), this test measures the levels of white blood cells, red blood cells, and platelets in the blood.
- Comprehensive metabolic panel (CMP): A CMP measures 14 blood substances, including glucose, calcium, sodium, and total protein, thus offering insights into the body’s chemical balance and metabolism.
- Thyroid-stimulating hormone (TSH) test: Abnormal thyroid-stimulating hormone levels, whether too high or too low, may indicate a thyroid problem.
- Urinalysis: Also known as a urine test, this helps identify problems such as infections or kidney issues. Urine ketones can indicate insufficient calorie intake.
- Testosterone test: A testosterone test is performed for males. Adolescent boys with anorexia typically possess lower body mass index (BMI), fat mass, and testosterone levels.
- Electrocardiogram (ECG): An electrocardiogram is the quickest and most straightforward test used for heart evaluation. It can be used to assess for life-threatening arrhythmias, which is one complication of anorexia.
- Echocardiogram: Also known as echocardiography, echocardiogram uses high frequency sound waves to make images of the heart. It may be used if a patient has hemodynamic compromise, such as a fainting or shortness of breath, and a BMI lower than 14.
Anorexia Nervosa
Anorexia is diagnosed based on three criteria:- Weighing less than the normal minimum for age, sex, growth stage, and physical health.
- Having an intense fear of gaining weight, even when underweight or at a significantly low weight.
- Demonstrating a disturbance in the perception of body weight or shape.
Bulimia Nervosa
Bulimia is diagnosed after ruling out other medical conditions that would cause the symptoms, especially if the patient describes bingeing or purging behavior as involuntary. These diseases include biliary disease, irritable bowel syndrome, and certain neurological conditions.The clinical criteria for diagnosing bulimia nervosa involve:
- Recurrent episodes of binge eating accompanied by a loss of control, occurring at least once a week for three months.
- Recurrent inappropriate compensatory behaviors related to body weight, also occurring at least once a week for three months.
- Self-evaluation that is overly influenced by concerns about body shape and weight.
Binge-Eating Disorder
The clinical criteria for diagnosing BED are:- Occurrence of binge eating at least once a week for three months.
- A sense of lack of control over eating.
- Three or more specific eating behaviors, including eating more rapidly than normal, eating until uncomfortably full, consuming large amounts of food when not physically hungry, solitary eating due to embarrassment, and experiencing feelings of disgust or guilt after overeating.
What Are the Complications of Eating Disorders?
Eating disorders can have severe complications.
Anorexia Nervosa
Complications of anorexia include:- Hormonal changes, including the absence of menstrual periods, infertility, and delayed puberty.
- Cardiovascular complications, such as heart muscle disease, an abnormally slow heart rate, or an irregular heartbeat.
- Neurological issues, like seizures and challenges with concentration and memory.
- Weakened immune system.
Bulimia Nervosa
Complications of bulimia include:- Esophageal issues, including gastroesophageal reflux disease (GERD), Barrett’s esophagus, laryngopharyngeal reflux, spasms, and esophageal tears from forceful vomiting.
- Constipation, due to chronic abuse of stimulant laxatives.
- Stomach ulcers.
Binge-Eating Disorder
Complications of BED overlap with those of obesity, including:- Muscular, neck, shoulder, and lower back pain.
- Hypertension.
- Diabetes.
- Asthma.
- Coronary artery diseases and heart failure.
- Sleep apnea, which involves frequent pauses in breathing during sleep.
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What Are the Treatments for Eating Disorders?
Successful treatment of eating disorders is achievable with early detection and intervention, and prompt action is necessary for a complete recovery. The treatment options for eating disorders include:
1. Psychoeducation: This includes self-help resources and resources for families to help the patients.
2. Nutritional counseling and rehabilitation: Nutritional counseling is a crucial component of eating disorder treatment, addressing topics such as incorrect nutritional knowledge, understanding hunger and satiety, and dealing with prohibitions and guilt. The relationship between the patient and the dietitian is a significant aspect of this treatment process.
A dietitian can help someone with an eating disorder to establish healthy eating habits, aiming to prevent hunger and cravings while ensuring proper nutrition. Consistent and regular eating plays a crucial role in the treatment of bulimia, especially.
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3. Psychotherapy: Also known as talk therapy, psychotherapy encompasses a range of treatments designed to assist people in recognizing and modifying distressing emotions, thoughts, and behaviors. Several types of psychotherapy can be used to treat eating disorders, including:
- Cognitive behavioral therapy (CBT): Cognitive behavioral therapy focuses on managing issues by altering thought patterns and behaviors. It recognizes the interconnectedness of thoughts, feelings, physical sensations, and actions, aiming to break negative cycles and address overwhelming problems in a more positive and manageable manner. CBT is the treatment of choice for BED, as it is well-tolerated and has a remission rate of over 60 percent. However, patients with BED and comorbid anorexia or bulimia do not typically respond well to CBT.
- Interpersonal psychotherapy: Interpersonal psychotherapy recognizes psychological symptoms as responses to current challenges in everyday relationships, including conflicts, life changes, grief, loss, and difficulties in initiating or maintaining relationships.
- Family-based therapy: In this therapy, parents of adolescents with anorexia take charge of their child’s feeding. This seems to be effective in promoting weight gain and improving the child’s eating habits and moods.
- Dialectical behavioral therapy: This therapy involves educating patients about the skills necessary to manage problematic behaviors associated with emotional issues. This therapy may teach patients about mindful eating, emotional regulation, endurance of unfavorable situations, and relapse prevention.
For people with anorexia, use of the antipsychotic medication olanzapine may be considered if initial treatment is ineffective.
Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is the only medication with FDA approval for bulimia. This medication can decrease the occurrence of binge eating and vomiting, although the long-term results remain unknown. It is also effective in addressing concurrent anxiety and depression.
SSRIs are considered to be the first-line medications for BED. Their short-term effectiveness has been proven, with long-term effects unknown. As an alternative to SSRIs, lisdexamfetamine is FDA-approved to treat moderate to severe BED in adults aged 18 to 55.
How Does Mindset Affect Eating Disorders?
Mindset refers to a person’s established attitudes, beliefs, and cognitive processes that shape their perception of themselves and the world. How a person perceives body weight and eating habits can have a profound impact on their health and well-being. Therefore, mindset plays a significant role in the prevention, development, management, and treatment of eating disorders, in different ways.
1. Body Image Perception
A negative mindset about one’s body image can contribute to the development of eating disorders. For instance, body dissatisfaction reliably predicts the onset of such disorders in adolescent girls.Story continues below advertisement
Eating disorder treatment providers are recommended to explore body neutrality for both eating disorder prevention and intervention, as body neutrality can serve as a protective factor against body dissatisfaction. It involves three main elements:
- Being more realistic, mindful, and flexible about the body.
- Appreciating, respecting, and caring for the body’s functionality.
- Not defining self-worth based on appearance.
2. Perfectionism
Perfectionism and an excessive desire for success or control can contribute to the development of eating disorders.Maladaptive perfectionists tend to have a fixed mindset, believing that personal characteristics are fixed and unchangeable. People with a fixed mindset may get frustrated and abandon treatment due to the fear of failure. During the treatment process, instilling a growth mindset instead can act as a buffer against temporary setbacks.
Research also found that compared to a fixed mindset, a growth mindset can indirectly reduce the risk of developing eating disorders, engaging in unhealthy weight control behaviors, and experiencing psychological distress.
3. Fear of Success
In an early study of 104 female undergraduates, researchers discovered connections between eating disorder symptoms and factors such as fear of success, self-deprecation, insecurity, and anxiety. The findings suggest a potential model for the development of eating disorders with the influence of early childhood experiences on self-confidence and self-acceptance.Another study found that young women might display a fear of success between the emergence of initial anorexia symptoms and the disorder’s full development, suggesting that this fear could serve as a potential marker for the risk of developing anorexia.
4. Scarcity Mindset
Food insecurity, which is the lack of consistent access to sufficient food, may lead mothers to exhibit unhealthy eating behaviors, which may include psychological restriction of food or a scarcity mindset, which considers an irrational number of foods off-limits. This ultimately leads to guilt. In turn, this can potentially influence similar behaviors in their children, such as binge eating. These children’s binge eating episodes may then lead to more restrictive feeding practices by the parent.Story continues below advertisement
What Are the Natural Approaches to Eating Disorders?
There are several natural remedies to treat eating disorders. However, as their effectiveness and dosage have not been confirmed through extensive research, consultation with a doctor is necessary before using them.
1. Medicinal Herbs
In an experimental model in rats, the dry extract of St. John’s wort (Hypericum perforatum) was shown to potentially have therapeutic properties in bingeing-related eating disorders such as bulimia and BED.St. John’s wort contains various biologically active compounds, including hypericin, pseudohypericin, hyperforin, adhyperforin, and flavonoids. The potential impact of this herb on binge eating is of interest due to its reported anti-stress properties. It may also contribute to inhibiting binge eating by suppressing addictive-like behaviors, particularly those associated with the binge/intoxication stages of addiction.
2. Bright Light Therapy
Bright light therapy involves exposure to a bright light that mimics natural sunlight.In one study involving 34 patients of bulimia and BED, the participants received morning bright light and normal light for 10 consecutive days, and experienced a reduction in binge eating and food preoccupation. In addition, circadian rhythm disruptions linked to binge eating can contribute to negative mood, and they may be alleviated with bright light exposure. These results imply that morning bright light could be a helpful addition to evidence-based treatments for binge eating-related disorders.
3. Yoga
Yoga, which fosters a direct experience of the body, may effectively increase body awareness, thus counteracting the development of body dissatisfaction and preventing eating disorders.One study randomly assigned 38 female patients with bulimia or BED into two groups, with one undertaking an 11-week yoga intervention program. Compared to the other group, the yoga group exhibited significant reductions in Eating Disorder Examination global score, restraint, and eating concern. These differences continued to increase at the 6-month follow-up. The findings suggested that yoga might be beneficial in treating eating disorders.
4. Meditation
A meta-analysis of 74 samples discovered that practicing mindfulness is associated with lower levels of issues related to eating disorders, both concurrently and in the future. The connection is most significant for binge eating, emotional or external eating, and body dissatisfaction, as well as aspects of mindfulness such as being aware and not being judgmental.Another integrated review of eight studies found that multimodal mindfulness-based therapies seemed to work effectively. The researchers concluded that incorporating mindfulness as an integral aspect of therapy or practicing it regularly might be more useful clinically than single-episode mindful eating interventions.
5. Food Diaries
Food diaries, which are typically an essential part of a CBT program, are monitored by a nutritionist. Daily food diaries offer a comprehensive record of eating habits and weight control strategies. Analyzing these diaries helps identify triggers for binge eating and purging, enhancing overall awareness of food intake.In one study, a small group of adolescent girls with anorexia and bulimia participated in an 8-week treatment program, where they kept food diaries and shared them among themselves for constructive advice. The study found that it helped the girls become more aware of their eating patterns, with the potential to make changes to their behavior.
How Can I Prevent Eating Disorders?
Prevention efforts for eating disorders aim at decreasing negative risk factors such as body dissatisfaction, low self-esteem, and depression, while enhancing protective factors like a positive self-definition and healthy eating. These measures focus on fostering a healthier relationship with one’s body and reducing behaviors that contribute to the development of eating disorders.
While it is uncertain that prevention programs can lower the rates of diagnosed eating disorders, they have demonstrated successful reduction in risk factors associated with these conditions.
Different types of programs include:
- Universal prevention: This involves educating all the people in one population, such as elementary students in one school, who have varying degrees of risk.
- Selective prevention: This prevention method focuses on specific groups, such as girls facing puberty, who do not have eating disorders but are at risk of developing one.
- Targeted prevention: This type of program concentrates on people at high risk with mild symptoms or warning signs, such as high body dissatisfaction.
You can also do the following activities at home, school, and workplace to help prevent eating disorders:
- Educate yourself and your children about eating disorders, such as their risk factors and health consequences.
- Speak out against unhealthy beauty standards and body image presented by the media.
- Promote an understanding of natural weight gain during puberty.
- Be a positive role model for a healthy lifestyle and positive eating behaviors.
- Nurture healthy eating habits in families.
- Avoid labeling foods as “good” or “bad.”
- Create time and space for meals at school or work.
- Encourage self-esteem based on qualities other than appearance.
- Support others in fostering positive mindsets.
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