What Is an Eating Disorder?
Eating disorders are a group of conditions marked by an unhealthy relationship with food. They tend to develop during the teenage and young adult years, and they are much more common in girls and women. No one knows exactly what causes eating disorders. However, mental health issues such as low self-esteem, depression, anxiety, trouble dealing with emotions, and substance use problems seem to increase the risk.
At first, the focus on food may be a way to gain control over one aspect of a person's life. Although it may start as simply eating a bit more or less than usual, the behavior can eventually take over their life. It can be hard to spot the signs of an eating disorder, especially early on. People with eating disorders may try to hide their food restrictions or wear baggy clothes to conceal the weight loss.
An eating disorder is a serious medical condition that can have long-term health consequences. That's why it's important to get help if you think that you or a loved one may have an eating disorder.
Types of Eating Disorders
There are four main types of eating disorders.
Anorexia nervosa
People with this eating disorder lose weight through excessive dieting, calorie restriction, and extreme exercise, sometimes to the point of starvation. They feel like they can never be thin enough and see themselves as overweight, even after they've lost a lot of weight.
Bulimia nervosa
People with this eating disorder go through cycles where they eat large amounts of food, known as bingeing. Then they purge through vomiting, extreme exercise, or other behaviors to avoid weight gain. Feeling like you've lost control over your eating is a sign of this eating disorder.
Binge eating disorder
This eating disorder involves episodes of eating large amounts of food in a short period. You may feel like you can't control what or how much you eat. And you may try to hide it, even to people closest to you. Binge eating at least once a week for three months or more is considered binge eating disorder.
Avoidant/restrictive food intake disorder (ARFID)
People with this eating disorder either eat very little or avoid foods with certain colors, smells, textures, or tastes to help them lose weight. Some doctors call ARFID a selective eating disorder. It usually begins in childhood. But unlike typical picky eaters, children with ARFID don't grow out of it when they get older.
Other eating disorders
A few other eating disorders also exist, including:
Orthorexia nervosa. People with this eating disorder are so obsessed with healthy eating that they severely restrict what they eat. Their limited diet may lead to nutrient deficiencies.
Pica. This is when someone eats things that aren't food, such as grass, dirt, or chalk. It's often linked to mental health conditions such as autism spectrum disorder or schizophrenia. Pica can be harmful to your health if not treated.
Purging disorder. People with this eating disorder purge themselves of food they've eaten by vomiting, using laxatives, or taking diuretic medicines. Purging disorder is different from bulimia because no food binge comes before the purge.
Rumination disorder. In this rare condition, recently eaten food comes back into the mouth. Sometimes, the person may chew and swallow the food again and might not realize they're doing it.
Other specified feeding or eating disorders (OSFED). Doctors use this umbrella term to describe symptoms that don't exactly fit any other eating disorder. OSFED may include some but not all symptoms of anorexia, bulimia, or another eating disorder. Like other eating disorders, it can be a way to feel more in control or to deal with unpleasant feelings. People with OSFED need treatment, just like those with other types of eating disorders.
Looking for the following symptoms can help you know whether you or someone you care about has an eating disorder.
Anorexia Nervosa Symptoms
People with anorexia nervosa have an extreme fear of gaining weight. They often diet and exercise too much, sometimes to the point of starvation. About one-third to one-half of people with anorexia also binge and purge by vomiting or taking a lot of laxatives. They may think they're overweight despite being underweight. This distorted body image may cause them to count calories obsessively and only allow themselves tiny portions of specific foods. People with anorexia may not realize they have an eating disorder or that they're seriously underweight.
The signs of anorexia can be subtle at first because it develops slowly. It may begin as an interest in dieting before an event such as a school dance or beach vacation. But as the disorder progresses, their obsession with weight intensifies. It creates a vicious cycle: The more weight the person loses, the more they worry and obsess about weight.
Anorexia has two subtypes, each with its own set of symptoms.
People with the restrictive type of anorexia:
- Severely limit the amount of food they eat
- Fast or eat a restrictive diet
- Cut out certain types of foods, such as carbs or fats
- Exercise excessively
People with binge-purge anorexia:
- Severely limit the amount of food they eat
- Have episodes of binge eating and then purging the food they've eaten through vomiting, extreme exercise, or laxatives
These can be symptoms of both anorexia types:
- Losing a lot of weight
- Wearing loose, bulky clothes to hide weight loss
- Being very focused on food, dieting, and calorie counting
- Avoiding mealtimes or not eating in front of others
- Preparing elaborate meals for others but not eating them
- Exercising excessively
- Making comments about weighing too much
- Not getting menstrual periods
- Having physical symptoms such as constipation or stomach pain
- Not believing they are too thin
Weight loss isn't the only sign to look for, as not everyone with anorexia nervosa is underweight. Some people are in a healthy weight range or overweight, but their restrictive eating still puts strain on their body.
Because people with anorexia may hide it, this eating disorder could become severe before anyone around them notices anything is wrong. If you think someone you care about has anorexia, it’s important for a doctor to evaluate them right away. If left untreated, anorexia can lead to serious complications, such as malnutrition and organ failure. However, with treatment, most people with anorexia gain back the weight they lost and recover from the physical problems they developed due to the disorder.
Mental and behavioral signs of anorexia nervosa
A person with anorexia nervosa may:
- Be intensely focused on food, dieting, and calorie intake
- Be afraid of weight gain, for example, weighing themselves or looking in the mirror very often
- Have a distorted body image — thinking they are overweight when they're at a healthy weight or underweight
- Eat very specific foods or food groups that may be low in fat and calories
- Make excuses for not eating or not be open about how much they eat
- Criticize their body often
- Not believe their weight loss or food restriction is a problem
- Have trouble concentrating
- Lose interest in sex
- Avoid friends and social situations
- Have symptoms of other mental health conditions, such as anger, depression, anxiety, or irritability
Physical signs of anorexia nervosa
Look for physical symptoms such as:
- Extreme thinness
- Tiredness and weakness
- Dizziness and fainting
- Dry or yellow skin
- Thin hair that falls out easily
- Brittle nails
- Soft, downy hair called lanugo all over the body
- Belly pain, bloating, or constipation
- Feeling cold when it's warm
- Tooth damage from forced vomiting
- Arm or leg swelling
- Bone fractures
- No menstrual periods
Symptoms of Bulimia Nervosa
People with bulimia nervosa have episodes where they eat large amounts of food (called bingeing). Those binges are followed by purging (vomiting or using laxatives), fasting, or exercising excessively because they feel guilty about overeating. They may find it hard to get out of this binge-purge cycle.
You can have bulimia at any body size. Unlike other eating disorders, people with bulimia may not be underweight or overweight. But they have the same intense fear of gaining weight and a distorted body image. They see themselves as overweight and want to lose weight. Out of a sense of shame, they may try to hide their eating disorder, for example, by wearing baggy clothes.
Mental and behavioral signs of bulimia nervosa
Watch for these common signs of bulimia:
- Eating large amounts of food in a short time
- Often going to the bathroom or using laxatives or diuretics after meals
- Skipping meals, not eating in front of others, or eating very small portions
- Being overly focused on weight or body image
- Constantly dieting
- Exercising to excess
- Feeling guilt or shame about their eating
- Wearing baggy clothes to hide their body
- Using gum, mouthwash, or mints often
- Withdrawing from friends and family
- Feeling out of control
- Having depression, anxiety, or substance use issues
Physical signs of bulimia nervosa
The physical symptoms of bulimia include:
- Constipation
- Acid reflux
- Swollen cheeks and jaw
- Tooth damage
- Scars and scrapes on the knuckles from forced vomiting
- Fainting
- Weakness
- Bloodshot eyes
- Irregular menstrual periods
Bulimia is treatable with cognitive behavioral therapy, certain anti-seizure medicines, antidepressants, or combinations of these treatments. It’s important to seek help if you think that you or someone you care about has bulimia.
Signs of Binge Eating Disorder
People with binge eating disorder have frequent episodes where they binge on large quantities of food. Like those with bulimia, they often feel out of control during these episodes and later feel guilt and shame about it. They have trouble stopping the bingeing cycle. As they tend to overconsume food, they're at a higher risk for obesity and related medical complications. However, binge eating disorder can affect people of any body size.
Unlike other eating disorders, binge eating disorder is almost as common in men as it is in women. Although binge eating disorder can start at any age, teenagers are especially vulnerable because of the social pressures they face.
Mental and behavioral signs of binge eating
Someone with binge eating disorder might:
- Eat large amounts of food in a short time
- Eat when they're not hungry or until they're overly full
- Eat very quickly
- Hide food or eat alone
- Feel like they can't control their eating
- Wear baggy clothes to hide their body
- Skip meals or avoid eating in front of others
- Diet constantly
- Feel depressed, ashamed, anxious, or guilty about their eating
Physical signs of binge eating
Some of the physical signs and complications of binge eating disorder include:
- Weight gain
- High blood pressure
- High cholesterol
- Type 2 diabetes
- Heart disease
Because binge eating leads to obesity, it can have serious health consequences if left untreated. Behavioral weight reduction programs can be helpful both for weight loss and controlling the urge to binge eat. The stimulant drug Vyvanse is FDA-approved to treat binge eating disorder. Another medication, Contrave, helps reduce appetite. Because depression often goes hand in hand with binge eating disorder, antidepressants and psychotherapy may also help.
Signs of Avoidant/Restrictive Food Intake Disorder (ARFID)
People with ARFID avoid certain foods and limit how much they eat. The goal is not to lose weight, and they don't have a distorted body image. Instead, they're afraid or not interested in eating. Usually, this behavior stems from fear, anxiety, or trauma.
Mental and behavioral signs of ARFID
People with ARFID may:
- Worry about choking, vomiting, or having other problems when they eat
- Gag when they eat certain foods
- Be very picky about the types of food they eat, avoiding foods with specific colors, smells, textures, or tastes
- Not have any appetite or desire to eat
- Become very upset or anxious when they eat
- Severely limit how much they eat
Physical signs of ARFID
Look for these symptoms, which could signal ARFID:
- Extreme weight loss
- Belly pain or cramps
- Constipation
- Fine hair called lanugo all over their body
- Weak muscles
- Dizziness or fainting
- Irregular menstrual periods
- Low body temperature
How to Help Someone With an Eating Disorder
Spotting the signs and symptoms of an eating disorder is the first step toward getting help or helping someone else. Eating disorders are treatable. With the right treatment and support, most people can learn healthy eating habits.
These resources offer screening, counseling, and other services for people with eating disorders:
- National Eating Disorders Association (NEDA). This nonprofit organization promotes awareness and research and supports people with eating disorders.
- National Association of Anorexia Nervosa and Associated Disorders (ANAD). This national network of volunteers offers free support and connection to help people with eating disorders recover.
- Overeaters Anonymous (OA). It's a community of people who help each other recover from compulsive eating and other difficulties with food.
- National Institute of Mental Health (NIMH). This division of the National Institutes of Health offers information about mental health conditions, including eating disorders.
Takeaways
An eating disorder is when someone has an unhealthy relationship with food. Anorexia nervosa, binge eating disorder, and bulimia nervosa are examples of eating disorders. These conditions can cause serious health complications if not treated. But with the right treatment and support, many people can overcome an eating disorder and develop a healthier relationship with food.
Eating Disorder FAQs
What is the most common symptom of an eating disorder?
Symptoms depend on the type of eating disorder, but they can include limiting how much you eat, eating a lot of food in a short time, vomiting or using laxatives after you eat, and only eating specific foods.
Is an eating disorder a mental illness?
An eating disorder is a mental health condition. It's linked to upsetting thoughts and behaviors, and it can harm your body image and your relationship with food.
How to recover from binge eating disorder
Talk therapy and the drug Vyvanse are treatments for binge eating disorder. Eating at regular intervals and avoiding things that trigger your binges can help you recover.
Are eating disorders genetic?
Genes do play a role in eating disorders. These conditions stem from a mix of genetic, environmental, and psychological factors.
