Did you know that nearly 30 million Americans experience an eating disorder in their lifetime? Eating disorders are health conditions that are serious, common, and treatable. This comprehensive guide will define eating disorders, explain signs and symptoms, dive deep on common disorders, and help connect you to the support you or a loved one may need.
What Is An Eating Disorder?
An eating disorder is defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition characterized by extreme and persistent changes in eating behaviors, often accompanied by negative emotions and thoughts. Eating disorders may appear as preoccupations regarding relationships with food and eating, hyperfocus on body weight, and distorted body image. Eating disorders have significant negative impacts on physical health and emotional wellbeing as well as mental health. Oftentimes eating disorders co-occur with other mental illnesses or psychiatric conditions such as anxiety and depression, obsessive-compulsive disorder (OCD), and addiction and substance use disorders. Behaviors such as food restriction, excessive exercise, binging, and induced vomiting commonly appear as symptoms in those experiencing eating disorders.
Though most people who experience eating disorders tend to be women, anyone can develop an eating disorder regardless of gender, age, race, or demographic background. Eating disorders can manifest in various ways and have varying severities. If left undiagnosed and untreated, an eating disorder can cause severe health problems and even be fatal. Given how common and variable eating disorders are in the population, it’s important to understand what they can look like so you or a loved one can seek support.
What Are Signs And Symptoms of An Eating Disorder?
Each person who experiences an eating disorder may find themselves with varying symptoms. Signs and symptoms can be different depending on the particular disorder, the severity of the disorder, social and physical environment, and differing personal behaviors. Nevertheless, all eating disorder centers around issues with food and eating, body weight, and/or body image. Many types of eating disorders have overlapping signs and symptoms despite their distinct diagnostic differences. Symptoms can be physical, mental, or behavioral. The following is a general list of both physical and behavioral signs of eating disorders. This list is not exhaustive, but includes signs commonly seen in many eating disorders.
Physical signs of an eating disorder may include:
- Excessive weight gain or weight loss
- Gastrointestinal issues
- Dizziness and fainting
- Inability to regulate body temperature
- Problems with sleeping
- Menstrual irregularity
- Dry skin and nails
- Thinning hair
- Fatigue and muscle weakness
- Lowered immune response
Behavioral signs of an eating disorder may include:
- Anxiety and depression
- Frequent dieting
- Preoccupation with body weight or body shape
- Fixation on calories, fat, carbohydrates, or other nutrients
- Avoidance of eating with others
- Restriction of particular food groups
- Excessive exercise
- Patterns of binge eating and purging
- Ritualizing mealtimes
- Secrecy around eating habits
If any of the signs and symptoms on this list feel familiar to you or have been observed in a loved one, you or your loved one may have an eating disorder. It’s important to seek help and reach out to a healthcare professional to find treatment that is right for you.
Health Impacts
The risk and impacts of any eating disorder can be severe and may lead to long-term health problems if not diagnosed and appropriately treated by medical professionals. Medical complications, such as chronic gastrointestinal issues, heart problems, persistent menstrual irregularity, organ dysfunction, infertility, and osteoporosis are all potential outcomes of eating disorders depending on the type and severity of the disorder. Many individuals experiencing eating disorders also experience psychological health impacts as well. These may include feelings of shame and guilt, self-harm, substance misuse and addiction, depression, and anxiety. These risks and health impacts can be minimized with prompt professional treatment.
Causes
Various factors contribute to the development of an eating disorder and can vary based on personal, medical, and environmental history. One of the highest predictors of developing an eating disorder is if a family member also has had an eating disorder. Experts believe genetic predisposition plays a significant role in causing the development of various eating disorders. Beyond family medical history, social and cultural factors have been found to contribute to eating disorders. Social pressures around body size and image, often exacerbated by the influence of social media, may have a role in the development of eating disorders. Additionally, all eating disorders are commonly triggered by mental health conditions such as anxiety and depression, as well as trauma.
If you or a loved one have a family history of an eating disorder, feels negatively influenced by culture and social media, or is experiencing mental health problems, it’s recommended to seek support from a specialized professional.
Types of Eating Disorders
There are eight different eating disorders defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), each with a unique diagnostic criteria. Eating disorders are diagnosed with particular diagnostic questionnaires and examinations utilized by medical professionals to screen, assess, and diagnose patients. This section will dive deeper on the eight diagnosable eating disorders and explore particular symptoms and behaviors associated with each one.
Anorexia Nervosa
Anorexia nervosa is an eating disorder characterized by an obsessive fear of gaining weight. The consuming fear of weight gain leads to distorted body image and disturbances in eating behaviors. This eating disorder occurs in up to 4% of females and 0.3% of males.
There are two subtypes of anorexia nervosa:
- Restricting subtype
- Binge-eating and purging subtype
Those who struggle with the restricting subtype tend to significantly limit food intake, leading to low body weight. Those who struggle with the binge-eating and purging subtype also may restrict food intake as well as engage in binging behaviors and purging behaviors.
Warning signs of anorexia nervosa include:
- Distorted body image
- Intense fear of weight gain
- Fixation on weight, calories, and food
- Food rituals
- Denial of hunger
- Weight loss
Anorexia nervosa can cause a variety of severe health complications. The longer a person with anorexia nervosa goes without diagnosis and treatment, the more long-lasting and severe these impacts may be, and may even become life-threatening. Some common risks and side effects of anorexia nervosa are:
- Anemia
- Poor circulation
- Gastrointestinal issues
- Organ failure
- Menstrual irregularly
- Infertility
- Osteoporosis
- Growth of downy hair (lanugo) on the body
- Memory loss and disorientation
Bulimia Nervosa
Bulimia nervosa is an eating disorder defined by regular episodes of binge eating followed by purging. Binge eating is the consumption of a large amount of calories in a short period of time, while purging is the act of ridding the body of calories by inducing vomiting, exercising excessively, or misusing laxatives and diuretics. The cycles of binge eating and purging that are characteristic of bulimia nervosa generally occur at least once per week for three months or more. Those experiencing bulimia nervosa tend to perseverate on body weight or shape and commonly have negative body image or low self-esteem. It’s common that bulimia nervosa co-occurs with conditions of self-harm and substance use.
Warning signs of bulimia nervosa include:
- Binging and purging
- Weight fluctuation
- Secretive eating
- Misuse of diet pills, laxatives, and diuretics
- Feeling out of control when eating
- Visits to the bathroom after meals
- Discoloration of teeth
- Heartburn or acid reflux
As with any eating disorder, bulimia nervosa can take a toll on an individual’s physical and mental wellbeing. The dangers and side effects of bulimia nervosa can be mitigated with prompt diagnosis and medical attention. Common health risks of bulimia nervosa may include:
- Fatigue
- Dizziness or fainting
- Tooth decay and gum disease
- Dehydration
- Development of ulcers
- Gastrointestinal issues like bloating, diarrhea, or constipation
- Kidney and liver damage
- Cardiac arrest
Binge Eating Disorder (BED)
Binge eating disorder is a condition where people experience recurring episodes of overeating. These episodes generally take place in a rapid manner and in a short amount of time. Binge eating episodes tend to occur when an individual is not hungry, not hungry, and often result in eating well past the point of extreme fullness. Those experiencing binge eating disorder often feel a lack of control over eating habits, a reduced ability to sense fullness, and an indecision of what to eat. Binge eating disorder is the most common eating disorder among American adults, affecting three times the number of individuals diagnosed with anorexia nervosa and bulimia nervosa combined.
Warning signs of binge eating disorder include:
- Restriction of food intake
- Sense of lack of control over eating
- Self-medicating or self-soothing with food
- Secretive eating
- Eating large amounts of food
- Feelings of shame and embarrassment
Binge eating disorder can have harmful effects on the health of an individual. Common dangers of binge eating disorder are:
- Type 2 diabetes
- Osteoarthritis
- Increased blood pressure and cholesterol
- Chronic kidney problems
- Sleep apnea
- Polycystic ovary syndrome (PCOS)
- Heart disease
Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant Restrictive Food Intake Disorder is an eating disorder causing a refusal or lack of interest in eating or of food in general. Those who suffer from ARFID may avoid foods based on smell, texture, or other sensory characteristics, and hold obsessive concerns about consuming particular foods. Individuals experiencing ARFID often are unable to obtain sufficient nutritional or energy needs due to their tendency to avoid particular foods. Behaviors of food avoidance often start in early childhood and can continue into adulthood.
Warning signs of Avoidant/Restrictive Food Intake Disorder are:
- Extreme pickiness in choosing foods
- Refusing food related to aversive experience
- Avoidance of food due to sensory issues
- Anxiety around particular foods
- Lack of appetite
- Reduced interest in eating
Prolonged experience of ARFID can lead to deleterious health effects. Some health risks of ARFID include:
- Stalled weight gain and stunted growth in children and adolescents
- Organ failure
- Hair loss
- Difficulty concentrating
- Electrolyte and nutrient imbalance
- Anemia
Other Specified Feeding and Eating Disorders (OSFED)
Other Specified Feeding and Eating Disorders (OSFED) is a classification of eating disorders for those with conditions that do not meet diagnostic criteria of other eating disorders despite similar symptoms. A person with OSFED may exhibit many symptoms of disordered eating similar to conditions such as anorexia nervosa or bulimia nervosa, but will not meet the entire criteria necessary to be diagnosed with these conditions. People diagnosed with OSFED generally show symptoms and behaviors present in other eating disorders, but to a lesser degree or lower frequency. Low frequency and limited duration of these symptoms can nevertheless be clinically significant and cause function impairment to the individual experiencing them.
There are currently five diagnostic categories of OSFED.
- Atypical anorexia nervosa: An individual with this condition will likely present all the symptoms typical of anorexia nervosa, but their body weight is within or above the normal range. Signs may include:
- Fixation on food and body image
- Restricting food intake
- Preoccupation with weight gain
- Disordered rituals around food and meals
- Binge eating disorder of low frequency or limited duration: An individual experiencing this condition will likely present all the symptoms typical of binge eating disorder, however binge eating episodes occur less than once per week and/or last for less than three months. Signs of binge eating disorder may include:
- Eating large quantities of food
- Reduced fullness signaling
- Eating until discomfort or pain arise
- Bulimia nervosa of low frequency or limited duration: Someone experiencing this OSFED category may exhibit all the signs of someone struggling with typical bulimia nervosa, but the binging and purging behaviors occur with less frequency and/or for less than three months. Signs of bulimia include:
- Eating large quantities of food
- Extreme exercise habits
- Purging disorder: Individuals experiencing purging disorder may show habits of repeated purging behavior without binge eating. Excessive exercise, misuse of laxatives or other diuretics, and self-induced vomiting are common forms of purging. Signs of this condition might include:
- Fear of weight gain
- Repeated episodes of purging with the goal of weight loss
- Dysmorphic body image
- Night eating syndrome: Those experiencing night eating syndrome exhibit excessive eating habits after an evening meal or after waking up from sleep. Signs of this condition are:
- Unmanageable urges to eat between dinner and sleep
- Disrupted sleeping patterns
- Waking up to eat throughout the night
Rumination Disorder
Rumination disorder is a condition characterized by the process of regurgitation, re-chewing, and re-swallowing or spitting out of previously eaten food. Rumination generally happens within a half hour after eating a meal. Individuals with rumination disorder often develop these behaviors in infancy or childhood and the condition tends to disappear on its own. However, when rumination disorder persists into adulthood it can lead to negative health effects.
Warning signs of rumination disorder:
- Un-induced regurgitation soon after meals
- Abdominal pain or pressure relieved by regurgitation
- Nausea
- Unintentional weight loss
Untreated rumination disorder can lead to various health problems such as:
- Extreme weight loss
- Malnutrition
- Dental erosion
- Esophagus damage
Pica
Pica is an eating disorder where individuals eat non-nutritive, non-food substances such as paper, glass, clay, paint, hair, chalk, dirt, or other nutrient-deficient non-food items. Pica is a relatively rare condition seen most commonly in pregnant women and young children. However, pica can affect anyone.
Risk factors for pica may include:
- Autism spectrum disorder
- Intellectual disabilities
- Obsessive-compulsive disorder
- Schizophrenia
- History of neglect or abuse
- Malnutrition, especially in cases of low iron or zinc levels
Though rare, pica can cause a myriad of medical complications for those who struggle with it, often attributed to the non-food substances an individual tends to consume. These may include:
- Anemia
- Lead poisoning
- Constipation or diarrhea
- Intestinal obstruction
- Mouth injuries
- Dental erosion
- Nutritional deficiencies
Unspecified Feeding or Eating Disorder (UFED)
Unspecified Feeding or Eating Disorder (UFED) is diagnosed when symptoms of an eating disorder impair the social, occupational, or functional realms of an individual’s life but do not meet the criteria or classification for other eating disorders. This category of diagnosis is often used when a clinician opts not to specify or if there is insufficient information about the patient to diagnose a more specific eating disorder. UFED is an eating disorder with the same urgency for treatment and similar negative health effects as any other disorder.
Treatment
Eating disorder treatment is critical for full recovery. It’s important to not only seek diagnosis but also find a care team and treatment facility that can help you or your loved one on the path to recovery. Eating disorder treatment varies based on different types of eating disorders, the severity, the type of facility, and geographic availability. Depending on these factors, there are various levels of care, from outpatient treatment to residential treatment. Working closely with a care team will help you find the treatment that is right for you on your journey to recovery.
Seek Help
If you or a loved one is experiencing an eating disorder or any of the signs and symptoms listed above, you are not alone. Recovery is always possible and help is available with the National Alliance for Eating Disorders and at (561) 841-0900.