Misunderstood and sometimes even normalized, eating disorders affect around 10% of the U.S. population, and rates are on the rise. While often associated with adolescents, clinicians are noticing that eating disorders are being diagnosed in younger and younger children. But what about the other side of the age spectrum? Here, we examine how eating disorders may show up in adults, and why many individuals may go undiagnosed. 

Eating Disorders in Adults

Eating disorders in adults may show up in a few different ways. In some cases, adults may still be dealing with an eating disorder that started in their youth. In others, they may have previously recovered from an eating disorder, only to have something retrigger it later in life. Some people may develop an eating disorder in adulthood despite never having experienced one before. In any situation, no one should have to struggle with an eating disorder alone.

What Eating Disorders Really Look Like

Eating disorders are mental illnesses that disrupt how someone relates to food, eating, or their body. Though they can sometimes be connected to someone’s self-image, they aren’t about vanity or willpower. Eating disorders are caused by a combination of genetic and environmental factors, and they can affect anyone.

Let’s say that again: eating disorders can impact anyone. Pop culture has reinforced the message that only white teenage girls have eating disorders. But this ignores the reality that these harmful illnesses affect people of all ages, genders, races, and body sizes. When we wonder why adult eating disorder diagnoses might fly under the radar, this is a key piece of the puzzle. To undermine the stereotypes and help those struggling, we need to understand what eating disorders really look like. 

Types of Eating Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes several different types of eating disorders, including:

• Anorexia Nervosa (AN): Perhaps the most recognized eating disorder, it is defined by severe restriction of food intake and an intense fear of weight gain.
• Bulimia Nervosa (BN): Cycles of binge eating followed by compensatory behaviors like purging, fasting, or compulsive exercise.
• Binge Eating Disorder (BED): Recurring binge eating episodes accompanied by distress or a sense of loss of control over eating.
• Avoidant/Restrictive Food Intake Disorder (ARFID): Restrictive eating that is not driven by body image concerns or desire to lose weight. ARFID is often tied to sensory sensitivities, fear of choking, or difficulty tolerating certain foods.
• Other Specified Feeding or Eating Disorder (OSFED): Eating disorders that don’t perfectly fit another diagnosis but are still serious and deserving of treatment.

For many adults, these symptoms can be difficult to recognize because disordered behaviors are often socially reinforced. For example, skipping meals due to stress may seem normal for your overwhelmed coworker, or an excessive exercise regimen may look like dedication. Here, we take a closer look at why eating disorders may go unnoticed for adults. 

Atypical Eating Disorders and the “Healthy” Appearance Myth

A common reason that an adult may not realize they have an eating disorder is that they don’t think they “look like” they have one. Despite the stereotype that people with eating disorders must be extremely thin, eating disorders occur in people of all body sizes.

OSFED

While most people are familiar with Anorexia Nervosa and Bulimia Nervosa, it’s the lesser-known eating disorders that are actually the most common. OSFED (Other Specified Feeding or Eating Disorder) accounts for about 50% of all eating disorder diagnoses. It’s a bit of a catch-all category that includes eating disorders that don’t meet the diagnostic criteria for one of the other disorders. 

For example, OSFED includes “Atypical” Anorexia Nervosa. This disorder has all the same signs and symptoms as its “typical” counterpart, but without the requirement that someone is underweight. Though someone may be a “normal” or “high” weight with an OSFED diagnosis, the consequences to their overall health may be just as severe. 

Easy to Miss, Dangerous to Overlook

BMI and body weight have historically been used by medical providers to identify eating disorders. Therefore, if someone’s weight appears to be within a “normal range,” other signs and symptoms may go unnoticed. Current numbers estimate that around 6% of the population may have OSFED. Given the likelihood that it is underdiagnosed, this reality may be much higher. 

But why is it missed? Someone with an “atypical” eating disorder may also be unaware that their restriction or compensatory behaviors could cause severe health problems and just not bring it up with their doctor. On the other hand, they might feel shame around their behaviors and not bring them up for fear of judgment. In some cases, these behaviors might actually be praised. 

The Normalization of Restriction

This brings up a contributing factor to eating disorders as a whole. Even though they are highly genetic, it often takes a societal or environmental force to “trigger” the disorder. Diet culture is a ubiquitous presence in Western society that normalizes weight loss and weight loss efforts. So if an adult is restricting their food to a dangerous level, but still meets the “normal” metric for body weight, their peers, their healthcare providers, and their internal dialogue may all rationalize their eating disorder as “healthy discipline” or “being good.”

This brings us to another significant reason that adults may not realize they have an eating disorder. Too often, these mental illnesses are disguised behind a veil of wellness or fitness.

Orthorexia & Fitness Culture

Disordered eating behaviors in adults, especially with “atypical” presentations, may be misconstrued as “healthy.” This line may become additionally muddled with orthorexia nervosa, which is defined by an obsession with eating “clean” foods. While it’s not an official DSM-5 diagnosis, it is widely recognized by clinicians that a fixation on “healthy eating” can be both emotionally distressing and have consequences for one’s physical health. 

However, since we live in a culture that glorifies dieting, exercise, and extreme weight loss stories, someone with orthorexia may likely be seen as normal or even admirable. The patterns of orthorexia are reinforced throughout culture, especially on social media. Trends on “clean eating” and exercise tips are extremely common on every social media platform. Even if an adult is aware of their extreme behaviors around food and exercise, they may not see them as harmful. But orthorexia nervosa can have severe consequences due to both undernourishment and malnutrition.

Why Binge Eating Disorder Often Goes Unnoticed

Binge Eating Disorder (BED) and the OSFED subdiagnosis, Binge Eating Disorder (of Low Frequency and/or Limited Duration), are other eating disorders that are more common than you may think. In fact, the reported rates of BED are likely skewed as clinicians estimate that less than half of people with BED ever seek treatment specifically for their eating disorder.

Unlike the stereotypical portrayals of eating disorders in movies and media, BED is not about a lack of willpower or simply “overeating.” Someone with BED experiences recurring episodes of eating large amounts of food while feeling emotionally out of control. Often, these episodes are accompanied by intense guilt, shame, or secrecy.

Unfortunately, because weight stigma is so deeply embedded in society, many adults with BED never realize they have a diagnosable mental health condition. Instead, they may internalize harmful stereotypes that frame binge eating as “laziness” or a “personal failure.” In healthcare settings, symptoms may also be reduced to conversations about weight loss rather than addressing the underlying emotional distress driving the disorder.

Treatment and Recovery Are Possible

No matter your age or how long you have been suffering from an eating disorder, with access to care and support, a life beyond eating disorders is possible. 

Treatment often looks a bit different for everyone. Therapeutic modalities like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are often used when treating eating disorders. Medication may be used as well to treat any co-occurring mental illnesses, like depression or anxiety. Other aspects of treatment may include nutritional counseling or support groups. The moral is that there is no single path to eating disorder recovery. 

Most importantly, adults should know that they do not have to “look sick enough” to deserve support. Eating disorders are treatable, and recovery is possible at any age.

At The Alliance, we are here to support anyone who is impacted by eating disorders. To get support, call our helpline at (866) 662-1235, where licensed mental health professionals can refer you to the care you need. We also hold free, virtual support groups 7 days a week, including a group for those in Mid-Life & Beyond.