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Eating Disorders

Written by Jonathan Strum

& Medically Reviewed by Dr. Sarah Dash, PHD

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Last Updated - 7/15/2020

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Updated 07/15/2020

Key Takeaways

  • Risk factors for eating disorders can include genetics, early life trauma, perfectionism and body dissatisfaction.
  • Thinness or avoidance of food are not the only symptoms of eating disorders, and symptoms can include eating an excessive amount of food, eating only ‘clean’ foods and compensating for food intake.
  • People with eating disorders can be a range of sizes, weights and body shapes.
  • Long-term consequences of eating disorders can include heart problems, digestive issues and poor bone health.
  • Eating disorders tend to emerge for the first time during adolescence and are generally more common among women than men.
  • Eating disorders can often co-occur with substance use disorders.

Eating disorders are serious illnesses that can impact long-term physical and mental health. Learn about the different types of eating disorders, as well as how they are identified and treated.

Eating disorders are serious illnesses that can significantly impact physical and mental health. These effects of eating disorders can impact a person’s ability to live normally, and they can even be life-threatening.

The history of eating disorders dates back centuries, when people would participate in self-starvation as part of religious practice. The medical community’s understanding of eating disorders continues to expand, and scientific research has helped define risks, causes and treatments.

Eating disorders represent a broad category of symptoms, and many eating disorders are not identified by extreme thinness or refusal of food. Learning about the different types of eating disorders can help people recognize the signs and symptoms of this serious illness.

What Is an Eating Disorder?

Many people may picture an eating disorder as self-starvation or obsession with thinness. Although these may be signs of some eating disorders, few people may know that these conditions are often far more complex.

An eating disorder is a type of illness that impacts both physical and mental health. It is not a lifestyle choice or obsession with appearance. Instead, it is a complicated mental disorder involving maladaptive eating patterns, preoccupation with body weight and extreme thoughts and feelings related to food.

There are many different types of eating disorders with features that range from extreme food restriction to obsessive avoidance of unhealthy foods. While disordered eating (meaning any abnormal eating behavior) is quite common, the formal diagnosis of an eating disorder must meet specific diagnostic criteria.

What Causes Eating Disorders?

There are many potential risk factors for eating disorders, and it is unlikely that a single experience or characteristic could cause one.

Recent research suggests that there may be a genetic component associated with the risk of eating disorders. In addition, early life experiences like abuse or trauma can increase the risk of eating disorders later in life. There is also evidence that personality characteristics, such as perfectionism, can increase the risk of an eating disorder.

Body image and self-esteem are also closely linked with eating disorders. The media has been heavily criticized for promoting unrealistic beauty standards that can contribute to some types of eating disorders.

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Symptoms of Eating Disorders

Eating disorder symptoms can vary depending on the type of disorder, severity of the condition and any possible co-occurring conditions. Some of the early signs of an eating disorder can include avoidance of food or situations involving food, significant weight loss or unusual behaviors regarding food, such as secrecy or lying. A person with an eating disorder may also fail to see any issues with their behavior, or deny they have a problem.

Other eating disorder symptoms may not be as obvious to others, such as obsessive thoughts about food and body weight and extreme fear of gaining weight. Although extreme thinness is commonly known as a symptom of an eating disorder, people with eating disorders can be a range of sizes and body types. The side effects of eating disorders can impact a person’s ability to function normally and affect other aspects of health, such as by increasing the risk of disease and mortality.

Health Problems Related to Eating Disorders

Many behaviors that are characteristic of eating disorders, such as extremely abnormal eating or failure to eat a nutrient-sufficient diet, can cause other health complications. Without adequate energy or nutrients, other systems of the body can weaken and begin to fail.

For example, eating disorders characterized by severe undernutrition have been linked with heart problems, decreased bone density and gastrointestinal problems. This occurs because the body begins breaking down tissue to meet its energy needs.

Eating disorders can also impact the endocrine system, which is responsible for sending messages to the body through hormones. The thyroid plays a key role in releasing hormones that support bone growth, body temperature, fertility and overall health. Severe eating disorders can have a lasting effect on the body’s hormones.

While eating disorders themselves are extremely dangerous, the complications of eating disorders can also be very serious. In addition to physical consequences, complications include mental health problems like depression or suicide. Although the body is adaptive and has the ability to repair itself during recovery from an eating disorder, health problems may persist for years or even permanently.

Different Types of Eating Disorders

When most people think of eating disorders, they typically imagine common eating disorders like anorexia or bulimia. However, there are many different types of eating disorders that have distinct symptoms, triggers, clinical presentation and forms of treatment.  Types of eating disorders include:

Anorexia Nervosa

Anorexia nervosa is one of the better-known eating disorders, but not all of the signs of anorexia are noticeable. Anorexia is usually characterized by extreme food restriction, significantly low body weight and fear of being overweight. However, those with atypical anorexia can have the same symptoms but without extreme weight loss or thinness.

Bulimia Nervosa

Bulimia is defined as a serious eating disorder that involves eating very large amounts of food in a short period of time, experiencing a loss of control and using behaviors like purging or over-exercising to compensate for food intake. The effects of bulimia on the body can be serious, including intestinal problems, gum disease and organ failure.

Binge Eating Disorder

Binge eating disorder is a relatively new diagnosis, and the exact causes are unclear. Like bulimia, the signs of binge eating disorder include consuming unusually large amounts of food in a short time. However, a key difference between binge eating and bulimia is that there is no compensatory behavior after a binge.

Diabulimia

Diabulimia is a lesser-known eating disorder that occurs in people with type 1 diabetes. The primary sign of this eating disorder is seen when someone with diabetes gives themselves less insulin than they require (or stops use) in order to lose weight.

Pica

Pica is associated with chewing or eating things that do not have nutritional value and are not considered food, such as dirt, hair or ice. Pica symptoms include persistent eating of non-food items when it is not part of a cultural practice and is not considered age-appropriate (for example, young children commonly put things in their mouths). Pica is also linked to nutrient deficiencies, and iron deficiency and pregnancy are both considered risk factors.

Rumination Disorder

Rumination eating disorder is sometimes called regurgitation eating disorder, and it is most common in young children. The disorder involves bringing up food that has been chewed, swallowed or partially-digested, and the food is spat out or re-swallowed. It is thought that events like illness or digestive discomfort may be a cause of rumination disorder.

Orthorexia Nervosa

Orthorexia nervosa is defined by an obsession with healthy eating. Orthorexia symptoms can be hard to spot, as they may appear as “healthy eating” or dieting. However, people with orthorexia are consumed by maintaining a “perfect” or “clean” diet, which is linked to feelings of purity or health. Orthorexia can be linked to other lifestyle obsessions, such as exercise addiction.

Avoidant or Restrictive Food Intake Disorder (ARFID)

ARFID is sometimes known as “picky eating disorder,” and it involves a disruption in eating that results in failure to meet nutritional needs. ARFID symptoms can include eating only a few specific foods and failure to maintain a healthy weight.

Other Specified Feeding or Eating Disorder (OSFED)

OSFED is a surprisingly common diagnosis that occurs when someone has symptoms of eating disorders but does not meet the full diagnostic criteria. People with OSFED have significant disturbances in eating behaviors and problematic evaluation of body shape or size.

Diagnosing Eating Disorders

Diagnosing an eating disorder is not as straightforward as assessing body weight or food intake. Eating disorder assessment requires a detailed analysis of health history, current thoughts, behaviors and functioning.

Eating disorders are diagnosed during a formal clinical interview, guided by the diagnostic criteria included in the DSM-5. An interview consists of specific questions related to symptoms and must be conducted by a trained health professional, such as a doctor or psychiatrist.

Diagnostic criteria helps to distinguish between different types of eating disorders. For example, a diagnosis of bulimia nervosa requires that the cycle of binging and compensating occurs at least once a week for three months, and that it does not occur only during a cycle of anorexia. Accurate eating disorder diagnosis is important to ensure a person receives the right treatment and care to prevent health complications.

Eating Disorder Statistics

Eating disorder statistics vary by the type of eating disorder, and they have changed alongside the diagnostic criteria in recent years. Importantly, changes from DSM-IV to DSM-5 meant that some disorders were no longer included, and new disorders were introduced.

The lifetime prevalence of eating disorders in the United States is estimated to be 0.80% for anorexia, 0.28% for bulimia and 0.85% for binge eating disorder. The odds of having a lifetime eating disorder are significantly greater for women compared to men, and eating disorders may differ based on cultural beliefs or norms related to appearance.

Anorexia, bulimia and binge eating disorder are usually thought of as the most common eating disorders. However, rates of diagnosis for OSFED are higher since the release of the DSM-5. Although all eating disorders can significantly impact health and well-being, anorexia is associated with the greatest risk of mortality.

Eating Disorders In Children and Teens

Eating disorders usually develop relatively early in life, and there may be warning signs of an eating disorder as early as childhood. Some factors, such as picky eating or body dissatisfaction, may indicate the risk of developing a disorder. Although picky eating or food refusal is relatively common in childhood, only a small percentage of these cases develop into an eating disorder.

Eating disorders most commonly emerge for the first time during adolescence, though binge eating disorder tends to emerge slightly later. This is an important developmental period where adolescents are experiencing many physical and emotional changes.

While the exact percentage of teens with eating disorders is difficult to study, it is estimated that around 6% of teens demonstrate serious symptoms. This tends to differ between males and females, with females experiencing eating disorders at higher rates than males. However, this depends on the type of eating disorder, and there is evidence to suggest that the eating disorder gender gap is closing.

Co-Occurring Substance Abuse and Eating Disorders

Eating disorders share some of the risk factors for other types of mental health problems, and people with eating disorders have an increased risk of substance abuse or addiction. For example, childhood trauma can be considered a risk factor for both eating disorders and substance use disorders.

Evidence suggests that eating disorders and addiction may be related, but rates of co-occurring eating disorders and substance misuse depend on the type of eating disorder. Research has estimated that 21.9% of those with an eating disorder also have a co-occurring substance use disorder. The prevalence of co-occurring eating disorders and substance use is higher among binging and purging eating disorders.

Treatment for co-occurring eating disorders and substance abuse helps address unhelpful coping strategies and change behavior patterns. However, the presence of substance misuse may require that medical detox is completed before treatment begins.

Eating Disorder Treatment

Treating eating disorders can be complex, as treatment must often address ingrained beliefs, feelings and behaviors. Treatment for eating disorders depends on the type of diagnosis and whether there are any co-occurring disorders. While there are general treatment options for eating disorders, an effective treatment strategy must consider the specific needs of the individual.

Eating disorder treatment aims to address problematic thoughts and behaviors and help develop new ways of thinking and coping. Cognitive behavioral therapy is a common and effective type of therapy for eating disorders that focuses on identifying, challenging and changing unhelpful ways of thinking and behaving. In some cases, therapy may be supported by medication.

Medication for eating disorders can help to address physiological or neurochemical imbalances. Research suggests that medication may be most effective for bulimia and binge eating disorder, but more research is required for anorexia and other eating disorders. Beneficial types of medication may include antidepressants or weight management medication. Medication can help to stabilize or improve a patient’s symptoms so that they are well enough to benefit from therapy.

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