What is an Eating Disorder?
Eating disorders are severe disturbances in attitudes and behaviors around eating, weight, shape, and/or body image. They often are associated with significant distress and impairment, and may be accompanied by depressed mood, anxiety, and problems with interpersonal functioning. Many people with eating disorders suffer from medical complications that can be life threatening and require hospitalization.
Eating disorders rarely go away on their own and often require professional attention. Fortunately, there are many treatments available for people with eating disorders.
There are several different types of eating (or feeding) disorders:
Anorexia Nervosa involves persistent restriction of energy intake leading to a significantly low body weight and an intense fear of gaining weight or becoming fat. In order to maintain low weight, people with anorexia nervosa severely restrict their diets by consuming only small quantities of food, eliminating “high-calorie” foods, or fasting. Some individuals may self-induce vomiting, abuse laxatives, diuretics, or enemas, exercise excessively, or have episodes in which they lose control over eating and consume unusually large amounts of food (binge eating). In general, individuals with anorexia nervosa are preoccupied with body weight, body shape, dieting, food, fat, or calories and often have distortions in the way they perceive the shape or size of their bodies. Women and girls with anorexia nervosa often stop menstruating or fail to begin menses.
Anorexia nervosa has one of the highest mortality rates of any psychiatric disorder and is associated with numerous medical complications, including electrolyte imbalances, heart failure, irregular heartbeat, kidney dysfunction, dehydration, cerebral atrophy, gastrointestinal problems, bone abnormalities, dental problems, hair loss, and infertility. Many of these medical complications are reversible with proper nutrition and cessation of purging behaviors.
Bulimia Nervosa is a severe eating disturbance involving recurrent episodes of binge eating, which involve consuming an unusually large amount of food and experiencing feelings of loss of control. These binge eating episodes are followed by compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, laxative or diuretic abuse, fasting, or excessive exercising. This disorder also involves a preoccupation with shape and weight that influences self-evaluation. Individuals with bulimia nervosa have a body weight at or above a minimally healthy level.
Bulimia nervosa is associated with numerous medical complications, including electrolyte imbalances, cardiac problems, gastrointestinal problems, swollen salivary glands, dental problems, edema and dehydration, and menstrual irregularities. Many of these problems are reversible with cessation of purging behaviors.
Binge Eating Disorder
Binge Eating Disorder involves recurrent episodes of binge eating, which involve consuming an unusually large amount of food and experiencing feelings of loss of control. Unlike bulimia nervosa, binge eating disorder does not involve the use of compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, laxative or diuretic abuse, fasting, or intense exercising. Individuals with binge eating disorder experience significant distress, including feelings of guilt, shame, anger, and/or depressed mood.
Recurrent binge eating can lead to several medical complications including swollen salivary glands, abdominal discomfort, and obesity (which has been associated with high cholesterol, high blood pressure, gall bladder disease, diabetes, heart disease, and certain types of cancer).
Avoidant/Restrictive Food Intake Disorder
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or feeding disturbance characterized by a lack of interest in eating or food, avoidance of eating based on sensory characteristics of food, or concern about aversive consequences of eating, which results in an inability to meet appropriate nutritional and/or energy needs. ARFID is associated with significant weight loss, significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, and/or impairments in psychosocial functioning.
Other Feeding or Eating Disorders
A substantial proportion of patients with disordered eating do not meet full diagnostic criteria for anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidant/restrictive food intake disorder. These individuals can suffer from a variety of eating disorder symptoms, such as severely restricting their food intake; engaging in episodes of binge eating, self-induced vomiting, or misuse of laxatives, diuretics, or enemas; or they may be repeatedly chewing and spitting (not swallowing) large amounts of food. Depending on their symptoms, individuals may suffer from various psychological or medical problems, which are similar to those seen in the other eating disorders.
Some examples of these presentations include:
- Atypical anorexia nervosa: All criteria for anorexia nervosa are met, except that despite significant weight loss, the individual remains within or above a healthy weight range
- Purging disorder: Recurrent purging behaviors (e.g., self-induced vomiting) to influence one’s weight or shape in the absence of binge eating
- Night eating syndrome: Recurrent episodes of night eating (i.e., eating after awakening from sleep or excessive food consumption after the evening meal) that cause significant distress and/or impairment in functioning
Eating Disorders: Development and Course
Age of onset: Anorexia nervosa and bulimia nervosa typically develop during adolescence or young adulthood, and rarely develop past the age of 40. Binge eating disorder is more likely to develop in adulthood, with an average age of onset during the mid-20s, although youth may engage in recurrent loss of control eating episodes (i.e., in which the individual experiences feelings of loss of control while eating, regardless of the amount of food consumed during the eating episode).
Prevalence: Anorexia nervosa is significantly more common in females than males. The 12-month prevalence of anorexia nervosa among females is approximately 0.4% (APA, 2013). Less is known about the prevalence in males. Similarly, bulimia nervosa is more common in females than males, with a 12-month prevalence of approximately 1-1.5% in females (APA, 2013). Binge eating disorder is more common than either anorexia nervosa or bulimia nervosa, with a 12-month prevalence estimate of 2.4% across males and females (APA, 2013).
Causes: There is not one specific cause of eating disorders, and the reasons for why some people develop eating disorders are largely unknown. However, research suggests that a combination of biological, psychological, social, and cultural factors likely influences eating disorder development.
Outcome: Recovery rates for individuals with anorexia nervosa have ranged from 29-84% across studies, with an average of 50% of individuals achieving remission (Keel & Brown, 2010). Recovery rates for individuals with bulimia nervosa also have ranged across studies depending on duration of follow-up, but approximately 70% of individuals achieve full remission (Keel & Brown, 2010). Fewer follow-up studies have been conducted with individuals with binge eating disorder or other eating disorders. However, the majority of studies suggest higher remission rates for these eating disorders compared to anorexia nervosa or bulimia nervosa (Keel & Brown, 2010).
Individuals who do not achieve remission from an eating disorder within 5-10 years often demonstrate a chronic course (Keel & Brown, 2010). Additionally, individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in individuals with anorexia nervosa. Specifically, individuals with anorexia nervosa have a five-fold increased mortality risk compared to the general population (Arcelus, Mitchell, Wales, & Nielsen, 2011). Individuals with bulimia nervosa and other eating disorders have a two-fold increased mortality risk compared to the general population (Arcelus, Mitchell, Wales, & Nielsen, 2011). Suicide and suicide attempts also are common in all eating disorders.
What Can Friends and Family do to Help?
It may be difficult to approach a friend or loved one about his or her eating behaviors. Some suggestions for how to approach a friend or loved one about this topic are included below:
- Before approaching someone about their eating behaviors, try to get information about resources and treatments that are available for eating disorders in your community.
- The National Eating Disorders Association has volunteer Navigators who can be a helpful resource: https://www.nationaleatingdisorders.org/neda-navigators.
- Once you have done some research on eating disorders and treatment, approach the person privately, when you think you will not be interrupted, and allow for enough time to discuss your concerns.
- Start by telling the person how much you care about him/her, and then tell the person that you are worried about him/her. Offer specific observations about his/her behavior that concern you. It is important to stay calm and not argue with the person as to whether or not they have an eating disorder. Instead, explain that you are concerned and worried about their health and well-being.
- Encourage the person to express his/her feelings, and listen carefully.
- If the person agrees to seek help, present the person with the information you gathered on eating disorder treatment options, and offer to take the person to his/her appointment. Even if the person refuses to seek help, you can give him/her a written list of resources in the community that they can contact. Many people with eating disorders are embarrassed about their symptoms and may contact a resource you provide privately.
- If there is concern that the eating disorder is life-threatening or has created serious medical complications, or if the person seems suicidal or in danger, contact a mental health professional immediately, call 911, or tell this person to go to the nearest emergency room.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Arcelus, J., Mitchell, A.J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731.
Keel, P.K. & Brown, T.A. (2010). Update on course and outcome in eating disorders. International Journal of Eating Disorders, 43(3), 195-204.