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Eating Disorders

Understanding the causes, signs, and treatment options for the most fatal and misunderstood mental disorders.

Last Updated: Jul 18, 2022
Eating Disorders

Aside from opioid addiction, eating disorders comprise the highest mortality rates of all psychiatric disorders, affecting over 9% of the global population and directly causing 10,200 deaths yearly.¹ ² Anorexia nervosa is the most fatal of eating disorders, with an estimated mortality rate of about 10%.³

Between 85% to 95% of individuals with anorexia or bulimia are women, although recent years have shown a significant spike in eating disorders among children, transgender individuals, older adults, and military personnel.³ Causes for the high rates of mortality with eating disorders are complicated but include:

  • Starvation
  • Metabolic collapse
  • Suicide

This guide examines the causes, symptoms, and available treatments for individuals struggling with eating disorders and disordered eating behaviors.

Jump to:

The three main types of eating disorders
Understanding eating disorders
Causes of eating disorders
The most common eating disorders
Impacts of eating disorders
Signs of an eating disorder
Myths and realities about eating disorders
Statistics on eating disorders
Anorexia nervosa
Bulimia nervosa
Binge eating
EDNOS
Why are eating disorders common among college students?
Eating disorder resources
Frequently asked questions about eating disorders
References

The three main types of eating disorders

Here is a handy chart breaking down important details about anorexia nervosa, bulimia nervosa, and binge eating disorder.

  Anorexia nervosa Bulimia nervosa Binge eating disorder
What is it? Self-starvation that results in drastic and unhealthy weight loss Repetitive binging and purging (induced vomiting, laxatives, etc.) Repeated behaviors of eating large quantities of food, usually accompanied by the feeling of loss of control
What are the physical signs? Severe weight loss, fatigue, malnutrition, and irregular or absent menstruation Eroded teeth, acid reflux, electrolyte imbalances or irregularities, and scars or calluses on the backs of hands Excessive weight gain
What are the emotional signs? Intense anxiety about weight gain, depression, anxiety, denial of eating disorder, and equating body weight and self-worth Low self-esteem, anxiety, depression, and feelings of guilt Depression, anxiety, low self-esteem, and feelings of loss of control
Eating behaviors Eating small amounts of food or no food for extended periods Eating large quantities of food, followed by purging behaviors Eating large amounts of food in short periods (once a week for three months), secretive eating, and scheduling binges
Body image issues Perception of being overweight despite evidence to the contrary Poor self-image, perfectionist traits, and extreme focus on physical appearance Feelings of disgust concerning one’s body image
Weight Substantially underweight Ranges from underweight to overweight, but often average weight Often overweight
Social interaction May eat alone or withdraw from interacting with others Maintains relationships but may become more withdrawn Ranges from being overly defensive to avoiding all confrontation

Understanding eating disorders

Eating disorders are mental illnesses characterized by severe and persistent disturbance in eating behaviors with associated distressing emotions and thoughts related to eating. The most common symptoms of eating disorders are:

  • Binge eating
  • Purging
  • Severe calorie restriction

The obsessive nature of eating disorders concerning food, weight, and body image often leads to significant psychological distress. Eating disorders are also commonly comorbid with other issues, including depression, anxiety, and substance abuse. Eating disorders may develop during childhood or early adolescence. More rarely, they manifest in adults.

Causes of eating disorders

Eating disorders can have many causes and are often a complex interaction of genetic, psychological, and social factors. Social and psychological factors appear to be the leading causes. Many eating disorders relate to feelings of poor body image and low self-esteem.

Poor body image and/or low self-esteem often manifest from societal pressure about appearances. Certain personality traits are often linked to eating disorders, such as:

  • Individuals living with anorexia nervosa tend to have perfectionist traits.
  • Individuals living with bulimia often have impulsive personality traits.

However, determining the exact cause of an eating disorder is not simple, and a wide variety of things may trigger them. Research is ongoing in determining the causes of disordered eating behaviors.

The most common eating disorders

Anorexia and bulimia are the most common eating disorders, followed by binge eating disorder. Eating disorders not otherwise specified (EDNOS) comprise the fourth category for individuals who do not align with the first three disorders.

Disordered eating or diets evolve into eating disorders by degrees. The degree to which a person controls what or how they eat and the person’s motivation for the behavior can turn a diet into an eating disorder.

A diet is an intentional regulation of food intake to modify the body (losing weight, etc.). A diet has a finite objective: losing 10 pounds or adding 15 pounds of muscle, for instance. Even with a strict diet, no compulsive or extreme behaviors are typically involved.

Disordered eating, on the other hand, refers to abnormal eating behaviors that don’t meet the criteria for an eating disorder. For example, someone who occasionally binges and purges but does not engage in these activities often or in as extreme a fashion may be diagnosed with disordered eating behaviors and not fit the complete diagnosis of bulimia.

Eating disorders take dieting and disordered eating to the extreme. Individuals with eating disorders often find it impossible to let go of their behaviors even after they have met a goal to lose 10 pounds. Once they complete an objective, a new goal replaces it. Eating habits become a compulsion.

Anorexia nervosa

Anorexia often involves the desire to consume as few calories as possible and involves counting calories and sometimes excessive exercise to burn off calories consumed.

Bulimia nervosa

Bulimia often includes eating regularly or excessively and then purging (vomiting or laxative use) to expel the calories.

Binge eating

Binge eating manifests as eating a great deal of food in one sitting, often consuming excessive calories.

EDNOS

Non-specified eating disorders may present as various eating behaviors, such as starving, binging, purging, extreme food aversions, and more. These issues do not fit neatly into bulimia, anorexia, or binge eating categories.

Impacts of eating disorders

Eating disorders have both long-term and short-term impacts. In the short term, eating disorders can evoke physical consequences:

  • Tooth erosion
  • Abnormal blood pressure
  • Low heart rate
  • Muscle atrophy
  • Hair loss
  • Electrolyte imbalances
  • High cholesterol
  • Inflamed esophagus
  • Peptic ulcers
  • Constipation
  • Fatigue

The emotional and psychological impacts of eating disorders can be equally devastating to the sufferer and include issues like depression, anxiety, low self-esteem, social isolation, and more.

In the long-term, eating disorders carry an increased risk for:

  • Diabetes
  • Anemia
  • Osteoporosis
  • Kidney failure
  • A drop in internal body temperature
  • Infertility
  • Organ failure
  • Severe constipation
  • Brittle hair and nails
  • Dry skin
  • Heart disease
  • Brain damage

The long-term consequences of eating disorders can severely raise a patient’s mortality rate. Individuals suffering from anorexia have the highest mortality rate for psychological illnesses other than opioid addiction.⁶

Signs of an eating disorder

Consider your behaviors and emotions when evaluating your own behavior to determine whether you have an eating disorder. The following are signs of some form of disordered eating:

  • Feeling guilty after meals
  • Using diet pills
  • Defining your self-worth by the food choices you make
  • Excessive exercising to compensate for calories consumed
  • Having trouble in social situations
  • Feeling nervous, anxious, or tense when faced with unplanned eating
  • Frequent weight fluctuations
  • Yo-yo dieting
  • Very rigid eating and/or exercising schedules
  • Feelings of guilt when eating
  • Preoccupation with weight gain
  • Emotionally driven eating
  • Occasional purging or binge eating
  • Feeling possessive of food
  • Categorizing foods as “good” or “bad”
  • Drinking a lot of fluids to feel full faster when eating
  • Skipping meals
  • Restrictive dieting
  • Irregular eating patterns

When identifying the signs of eating disorders in friends and family, it’s essential to remember that these signs can often be challenging to spot, particularly in the earliest stages. Eating disorders are about shame, and hiding them is often a priority for the sufferer.

However, keeping the disorder hidden as time passes becomes more challenging, especially if the individual begins to lose or gain weight quickly. The following are common physical or emotional signs that may indicate someone you know suffers from an eating disorder:

  • Tooth decay and/or erosion
  • Dehydration
  • Constant sore throat
  • Purging behaviors, such as frequent bathroom visits after meals or the unusual use of laxatives
  • Secretive food behaviors
  • Extreme and rapid weight loss
  • Refusing to eat normal quantities of food
  • Avoiding food altogether
  • Worry over weight gain
  • Withdrawal from friends and activities
  • Dry or yellowing skin
  • Emaciation
  • Unusual fatigue and lethargy
  • Ulcers

Myths and realities about eating disorders

As with many subjects, it’s often a challenge to identify factual information about eating disorders in the sea of misinformation. Here we’ll separate reality from myth.

Myth Reality
Most people with eating disorders get treatment. Only about 10% of individuals with eating disorders receive treatment.
Eating disorders have low mortality rates. Eating disorders have the highest mortality rates of all mental illnesses except opioid addiction.
Only women develop eating disorders. 1 in 4 people with an eating disorder is male.
You can’t die from anorexia nervosa. It will kill about 4% of sufferers. Other indirect causes of anorexia-related death include suicide and other health conditions.
Anorexia is a lifestyle choice. Anorexia is a mental illness.
Bulimics always purge by vomiting. Bulimics purge in numerous ways, including laxative use.
Wanting to exercise frequently is always a good sign of physical health. The desire to exercise often and build muscle can signify an eating disorder.
Eating disorders have no genetic cause. Eating disorders are closely associated with genetics. Individuals with parents or siblings with an eating disorder are 11 times more likely to develop a condition themselves.
Eating disorders are equally likely for people of all ages. Young women and teenage girls are more likely to develop an eating disorder than their male peers.
Society and the media are the cause of eating disorders. The environment may play a role in issues with self-image and eating disorders, but there is also a genetic cause.

Statistics on eating disorders

The following statistics give a sense of the magnitude and severity of these disorders.

  • Eating disorders affect at least 9% of the global population, including 28.8 million Americans in their lifetime.²
  • Less than 6% of individuals with eating disorders are medically diagnosed as underweight, meaning that the vast majority fall into average or healthy weight ranges.²
  • Between 28% to 74% of the risk for eating disorders is genetic.²
  • Eating disorders are the deadliest mental illnesses, except for opioid dependence and overdose.²
  • Approximately 26% of people with eating disorders attempt suicide.²
  • The economic cost of eating disorders is $64.7 billion annually.²
  • Gay men are seven times more likely to report binge eating and 12 times more likely to report purging than their heterosexual counterparts.²
  • Transgender college students report experiencing disordered eating at four times the rate of cisgender students.²
  • 20%-30% of adults with eating disorders also have autism.²
  • Up to 4% of females in the U.S. will have bulimia during their lifetime, and 3.9% of those afflicted will die from the condition.⁷
  • 5.2% of individuals with EDNOS will die from health complications.⁷
  • 25% of college-aged women engage in binging and purging to control weight.⁷
  • Over 50% of teenage girls and 33% of adolescent boys use restrictive measures to lose weight.⁷

Anorexia nervosa

Anorexia nervosa has the highest mortality rate of all mental illnesses, except for opiate addiction.⁶ This disorder is characterized by periods of self-starvation resulting in low body weight. Psychologically, patients with anorexia are motivated by an intense fear of gaining weight or becoming fat.

There are two subtypes of anorexia nervosa:

  1. Restricting type. This disorder manifests when individuals limit calories primarily by dieting, fasting, and/or excessively exercising.

  2. Binge eating/purging type. This subtype involves intermittent binge eating and purging behaviors.

Signs of disorder

Signs of anorexia nervosa develop over time as the condition worsens and may include:⁶

  • Cold intolerance
  • Muscle weakness and atrophy
  • Heartburn and reflux
  • Cessation of menstrual periods
  • Dizziness or fainting from dehydration
  • Brittle hair and nails
  • Stress fractures from compulsive exercise
  • Severe constipation, bloating, and fullness after meals
  • Bone loss resulting in osteopenia or osteoporosis
  • Depression, irritability, anxiety
  • Poor concentration and fatigue

The impacts of anorexia nervosa are tragic and deadly, with approximately 8% of sufferers dying from starvation or suicide.⁶

Treatment

Treatment for anorexia nervosa consists of several elements, depending upon the severity of the problem and the individual. As with other conditions, getting help early is preferable and often more successful.

Your doctor will need to address any imminent medical problems first. This may mean getting treatment for related heart issues, osteoporosis, anemia, and malnutrition. Medical evaluations and psychiatric assessments are essential components to help patients normalize their eating and weight control behaviors.

Your doctor will help you develop a nutritional plan that counters anxieties about eating and gives you practice consuming a wide variety of foods across regularly spaced meals. You will also be counseled to address body dissatisfaction issues, although these usually take longer to correct than eating behaviors.

In cases of severe anorexia, inpatient treatment or a residential behavioral program may be the best option. Forms of therapy in treating anorexia include cognitive behavioral therapy (CBT), psychotherapy, and medications to assist with comorbid anxiety or depression.

Understanding that you have a problem with eating is the first step to getting help. If you or someone you know suffers from an eating disorder, look at the resources below for treatment information and advice.

Once you’ve acknowledged the problem, seeing your primary care physician is the best next step. They can help you access the mental health resources to begin your path to recovery.

Resources for help

Bulimia nervosa

Bulimia is another serious mental health condition with extreme consequences on the digestive system. People who have bulimia and use vomiting as a means of purging can cause long-term physical damage to the esophagus, mouth, and teeth. Those who use laxatives to purge can incur long-term problems with bowel movements.

Bulimics generally suffer from comorbid conditions related to their disorder, including low blood pressure, osteoporosis, and electrolyte imbalances. Another physiological issue that arises with bulimia is an addiction to vomiting. When we vomit, our bodies release endorphins, leading to additional tendencies toward the behavior.

Signs of disorder

Signs of bulimia nervosa develop over time as the condition worsens and may include:⁶

  • Recurrent diarrhea
  • Misuse of diuretics
  • Dehydration as a result of excessive purging
  • Misuse of laxatives or diet pills
  • Frequent trips to the bathroom after meals
  • Large amounts of food disappearing
  • Chronic sore throat
  • Dental decay and erosion of tooth enamel
  • Heartburn and gastroesophageal reflux
  • Swelling of the salivary glands

Treatment

Bulimia is a particularly secretive disorder, so getting treatment can be difficult. If you are struggling with bulimia or know someone who is, seeking treatment is imperative for long-term health and wellness. Seeing a medical doctor or mental health professional should be your first step. For more resources on treatment options, see the resources below.

Resources for help

Binge eating

Binge eating is more than simply overindulging on occasion. It becomes a severe disorder driven by uncontrollable urges that disrupt a person’s life. Binge eating can lead to:

  • Social isolation
  • Depression
  • Type 2 diabetes
  • Heart disease
  • Obesity
  • Sleep apnea
  • High blood pressure
  • Joint problems

Signs of disorder

A diagnosis of binge eating disorder requires frequent binges associated with feelings of a lack of control. It must also include three or more of the following behaviors:⁶

  • Eating food more rapidly than usual
  • Eating large amounts of food when not hungry
  • Eating until uncomfortably full
  • Eating alone to avoid judgment about the quantity one is eating
  • Feeling shame, guilt, and depression after eating binges

Treatment

The most effective treatment for binge eating disorder is cognitive behavioral therapy. Interpersonal therapy may also be effective, and your doctor may prescribe antidepressant medications during and after treatment.

If a patient has incurred physical health issues due to binge eating, those will also need to be addressed by their doctor or treatment professional. Comorbid conditions with binge eating disorder may include type 2 diabetes, obesity, high blood pressure, or heart disease.

Resources for help

EDNOS eating

Eating disorders not otherwise specified (EDNOS) comprise many lesser-known eating disorders, such as:

Orthorexia

Orthorexia is a condition where the sufferer has a compulsion to avoid eating foods they perceive to be impure or unhealthy. It is an unhealthy obsession with eating only healthy foods. This condition limits food selection and can create social isolation due to an intolerance of other eating behaviors. This condition is not recognized as a clinical diagnosis in the DSM-5.

ARFID

Avoidant/restrictive food intake disorder (ARFID) involves a disturbance in eating that results in persistent failure to meet nutritional needs. Food avoidance may arise from low appetite and lack of interest in food, extreme avoidance based on sensory characteristics of foods (texture, smell, appearance, etc.), or anxiety about consequences of eating like fears of choking, vomiting, constipation, allergic reactions, etc. ARFID is associated with significant weight loss, nutritional deficiency, the need for a feeding tube to maintain sufficient nutrient intake, and interference with social functioning.

Yo-yo dieting

Yo-yo dieting is a behavior wherein a sufferer repeatedly diets but immediately gains back the weight, leading to more dieting. Yo-yo dieting is an unhealthy behavior that alters the body’s muscle-to-fat ratio, eventually depleting muscle and replacing it with fat.

Diabulimia

Diabulimia is a form of bulimia isolated in individuals with diabetes who are dependent on insulin. Its crucial symptom in patients with type 1 diabetes is severe weight loss. Other symptoms include extreme thirst and frequent urination. This dangerous disorder can lead to long-term kidney and vision problems, cardiovascular issues, and other complications.

Rumination disorder

Rumination disorder involves regurgitating food and then re-chewing and swallowing the regurgitation. It can occur in infancy, childhood, adolescence, or adulthood.

Why are eating disorders common among college students?

Over a quarter of college-aged women report binging and purging behaviors, and other eating disorders appear at much higher rates among college students.⁷ There are several reasons for this common problem, which we’ll examine below.

  • Academic pressure and stress often lead to eating disorders. This stress can bleed into everyday life and behaviors, such as eating.
  • Social stresses in college lead to many students’ attempts to fit in and feel accepted. Body image is a significant component of self-esteem, and many students seek unhealthy beauty standards to gain popularity.
  • Many college students do not seek treatment for their eating disorders due to shame and social stigma.
  • Eating disorders among female college students are much higher than among males. This may be due to more significant social pressure to fit in, academic stress, and a lack of structure around food in their family home.
  • An increase in alcohol use in college brings added calories and weight gain. Many students may engage in risky eating behaviors to drop the “freshman 15” or reduce weight from drinking.
  • All-you-can-eat meal plans may contribute to eating disorders because they provide unlimited food choices that may increase weight, followed by immediate crash dieting. Repeated crash dieting can evolve into an eating disorder.
  • College athletes are at a higher risk of developing an eating disorder based on athletic pressure, desires for improved physical performance, and holding onto college scholarships based on athletics.

How to address disordered eating in college

One of the first steps you can take if you believe you or someone you know is suffering from disordered eating or an eating disorder is to contact your school’s medical health center for counseling with a professional. Colleges today recognize the problem of eating disorders among college students and will have resources to help them seek treatment on-campus or off.

Eating disorder resources

Browse the following list for valuable resources we can recommend.

  • About Face is an organization dedicated to arming girls and women with the knowledge to stand tall in a culture that diminishes them.
  • Academy for Eating Disorders provides resources for professionals, students, and experts.
  • ANAD (National Association of Anorexia Nervosa and Associated Disorders) is the leading non-profit in the U.S. providing free support services to those with eating disorders, disordered eating, and impaired body image.
  • ANRED (Anorexia Nervosa and Related Eating Disorders) is a non-profit organization that ceased operation in 2009. However, the organization still provides comprehensive information about eating disorders.
  • The American Psychiatric Association provides resources and comprehensive information about many eating disorders and disordered eating.
  • The American Psychological Association provides information and resources for those suffering from eating disorders or those worried about a friend or family member.
  • Bulimia.com provides resources for individuals with bulimia and co-occurring eating disorders.
  • The Center: A Place of Hope is a Top Ten Facility for treating depression, eating disorders, and other mental health issues.
  • Center for Eating Disorders provides outpatient treatment, education, support, and referral services for individuals struggling with eating disorders and related issues. It currently includes telehealth treatment instead of in-person therapy.
  • Eating Disorders Online offers educational information, scientific research, and resources on eating disorders.
  • Calmerry provides a mental health digest and online resources for patients and professionals treating eating disorders. Read our full review of Calmerry.
  • Eating Recovery Center is a nationwide leader in eating disorder recovery, with 35 centers nationwide and virtual treatment options.
  • EDReferral.com provides referrals for those with eating disorders seeking treatment.
  • F.E.A.S.T. is a global organization providing resources, information, and support for families dealing with eating disorders.
  • The Multi-Service Eating Disorder Association is a non-profit organization dedicated to education and awareness of eating disorders and their early detection.
  • MedlinePlus is the National Institute of Health’s online library of eating disorder information and resources.
  • Mindfulness is an outpatient clinic providing individual and family therapy for eating disorders.
  • Mirror-Mirror: Eating Disorders provides information and support for those struggling with eating disorders and their loved ones.
  • The National Institute of Health offers information and resources regarding eating disorders.
  • NEDA includes screening tools, eating disorder hotlines, comprehensive information, and additional resources for those seeking help.

Frequently asked questions about eating disorders

What more subtle signs should a friend or family member examine if they suspect someone has an eating disorder?

Individuals with anorexia often dress in warm, baggy clothing, even in the summer. They’ll often have sallow, dry skin. They may disappear to the restroom after eating or make excuses for skipping meals. They may exercise excessively. Rapid weight loss and OCD symptoms are also common. Bulimia symptoms include signs of binging, particularly at night. You may notice empty food containers while not having seen them eat. They may have dental problems from frequent vomiting, including inflamed gums or marks on their hands from induced purging. Increasing depression and repeated attempts at losing weight are additional signs of bulimia.

Are eating disorders more prevalent in college? If so, why?

Anorexia usually develops earlier than bulimia — often in late puberty. Bulimia, on the other hand, often develops during the college years. Anorexia is associated with high IQ and educational levels, which is evident on college campuses. The escape from family supervision around eating can trigger those who have recovered to relapse during college.

What can you do to help someone with an eating disorder?

Medical treatment is essential. You should encourage this individual to seek professional treatment to help them work through the issues and return to a happy life. Do not simply look the other way and hope the problem will resolve itself. This individual needs help, and without it, they are seriously damaging their body and mind.

What should someone with an eating disorder expect from professional treatment?

Suppose the patient is under 18 and suffers from anorexia. In that case, they will often receive treatment on an inpatient basis for the first weeks or even months, depending on the severity of the condition. Adults are more challenging to treat because they can refuse inpatient treatment. Anorexia takes about five years to recover from fully, and many never fully recover. Psychiatric medications modestly benefit those with eating disorders in addition to undergoing therapy for several years beyond inpatient treatment.

What are the main difficulties in treating patients with eating disorders?

Denial is a significant component that can make it challenging to get someone into treatment. Many individuals with anorexia do not recognize they have a problem. Often, the patient’s family must force them into inpatient treatment. But therapy is again critical. Even beyond the high percentage of anorexic individuals who die from starvation or suicide, many more suffer from long-term health issues, including infertility, heart problems, osteoporosis, and increased risk of learning problems and dementia.

References

[1] Proposed eating disorder and body image division announces Eating Disorder Awareness Week (2022, February 23). American Psychological Association. Retrieved on July 10, 2022, from https://www.apa.org/about/division/digest/share-members/eating-disorder-awareness-week.

[2] General Eating Disorder Statistics (2022). ANAD. Retrieved on July 10, 2022, from https://anad.org/eating-disorders-statistics/.

[3] Arcelus J, et al. Mortality rates in patients with anorexia nervosa and other eating disorders (2011, July). Archives of General Psychiatry, PubMed Central. Retrieved on July 11, 2022, from https://pubmed.ncbi.nlm.nih.gov/21727255/.

[4] National Eating Disorders Awareness Week, 2022 (2022, February 18). A Presidential Document by the Executive Office of the President. National Archives, Federal Register. Retrieved on June 9, 2022, from https://www.federalregister.gov/documents/2022/02/24/2022-04096/national-eating-disorders-awareness-week-2022.

[5] Mental health disparities: Women’s mental health (fact sheet). American Psychiatric Association. Retrieved on June 9, 2022, from https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-Women.pdf.

[6] Guarda, A. (2021, March) What are eating disorders? American Psychiatric Association. Retrieved on July 12, 2022, from https://psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders.

[7] Rittenhouse, M. (2022) Eating disorder demographic statistics. Eating Disorder Hope. Retrieved on July 14, 2022, from https://www.eatingdisorderhope.com/information/eating-disorder/statistics-demographics.