Eating disorders are serious but treatable mental health disorders that can have serious medical consequences. They affect people of all genders, races, ethnicities, income levels, abilities and sexual orientations. More than half of LBGTQ young people in a recent survey reported being diagnosed with an eating disorder. National surveys estimate that more than 20 million women and 10 million men in the U.S will have an eating disorder in the course of their lives. While most eating disorders begin during adolescence, people of any age can develop an eating disorder.
Eating disorders are not an indulgence or a choice. They are very dangerous. In fact, more people die from eating disorders than from any other mental illness. But with treatment, people with eating disorders can recover and live healthy lives.
Negative body image is not the only cause of eating disorders. Perfectionism, anxiety, bullying, trauma, genetics and other factors all play a role in putting someone at risk for an eating disorder.
Many eating disorders involve behaviors around food that are dangerous such as binge eating and/or purging. Binge eating is when someone eats more in a specific period of time than most people would under similar circumstances. When people binge eat, they feel like they can’t control their own behavior—they can’t force themselves to stop eating even when they want to. Often, binge eating involves eating to the point of discomfort, and feeling guilty, embarrassed or ashamed.
Purging is when someone takes drastic actions to prevent gaining weight, often after binge eating. This can include forcing themselves to vomit, exercising excessively, fasting, or misusing laxatives (medications that give you diarrhea), diuretics (medications that help your body get rid of sodium and water), or other medications.
Anorexia nervosa is probably the best-known eating disorder. People with anorexia restrict the number of calories and types of food they eat. Some people also exercise compulsively, binge eat, and/or purge with vomiting or laxatives. Many people with anorexia lose unhealthy or even dangerous amounts of weight, or don’t gain weight like they’re supposed to during puberty. People with anorexia often have a distorted body image. They worry about being overweight even when they are dangerously underweight. That being said, it’s impossible to diagnose anorexia just by looking at someone. The weight loss can affect every body organ. Serious, even life-threatening medical problems can occur as a result of this weight loss.
Bulimia nervosa is characterized by episodes of binge eating and purging (which can include self-induced vomiting, misusing laxatives, diuretics or other medications, fasting or over-exercising). People with bulimia can be of any weight, even normal body weight. Often, they have a distorted body image and worry obsessively about their weight .
Binge eating disorder (BED) is the most common eating disorder in the U.S. People with BED have episodes of binge eating where they feel out of control. After, they may feel shame, distress or guilt. Unlike people with bulimia, people with BED do not regularly purge (vomit, use laxatives, etc.). To be diagnosed with BED, someone must binge eat at least once a week for 3 months or more. Not everyone who is obese has BED, but up to two-thirds of those with BED are obese.
Avoidant restrictive food intake disorder (ARFID) involves limiting the amount and/or types of food someone eats. It’s normal for some kids to be picky eaters. But a young person with ARFID doesn’t take in enough calories to grow properly or, in adults, to maintain basic body functioning. People with ARFID don’t have especially bad body image, and aren’t afraid of being fat. Instead, they avoid eating because they don’t like food’s smell, texture, color or other sensory characteristics. Signs of ARFID include picky eating that gets worse over time, lack of interest in eating or food, dramatic restriction of the types or amounts of food eaten, and avoiding food based on its smell, texture or other sensory characteristics. Sometimes, people with ARFID are also afraid that they will choke or vomit when they eat.
Orthorexia is an obsession with “healthy” eating. People with orthorexia become so concerned with healthful eating that they actually damage their own health. They compulsively check ingredient lists and nutrition labels, cut out food groups (all sugar, all carbs, all dairy, all meat), and are distressed when they can’t get “safe” or “healthy” foods. Like anorexia, orthorexia involves limiting the amount and variety of foods eaten. It can lead to malnutrition and losing unhealthy or dangerous amounts of weight.
Many people’s eating disorders don’t fit neatly into one of the diagnoses listed here, so they may be diagnosed with Other Specified Feeding or Eating Disorder (OSFED). However, that doesn’t mean that their behavior isn’t just as dangerous. Other eating disorders not listed here include laxative abuse and Rumination Disorder.
Different eating disorders have different warning signs, and someone struggling with an eating disorder typically won’t have all of these symptoms at once. However, these types of behaviors may indicate that someone has a problem, according to NEDA.
Here are some common emotional symptoms and behaviors:
- Being obsessed or overly concerned with weight, food, calories, dieting, or body size and shape
- Excessive, compulsive exercise; upset when not able to exercise
- Refusing to eat certain foods or groups of food like all food containing fat
- Eating the same foods at every meal day after day
- Being uncomfortable or avoiding eating around others; avoiding social situations that involve eating
- Skipping meals or taking small portions; making excuses about not eating like “I ate already”
- Withdrawing from friends and activities
- Extreme mood swings; feeling irritable or depressed
- For bulimia and BED, evidence of binge eating, including the disappearance of large amounts of food in a short time period, lots of empty food packages and containers
- Eating rituals that hide how little food they eat, such as cutting food into tiny pieces or moving it around on the plate without eating
- Rigid eating patterns; needing to eat at very specific times and refusing to eat at other times
Physical symptoms are caused by the effects of the eating disorder, such as:
- Noticeable changes in weight, up or down
- Stomach problems
- Missing periods or only having a period while on hormonal contraceptives (like the pill)
- Dizziness or fainting
- Feeling cold all the time
- Fatigue or tiredness
- Abnormal lab test results (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
- Dental problems like enamel erosion and cavities
- Cuts and calluses across the top of finger joints (from inducing vomiting)
Eating disorders are serious and can be life-threatening. They impact every part of the body, including the digestive system, heart and brain. Here are just a few of the potential consequences:
- When your body doesn’t have enough calories to function normally, it begins to use muscle instead. One of your most important muscles is the heart, which can become dangerously weak as a result. It can also beat too slowly which can be life threatening.
- The brain needs fuel to function. Without enough nutrients, it becomes hard to concentrate and people often feel depressed.
- Purging behaviors can cause dental and digestive problems such as stomach pain, bloating, constipation, bleeding and other issues with digestion. Purging results in the loss of chemicals such as potassium that are vital to keeping the heart beating properly. This can result in sudden death from heart dysfunction.
- Lack of nutrition can cause dry skin, and hair to fall out.
Learn more about the health consequences of eating disorders from NEDA.
Many patients with eating disorders do not receive treatment. There is a lot of shame and guilt associated with having an eating disorder as well as resistance to getting treatment. Remember, no one chooses to have an eating disorder.
Getting a diagnosis is the first step toward treatment and recovery from an eating disorder. If you or your parents suspect you have an eating disorder, your primary care physician may be able to evaluate you and recommend local therapists and dietitians who have experience in treating eating disorders. If you’re not sure what to do, you can call the confidential NEDA Helpline at 1-800-931-2237.
Treatment will depend on the type of eating disorder you have and how it has affected your physical health. It generally involves therapy, help establishing more normal eating patterns, nutrition education and counseling, challenging unhealthy thoughts and behaviors, and making a plan to prevent relapsing. Family-based therapy is another treatment option. Some patients are also treated with psychiatric medications. Your physical health, motivation to recover, and any other disorders you may have guide the level of care you will need.
If you are 10-22 years old and live in the New York City area, the Mount Sinai Adolescent Health Center can help you, free of charge and regardless of insurance or immigration status. Our team of adolescent medicine physicians, social workers, psychologists, psychiatrists, and a registered dietitian will customize a treatment plan to best meet your needs and help you recover.
This information is not intended to provide medical advice, professional diagnosis, opinion, treatment or services, only general information for education purposes only.