Eating Disorders

overview

An eating disorder is a serious medical condition, encompassing problematic thoughts about eating food and trouble eating behaviors. This mental health disorder ends up negatively affecting one’s physical health as well, due to problems with obtaining proper nutrition. Eating disorders can occur in any individual, regardless of gender or race, but tends to be most common amongst women. Genetic, biological, behavioral and psychological factors all play a role in the development of an eating disorder.[1]

In the United States, eating disorders affect nearly 10% of the population (approximately 20 million females and 10 million males). While common, these disorders can sometimes be difficult to recognize. Eating disorders are treatable, but neglecting treatment can result in life-threatening issues.[2]

Types of Eating Disorders

There are multiple types of different eating disorders, including:[3] 

  • Anorexia Nervosa: This is defined by extreme weight loss due to an excessive and rigorous restriction on calories and amount of food consumed. People affected by this disorder tend to have difficulty maintaining a healthy and appropriate body weight according to their age and height, and can especially affect growth in children. Many individuals with this disorder also exercise compulsively, take laxatives, or purge via vomiting to lose weight. They may dress in multiple layers to conceal their dramatic weight loss, or have difficulty staying warm due to a lack of fat protecting them from the cold.

  • Bulimia Nervosa: This is characterized by cycles of binging (i.e., eating excessively) and purging (i.e., forced vomiting or bowel movements), especially in large amounts, to avoid weight gain. These uncontrollable episodes of binge-eating, followed by self-induced purging, allows individuals to maintain a normal or above normal body weight, concealing their problem for long periods of time. Other behaviors, like excessive exercise and fasting, can be used in conjunction or instead of purging. Excessive vomiting episodes also lead to erosion of dental enamel over time.[4]

  • Binge-Eating: This simply involves eating an abnormally large amount of food in a very short period of time, such as 2 hours. Individuals with this eating disorder are unable to stop eating, even if they want to. They often feel like they cannot stop eating until they feel uncontrollably full, leading to feelings of shame and guilt afterwards. After a binge episode, they may limit themselves from eating for an even longer period of time, leading to another binge episode later on, trapping them in a cycle of binging. 

  • Avoidant Restrictive Food Intake Disorder (ARFID): This is when one excessively limits their food intake or certain types of foods, commonly known as “fear foods.” These individuals often fail to meet proper daily nutrition needs, leading to unhealthy weight loss or difficulties with growth and development, as well as normal bodily functions. These individuals may not necessarily have a poor body image or desire to lose weight, but rather have other reasons to avoid certain foods, such as unappealing texture/taste, or a fear of choking/vomiting while eating. This disorder is more common in younger children, who especially suffer from the negative effects of improper nutrition as they are still growing and are supposed to be gaining healthy weight.[5] 

  • Rumination Disorder: This is frequently confused with bulimia nervosa, is the condition in which one unintentionally regurgitates partially digested food, proceeds to rechew, and either or swallow or spit the food out. Rumination usually occurs at every meal that the individual eats, and treatment for this disorder can start from teaching people proper breathing techniques from the diaphragm.[6] 

  • Unspecified Feeding or Eating Disorder (UFED): This is when one experiences symptoms of an eating disorder that results in a great amount of distress or detriment in a social, occupational, or any other area of one’s daily life. Physicians often utilize this diagnosis when the specific reason of the eating disorder is not properly supported by sufficient diagnostic information.[7] 

Signs & Symptoms

Individuals with eating disorders may sometimes be difficult to recognize, but one can look for warning signs or symptoms. These individuals may have a significant preoccupation with weight loss, dieting, food intake, calorie intake, carbohydrate intake, or fat intake. They also may appear uncomfortable with eating around other people in social settings. They may have specifically small portions of food, or skip meals in general. They may obsessively cut out specific food groups for long periods of time, such as carbohydrates, dairy or sugar.  Those with an eating disorder tend to frequently or constantly diet, even when they are not statistically overweight. They may be constantly checking their flaws and body image in the mirror. 

On a more physical level, some symptoms of most eating disorders include:[8]

  • Large fluctuations in weight

  • Stomach pain/cramps

  • Irregular menstrual periods

  • Lack of concentration 

  • Feeling cold, constantly or frequently 

  • Sleeping disorders

  • Anemia

  • Low thyroid/hormone levels

  • Low potassium 

  • Low white/red blood cell counts 

  • Dental enamel erosions, cavities, sensitivity

  • Fine hair 

  • Dry skin

  • Muscle weakness

  • Impaired immune system functioning 

 

Specifically, each eating disorder will have unique symptoms. For example, individuals with anorexia nervosa tend to dress in layers to stay warm due to dramatic weight loss, are well below the appropriate body weight for their height and age, or tend to have an excessive exercise routine with strict self-pressure to stick to the routine.[9] 

Individuals with bulimia nervosa may also have large fluctuations in their body weight, but may also be seen in frequent binging episodes. They may have a habit of hiding their food, or expressing shame/guilt after a binge episode. Like individuals with anorexia, these individuals are also preoccupied with their body weight, exercise, and dieting. An individual who has been purging may be identified with swollen cheeks, cuts/scabs on back of their hands, and discolored teeth or tooth decay.[10]

Causes & Risk Factors

Eating disorders are commonly misconceived as a “lifestyle choice”. However, they are actually a result of a serious mental disorder, as individuals affected by them have strong disturbances with their thoughts, emotions, and behavior related to food and eating. Eating disorders are overall thought to be caused by a combination of genetic, biological, and social factors. 

Eating disorders can impact anyone, but certain individuals are at higher risk than others. While teenagers and young adults are especially prone to developing eating disorders, an eating disorder can develop at any age. They can also run in families, passed through both genetics and parenting strategies. Studying brain patterns of individuals with eating disorders has also shown that there is a clear difference between brain activity in women with and without eating disorders.[11] 

A history of trauma, anxiety, depression, or any other psychiatric disorder puts an individual at a higher risk for developing an eating disorder. Societal views and media stigmatizing overweight people can also place an individual at a higher risk. Additionally, intense participation in activities that revolve around highly fit/skinny appearances, like swimming, modeling, and running, can increase the likelihood of developing an eating disorder. Further, individuals with Type 1 Diabetes (as they try to manage their blood sugar levels), those experiencing a major life change, or perfectionist personalities are also more likely to develop eating disorders.[12]

Diagnosis & Complications

Physicians can diagnose eating disorders by reviewing symptoms, performing a physical examination, and conducting blood tests. A psychologist or psychiatrist can also conduct a psychological evaluation to study an individual's thoughts and emotions in relation to food and eating. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines symptoms of eating disorders, but not all of the symptoms must be present in order to be diagnosed. 

Eating disorders are the second most lethal of psychiatric disorders, as eating extremely improperly can put an individual at serious risk of complications for developing further mental or physical issues. Some of these complications include:[13]

  • Arrhythmia (irregular heart beat)

  • Heart failure

  • Gastrointestinal issues

  • Hypotension (low blood pressure)

  • Organ failure

  • Brain damage

  • Osteoporosis (brittle bones)

  • Severe dehydration

  • Constipation

  • Infertility 

  • Amenorrhea (absence of menstrual periods)

  • Stroke

  • Suicidal thoughts or actions

 

Treatment Plans & Barriers to Care

Early detection and early treatment of eating disorders are imperative to lead to a complete recovery. Since eating disorders can put an individual at a higher risk of suicidal thoughts or actions, these disorders should be treated as soon as possible. A strong support system (e.g., family, friends, therapist), is extremely important towards recovery. Encouraging the individual to eat and feel good about themselves in the process is crucial to developing a better self-image. For this reason, treatment strategies often involve help from one's family, especially for adolescents. 

Treatment plans typically consist of a combination of psychotherapy, medical care, nutritional counseling, and sometimes medicine. The goals of treatment are to bring the individual back to a normal diet with proper nutrition, reduce their excessive exercise, bring their weight to a healthy level, and stop other eating disordered behaviors. Other mental health disorders, like anxiety or depression, should also be treated concurrently to reduce the eating disorder from remaining or returning.[14] 

Sometimes barriers to care can interfere with an individual’s ability to properly recover. For example, treatment plans are usually long-term, which can make them time-consuming and costly. Individuals with a lower socioeconomic status may fail to get the full long-term treatment, cutting their recovery short. Lack of insurance, limited benefits, or lack of access to appropriate physicians or psychiatric specialists can also deter from recovery.[15]

If one has been experiencing symptoms of an eating disorder, or having severely anxious thoughts related to eating and weight, it is crucial to contact a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance on how to recover physically and mentally. 

Contributed by: Ananya Udyaver

Editor: Jennifer (Ghahari) Smith, Ph.D. 


References

1 U.S. National Library of Medicine. (n.d.). Eating disorders. MedlinePlus. https://medlineplus.gov/eatingdisorders.html  

2 Cleveland Clinic (2020, October 7). Eating disorders: Types, causes, treatment & outlook. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4152-eating-disorders 

3 Types of eating disorders. Types of Eating Disorders | Anxiety and Depression Association of America, ADAA. (2022). https://adaa.org/eating-disorders/types-of-eating-disorders 

4 Bulimia nervosa. Johns Hopkins Medicine. (2023, January 31). https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa  

5 Mayo Foundation for Medical Education and Research. (2023, March 28). Eating disorders. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603 

6 Ibid.

7 Unspecified feeding or eating disorder. National Eating Disorders Association. (2022, October 14). https://www.nationaleatingdisorders.org/unspecified-feeding-or-eating-disorder 

8 Warning signs and symptoms. National Eating Disorders Association. (2023, September 15). https://www.nationaleatingdisorders.org/warning-signs-and-symptoms  

9 Ibid.

10 About eating disorders. Eating Disorder Foundation.org. (n.d.). https://eatingdisorderfoundation.org/learn-more/about-eating-disorders/signs-and-symptoms/ 

11 U.S. Department of Health and Human Services. (2023, January). Eating disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/eating-disorders  

12 Cleveland Clinic (2020, October 7). 

13 Ibid.

14 U.S. Department of Health and Human Services. (2023, January). 

15 Rome, E., & Ammerman, S. (2003). Medical complications of eating disorders: An update. Journal of Adolescent Health, 33(6), 418–426. https://doi.org/10.1016/s1054-139x(03)00265-9