Eating disorders are serious mental and physical illnesses that involve complex and damaging relationships with food, eating, exercise, and body image. These disorders impact approximately 20 million women and 10 million men in the United States and are found in all populations regardless of age, ethnicity, socioeconomic status, religion, sex, gender, etc.
Eating Disorder Definition from the DSM-5
The DSM-5 (Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition) lists eating disorders under the category of “Feeding & Eating Disorders” and describes that they are “characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food that significantly impairs physical health or psychosocial functioning .”
This category specifies diagnostic criteria for the disorders of “pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, and binge-eating disorder .”
Eating Disorder Facts
Eating disorders are complicated and nuanced disorders and vary from person to person. However, there are some overall eating disorder facts that research has been able to clearly delineate regardless of the individual.
- Eating disorders do not discriminate and are observed in “people of all ages, racial/ethnic backgrounds, body weights, and genders [2 – NIMH].”
- Eating disorder onset typically occurs in adolescence or young adulthood but is not limited to these life stages.
- There is no one distinct cause of eating disorders. Research has found a number of “genetic, biological, behavioral, psychological, and social factors” that can increase the risk of eating disorder development .
- Eating disorders can be life-threatening and have the highest mortality rate of any mental illness.
- While eating disorders do not have a “miracle cure,” there are numerous evidence-based practices proven to support eating disorder recovery.
Types of Eating Disorders
As mentioned above, there are many more eating disorder diagnoses than the three most commonly heard about (Anorexia Nervosa, Bulimia Nervosa, & Binge Eating Disorder). Each diagnosis has specific criteria differentiating it from other mental illnesses and eating disorders. Recognizing the distinct difference in disorders can help to improve treatment and recovery outcomes.
For Anorexia Nervosa to be diagnosed, the DSM-5 specifies that the individual must engage in persistent energy intake restriction, have an intense fear of gaining weight or becoming fat, or be engaging in a persistent behavior that interferes with weight gain, and the individual has a disturbance in their own perception of their body weight or shape .
These individuals often present with a bodyweight that is “below a minimally normal level for age, sex, developmental trajectory, and physical health,” but this is not always the case. You cannot determine if someone struggles with anorexia based on their body appearance alone.
Learn About Anorexia Nervosa
Bulimia Nervosa is characterized by three essential features: “recurrent episodes of binge eating, recurrent inappropriate compensatory behaviors to prevent weight gain, and self-evaluation that is unduly influenced by body shape and weight .”
An individual must engage in these behaviors at least once per week for three months to meet the criteria for diagnosis .
Referring to the first feature, a binge is characterized by an individual “eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances” and that the individuals feel “a sense of lack of control over eating during the episode .”
Learn About Bulimia Nervosa
Binge Eating Disorder (BED)
Binge Eating Disorder, commonly referred to as BED is the most common eating disorder diagnosis among all others. The DSM-5 specifies that BED involves binge eating episodes defined as mentioned above in the Bulimia Nervosa diagnosis.
BED differs from Bulimia Nervosa in that BED involves no recurrent use of inappropriate behaviors to compensate for binge episodes and does not occur exclusively during anorexia or bulimia episodes
BED also does not include an individual’s perception of body shape and weight in diagnostic criteria.
Learn About Binge Eating Disorder
Pica involves an individual eating one (or more) non-nutritive, nonfood substance on a persistent basis for at least one month . Pica is diagnosed when this behavior occurs, often enough to warrant clinical attention .
The DSM-5 specifies that the eating of non-nutritive, non-food substances must be inappropriate to the developmental level of the individual and “not part of a culturally supported or socially normative practice .”
Rumination Disorder is characterized by “repeated regurgitation of food occurring after feeding or eating over a period of at least one month .” Those with Rumination Disorder regurgitate previously swallowed food with no apparent symptoms of nausea, involuntary retching, or disgust .
Diagnostic criteria of Rumination Disorder specifies that it should not be diagnosed if behaviors can be better explained by a gastrointestinal or medical condition or if they occur exclusively during an anorexia, bulimia, BED, or ARFID episode .
Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant Restrictive Food Intake Disorder, often shortened to ARFID, replaced the previous DSM-5 diagnosis of “feeding disorder of infancy or early childhood.” One reason for this is that ARFID occurs predominantly, but not exclusively, in infants or children.
An essential diagnostic feature of ARFID is “avoidance or restriction of food intake manifested by clinically significant failure to meet requirements for nutrition or insufficient energy intake through oral intake of food .” This restriction does not occur as a result of another eating disorder diagnosis, and there should be no evidence of disturbance in body weight or shape perception.
Individuals that struggle with ARFID often experience food-related distress based on sensory characteristics of qualities of food. ARFID behaviors may also be based on a conditioned negative response associated with certain foods, such as a trauma.
Other Specified Feeding or Eating Disorder (OSFED)
This category is intended for cases wherein symptoms of a feeding or eating disorder are present and cause clinically significant distress or impairment but do not meet the full criteria for the above-specified disorders.
OSFED Disorders include:
- Atypical Anorexia Nervosa: An individual meeting all criteria for anorexia are met except the individual’s weight is within or above the normal range.
- Bulimia Nervosa (of low frequency and/or limited duration: As the individual meets, all criteria for bulimia except binge eating and compensatory behaviors occur less than once a week and/or for less than three months.
- Binge-Eating Disorder (of low frequency and/or limited duration): An individual meets all criteria for BED except binge eating episodes occur less than once/week and/or for less than three months.
- Purging Disorder: An individual engages in regular purging behavior to influence body weight or shape but does not engage in binge eating behaviors.
Unspecified Feeding or Eating Disorder
This category, as with OSFED, includes disorders that are symptomatic of an eating disorder diagnosis but do not meet full criteria.
UFED duffers from OSFED in that it is used “in situations in which the clinician chooses not to specify the reason that the criteria are not met” for a specific disorder or “there is insufficient information to make a more specific diagnosis” such as emergency room settings .
- Weight & Body Image
- Orthorexia, Excessive Exercise & Nutrition
- Addictions & Eating Disorders
- Eating Disorder Statistic
- Eating Disorder Research, Studies, and Tests
- Eating Disorders in Men
Eating Disorder Symptoms
Eating disorders manifest in varying ways as they are complicated disorders that impact psychological, physical, and sociological health. Determining whether someone is struggling with an eating disorder is not an exact science due to the many manifestations of these disorders, but, there are some symptoms that can present as warning signs.
Emotional & Behavioral ED Symptoms
Our physical bodies, psychological, functioning, cognitive wellness, and choices and behaviors are all deeply intertwined and impactful of one another. Below are a few emotional and behavioral symptoms that may indicate an individual is struggling with eating disorder beliefs or behaviors.
- Beliefs/patterns/choices that indicate a focus on weight loss, dieting, food rules, or eating patterns.
- Extreme mood swings.
- Checking in the mirror often.
- Withdrawing from others, decreased socializing, especially when food is involved.
- Presenting as hyper-focused on weight, food, calories, nutritional content of food.
- Eating alone or hiding food.
- Skipping meals.
- Intense fear of gaining weight.
- Distorted body image.
- Tangential thought process and difficulty concentrating.
Physical Warning Signs of Eating Disorders
A starved brain and body cannot function optimally. Therefore, an individual struggling with an eating disorder will present with at least some, if not all, of the physical signs below:
- Weight fluctuations (both up and down) that occur rapidly.
- Severe constipation.
- Low blood pressure
- Slowed breathing and pulse.
- Lethargy, sluggishness, or consistent reports of feeling tired.
- Brittle hair and nails.
- Dry, yellowish skin.
- Loss of menstrual cycle (amenorrhea).
- Growth of soft hair all over body (lanugo).
- Stomach/gastrointestinal issues.
- Muscle weakness.
- Impaired immune system functioning.
Risk Factors for Eating Disorders
It is unsurprising with all of the physical, emotional, and behavioral symptoms of eating disorders above that the long-term consequences can be severe. The malnourishment that results from disordered eating impacts all organ systems in the body including the brain as well as the cardiovascular, endocrine, and gastrointestinal systems.
Due to malnourishment, the body breaks down its own tissues, including the heart, which leads to a lack of energy to pump blood through the body, lowering pulse and blood pressure and increasing the risk of heart failure. The electrolyte imbalance caused by vomiting or laxative use or excessive water intake can also increase the risk of heart failure.
Lack of fat and cholesterol through disordered eating impacts functions of the endocrine system, such as the production of sex and thyroid hormones. For this reason, individuals may experience loss of or irregularities in the menstrual cycle. This also impacts bone density, metabolic rate, and issues regulating core body temperature (which can result in hypothermia).
It is difficult for the brain to function when it is not receiving proper and consistent nourishment. This leads to difficulty concentrating, sleeping, or staying asleep, sleep apnea, and dizziness or fainting. The electrolytes mentioned above are also used to create signals in the brain, meaning malnourishment disrupts the ability of the brain to communicate effectively to the body.
Finally, gastrointestinally, eating disorders impact stomach emptying and absorption of nutrients which can lead to severe stomach issues. Consistent vomiting can wear down the esophagus causing it to rupture, which is life-threatening. Binge eating can also cause a life-threatening emergency in that it can lead to a stomach rupture. Essentially, all of the organs and gastrointestinal functions are severely disturbed in eating disorder behaviors and can result in many life-threatening illnesses and issues.
What Causes Eating Disorders?
There are many genetic, environmental, and sociological factors that contribute to eating disorder development.
Biological risk factors for eating disorders include many genetic factors such as predispositions to medical and mental illness.
Individuals that have a family history of mental illness diagnoses are more likely to experience mental illness themselves. Even if the predisposed mental illness is not an eating disorder, eating disorders commonly co-occur with diagnoses such as depression, anxiety, or substance use issues, to name a few.
An individual’s medical history can also increase eating disorder risk, as research indicates that certain illnesses, such as Type 1 Diabetes, are associated with increased risk for eating disorder development.
Psychological factors for eating disorders include a co-occurring diagnosis of another disorder, as mentioned above.
Additionally, there are specific personality traits that research indicates can increase the likelihood of developing an eating disorder, such as perfectionism, low self-worth, distorted body image, or impulsivity.
Experiencing a past or present trauma also increases one’s likelihood of developing a disordered eating belief or pattern.
Environmental factors include the dynamics that surround an individual.
This can include family dynamics, as family-related beliefs and discussions around weight, food, and self-view are shown to be associated with eating disorder diagnoses.
The social views one absorbs via peers, social media, television/movies, and consumer culture are also related to the increased development of eating disorders.
How to Treat Eating Disorders
Due to the insidious ways in which eating disorders pervade all aspects of one’s body, mind, and life, receiving the appropriate treatment is important. There are various levels of care designed to treat specific stages of eating disorder severity—these range from inpatient at a medical facility down to outpatient. Any eating disorder treatment center can assess a struggling individual to determine the appropriate level of care.
Outside of receiving treatment in general, it is also important to ensure the facility uses evidence-based practices, as these can lead to better long-term outcomes.
There are many evidence-based treatments that can support eating disorder recovery; the most well-known and most commonly used is Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family-Based Treatment (also known as “The Maudsley Method”).
Do not be afraid to ask any questions that arise if you or a loved one are searching for the treatment that will best support recovery.
References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)  Unknown (2021). Eating disorders: about more than food. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/eating-disorders/eatingdisorders_148810.pdf.
Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed and Updated By: Jacquelyn Ekern, MS, LPC on June 14, 2021
1. Anorexia kills people. In fact, this disease enjoys the highest fatality rate of any psychiatric disorder. In the case of a celebrity death, the media provides coverage. Perhaps the first recognized case was that of Karen Carpenter in the early 8Os. An anorexic who relied on ipecac for vomiting, she died of heart failure. Years later, she was followed by Christina Renee Henrich, a world-class gymnast who died in 1994.
2. Female Athlete Triad Syndrome is a dangerous illness that can cause women who are extreme in their sports to have lifelong health concerns. Their coaches, friends, and family need to pay attention and help prevent the athlete from developing Female Athlete Triad Syndrome.
3. Major life changes can be a trigger to those fighting an eating disorder. Beginning college is no exception. The young man or woman is leaving home, friends and family to venture off into the unknown. College can be challenging and difficult for all students, but more so for others. This progression into adulthood is often a significant life altering event, and college can sadly trigger or lead to an eating disorder.
4. Eating disorders are more commonly associated with Caucasian females who are well-educated and from the upper socio-economic class. Eating disorders are also viewed as a western world affliction and not commonly related to other ethnic groups. This is not an accurate assumption. Eating disorders are prevalent in many different cultures and have been for a long time. This just continues to prove there are no barriers when it comes to disordered eating. Males, females, Caucasians, African Americans, Asian Americans, Mexican Americans and other ethnic minorities all can struggle with eating disorders.
5. According to the National Eating Disorders Association, people who are lesbian, gay, bisexual and transgender (LGBT) are at a higher risk of developing eating disorders including anorexia and bulimia. Gay and bisexual men who are single tend to feel more pressure to be thin and resort to restrictive EDs while those in a relationship turn to bulimia. Women in the lesbian and bisexual community still struggle with eating disorders similar to most heterosexual women with eating disorders, but lesbian and bisexual women are more likely to have mood disorders.
6. There is no such thing as the perfect dancer. Female ballet dancers work very hard at their craft but often find themselves in the throes of an eating disorder. Ballet dancers have long been known to develop eating disorders, and this can, to a degree, be understood because the dancer stands in front of a large mirror during practice and compares herself to all of her peers. In addition, it does not help that the industry of ballet dancing is extremely obsessed with weight.
7. Is vegetarianism contributing to disordered eating? Currently, just about five percent of Americans define themselves as a vegetarian (a person who removes meat and animal products from their diet). This percentage does not include those who consider themselves to be “quasi-vegetarians” (people who eat some animal-based products but primarily rely on a plant-based diet). Vegetarianism is much more prevalent for those who struggle with eating disorders. About half of the patients fighting an eating disorder practice some form of vegetarian diet.
8. In addressing the many medical complications of an eating disorder, the more urgent concerns typically take priority, such as undernourishment or an unstable heartbeat. However, some of the health consequences related to disordered eating affect the individual in the long term, even if they aren’t more apparent or obvious. Bone loss, or osteoporosis, is a silent but debilitating condition that commonly impacts women with EDs, such as Anorexia Nervosa. If you or a loved one is struggling with an eating disorder, read this article to learn more about ways you can prevent and treat bone density loss and eating disorders
9. With the mass amount of misguided information about eating disorders, it is common for these serious illnesses to be misunderstood, oversimplified, or greatly generalized. The truth of the matter is that Eating Disorders are complex diseases caused by a multitude of factors. Men or women who struggle with disordered eating have a serious mental illness with potentially life-threatening consequences. Understanding the implications of disordered eating can help increase awareness about ways to get help. Read this article to learn the myths vs. facts about eating disorders, which are serious mental conditions.
10. In the rapid evolution of our society today, advances in technology have dictated the course of human interactions. The way we interface with one another is largely hinged on the capacities that have developed throughout the years. Face-to-face connections are often pushed aside for text messaging, emails, and the like. What has been lost and sacrificed in the name of convenience and expediency? Read more here.
11. The media can be a culprit for generating images that falsify the reality of human bodies, but what drives an individual to idealize the representation of body perfection? As scientists unfold the blueprint of our genetic make-up, it is evident that both environment and genetics play an integral role in the formation of body image. Read more here.
12. While the transition to college is an exciting time for young adults, full of opportunities for independence and self-discovery, it also comes with an array of stressors. It’s often the first time a young adult lives apart from their primary support system. Learn about how college life (and especially as an athlete) can put people at risk for eating disorders.
13. Anyone who has any experience with doing battle with an eating disorder knows the challenge of wrestling with their “demons” and regaining control of their lives. I can’t think of any time more difficult than the free time from work or college, aka summer vacation. This is when most of us can find ourselves even more focused on body image and hear our ED talking loudest to us.
14. For individuals struggling with an eating disorder spurred from pressures or dysfunctions in their family, this summer break readjustment is exacerbated. For most, home is a loving and safe environment. However, for some, home may have been different.
15. In the treatment of eating disorders, mirror neurons play an interesting role. Often those with a disorder such as anorexia tend to experience rigidity and inflexibility in their thoughts and actions. The way they conduct their lives is often through a very black and white perspective. This is particularly evident in their perceptions of food and food consumption.
16. Most college students have been primed on how not to gain the “freshman 15.” But they likely haven’t been primed on just how dangerous it can be to try and avoid gaining those 15 pounds as a freshman or primed on the red flag warning signs of an eating disorder.
17. There is a close relationship between anxiety and all types of disordered eating. One study found that 64% of the 674 anorexic and bulimic participants had a diagnosable anxiety disorder at some point in their lives.
18. Eating disorders have the highest mortality rate of any mental illness, which is why treatment is often so critical. In ED treatment, those with anorexia, bulimia or binge eating disorder are given the tools and skills to get well. These strategies are designed to help them cope with uncomfortable feelings or distress; they are intended to replace the need for disordered eating and prevent a relapse. Because the truth is, an eating disorder is an unhealthy, maladaptive coping technique.
19. Anyone, from a princess to a pauper, can fall victim to these life-altering—and life-threatening—mental illnesses. Friends, relatives, lovers, acquaintances—even celebrities, the people we admire as stars, the most powerful, or the most beautiful among us, are or have been afflicted.
20. Interview with Dr. Thomas Britton, DrPH, LPC, LCAS, CCS, ACS: “I was very fortunate that my own journey to recovery didn’t include the pain and isolation of disordered eating, but the patterns and pain experienced in my early years shared many parallels and gave me great empathy for those with eating disorders. Back then, there was only one treatment center in my area that provided hospital-based care and no outpatient therapists existed that were trained in ED.”
21. Many individuals work diligently and tirelessly to make college a reality, and can abruptly interfere with these goals and dreams. Is it possible to both attend college while receiving treatment for disordered eating?
22. If you’ve also had a pre-existing fear about food and a pre-occupation (or full-blown obsession) with your weight, shape, and size then college can be an extremely difficult time. In addition, there can be whole new levels of social pressure around being thin that you’re just not used to dealing with.
23. Your loved one cannot be in a position to communicate effectively with you until that stabilization and maintenance have occurred. After that stabilization of eating patterns occurs, the real family work can develop. It is important to recognize that your loved one still needs patience from you as they continue to learn how to communicate their emotions in a healthy way.
24. As a marriage and family therapist, I have treated numerous families where a son or daughter is recovering from these debilitating disorders. Moms and Dads and brothers and sisters are on the front lines with the one struggling to recover from anorexia or bulimia. They are also vital members of the treatment team whose support is crucial in helping someone fully recover from their eating disorder. And one thing I reiterate to all of the families I work with during counseling is that no one is to blame for the disorder but everyone can assist in the recovery.
25. Most eating disorders are anathema to those who do not have one, but certain food-related illnesses are particularly alarming and baffling to the public at large. PICA is certainly one of them.
26. This led me to wonder- how hard must mindfulness be for those that look toward these holidays with dread rather than joyous anticipation? While there are many reasons that the holiday season is challenging for people, for the purposes of this article, I will focus on those individuals whose difficulty around the holidays is related to their eating disorders.
27. We all have well learned that while there is excitement about being with family and friends during the Holiday season, there is also a certain amount of stress. For those who are feeling “pretty good” emotionally, the holidays can enhance those positive emotional and relationship experiences.
28. The holidays can be a stressful time for anyone, regardless of whether an eating disorder is involved in your life. Commonly, there are plans to be made, family members and loved ones to visit with, parties and social gatherings to attend, gifts to buy, meals to make, and often inundation with food.
29. Thyroid problems are extremely common population-wide and are an issue for some in recovery from eating disorders as well. However, the type of dysfunction that occurs in the general population and those with a history of an eating disorder are not usually the same.
30. Today, we are bombarded with photos of today’s “beautiful women” in magazines, commercials, TV shows, movies and online photos. These women that represent today’s standard of beauty look very different from women of the past. The women displayed on the nationally broadcasted Victoria’s Secret runway shows each year epitomize the extreme standards the media portrays as “sexy” and “beautiful.”