Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. Research shows that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Personality traits are another contributing source. In particular, neuroticism, perfectionism, and impulsivity are often linked to a higher risk of developing an eating disorder. Other potential causes include perceived pressures to be thin, cultural preferences for thinness, and exposure to media promoting such ideals.
Symptoms and Types
Individuals with eating disorders can present with a variety of symptoms. However, most include the severe restriction of food, food binges, or purging behaviors, like vomiting or over-exercising. There are 6 main categories of Eating Disorders that treatment professionals use to diagnose patients:
1. Anorexia Nervosa – People with anorexia generally view themselves as overweight, even if they’re dangerously underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and severely restrict their calories. Anorexia is categorized into two subtypes —the restricting type and the binge eating and purging type. Individuals with the restricting type lose weight solely through dieting, fasting, or excessive exercise. Individuals with the binge eating and purging type may binge on large amounts of food or eat very little. In both cases, after they eat, they purge using activities like vomiting, taking laxatives or diuretics, or exercising excessively. Anorexia can be very damaging to the body and over time, individuals living with it may experience the thinning of their bones, infertility, brittle hair and nails, and the growth of a layer of fine hair all over their body. In severe cases, anorexia can result in heart, brain, or multi-organ failure, and death.
2. Bulimia Nervosa – People with bulimia frequently eat unusually large amounts of food in a specific period of time. During a binge, the person usually feels that they cannot stop eating or control how much they are eating. Individuals with bulimia then attempt to purge to compensate for the calories consumed and to relieve gut discomfort. Common purging behaviors include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise. Symptoms may appear very similar to those of the binge eating or purging subtypes of anorexia nervosa. The difference is that individuals with bulimia usually maintain a relatively normal weight, rather than becoming underweight. Side effects of bulimia may include an inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut, severe dehydration, and hormonal disturbances. In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium, and calcium. This can cause a stroke or heart attack.
3. Binge Eating Disorder – Individuals with this disorder have symptoms similar to those of bulimia or the binge eating subtype of anorexia. They typically eat unusually large amounts of food in relatively short periods of time, in secret, and feel a lack of control during binges. The difference is that people with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges. They do experience significant feelings of distress, such as shame, disgust, or guilt when thinking about the binge-eating behavior
4. Pica – Involves eating things that are not considered edible. Individuals with pica crave non-food substances, such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch. Pica can occur in adults, as well as children and adolescents. Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal. To be considered pica, the eating of non-food substances must not be a normal part of someone’s culture or religion. This disorder may particularly affect children, pregnant women, and individuals with mental disabilities.
5. Rumination Disorder – Is a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out. This rumination typically occurs within the first 30 minutes after a meal. Unlike medical conditions like reflux, it’s voluntary. In infants, it tends to develop between 3–12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it. If not resolved during infancy, rumination disorder can result in weight loss and severe malnutrition that can be fatal. Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight.
6. Avoidant/Restrictive Food Intake Disorder (ARFID) – Individuals with this disorder experience disturbed eating either due to a lack of interest in eating or distaste for certain smells, tastes, colors, textures, or temperatures. This avoidance or restriction of food intake prevents the person from eating sufficient calories or nutrients. Their eating habits interfere with normal social functions, such as eating with others. Nutrient deficiencies or dependence on supplements or tube feeding can occur due to their restrictive food consumption. It’s important to note that ARFID goes beyond normal behaviors, such as picky eating in toddlers or lower food intake in older adults. Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.
7. Orthorexia – This disorder is increasingly being mentioned in research and the media. Individuals with Orthorexia tend to have an obsessive focus on healthy eating to an extent that disrupts their daily lives. For instance, the affected person may eliminate entire food groups, fearing they’re unhealthy. This can lead to malnutrition, severe weight loss, difficulty eating outside the home, and emotional distress. Individuals with Orthorexia rarely focus on losing weight. Instead, their self-worth, identity, or satisfaction is dependent upon how well they comply with their self-imposed diet rules.
Treatment and Therapies
It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have co-occurring mental disorders such as depression or anxiety, or problems with substance use. Complete recovery is possible when the patient follows the treatment plan established by his/her treatment team.
Treatment plans are tailored to individual needs and may include one or more of the following:·
Individual, group, and/or family psychotherapy: Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, are one effective method in helping people gain weight and improve eating habits and moods. To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT). This form of treatment helps a person learn how to identify distorted/unhelpful-thinking patterns, recognize and change inaccurate beliefs, and replace them with healthy/rational ones.
Medical care and monitoring: Eating disorder clients need collaborative care with primary care physicians in order to assist with weight restoration and stabilization. Frequent and consistent monitoring for any physical or medical complications is imperative to ensure the safety and well being of the client.
Nutritional counseling: Having a licensed nutritionist or dietitian as part of the treatment team is also part of best practices in the care of eating disorder clients. They will develop medically appropriate meal planning that is tailored to the individual’s needs and monitor weight gain/loss throughout the treatment process.
Medications: Evidence also suggests that medications such as antidepressants or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression.
Higher Level of Care: Should the client not respond to outpatient therapy and their medical team evaluates them at risk for health complications related to their eating disorder, then they will be recommended for more intensive treatment options such as intensive outpatient, partial hospitalization, inpatient, or residential care depending on the severity of their symptoms and condition.
Although there’s no sure way to prevent eating disorders, here are some strategies to help your child develop healthy-eating behaviors:
Avoid dieting around your child. Family dining habits may influence the relationships children develop with food. Eating meals together gives you an opportunity to teach your child about the pitfalls of dieting and encourages eating a balanced diet in reasonable portions. Talk to your child. For example, there are numerous websites that promote dangerous ideas, such as viewing anorexia as a lifestyle choice rather than an eating disorder. It’s crucial to correct any misperceptions like this and to talk to your child about the risks of unhealthy eating choices. Cultivate and reinforce a healthy body image in your child, whatever his or her shape or size. Talk to your child about self-image and offer reassurance that body shapes can vary. Avoid criticizing your own body in front of your child. Messages of acceptance and respect can help build healthy self-esteem and resilience that will carry children through the rocky periods of their teen years. Enlist the help of your child’s doctor. At well-child visits, doctors may be able to identify early indicators of an eating disorder. For instance, they can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments. These visits should include checks of height and weight percentiles and body mass index, which can alert you and your child’s doctor to any significant changes.
If you notice a family member or friend who seems to show signs of an eating disorder, consider talking to that person about your concern for his or her well-being. Although you may not be able to prevent an eating disorder from developing, reaching out with compassion may encourage the person to seek treatment
The categories mentioned above are meant to provide a better understanding of the most common eating disorders and dispel myths about them. Eating disorders are serious conditions related to persistent eating behaviors that negatively impact your health, your emotions, and your ability to function in important areas of life. If you have an eating disorder or know someone that does, please seek help from a qualified professional.
Unfortunately, many people with eating disorders may not think they need treatment. If you’re worried about a loved one, urge him or her to talk to a doctor. Even if your loved one isn’t ready to acknowledge having an issue with food, you can open the door by expressing concern and a desire to listen. Be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders.
Red flags that may indicate an eating disorder include:
- Skipping meals or making excuses for not eating
- Adopting an overly restrictive vegetarian diet
- Excessive focus on healthy eating
- Making own meals rather than eating what the family eats
- Withdrawing from normal social activities
- Persistent worry or complaining about being fat and talk of losing weight
- Frequent checking in the mirror for perceived flaws
- Repeatedly eating large amounts of sweets or high-fat foods
- Use of dietary supplements, laxatives, or herbal products for weight loss
- Excessive exercise
- Calluses on the knuckles from inducing vomiting
- Problems with loss of tooth enamel that may be a sign of repeated vomiting
- Leaving during meals to use the toilet
- Eating much more food in a meal or snack than is considered normal
- Expressing depression, disgust, shame, or guilt about eating habits Eating in secret
- Eating in secret