What Are Eating Disorders?
Eating disorders are psychological conditions characterized by unhealthy, obsessive, or disordered eating habits. Eating disorders come with both emotional and physical symptoms and include anorexia nervosa (voluntary starvation), bulimia nervosa (binge-eating followed by purging), binge-eating disorder (binge-eating without purging), and other or unspecified eating disorders (disordered eating patterns that do not fit into another category).
Eating disorders occur more frequently in affluent cultures than in non-affluent ones, but they are not exclusive to the well-off. A disproportionate number of those diagnosed are young women in their teens and 20s, but anyone—including young men and older adults of any gender—can develop an eating disorder. Eating disorders often become all-consuming, forcing the afflicted to focus on eating (or not eating) to the exclusion of much else in their life.
Biological factors, social and interpersonal pressures, and family history are some of the factors associated with eating disorders. Culturally mediated body-image concerns and personality traits like perfectionism and obsessiveness also play a large role in the disorders, which are often accompanied by depression or anxiety.
Treatment is rarely simple. Eating disorders may create additional medical problems and can even be acutely life-threatening, requiring hospitalization and forced nourishment. It often takes multidisciplinary teams of health professionals—including psychotherapists, medical doctors, and specialized dietitians or nutritionists—to bring about full recovery.
Anorexia nervosa is an eating disorder marked by an extreme obsession with weight loss or exercise. It is especially prevalent among young to middle-aged women, and increasingly among young men, but it can affect anyone at any age.
Characterized by a distorted sense of body image and extreme voluntary starvation or overexercising—and closely associated with perfectionism and depression—it is the most deadly psychiatric disorder. The most common behavioral signs of anorexia include extreme dieting, obsessive food rituals, and secretive and antisocial behavior.
Anorexia is highly resistant to treatment and is often accompanied by anxiety and depression. Treatment may include cognitive behavioral therapy, medication, nutrition education and management, and family-based therapies, all of which may take place at specialized eating-disorder centers.
If the condition becomes life-threatening, the only recourse may be hospitalization with forced feeding, which may create ethical and legal dilemmas for all caregivers involved.
For more, see Anorexia Nervosa.
Bulimia nervosa is an eating disorder marked by frequent cycles of binge-eating excessive amounts of food, followed by purging. Purging is usually done by self-induced vomiting but may sometimes include the use of laxatives, diuretics, or non-purging compensatory behaviors, such as fasting or overexercising.
The disorder typically begins during adolescence, but it can also develop earlier or later. Regardless of age, it can be difficult to identify because those with bulimia are often secretive about their eating and purging habits. Although many people with bulimia are overweight, they generally have an intense fear of weight gain and often suffer anxiety, depression, and poor self-esteem.
Signs of bulimia include unusual eating behaviors, constant weight fluctuation, frequent use of the bathroom, and avoidance of social events. Treatment usually includes cognitive-behavioral or other forms of psychotherapy, antidepressant medication, and nutrition counseling.
For more, see Bulimia Nervosa.
Binge-eating disorder is marked by recurrent episodes of extreme overeating not accompanied by compensatory behavior; as a result, those with the disorder are often overweight or obese.
People with this disorder tend to eat much more rapidly than normal and don't stop until feeling uncomfortably full. They may consume large amounts of food even when they're not hungry. They often eat alone because of shame or embarrassment about their eating behaviors.
Many people experience occasional instances of overeating and may even "binge" from time to time. To be considered a disorder, then, these behaviors must occur at least two days a week for six months or more.
For more, see Binge-Eating Disorder.
Avoidant/restrictive food intake disorder is characterized by the avoidance or restriction of food. People with the condition may be uninterested in food—perhaps trying to avoid a negative experience they had in the past, or because they are unsettled by particular sensory characteristics of food, such as its smell or texture.
As a result, people with ARFID do not consume enough food or receive adequate nutrition. In contrast to anorexia, ARFID food constraints are not due to fears related to weight or body image.
For more, see ARFID (Avoidant Restrictive Food Intake Disorder).
Orthorexia is an eating disorder characterized by an obsession with healthy eating. People with orthorexia fixate on the purity of food and the ingredients within the food they prepare and consume, perhaps cutting out certain food groups or adhering to a strict diet. Orthorexia often involves rigid routines and the removal of pleasure and fulfillment from the experience of eating.
Orthorexia is not an official psychiatric diagnosis in the DSM-5, but it is increasingly recognized and studied as a form of disordered eating.
For more, see Orthorexia.
Though anorexia, bulimia, and binge-eating disorder are the most well known, eating disorders encompass a number of other conditions, too. These include rumination disorder, pica, and others.
Rumination disorder is characterized by repeated regurgitation of food after eating, bringing previously swallowed food up into the mouth without displaying nausea, involuntary retching, or disgust. The food is typically then re-chewed and spit out or swallowed again.
Pica is a condition characterized by the eating of one or more nonnutritive, nonfood substances on a regular basis, such as paper, soap, or hair. Those with the disorder typically do not have an aversion to food in general.
Other eating disorders, such as night eating syndrome or atypical anorexia, may be classified under "other specified feeding and eating disorders" in the DSM-5.
For more, see Types of Eating Disorders.
Eating disorders involve disturbances in how individuals eat and perceive their body and weight. But those disturbances can manifest in very different ways. In some cases they can be obvious, such as dramatic weight loss or refusing to eat. In other cases they can be subtle, such as developing rigid routines around meals—only eating specific foods or at specific times—or beginning to exercise obsessively. Still in others, signs of the disorder can be hidden, such as going to the restroom after meals in the case of bulimia or eating in private in the case of binge-eating disorder.
Mental health symptoms can also emerge from or be exacerbated by the condition. People with eating disorders may become more withdrawn, avoiding people or activities they previously enjoyed, or they may struggle with mood swings and anxiety. Although it can be difficult to discuss, recognizing an eating disorder early on can help the person seek the help they need to recover.
For more, see Signs and Symptoms of Eating Disorders.
There is no single cause of any eating disorder. It's not yet understood why ostensibly voluntary behaviors associated with eating turn into disorders for some people but not for others.
A disturbed relationship with food and a sense of emotional fragility are hallmarks of all eating disorders. Eating disorders typically start out unnoticed––a person eats a little more or a little less food than usual. The urge to eat more or to eat less becomes increasingly compelling until it can become the focus of a person's existence.
Biology also plays a role. Appetite control and the regulation of food intake is highly complex, with many hormones in the brain and the body signaling hunger and satiety. Evidence also suggests that eating disorders have genetic roots.
Culture is thought to also play a significant role, as people—women especially—are pressured to fit an ideal of beauty that is largely defined by weight.
For more, see What Causes Eating Disorders?
It can take a long time—sometimes years or decades—for people with an eating disorder to decide to seek help. When they do, there are numerous treatment options that can help them recover.
People with eating disorders often receive outpatient treatment, but severe cases may require hospitalization or treatment at an inpatient facility. Treatment involves a physician, a psychologist, and a nutritionist to address the different elements of the illness. Therapies for eating disorders of any type include cognitive behavioral therapy, and a version tailored to eating disorders called enhanced cognitive behavioral therapy, as well as family-based treatment.
For more, see How Are Eating Disorders Treated?
Recovering from an eating disorder can be a long and winding road. And once in recovery, people must continue to observe and adapt to prevent setbacks and relapses. Treatment can provide the necessary skills to do that.
In concrete terms, recovery means that a person no longer meets the diagnostic criteria for an eating disorder, that they have healed both physically and emotionally. That experience will be different for everyone, as they develop a personalized approach to treatment, eating habits, social support, and coping skills.
For more, see The Recovery Process.
Watching a child suffer through an eating disorder can be deeply upsetting. Parents shouldn’t blame themselves for the development of the disorder, but they can take steps to provide support and help their child heal.
Different stages of the process require different actions. Those steps might include recognizing the signs of a disorder, learning about the illness, discussing it with the child, and encouraging them to seek treatment.
For more, see Parenting a Child with an Eating Disorder.