What Are Eating Disorders?

What Are Eating Disorders?

Formally classified as "feeding and eating disorders" in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the term "eating disorders" represents a group of complex mental health conditions that can seriously impair health and social functioning

Because of the physical nature of their defining symptoms, eating disorders can cause both emotional distress and significant medical complications. They also have the highest mortality rate of any mental disorder.

Types

There are many types of feeding and eating disorders, and they all come with their own defining characteristics and diagnostic criteria. The eating disorders formally recognized the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official guidebook to the diagnosis of psychiatric disorders used by mental health providers, include the following.

Binge Eating Disorder (BED)

Binge eating disorder, the most recently recognized eating disorder, is actually the most common. It is characterized by repeated episodes of binge eating—defined as the consumption of a large amount of food accompanied by a feeling of loss of control. It is found in higher rates among people of larger body size. Weight stigma is commonly a confounding element in the development and treatment of BED.

Bulimia Nervosa (BN)

Bulimia nervosa involves recurrent episodes of binge eating followed by compensatory behaviors—behaviors designed to make up for the calories consumed. These behaviors may include vomiting, fasting, excessive exercise, and laxative use.

Anorexia Nervosa (AN)

Anorexia nervosa is characterized by the restricted intake of food which leads to a lower than expected body weight, fear of weight gain, and disturbance in body image. Many people are unaware that anorexia nervosa can also be diagnosed in individuals with larger bodies. Despite the fact that anorexia is the eating disorder that receives the most attention, it is actually the least common.

Other Specified Feeding and Eating Disorder (OSFED)

Other specified feeding and eating disorder is a catchall category that includes a wide range of eating problems that cause significant distress and impairment but do not meet the specific criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder. OSFED, along with unspecified feeding or eating disorder (UFED), replaced the eating disorder not otherwise specified (EDNOS) category in previous versions of the DSM.

People who are diagnosed with OSFED often feel invalidated and unworthy of help, which is not true. OSFED can also be as serious as other eating disorders and can include subclinical eating disorders.

Research shows that many people with subclinical eating disorders will go on to develop full eating disorders. Subclinical eating disorders can also describe a phase that many people in recovery pass through on their way to full recovery.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Previously called selective eating disorder, avoidant/restrictive food intake disorder (ARFID) is an eating disorder that involves a restricted food intake in the absence of the body image disturbance commonly seen in anorexia nervosa. It is manifested by persistent failure to meet appropriate nutritional and/or energy needs.

Orthorexia Nervosa

Orthorexia nervosa is not an official eating disorder in the DSM-5, though it has attracted a great deal of recent attention as a proposed diagnosis for future editions. It differs from other eating disorders because the unhealthy obsession does not typically come from a desire to lose weight. Further, the focus is not on food quantity, but rather food quality. Orthorexia nervosa is an unhealthy obsession with healthy eating and involves adhering to a theory of healthy eating to the point that one experiences health, social, and occupational consequences.

Other Eating Disorders

In addition to the ones listed above, other eating disorders include:

• Night eating syndrome
• Pica
• Purging disorder
• Rumination disorder

Symptoms

Although symptoms of different eating disorders vary greatly, there are some that may indicate a reason to investigate further. What's more, if your thoughts and/or behaviors surrounding food, weight, or body image are causing distress and impacting their daily functioning, it's time to seek help.

• Dietary restriction
• Frequent weight changes or being significantly underweight
• Negative body image
• Presence of binge eating
• Presence of excessive exercise
• Presence of purging, laxative or diuretic use
• Excessive thoughts surrounding food, body image, and weight

Mental Effects

Eating disorders often occur along with other mental disorders, most often anxiety disorders, including:

• Body dysmorphic disorder (BDD)
• Generalized anxiety disorder (GAD)
• ​​Obsessive-compulsive disorder (OCD)
• Social anxiety disorder (GAD)

Anxiety disorders usually predate the onset of an eating disorder. Often, people with eating disorders also experience depression and score high on measures of perfectionism.

Physical Effects

Because sufficient intake of nutritionally balanced foods is essential for regular functioning, eating disorders can significantly affect physical and mental operations. A person does not have to be underweight to experience the medical consequences of an eating disorder. Eating disorders affect every system of the body and can lead to physical health problems like:

• Brain mass loss
• Cardiovascular problems
• Gastrointestinal issues (e.g. chronic constipation, gastroesophageal reflux)
• Dental problems
• Disrupted sleep patterns
• Fainting spells
• Hair loss or downy hair all over the body (called lanugo)
• Loss of menstrual period post-puberty (or delayed the first period)
• Musculoskeletal injuries and pain
• Weakened bones

Diagnosis

Eating disorders can be diagnosed by medical physicians or mental health professionals, including psychiatrists and psychologists. Often, a pediatrician or primary care doctor will diagnose an eating disorder after noticing symptoms during a regular check-up or after a parent or family member expresses concern over their loved one's behavior.

Although there is no one laboratory test to screen for eating disorders, your doctor can use a variety of physical and psychological evaluations as well as lab tests to determine your diagnosis, including:

• A physical exam, during which your provider will check your height, weight, and vital signs
• Lab tests, including a complete blood count, liver, kidney, and thyroid function tests, urinalysis, X-ray, and an electrocardiogram
• Psychological evaluation, which includes personal questions about your eating behaviors, binging, purging, exercise habits, and body image

There are also multiple questionnaires and assessment tools used to assess a person's symptoms, including:

• Eating Disorder Inventory
• SCOFF Questionnaire
• Eating Attitudes Test
• Eating Disorder Examination Questionnaire (EDE-Q)

Who Is Diagnosed?

Contrary to popular belief, eating disorders do not only affect teenage girls. They occur in people of all genders, ages, races, ethnicities, and socioeconomic statuses. They are, however, more commonly diagnosed in women.

Men are underrepresented in eating disorder statistics—the stigma of having a condition associated primarily with women often keeps them from seeking help and getting diagnosed. Furthermore, eating disorders may also present differently in men.

Eating disorders have been diagnosed in children as young as age 6 as well as in older adults and seniors. The different ways in which eating disorders manifest in these populations can contribute to their unrecognizable nature, even by professionals.

While eating disorders affect people of all ethnic backgrounds, they are often overlooked in non-white populations as a result of stereotyping. The mistaken belief that eating disorders only affect affluent white females has contributed to the lack of public health treatment for others—the only option available to many underserved and marginalized populations.

And, although not well-studied, it is postulated that the experience of discrimination and oppression among transgender populations contribute to higher rates of eating and other disorders among transgender individuals.

Causes

Eating disorders are complex illnesses. While we do not definitively know what causes them, some theories exist.

It appears that 50% to 80% of the risk for developing an eating disorder is genetic, but genes alone do not predict who will develop an eating disorder. It is often said that “genes load the gun, but environment pulls the trigger.”

Certain situations and events—often called “precipitating factors”—contribute to or trigger the development of eating disorders in those who are genetically vulnerable.

Some environmental factors implicated as precipitants include:

• Abuse
• Bullying
• Dieting
• Life transitions
• Mental illness
• Puberty
• Stress
• Weight stigma

It has also become common to blame eating disorders on the media. While media influence is recognized as a complicating factor, it isn't considered an underlying cause of eating disorder development in individuals. Ultimately, a person must also have a genetic vulnerability in order for eating disorders to develop.

Treatment

Early intervention is associated with an improved outcome, so please do not delay seeking assistance. Life may even need to be put on hold while you focus on getting well. And once you are well, you will be in a much better position to appreciate what life has to offer. Help is available in a variety of formats, although it is common to start treatment with the lowest level of care and progress to higher levels as needed.

Self-Help

Some people with bulimia nervosa and binge eating disorder may be helped by self-help or guided-self help based on the principles of cognitive behavioral therapy (CBT). The person may work through a workbook, manual, or web platform, to learn about the disorder and develop skills to overcome and manage it. Self-help is contraindicated for anorexia nervosa.

Cognitive Behavioral Therapy (CBT)

CBT is the best-studied outpatient therapy for adult eating disorders and includes the following elements:

• Cognitive restructuring
• Body image exposure
• Delays and alternatives
• Food exposure
• Limiting body-checking
• Meal planning
• Regular eating
• Relapse prevention
• Self-monitoring via paper or applications

Family-Based Treatment (FBT)

Family-based treatment (FBT) is the best-studied treatment for children and adolescents with eating disorders. Essentially, the family is a vital part of the treatment team. Parents commonly provide meal support, which allows the young person to recover in their home environment. Another important element of FBT is externalizing the eating disorder.

Nutritional Therapy

A registered dietitian can help you learn (or relearn) the components of a healthy diet and motivate you to make the needed changes.

Weekly Outpatient Treatment

Weekly outpatient treatment is the usual starting point for those who have access to treatment and typically includes treatment by a team of professionals including a therapist, a dietitian, and a medical doctor. Other successful outpatient therapies for adult eating disorders include:

• Dialectical behavior therapy
• Cognitive remediation therapy
• Interpersonal psychotherapy

Intensive Treatment

For people needing a higher level of care, treatment is available at multiple levels, including intensive outpatient, partial hospitalization, residential, and hospital levels of care. In these settings, treatment is almost always provided by a multidisciplinary team.

Coping

Caring for your physical and mental health will go a long way toward helping you cope with an eating disorder. In addition to talking to a therapist or joining a support group (like Eating Disorders Anonymous), seek support from a trusted friend or family member who can be there for you along your path to recovery.

Beyond self-care, it’s also important to identify a few healthy distractions you can turn to when you find yourself obsessing about food and weight or experiencing the urge to turn to disordered eating or behaviors. Here are a few to consider:

• Explore a new hobby, like photography, painting, or knitting
• Invest in an adult coloring book
• Practice mindfulness meditation
• Take a leisurely walk
• Try a yoga class or DVD
• Write in a journal

A Word From Verywell

Recovery from an eating disorder isn’t easy and it takes courage, but it is possible with the right support system in place.

If you are the parent of a minor with an eating disorder, then it is wise for you to seek treatment on their behalf. Supporting a child with an eating disorder is hard work, but there are resources for you. If your loved one with an eating disorder is an adult, you can still play an important role in helping them too.

Since people with eating disorders often do not believe they have a problem, family members and significant others play a critical role in getting them help. Although recovery from an eating disorder can be challenging and sometimes long, it definitely is possible.