What Is an Eating Disorder?

Eating disorders are medical illnesses marked by severe disturbances in a person’s eating behaviors. Those with eating disorders often have an unhealthy obsession with food, body weight, and shape. This can affect a person’s emotional, mental, and physical health. 

Learning to recognize early warning signs of an eating disorder in yourself or a loved one is key in seeking treatment before it potentially becomes life-threatening. 

Signs, Symptoms, and Traits

People with eating disorders may initially appear healthy. However, without treatment, they can cause a person to become extremely ill and lead to serious, potentially fatal complications. If you or someone you love starts to develop an unhealthy obsession with food, body weight, and shape, it may be an early sign of an eating disorder. 

While traits vary based on the type of eating disorder, here are some general signs and symptoms:

 Anorexia Nervosa

• Deep fear of gaining weight
• Distorted body image
• Extremely restricted eating and excessive exercise
• Extreme thinness (emaciation)

Bulimia Nervosa

• Unusual behavior around meals
• Chronically sore throat
• Swollen saliva glands 
• Worn tooth enamel 
• Gastrointestinal problems
• Severe dehydration 

Binge Eating Disorder

• Binge episodes (eating large quantities quickly)
• Eating even when not hungry and until uncomfortably full
• Eating in secret and feeling ashamed or guilty 
• Frequently dieting, possibly without weight loss

Identifying and Diagnosing

In addition to extreme weight loss or an obsession with weight, those with eating disorders may exhibit physical signs that may be cause for concern. The following observations may lead the healthcare team to perform tests to help find the source of weight loss or what damage the weight loss has caused:

• Bone thinning
• Anemia, extreme tiredness, and weakness
• Brittle hair and nails
• Yellowish skin
• Heart problems
• Decreased body temperature
• Infertility

Eating disorders may also lead to serious and potentially life-threatening medical emergencies. Tests that might be performed to look for these conditions include:

• Albumin and protein levels
• Complete blood count (CBC)
• Comprehensive metabolic panel (CMP)
• Kidney, liver, and thyroid function tests
• Urinalysis (urine test)
• Electrocardiogram (ECG), also called an EKG, which checks the electrical activity of the heart
• Bone density test to check for thin bones (osteoporosis)

Causes

It is important to note that eating disorders are not a lifestyle choice. They are medical illnesses. While the exact cause of eating disorders is not fully understood, research suggests a combination of factors.  

Genetics (heredity), hormones, psychological factors, and social circumstances can contribute to eating disorders. Some common risk factors include:

• Puberty
• Mental health conditions
• Negative self-image and weight stigma
• Eating problems during early childhood
• Social or cultural ideas about health and beauty
• Perfectionism
• Abuse or bullying

Types

Binge Eating Disorder (BED)

Binge eating is when a person eats a large amount of food in a short amount of time. While many people overeat occasionally, binge eating is frequent and ongoing, at least once a week for three months. Those who have a binge eating disorder feel they can’t control what or how much they eat. They eat when they are not hungry to the point of being uncomfortable.  

Bulimia Nervosa (BN)

People with bulimia nervosa use strategies after binge eating to avoid weight gain. These strategies include: 

• Excess use of laxatives or diuretics
• Fasting 
• Self-induced vomiting
• Intense exercise 

The difference between bulimia nervosa and binge eating disorder is that those with binge eating disorder may try these strategies occasionally, but it is not their regular pattern.

Anorexia Nervosa (AN)

Those with anorexia nervosa have a distorted body image and an intense fear of gaining weight. People with this disorder obsess about their food intake and see themselves as overweight even if they are underweight. They may diet or exercise excessively and lose more weight than is considered healthy for their age and height. It’s important to note that it can be diagnosed in all body sizes.

Other Specified Feeding or Eating Disorder (OSFED)

The OSFED category encompasses those with a severe eating disorder but who do not meet strict diagnostic criteria for binge eating disorder, anorexia nervosa, or bulimia nervosa. 

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant restrictive food intake disorder (ARFID) involves restricted food intake that causes depleted nutrition and energy. It is different than other disorders such as anorexia nervosa because the common body image disturbances are not present.

Orthorexia Nervosa

Orthorexia nervosa occurs when someone has an obsession with healthy eating that causes restrictive eating behaviors. They often over-restrict themselves and don’t get enough nutrition. This can lead to malnourishment, health problems, and poor quality of life.

Night Eating Syndrome

Night eating syndrome involves recurrent episodes of night eating or excessive food consumption after an evening meal.

Purging Disorder

Those with purging disorders exhibit recurring purging behavior to influence their weight or shape in the absence of binge eating.

Treatment

For those struggling with eating disorders, seeking help and getting treatment as soon as possible is vital in preventing mental and physical health complications. Treatment goals usually include reducing excessive exercise, restrictive eating behaviors, binging, and purging. The intent is to restore adequate nutrition and a healthy weight, and to treat secondary health problems the disease may have caused.  

Treatment plans may include a combination of the following approaches:

Self-Help

Self-help is a flexible and cost-effective treatment that can be a great starting point and may include: 

• Self-care 
• Journaling
• Reading self-improvement books
• Listening to podcasts
• Learning about nutrition

This treatment is not recommended for those who are severely underweight or diagnosed with anorexia nervosa. However, it is a helpful tool in conjunction with professional treatment. 

Monitoring

The healthcare team may monitor nutrition, weight, and lab work through direct observation and patient logs.

Nutritional Counseling

Nutritional counseling occurs with a dietitian who specializes in treating eating disorders. Dietitians are an integral part of the healthcare team and provide education about nutrients and proper amounts of food based on an individual’s size, age, gender, circumstances, and needs.

Therapy

Therapy can be used alone or in combination with other treatments and includes the following options:

• Cognitive behavioral therapy (CBT) is an excellent tool in helping patients change their thoughts and behaviors about food and their body. 
• Family-based treatment (FBT): In this model of treatment, the family is considered part of the solution to disordered eating.
• Support groups: This is a great way for patients and families to listen to and share with those who understand their struggles.

Outpatient Medical Care

The healthcare team will work as a group to provide testing, monitoring, counseling, and treatments outside of the hospital setting. This might include prescribing medications to treat eating disorders and co-occurring anxiety or depression. 

Inpatient Medical Care

A person with severe or life-threatening health complications may need to be hospitalized. These complications include:

• Severe dehydration
• Significant decrease in blood pressure or pulse
• Severe depression or suicidal ideations (thinking about committing suicide)
• Weight loss despite treatment 
• Weighing less than 75% of their ideal body weight

Coping

Choosing to put yourself first by seeking treatment for an eating disorder can stir up difficult emotions. Identifying the early signs, acknowledging the problem, and getting help are the first steps in breaking old, harmful habits that negatively impact your health. Congratulate yourself on all your milestones and remind yourself that recovery is entirely possible. 

For those caring for a loved one with an eating disorder, you are key in helping them overcome this hurdle. Remember to care for yourself as well and seek support when you need it. Your loved one may be in denial or feel out of control, ashamed, or guilty. In this case, finding a mental health therapist and support group can be helpful for everyone involved. 

A Word From Verywell

Living with an eating disorder can feel isolating and overwhelming. While it can be hard to ask for help, reaching out to someone close to you or a resource like the NEDA can make all the difference. The path to recovery is paved with those who care.