Types of 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. The five primary eating disorders recognized by the DSM-5 are:

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • Other specified feeding and eating disorder (OSFED)
  • Eating disorder not otherwise specified.

Without treatment, eating disorders can cause a number of health-related problems including cardiovascular issues, gastrointestinal issues, malnutrition, and in some cases, can be fatal. But with proper treatment, people affected by eating disorders can resume suitable eating habits and can improve their mental health.

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.

Different eating disorders all come with their own defining characteristics and diagnostic criteria. Read on to find out more about the eating disorders formally recognized in the DSM-5.

A despondent woman weighing herself in the bathroom

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Anorexia Nervosa

People with anorexia nervosa avoid food, severely restrict food, or eat very small quantities of only certain foods. Even when they are dangerously underweight, they may see themselves as overweight. They may also weigh themselves repeatedly.

Anorexia nervosa is relatively common among young women. While the overall incidence rate remained stable over the past decades, there has been an increase in the high risk-group of 15 to 19-year-old girls. The condition also afflicts men and boys and can be diagnosed in children as well as older adults.

Signs

Signs and symptoms of anorexia include:

  • Having an unusually low body mass index (BMI)
  • Missing meals, eating very little, or avoiding eating any foods you see as fattening
  • Believing you are fat when you are a healthy weight or underweight
  • Intense fear of gaining weight.
  • Taking medicine to reduce your hunger (appetite suppressants).
  • Physical problems, such as feeling lightheaded or dizzy, hair loss, or dry skin.

Some people with anorexia may also make themselves sick, do an extreme amount of exercise, or use laxatives or diuretics to try to stop themselves from gaining weight from any food they do eat.

Risks and Complications

People who have anorexia try to keep their weight as low as possible by not eating enough food, exercising too much, or both. This can make them very ill because they start to starve.

Long-term anorexia can lead to severe health problems associated with not getting the right nutrients (malnutrition). But these will usually start to improve once eating habits return to normal.

Possible complications include:

  • Problems with muscles and bones—including feeling tired and weak, osteoporosis, and problems with physical development in children and young adults.
  • Damage to the heart and blood vessels—including poor circulation, an irregular heartbeat, low blood pressure, heart valve disease, heart failure, and swelling in the feet, hands, or face.
  • Problems with the brain and nerves—including seizures, and difficulties with concentration and memory.
  • Kidney or bowel problems.
  • Having a weakened immune system or anemia.

Anorexia can also put your life at risk, with one study finding a six-fold increase in mortality compared to the general population. Deaths from anorexia may be due to physical complications or suicide.

Change to Anorexia Nervous Criterion

Amenorrhea (loss of a menstrual period) was eliminated as a criterion for anorexia nervosa in the DSM-5. This is important because it allows males to meet the criteria for anorexia nervosa.

It also allows official inclusion of the small minority of people who continue menstruating despite extreme weight loss and malnutrition.

Bulimia Nervosa

People with bulimia nervosa have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behaviors that compensate for the overeating, such as:

  • Forced vomiting
  • Excessive use of laxatives or diuretics
  • Fasting
  • Excessive exercise
  • A combination of these behaviors

Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.

Bulimia affects more women than men, with the National Comorbidity Survey finding lifetime prevalence of bulimia nervosa was five times higher among females (0.5%) than males (0.1%).

Bulimia affects more girls and younger women than older women. On average, women develop bulimia at age 18 or 19. Teen girls between ages 15 to 19, and young women in their early 20s are most at risk.

Signs

Symptoms of bulimia include:

  • Eating very large amounts of food in a short time, often in an out-of-control way—this is called binge-eating.
  • Making yourself vomit, using laxatives, or doing an extreme amount of exercise after a binge to avoid putting on weight.
  • Fear of putting on weight.
  • Being very critical about your weight and body shape
  • Mood changes—for example, feeling very tense or anxious

These symptoms may not be easy to spot in someone else because bulimia can make people behave very secretively.

Risks and Complications

Bulimia can eventually lead to physical problems associated with not getting the right nutrients, vomiting a lot, or overusing laxatives.

Possible complications include:

  • Feeling tired and weak
  • Dental problems – stomach acid from persistent vomiting can damage tooth enamel
  • Dry skin and hair
  • Brittle fingernails
  • Swollen glands
  • Fits and muscle spasms
  • Heart, kidney, or bowel problems, including permanent constipation
  • Bone problems – you may be more likely to develop problems such as osteoporosis, particularly if you have had symptoms of both bulimia and anorexia

Binge Eating Disorder

People with binge eating disorder (BED) lose control over their eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with BED are often overweight or obese, although most people who are labeled clinically obese do not necessarily have BED.

Men and women of any age can get BED, but it typically starts in the late teens or early 20s.

Signs

The main symptom of BED is eating very large amounts of food in a short time, often in an out-of-control way. But symptoms may also include:

  • Eating very fast during a binge
  • Eating until you feel uncomfortably full
  • Eating when you're not hungry
  • Eating alone or secretly
  • Feeling depressed, guilty, ashamed, or disgusted after binge eating

Risks and Complications

Complications from BED include:

  • Obesity
  • Increased risk for high cholesterol, high blood pressure, diabetes, gallbladder disease, and heart disease
  • Increased risk for psychiatric illnesses, particularly depression

Approximately half of all people with BED are also overweight.

Other Specified Feeding or Eating Disorders

Other specified feeding and eating disorder (OSFED), is less well known than conditions like anorexia nervosa, bulimia nervosa, and binge eating disorder. Despite its lack of public attention, as a catch-all category that includes a wide range of symptoms.

OSFED is actually the most common eating disorder diagnosis, representing an estimated 32 to 53% of all people with eating disorders. It was developed to encompass people who did not meet the full diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder.

Signs

Behavioral symptoms of OSFED often include a preoccupation with weight, food, calories, fat grams, dieting, and exercise, including:

  • Refusing to eat certain foods (restriction against categories of food like no carbs, no sugar, no dairy)
  • Frequent comments about feeling “fat” or overweight
  • Denial about feeling hungry
  • Fear of eating around others
  • Binge-eating
  • Purging behaviors (frequent trips to the bathroom after meals, signs and/or smells of vomiting, wrappers or packages of laxatives or diuretics)
  • Food rituals (such as excessive chewing or not allowing foods to touch)
  • Skipping meals or eating small portions at regular meals
  • Stealing or hoarding food
  • Drinking excessive amounts of water (or non-caloric beverages)
  • Using excessive amounts of mouthwash, mints, and gum
  • Hiding the body with baggy clothes
  • Exercising excessively (despite weather, fatigue, illness, or injury)

Risks and Complications

People with OSFED will experience health risks similar to those of the other eating disorders, including:

  • Weakened bones
  • Cardiovascular problems
  • Gastrointestinal problems (chronic constipation or diarrhea)
  • Dental issues from self-induced vomiting
  • Dry skin
  • Loss of menstrual cycle
  • Increased risk of infertility
  • Kidney failure

At least one previous study showed the mortality rate for OSFED was as high as for people who meet the defined thresholds for anorexia.

Furthermore, since eating disorder diagnoses are not stable over time, it is not uncommon for people to meet the diagnosis of OSFED on their way to a diagnosis of anorexia, bulimia, or binge eating disorder, or on their way to recovery.

Eating Disorder Not Otherwise Specified

This category applies to presentations in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.

The unspecified feeding or eating disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific feeding and eating disorder and includes situations in which there is insufficient information to make a more specific diagnosis such as emergency room settings.

Prevalence

Although it is probably the most known eating disorder, anorexia is not the most common. According to the Center for Behavioral Health Statistics and Quality, anorexia is less common among adults over than age of 18 than bulimia and BED, occurring in less than 0.1% of the adult population.

However, when younger women (15 to 19 years of age) are included, the lifetime prevalence of anorexia increases to 0.9% of women in the population; in addition, 0.3% of men exhibit the disorder at some point in their lives, usually later in life than women do. This results in a total of 1.2% of the population 15 years and older that has anorexia at some point in life. This compares to a 1.6% total prevalence for bulimia, and 5.7% prevalence of BED.

Diagnosing Eating Disorders

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.
  • Laboratory tests: Including a complete blood count, liver, kidney, and thyroid function tests, urinalysis, X-ray, and an electrocardiogram.
  • Psychological evaluation: Including personal questions about your eating behaviors, binging, purging, exercise habits, and body image.

There are also multiple questionnaires and assessment tools that may be used to assess a person's symptoms.

It is not uncommon for patients with eating disorders, especially patients with anorexia nervosa, to not believe that they are ill. This is a symptom called anosognosia. So, if you are concerned about a friend or loved one and he or she denies having a problem, it does not necessarily mean there is not a problem.

A Word From Verywell

Often, people with eating disorders won’t know they have a problem. It is common for patients with eating disorders to believe their problem is not serious. Without treatment, there can be serious physical and mental health implications, and eating disorders can even prove fatal.

If you are a loved one of a person with an eating disorder, please encourage them to get help. If you are suffering from an eating disorder and are not in treatment, please reach out to a treatment professional. With treatment, most people with eating disorders can recover.

Seek Help

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237

For more mental health resources, see our National Helpline Database.

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Article Sources
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