Eating disorders are mental health conditions defined by severe and harmful eating behaviors. Possible signs include obsession with your weight or how your body looks, eating too much or too little food, and controlling how you eat.
About 28.8 million people in the United States will experience an eating disorder at some point in their lives, and most people don’t receive treatment. Eating disorders can affect people of all ages, genders, and weights, but they’re most common among people between the ages of 12-35, particularly those who identify as women. One in eight people experience at least one type of eating disorder before turning twenty years old.
Complications from eating disorders can be serious and even life-threatening. Many people fully recover, but it might take a long time. Treatment typically includes psychotherapy and nutritional counseling. Ongoing support is a key aspect of recovery and long-term health.
Eating disorders are characterized by severe changes to eating behavior, but the ways in which they manifest differ by type, as well as from person to person. Anorexia nervosa, bulimia nervosa, binge-eating disorder (BED), and avoidant restrictive food intake disorder (ARFID) are among the most common eating disorders.
Like other mental health conditions, an eating disorder diagnosis requires meeting criteria, such as a certain number of symptoms or behaviors for a certain period of time—for example, at least one weekly binge with at least three specific characteristics (e.g., feeling very full, eating alone, and eating a lot of food when not hungry) for at least three months.
Anorexia Nervosa
Anorexia nervosa, often referred to simply as anorexia, is the most well-known eating disorder. It has the highest mortality rate of any mental health disorder. People with anorexia nervosa may avoid eating, severely restrict what they eat, or only eat very small amounts.
There are two subtypes of anorexia:
Restrictive: Severely limiting food intake, as well as sometimes engaging in excessive physical activity
Binge-purge: Severely limiting food intake, as well as binge-eating and purging (eating large amounts of food in a short period of time and vomiting or using laxatives, diuretics, or diet pills)
If you experience anorexia, you may view yourself as overweight (even if you are underweight), weigh yourself often, and have an intense fear of weight gain. Other characteristic signs of anorexia include:
Extremely low body weight
Excessive physical activity
Preoccupation with food, weight, and thinness
Distorted body image
Behaviors that resemble obsessive-compulsive disorder (OCD), such as always using the same cutlery or cutting food into very small pieces
Due to a lack of nutrition, anorexia can cause a range of physical health conditions including sarcopenia (muscle loss), hypotension (low blood pressure), infertility, brittle hair and nails, and eventually multiple organ failure.
Bulimia Nervosa
Bulimia nervosa is much more common than anorexia nervosa. People with bulimia nervosa, or bulimia for short, may eat large amounts of food in one sitting and feel they can’t control their eating. They may try to avoid weight gain by forcing themselves to vomit, using laxatives or diuretics, fasting, or exercising excessively.
Many people with bulimia experience symptoms that result from purging behaviors, including:
Sore and inflamed throat from self-induced vomiting
Swollen salivary glands in the neck and jaw
Sensitive or decaying teeth from induced vomiting
Gastrointestinal problems, such as acid reflux
Severe dehydration or electrolyte imbalance
Weight can vary in people with bulimia, in contrast to the common underweight appearance of people with anorexia.
Binge-Eating Disorder (BED)
Binge-eating disorder (BED) is the most common eating disorder in the United States. It’s characterized by episodes of eating large amounts of food accompanied by a lack of control.
Binge-eating disorder differs from bulimia in that people with BED don’t try to prevent weight gain by vomiting, exercising, or fasting. Many people with BED have a larger body size and may be overweight or obese. Over one-third of people with BED identify as male.
Signs of BED include:
Eating large amounts of food in a short time period
Eating when you’re feeling full, or eating until you feel overly fullFeeling like you’re out of control during bingesTrying to hide eating habits due to shame or embarrassment
Avoidant Restrictive Food Intake Disorder (ARFID)
People with avoidant restrictive food intake disorder (ARFID) severely limit the type or amount of food they eat, resulting in weight loss or inability to maintain expected weight gain (children). ARFID most commonly affects children younger than seven, but it can continue into adulthood.
ARFID differs from typical childhood picky eating because it leads to severe weight loss and malnutrition. It does not include restricting food from your diet for religious or other reasons, such as eating a vegan diet.
ARFID symptoms include:
Lack of interest in food
Lack of appetite
Severe dislike of certain textures, tastes, smells, or food colors
Progressively severe “picky eating”
Severe weight loss
Gastrointestinal issues, such as nausea or abdominal pain
Other Eating Disorders
Pica and rumination disorder are two other eating disorders.
Pica is characterized by craving non-food items such as soil, paper, or soap. Many children and pregnant people experience this, but it usually resolves. It might also develop—and be chronic—in people with intellectual disabilities.
Rumination disorder is regurgitating food you’ve already swallowed, chewing it, and then swallowing or spitting. It often resolves if present during infancy, but it can also develop in older children and adults.
Some eating disorders fall under the general diagnostic category “Other Specified Feeding and Eating Disorder (OSFED).” This includes:
Purging disorder: Attempting to control weight by making yourself vomit, exercising excessively, or using laxatives or diuretics (without binging)Night eating syndrome: Eating excessively after waking up in the middle of the nightOrthorexia: Obsession with “healthy” and “clean eating” (e.g., avoiding processed foods), including compulsively reading food labels and eliminating entire food groups
Orthorexia is not formally classified as a separate eating disorder at this point, but research suggests that it’s often accompanied by OCD.
Each person’s experience is unique, but certain signs suggest a possible eating disorder.
Physical signs include:
Dry skin, thin hair, and brittle nails
Fine body hair (lanugo)
Muscle weakness
Dizziness
Edema (swelling) in feet
Psychological and behavioral signs include:
Obsessing over food or weightRefusing to eat certain foodsFood rituals (e.g., odd food combinations, cutting food into tiny pieces)
Excessive exerciseVomiting or using laxatives, diuretics, or diet pills after eatingFeeling self-conscious about eating behaviors Avoiding eating in social settingsMood swings
Though anorexia nervosa is the most recognized eating disorder, very few people with eating disorders qualify as “underweight” (a BMI below 18.5). People with a higher BMI are more at risk of eating disorders. They’re also more likely to experience weight stigma in the medical community.
Eating disorder signs can vary greatly from person to person, and they might not be recognized by healthcare providers. For example, BIPOC people (Black, Indigenous, and People of Color) are about 50% less likely to be diagnosed with an eating disorder and might be less likely to receive treatment.
Reach out to a healthcare provider if you think you or someone you know might need support. They can refer you to a mental health provider who specializes in eating disorders, as well as other support professionals like a registered dietitian (RD).
The exact causes of eating disorders remain unclear. It seems to be a combination of biological, psychological, and sociological factors. These might include:
A family history of eating disorders
Your brain’s levels of serotonin, a hormone that helps regulate appetite and mood
A history of dieting or negative energy balance (using more calories than you consume, such as during intense athletic training)
Psychological patterns like perfectionism, impulsivity, neuroticism, inflexibility, and harm avoidance
Childhood experiences like bullying and sexual abuse
Acculturation (assimilating to Western culture, including social norms)
Exposure to social ideals of “thinness” and weight stigma
Risk Factors
Some people are at a greater risk of eating disorders. For example:
People who identify as female are five times more likely to be diagnosed with an eating disorder.
Asian American college students are more likely than non-Asian students to report food restriction behaviors and body dissatisfaction.
LGBTQ+ are about three times more likely than heterosexual people to have an eating disorder.
Transgender college students are four times more likely than cisgender students to be diagnosed with an eating disorder.
People who have eating disorders are much more likely to have other mental health conditions, including mood disorders like anxiety, OCD, and attention-deficit/hyperactivity disorder (ADHD).
Athletes are more likely to exercise excessively and use eating-related behaviors to reduce or maintain body weight. However, fear of stigma and other barriers related to sports may prevent them from seeking treatment.
The goals of eating disorder treatment include restoring nutrition levels, decreasing excessive physical activity, shifting unhealthy eating behaviors, and treating co-occurring mental health conditions and substance use disorder (SUD).
If you suspect that you or a loved one is experiencing an eating disorder, it’s important to seek treatment early to prevent further complications. Treatment for eating disorders may include a combination of psychotherapy, nutritional counseling, medical care, and medication.
Psychotherapy
Psychotherapy (talk therapy) or psycho-behavioral therapy is the primary treatment approach for treating eating disorders and related mental health conditions. It’s typically performed in an outpatient (day treatment) setting, though it might also be part of an inpatient (overnight) treatment program.
Mental health professionals might use different types of psychotherapy depending on the person and their diagnosis, including:
Cognitive behavioral therapy (CBT): CBT focuses on identifying negative or disruptive thought patterns and replacing them with more helpful thoughts and behaviors.
Enhanced cognitive behavioral therapy (CBT-E): This is a form of CBT that focuses on removing eating disorder beliefs and behaviors and helping people maintain changes long-term. CBT-E is typically the main treatment approach for all eating disorders.
Family-based treatment (FBT): FBT is often used for children and adolescents with anorexia nervosa. Treatment includes significant involvement of family members.
Interpersonal psychotherapy: This type of psychotherapy focuses on relationships and social functioning. It might be used to treat bulimia nervosa or BED.
Other techniques, such as dialectical behavioral therapy (DBT), might also be effective in treating eating disorders. DBT is a form of psychotherapy that combines CBT with other elements like mindfulness and emotional regulation.
Nutritional Counseling
Nutritional counseling is usually a core part of eating disorder treatment. Goals will depend on the diagnosis and individual circumstances. For example, goals for someone with anorexia nervosa may include progressive weight gain and restoring vitamins and minerals through gradual refeeding and monitoring of electrolytes.
Pairing nutritional counseling with psychotherapy can reduce the risk of relapse. Relapse occurs when symptoms begin again after a period of relief. It’s fairly common with eating disorders.
Medical Care
Inpatient treatment might be recommended or required to treat severe cases of eating disorders. A healthcare provider may recommend medical care and monitoring if an eating disorder is causing severe health complications.
Reasons for inpatient medical care might include losing more than 30% of your body weight, continual suicidal ideation, or not responding to outpatient treatment.
Medical care most commonly occurs with anorexia nervosa. For example, a person with severe anorexia nervosa might require refeeding due to malnourishment. The refeeding process requires specific strategies and monitoring.
Medication
Depending on the diagnosis, a healthcare provider may recommend medication. They may also recommend medication to address other mental health conditions, such as an antidepressant, antipsychotic, or mood stabilizer. Addressing underlying conditions can support eating disorder recovery.
The antidepressant Prozac (fluoxetine) is the only FDA-approved medication for bulimia and BED. Research continues to assess the possible effectiveness of drugs for other eating disorders.
If a friend or family member has an eating disorder, your support is crucial for their recovery. Eating disorder treatment can be incredibly challenging, which is why a circle of support is so valuable.
To support someone with an eating disorder, you can:
Learn as much as you can about eating disordersListen with judgmentBe clear and honest, but also empathetic—for example, use “I” statementsKeep track of any behaviors you’re concerned about
Eat meals together in a supportive and non-judgmental wayOffer to help them find a treatment provider
Supporting someone with an eating disorder requires honoring their boundaries. It can be an emotional experience but try to focus on the facts, and expect some negative reactions.
You can encourage them to get support, which can be difficult for someone who has an eating disorder. You might reach the point where you need to tell someone else—for example, if you’re concerned that the person’s life may be in danger.
Although risks and complications vary by eating disorders, they all can have serious health consequences. Possible complications include:
Cardiovascular conditions: For example, arrhythmia (irregular heartbeats), heart disease, and stroke
Digestive conditions: For example, blood glucose (sugar) fluctuations, blocked intestines, pancreatitis (pancreas inflammation), and infections
Anemia: Reduced number of red blood cells or hemoglobin, a protein that helps red blood cells transport oxygen
Cognitive deficits: Particularly memory and concentration
Type 2 diabetes: A condition that occurs when your body isn’t able to properly use the hormone insulin
Eating disorders can delay puberty and lead to stunted growth among children and adolescents. They can cause amenorrhea (missing three or more consecutive menstrual periods) and osteoporosis (decreased bone density). They can also affect fertility.
Eating disorders can eventually lead to life-threatening, multiple organ failure. People with anorexia are at the highest risk of mortality compared to other eating disorders due to the risk of starvation and suicide. Seeking treatment early and supporting loved ones in recovery are crucial.
Eating disorder prevention often focuses on children and adolescents. Prevention programs—for example, in schools—can help build self-esteem, reduce pressure to conform to ideals, and shift dieting behaviors.
Developing well-rounded eating habits is critical for preventing eating disorders, particularly among young people. This includes:
Choosing foods that nourish your body with a variety of nutrients rather than foods that are low-calorieExercising to become stronger and improve your cardiovascular healthModeling and supporting healthy eating behaviors during meals with family and friendsAvoiding dieting behaviors around childrenNot teasing other people about their weight or eating habits
Intuitive eating is another useful strategy for developing healthy eating habits. Intuitive eating means listening to your body’s hunger and fullness cues, eating nourishing foods that you enjoy, and not restricting any foods.
For example, if you’re considering eating a piece of cake, you might ask yourself how much you will enjoy the cake, how your body might feel afterward, and what size piece might satisfy you.
Intuitive eating has been shown to reduce eating disorder behaviors, while dieting has been shown to increase them.
Reach out to a healthcare provider if you think you or someone in your care may have an eating disorder. Treating eating disorders early is important for preventing further complications. If you have concerns, speak with your primary care provider about what you’re experiencing. They can help connect you to a mental health provider.
NEDA has a screening tool on its website for people ages 13 and up, as well as a treatment provider directory.
Eating disorders include a range of mental health conditions that can have serious health effects. They are characterized by disordered eating behaviors, but symptoms can vary greatly from person to person.
Psychotherapy and nutritional counseling are key aspects of treatment. Medical treatment might be necessary in more severe cases. Most people with bulimia nervosa recover within 10 years, but only about half of people with anorexia nervosa recover in that time period. Relapse is more common after more than one inpatient admission.
You can fully recover from an eating disorder, but the prognosis varies, and the process is often slow. Early treatment and the support of loved ones are both crucial to recovery and the prevention of serious complications.
