Eating Disorders

What are eating disorders?

Eating disorders are mental health conditions marked by persistent disturbances in eating behaviors, along with distressing thoughts and emotions about food, weight or body shape. They can affect physical health, relationships and daily life, and they are treatable.

Types

• Anorexia nervosa: restricting food intake, an intense fear of gaining weight, and a distorted view of body weight or shape.
• Bulimia nervosa: recurrent episodes of binge eating followed by behaviors to compensate, such as vomiting, laxative misuse, fasting or excessive exercise.
• Binge-eating disorder: recurrent episodes of eating large amounts of food with a sense of loss of control, without regular compensatory behaviors.
• Avoidant/restrictive food intake disorder (ARFID): limiting the amount or types of food eaten, not driven by body-image concerns.

Warning signs

Warning signs can include preoccupation with food, calories or weight; skipping meals; eating in secret; frequent trips to the bathroom after eating; rigid exercise routines; and withdrawal from social events involving food.

These signs can occur with eating disorders, but only a qualified professional can provide a diagnosis.

Causes and risk factors

Eating disorders arise from a mix of genetic, biological, psychological and social factors. A family history of eating disorders or other mental health conditions, dieting, perfectionism and weight-related bullying are associated with higher risk.

Treatment

Treatment is usually delivered by a team that may include a physician, therapist and dietitian. Evidence-based approaches include eating-disorder-focused CBT, family-based treatment for young people (see family therapy), nutritional rehabilitation and medical monitoring. Some people need more intensive care, such as day programs or inpatient treatment.

General online therapy services are not a substitute for specialist eating disorder care, and many will refer you on. If you use a service such as BetterHelp for related anxiety or low mood, tell your therapist about your eating so they can help you find the right level of care.

Eating disorders are not about vanity or willpower

Eating disorders are serious mental health conditions that involve a disturbed relationship with food, eating, weight or body image. They are not a lifestyle choice, a phase or a sign of vanity, and they can affect people of any age, gender, body size, ethnicity or background. They also carry a high risk of medical complications, and anorexia nervosa in particular is associated with some of the highest mortality rates among mental health conditions, which is why early recognition and treatment matter. Recovery is possible, and most people who receive evidence-based treatment improve.

Understanding the main types

• Anorexia nervosa: restriction of food intake, intense fear of gaining weight and distorted perception of body weight or shape. People with anorexia can be at any weight, and medical risk does not depend on appearing underweight.
• Bulimia nervosa: recurrent episodes of binge eating followed by behaviors intended to prevent weight gain, such as vomiting, laxative misuse, fasting or excessive exercise.
• Binge eating disorder: recurrent episodes of eating large amounts of food with a sense of loss of control, followed by distress, without regular compensatory behaviors. It is the most common eating disorder.
• Avoidant/restrictive food intake disorder (ARFID): limited eating driven by sensory sensitivity, fear of choking or vomiting or low interest in food, rather than body image concerns.
• Other specified feeding or eating disorders: significant eating disorder symptoms that don’t match the other categories but are still serious.

These descriptions are not a way to diagnose yourself. Only a qualified healthcare professional can provide a diagnosis.

Warning signs beyond the obvious

Signs can be behavioral, emotional and physical, and many are easy to miss:

• Preoccupation with food, calories, weight or body shape
• Skipping meals, rigid food rules or avoiding eating with others
• Eating in secret, or evidence of large amounts of food disappearing
• Going to the bathroom right after meals
• Compulsive or excessive exercise, even when ill or injured
• Mood changes, withdrawal and irritability
• Dizziness, fainting, fatigue, feeling cold, or changes in menstrual cycles
• Dental problems, swollen cheeks or calluses on the knuckles

Medical risks

Eating disorders can affect the heart, bones, digestive system, hormones and brain. Heart rhythm problems, electrolyte imbalances and, with severe restriction, dangerously low heart rate and blood pressure can be life-threatening. Anyone with suspected eating disorder symptoms should have a medical evaluation, even if they don’t appear unwell. Please seek urgent care for fainting, chest pain, severe weakness, confusion or thoughts of suicide.

Evidence-based treatment

The right treatment depends on the type of disorder, medical stability, age and personal circumstances. Options with research support include:

• Family-based treatment (FBT), where parents take an active role in refeeding, is the leading treatment for adolescents with anorexia and is also used for bulimia.
• Enhanced cognitive behavioral therapy (CBT-E), a form of CBT for adults and older adolescents with bulimia, binge eating disorder and other presentations.
• Other therapies, including DBT adaptations for binge eating and bulimia, and specialist adult anorexia approaches.
• Nutritional and medical care, with dietitians and physicians to restore healthy eating patterns and monitor health.
• Medication, which may be used for some conditions, such as certain medicines for binge eating disorder or bulimia, or to treat co-occurring depression or anxiety, but does not by itself treat anorexia.
• Higher levels of care, including intensive outpatient, day programs or inpatient care when medical or psychological risk is high.

Eating disorders often occur with anxiety, depression, OCD and trauma, so treatment usually addresses these too.

Supporting someone you’re worried about

• Choose a calm, private moment, and speak with care and concern rather than blame.
• Focus on how you feel and what you’ve observed, not on weight, food or appearance.
• Listen without arguing about whether they have a problem, and avoid comments on bodies.
• Encourage a visit to a doctor and offer to go with them.
• Don’t force eating or make mealtimes a battleground; seek professional guidance.
• Look after yourself, and consider support for family and friends.

Getting help

Start with a primary care clinician or a service specializing in eating disorders. Early help leads to better outcomes, and you don’t have to be underweight or “sick enough” to deserve treatment. Many countries have helplines and charities that offer support. If you are in crisis, or have thoughts of suicide, see Get Help Now for immediate resources. Our guide to finding care explains how to look for a specialist.