Eating Disorders

Eating disorders are serious mental health conditions that involve persistent disturbances in eating behaviours, thoughts about food, and body image. These disorders can affect your physical health, emotional well-being, and ability to function in daily life. Eating disorders are not about vanity, willpower, or lifestyle choices - they are complex medical conditions that require professional treatment.

Table of Contents

• What Are Eating Disorders?
• Types of Eating Disorders
• Causes and Risk Factors
• Signs and Symptoms
• Health Consequences
• Diagnosis
• Treatment
• Recovery and Prognosis
• Prevention
• Supporting Someone with an Eating Disorder
• Eating Disorders in Different Populations
• Cultural Considerations
• When to Seek Help
• Related Terms
• References

What Are Eating Disorders?

Eating disorders often develop during adolescence and young adulthood, but they can occur at any age. They frequently co-occur with other mental health conditions such as anxiety, depression, and substance use disorders. Without treatment, eating disorders can cause serious health complications and can be life-threatening.

It's important to understand that eating disorders are not a choice or a phase that someone will outgrow. They are serious medical conditions that require professional treatment and support from family and friends.

Types of Eating Disorders

Anorexia Nervosa

Key Features

• Restricted eating - Severely limiting food intake, often to dangerous levels
• Significantly low weight - Weight that is less than minimally normal for age and height
• Fear of weight gain - Intense fear of gaining weight or becoming fat
• Body image distortion - Seeing yourself as overweight even when underweight
• Denial of severity - Not recognising the seriousness of low body weight

Subtypes

• Weight loss achieved primarily through dieting, fasting, or excessive exercise
• No regular binge eating or purging behaviours

Binge-Eating/Purging Type:

• Regular binge eating or purging behaviours (vomiting, laxatives, diuretics)
• May occur even with small amounts of food

Physical Signs

• Extreme weight loss - Dramatic decrease in body weight
• Fatigue and weakness - Lack of energy due to inadequate nutrition
• Hair loss - Thinning hair on the head, growth of fine hair on the body
• Cold intolerance - Feeling cold all the time
• Irregular menstruation - Missed periods or complete loss of menstruation
• Dry skin and brittle nails - Poor nutrition affects skin and nail health

Bulimia Nervosa

Key Features

• Binge eating episodes - Eating large amounts of food in short periods with loss of control
• Compensatory behaviours - Vomiting, laxative use, diuretics, fasting, or excessive exercise
• Frequency - Binge eating and compensatory behaviours occur at least once a week for three months
• Body image concerns - Self-evaluation heavily influenced by body shape and weight
• Normal weight - Often maintain normal weight, making the disorder less obvious

Binge Eating Episodes

• Large amounts of food - Eating significantly more than most people would in similar circumstances
• Loss of control - Feeling unable to stop eating or control what or how much you eat
• Rapid eating - Eating much more rapidly than normal
• Eating until uncomfortable - Continuing to eat past the point of fullness
• Eating alone - Often eating in secret due to embarrassment

Compensatory Behaviours

• Self-induced vomiting - Most common method, can cause dental and throat problems
• Laxative abuse - Using laxatives to try to eliminate food from the body
• Diuretic abuse - Using water pills to reduce water weight
• Fasting - Going without food for extended periods
• Excessive exercise - Compulsive exercise to "burn off" calories

Binge Eating Disorder

Key Features

• Frequent binge episodes - At least once a week for three months
• No compensatory behaviours - Unlike bulimia, no regular vomiting, laxative use, or excessive exercise
• Distress about binge eating - Significant distress regarding the binge eating behaviour
• Loss of control - Feeling unable to control eating during binge episodes
• Often leads to weight gain - May result in overweight or obesity

Characteristics of Binge Episodes

• Eating rapidly - Eating much faster than normal
• Eating until uncomfortably full - Continuing past the point of satisfaction
• Large amounts when not hungry - Eating large quantities even when not physically hungry
• Eating alone - Often done in secret due to embarrassment
• Guilt and disgust - Feeling disgusted, depressed, or guilty after eating

Other Specified Feeding or Eating Disorder (OSFED)

Examples Include

• Atypical anorexia - All symptoms of anorexia except weight remains in normal range
• Night eating syndrome - Recurrent episodes of night eating
• Bulimia with lower frequency - Binge eating and compensatory behaviours less than once per week
• Binge eating disorder with lower frequency - Binge episodes less than once per week
• Purging disorder - Purging behaviours without binge eating

Avoidant/Restrictive Food Intake Disorder (ARFID)

Common Presentations

• Lack of interest in food - Little appetite or interest in eating
• Sensitivity to food characteristics - Avoiding foods based on texture, smell, taste, or appearance
• Concern about consequences - Fear of choking, vomiting, or other negative outcomes
• Sensory issues - Difficulty with certain textures, temperatures, or flavours

Pica

Characteristics

• Non-food substances - Eating items like starch, ice, dirt, paint chips, or paper
• Inappropriate for development - Behaviour is not appropriate for developmental level
• Not culturally sanctioned - Not part of cultural or religious practices
• Medical complications - Can lead to poisoning, infections, or intestinal blockages

Rumination Disorder

Features

• Regurgitation - Bringing up previously swallowed food
• Re-chewing or spitting out - Food is re-chewed, re-swallowed, or spit out
• Not due to medical condition - Not caused by gastrointestinal or other medical conditions
• Onset - Usually begins in infancy but can occur at any age

Causes and Risk Factors

Biological Factors

• Genetics - Having family members with eating disorders increases risk
• Brain chemistry - Imbalances in neurotransmitters like serotonin and dopamine
• Hormonal factors - Changes during puberty, pregnancy, or menopause
• Medical conditions - Diabetes, gastrointestinal disorders, or other medical issues

Psychological Factors

• Perfectionism - Setting unrealistically high standards for yourself
• Low self-esteem - Negative feelings about yourself and your worth
• Body dissatisfaction - Unhappiness with your body size, shape, or appearance
• Control issues - Using food and eating as a way to feel in control
• Trauma history - Physical, sexual, or emotional abuse or other traumatic experiences
• Mental health conditions - Anxiety, depression, or obsessive-compulsive tendencies

Social and Cultural Factors

• Cultural pressure - Societal emphasis on thinness and appearance
• Media influence - Exposure to unrealistic body images in media
• Peer pressure - Comments or teasing about weight or appearance
• Family dynamics - Family attitudes about food, weight, and appearance
• Sports and activities - Participation in activities that emphasise weight or appearance

Environmental Triggers

• Dieting - Restrictive dieting can trigger eating disorder behaviours
• Life transitions - Major changes like starting college, divorce, or job loss
• Stressful events - Traumatic experiences or ongoing stress
• Weight-related teasing - Comments about weight or appearance from others
• Medical issues - Illness or medical procedures that affect eating or weight

Signs and Symptoms

Physical Signs

• Dramatic weight changes - Significant weight loss, gain, or frequent fluctuations
• Fatigue and weakness - Lack of energy due to inadequate nutrition
• Dizziness or fainting - Especially when standing up quickly
• Hair loss or thinning - Poor nutrition affects hair growth
• Dry skin and brittle nails - Signs of nutritional deficiency
• Cold intolerance - Feeling cold all the time
• Dental problems - Tooth decay, enamel erosion from vomiting
• Gastrointestinal issues - Constipation, bloating, or stomach pain

Behavioral Signs

• Obsession with food - Constantly thinking or talking about food, calories, or weight
• Rigid eating patterns - Strict rules about what, when, or how much to eat
• Avoiding social eating - Making excuses to avoid meals with others
• Secretive eating - Hiding food or eating in private
• Excessive exercise - Compulsive exercise routines, anxiety when unable to exercise
• Frequent weighing - Obsessive weighing or body checking
• Food rituals - Cutting food into tiny pieces, eating very slowly, or other rituals

Emotional Signs

• Mood swings - Irritability, anxiety, or depression
• Social withdrawal - Isolating from friends and family
• Perfectionism - Setting unrealistic standards and being self-critical
• Anxiety around food - Distress when eating or around meal times
• Body image distortion - Seeing yourself differently than others see you
• Guilt and shame - Feeling guilty about eating or body size

Health Consequences

Physical Health Effects

Anorexia Nervosa

• Cardiovascular problems - Slow heart rate, low blood pressure, heart rhythm abnormalities
• Bone loss - Osteoporosis and increased risk of fractures
• Muscle wasting - Loss of muscle mass and strength
• Kidney problems - Dehydration and electrolyte imbalances
• Gastrointestinal issues - Constipation, bloating, delayed gastric emptying
• Reproductive problems - Irregular or absent menstruation, fertility issues
• Neurological effects - Difficulty concentrating, memory problems, mood changes

Bulimia Nervosa

• Dental problems - Tooth decay, enamel erosion, gum disease
• Electrolyte imbalances - Dangerous changes in sodium, potassium, and other electrolytes
• Dehydration - From vomiting and laxative abuse
• Gastrointestinal problems - Chronic constipation, irregular bowel movements
• Throat and oesophagus damage - From frequent vomiting
• Heart problems - Irregular heart rhythms from electrolyte imbalances

Binge Eating Disorder

• Weight gain and obesity - Increased risk of diabetes, heart disease, and other conditions
• Cardiovascular disease - High blood pressure, high cholesterol
• Type 2 diabetes - From weight gain and poor eating patterns
• Sleep apnea - Breathing problems during sleep
• Joint problems - Increased stress on joints from excess weight
• Gastrointestinal issues - Acid reflux, stomach pain

Mental Health Effects

• Depression - Persistent sadness and loss of interest in activities
• Anxiety - Excessive worry, especially around food and body image
• Social isolation - Withdrawal from friends, family, and activities
• Cognitive impairment - Difficulty concentrating, memory problems
• Increased suicide risk - Eating disorders have high rates of suicidal thoughts and behaviours
• Substance abuse - Higher risk of alcohol and drug abuse

Diagnosis

Assessment Process

Clinical Interview

• Detailed history - Information about eating behaviours, weight history, and symptoms
• Mental health history - Previous mental health conditions and treatments
• Family history - Eating disorders and mental health conditions in family members
• Medical history - Physical health problems and medications
• Psychosocial assessment - Relationships, work/school functioning, and social support

Physical Examination

• Vital signs - Blood pressure, heart rate, temperature, and weight
• Physical signs - Looking for signs of malnutrition or purging behaviours
• Laboratory tests - Blood tests to check for electrolyte imbalances, anaemia, and other problems
• Bone density - Testing for bone loss in cases of anorexia
• Cardiac evaluation - EKG to check heart rhythm and function

Psychological Assessment

• Eating disorder questionnaires - Standardised tools to assess symptoms
• Body image assessment - Evaluating attitudes toward body size and shape
• Mood assessment - Screening for depression, anxiety, and other mental health conditions
• Cognitive assessment - Evaluating thinking patterns and beliefs about food and weight

Diagnostic Criteria

• Specific symptoms - Particular eating behaviours and attitudes
• Duration - How long symptoms have been present
• Frequency - How often behaviours occur
• Impairment - How much symptoms interfere with daily life
• Medical stability - Whether the person is medically stable

Treatment

Treatment Team

Core Team Members

• Primary care physician - Monitors physical health and medical complications
• Psychiatrist - Manages medications and provides psychiatric care
• Therapist - Provides individual, group, or family therapy
• Registered dietitian - Provides nutrition education and meal planning
• Case manager - Coordinates care and connects with resources

Additional Team Members

• Medical specialists - Cardiologists, gastroenterologists, or other specialists as needed
• Dental professionals - For dental problems related to purging
• Social worker - Helps with practical issues and family support
• Peer support specialists - People in recovery who provide support and guidance

Levels of Care

Outpatient Treatment

• Individual therapy - One-on-one sessions with a therapist
• Group therapy - Treatment with others who have eating disorders
• Family therapy - Involving family members in treatment
• Nutrition counselling - Working with a dietitian on meal planning and nutrition education
• Medical monitoring - Regular check-ups with a physician

Intensive Outpatient Programs (IOP)

• Structured program - Several hours of treatment multiple days per week
• Combination of therapies - Individual, group, and family therapy
• Meal support - Supervised meals and snacks
• Medical monitoring - Regular medical check-ups
• Flexibility - Allows you to maintain work, school, or family responsibilities

Partial Hospitalisation Programs (PHP)

• Day treatment - Full-day program with evening and weekend time at home
• Comprehensive care - Medical monitoring, therapy, and nutrition counselling
• Meal supervision - All meals and snacks supervised by staff
• Group activities - Therapeutic activities and education groups
• Transition step - Often used as step-down from inpatient care

Residential Treatment

• 24-hour care - Round-the-clock supervision and support
• Structured environment - Highly structured daily schedule
• Intensive therapy - Multiple therapy sessions per day
• Medical supervision - Constant medical monitoring
• Meal supervision - All eating supervised by trained staff
• Length of stay - Typically 30-90 days or longer

Inpatient Hospitalisation

• Medical instability - For people who are medically unstable
• Psychiatric crisis - High suicide risk or severe psychiatric symptoms
• Intensive medical care - 24-hour medical monitoring
• Stabilisation focus - Getting medically and psychiatrically stable
• Short-term - Usually brief stays to address immediate medical needs

Types of Therapy

Cognitive Behavioural Therapy (CBT)

• Thought patterns - Identifying and changing negative thoughts about food, weight, and body image
• Behavioural changes - Developing healthy eating behaviours and coping skills
• Problem-solving - Learning to handle difficult situations without using eating disorder behaviours
• Relapse prevention - Developing strategies to maintain recovery

Dialectical Behaviour Therapy (DBT)

• Emotion regulation - Learning to manage intense emotions without using eating disorder behaviours
• Distress tolerance - Developing skills to cope with difficult situations
• Interpersonal effectiveness - Improving communication and relationship skills
• Mindfulness - Learning to be present and aware of thoughts and feelings

Family-Based Treatment (FBT)

• Family involvement - Parents and family members actively involved in treatment
• Meal supervision - Family helps with meal planning and supervision
• Weight restoration - Focus on helping the person gain weight and normalise eating
• Effective for adolescents - Particularly effective for young people with anorexia

Interpersonal Psychotherapy (IPT)

• Relationship focus - Examining how relationships affect eating disorder symptoms
• Communication skills - Improving communication and relationship skills
• Role transitions - Helping with major life changes
• Grief and loss - Processing losses that may contribute to eating disorder symptoms

Acceptance and Commitment Therapy (ACT)

• Value-based living - Focusing on what's important to you rather than weight and appearance
• Psychological flexibility - Learning to accept difficult thoughts and feelings
• Mindfulness - Developing awareness of thoughts and feelings without judgment
• Behavioural change - Making changes based on your values rather than eating disorder rules

Nutritional Rehabilitation

• Meal planning - Developing regular, balanced meal plans
• Nutrition education - Learning about proper nutrition and healthy eating
• Challenging food fears - Gradually introducing feared foods
• Normalising eating - Developing normal eating patterns and hunger/fullness cues
• Weight restoration - For those who are underweight, gradually gaining weight in a healthy way

Medications

Antidepressants

• SSRIs - May help with depression, anxiety, and some eating disorder symptoms
• Fluoxetine (Prozac) - FDA-approved for bulimia nervosa
• Other SSRIs - Sertraline, paroxetine, and others may be helpful

Other Medications

• Anti-anxiety medications - For severe anxiety symptoms
• Mood stabilisers - For people with bipolar disorder
• Antipsychotics - Sometimes used for severe anorexia or when there are psychotic symptoms

Recovery and Prognosis

What Recovery Looks Like

• Physical recovery - Restoring healthy weight, normal eating patterns, and physical health
• Psychological recovery - Developing healthy coping skills and improving self-esteem
• Social recovery - Rebuilding relationships and social connections
• Behavioural recovery - Eliminating eating disorder behaviours and developing healthy habits
• Cognitive recovery - Changing thoughts and beliefs about food, weight, and body image

Factors That Help Recovery

• Early intervention - Getting treatment as soon as possible
• Comprehensive treatment - Addressing all aspects of the eating disorder
• Family support - Having understanding and supportive family and friends
• Treatment compliance - Actively participating in treatment and following recommendations
• Motivation for change - Being ready and willing to work toward recovery
• Professional support - Working with experienced eating disorder professionals

Challenges in Recovery

• Ambivalence - Mixed feelings about giving up eating disorder behaviours
• Fear of weight gain - Anxiety about changes in body weight or shape
• Identity issues - Feeling like the eating disorder is part of your identity
• Perfectionism - Setting unrealistic expectations for recovery
• Relapse - Returning to eating disorder behaviours during stressful times

Long-term Outlook

• Full recovery is possible - Many people recover completely from eating disorders
• Recovery takes time - It's usually a gradual process that takes months or years
• Relapses can happen - Setbacks are common but don't mean recovery is impossible
• Ongoing support - Many people benefit from ongoing therapy or support groups
• Quality of life - Recovery leads to improved physical health, relationships, and life satisfaction

Prevention

Primary Prevention

• Promote body positivity - Encouraging acceptance of diverse body types
• Media literacy - Teaching critical thinking about media messages about appearance
• Healthy eating education - Teaching about balanced nutrition without focusing on weight
• Self-esteem building - Helping people develop confidence based on abilities rather than appearance
• Stress management - Teaching healthy ways to cope with stress and emotions

Early Intervention

• Recognise warning signs - Knowing the early signs of eating disorders
• Address risk factors - Dealing with perfectionism, low self-esteem, or body dissatisfaction
• Seek help early - Getting professional help as soon as problems are noticed
• Family education - Teaching families about eating disorders and how to help

School-Based Prevention

• Education programs - Teaching students about eating disorders and body image
• Healthy environment - Creating school environments that promote body positivity
• Staff training - Training teachers and staff to recognise eating disorder signs
• Support services - Providing counselling and support services in schools

Supporting Someone with an Eating Disorder

What You Can Do

• Learn about eating disorders - Educate yourself about the conditions and treatment
• Be supportive and non-judgmental - Avoid comments about food, weight, or appearance
• Encourage professional help - Support them in getting professional treatment
• Be patient - Recovery takes time and there may be setbacks
• Take care of yourself - Supporting someone with an eating disorder can be stressful

What Not to Do

• Don't comment on appearance - Avoid comments about weight, size, or how they look
• Don't police their eating - Don't monitor or control their food intake
• Don't make it about food - Focus on their feelings and well-being, not just eating
• Don't give up - Continue to offer support even if they resist help initially
• Don't blame yourself - Eating disorders are complex and not caused by family or friends

Family Involvement

• Family therapy - Participating in family therapy sessions
• Meal support - Helping with meal planning and eating when appropriate
• Creating a supportive environment - Making home a safe and supportive place
• Communication - Learning how to communicate effectively about the eating disorder
• Self-care - Taking care of your own mental health and well-being

Eating Disorders in Different Populations

Children and Adolescents

• Early onset - Eating disorders often begin during adolescence
• Developmental considerations - Treatment must consider normal growth and development
• Family involvement - Parents and family are crucial in treatment
• School impact - May affect academic performance and social relationships
• Body image issues - Adolescence is a time of significant body changes

Adults

• Later onset - Some eating disorders develop in adulthood
• Life stressors - Work, relationships, and family responsibilities can trigger eating disorders
• Treatment challenges - May be more set in their patterns and harder to change
• Medical complications - May have more serious health consequences
• Family impact - Eating disorders can affect spouses and children

Older Adults

• Underrecognized - Eating disorders in older adults are often overlooked
• Life transitions - Retirement, loss of spouse, or health changes can trigger eating disorders
• Medical complications - May have more serious health consequences due to age
• Treatment considerations - May need modified treatment approaches

Men and Boys

• Underdiagnosed - Eating disorders in males are often missed or misdiagnosed
• Different presentation - May focus more on muscle building than weight loss
• Stigma - May face additional stigma due to eating disorders being seen as "female" conditions
• Treatment needs - May need male-specific treatment approaches

Athletes

• Performance pressure - Pressure to maintain certain weight or appearance for sport
• Sport-specific risks - Some sports have higher risk (gymnastics, wrestling, distance running)
• Body image issues - Focus on body performance and appearance
• Treatment considerations - Need to balance treatment with athletic goals

LGBTQ+ Individuals

• Higher risk - LGBTQ+ individuals have higher rates of eating disorders
• Body image issues - May struggle with body image related to gender identity
• Discrimination stress - Minority stress can contribute to eating disorder development
• Treatment considerations - Need culturally competent care that understands LGBTQ+ issues

Cultural Considerations

Cultural Factors

• Beauty ideals - Different cultures have different ideals about body size and shape
• Food and culture - Food has different meanings and significance across cultures
• Family dynamics - Cultural values about family, authority, and decision-making
• Stigma - Attitudes toward mental health vary across cultures
• Religious considerations - Religious beliefs may affect attitudes toward body and food

Treatment Adaptations

• Culturally responsive treatment - Adapting treatment to fit cultural values and beliefs
• Language considerations - Providing treatment in the person's preferred language
• Family involvement - Understanding cultural family roles and expectations
• Religious integration - Incorporating religious or spiritual elements when appropriate
• Community resources - Connecting with cultural or religious communities for support

When to Seek Help

Emergency Situations

• Suicidal thoughts - Thoughts of hurting yourself or ending your life
• Medical emergency - Severe dehydration, heart problems, or other serious medical issues
• Severe restriction - Not eating or drinking for extended periods
• Dangerous behaviours - Excessive exercise, purging, or other harmful behaviours
• Mental health crisis - Severe depression, anxiety, or other psychiatric symptoms

Warning Signs

• Preoccupation with food - Constantly thinking about food, calories, or weight
• Dramatic weight changes - Significant weight loss or gain in short periods
• Social withdrawal - Avoiding friends, family, and social activities
• Mood changes - Increased irritability, depression, or anxiety
• Physical symptoms - Fatigue, dizziness, hair loss, or other physical problems

Getting Help

• Primary care doctor - Start with your family doctor for initial evaluation
• Mental health professionals - Therapists, psychologists, or psychiatrists who specialise in eating disorders
• Eating disorder specialists - Professionals with specific training in eating disorder treatment
• Treatment centres - Specialised eating disorder treatment programs
• Support organisations - National Eating Disorders Association and other organisations provide resources

Crisis Resources

• National Suicide Prevention Lifeline: 988
• Crisis Text Line: Text HOME to 741741
• National Eating Disorders Association: 1-800-931-2237
• Emergency services: 911

Related Terms

• Body Dysmorphic Disorder - Obsessive concern about perceived flaws in appearance
• Anxiety Disorders - Conditions involving excessive worry that often co-occur with eating disorders
• Depression - Mood disorder that frequently occurs with eating disorders
• Obsessive-Compulsive Disorder - Condition involving obsessions and compulsions that can relate to food and eating
• Body Image - How you see and feel about your body

References

National Institute of Mental Health. (2024). Eating Disorders. https://www.nimh.nih.gov/health/topics/eating-disorders

Cleveland Clinic. (2024). Eating Disorders: What They Are, Symptoms, Treatment & Types. https://my.clevelandclinic.org/health/diseases/4152-eating-disorders

Mayo Clinic. (2023). Eating disorders - Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603

Mayo Clinic. (2024). Eating disorder treatment: Know your options. https://www.mayoclinic.org/diseases-conditions/eating-disorders/in-depth/eating-disorder-treatment/art-20046234

National Institute of Mental Health. (2024). Eating Disorders: What You Need to Know. https://www.nimh.nih.gov/health/publications/eating-disorders

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions about mental health concerns.