A Guide To Understanding Eating Disorders
If you are experiencing a crisis related to an eating disorder or would like further resources, reach out to the ANAD Eating Disorders Helpline at 1-888-375-7767 from Monday through Friday, 9 am to 9 pm CT.
Eating disorders are common mental illnesses worldwide that can cause maladaptive thought patterns surrounding food, eating, body type, and weight. If you or someone you love might be living with an eating disorder, it can be valuable to understand the symptoms of these conditions and how to find support. Below is a comprehensive guide to eating disorders to keep in mind.
What are eating disorders?
Around five to ten million women and one million men experience eating disorders in the US. Eating disorders are serious mental illnesses related to eating behaviors that can adversely impact functioning in multiple areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder (BED).
Individuals with eating disorders often experience body image difficulties, including body dysmorphia. This difficulty with body image may lead to a desire to lose weight or difficulty seeing oneself realistically. In some cases, eating disorders lead to weight loss or gain. However, body size and shape are not necessarily undisputable indicators of an eating disorder.
Anyone can be diagnosed with an eating disorder, but it may be most common in the following populations:
- Women
- Those who struggle with a lack of control
- Survivors of abuse
- Overachievers
- Individuals whose parents hyper-focused on their weight as children
- Someone experiencing the loss of a loved one
- People with anxiety or depression
- Someone from a family that values thinness or "fitness"
- Someone who is the genetic relative of someone with an eating disorder
- Someone with low self-esteem
- An individual going through a significant life change, such as moving
- Someone experiencing issues with their hypothalamus, the part of the brain that controls hunger and eating behaviors
If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text "START" to 88788. You can also use the online chat.
Medical implications of eating disorders
Eating disorders can be dangerous and may lead to severe illness or death. For example, purging may be associated with a rupture in the esophagus. When an individual loses significant weight, they may develop a heart condition, lose their menstrual period, or break bones. If you suspect that you or someone you love has an eating disorder, seek professional support. Other potential complications of an eating disorder can include the following:
- Lack of adequate nutrition
- Harm to the heart
- Gastrointestinal conditions or symptoms
- Weakened bones
- Reduced enamel of the teeth and gums
- Lack of energy and increased fatigue
- Anemia
- Kidney stones
- Abdominal pain and bloating
- Gallbladder disease
- Type II diabetes
- Bone loss
- Sleep disruption
Types of eating disorders
Below are some of the most common eating disorders. However, note that other eating disorders may also be diagnosed, depending on symptoms. Not all eating disorders are focused on weight loss.
Anorexia nervosa
Anorexia nervosa is an eating disorder in which an individual withholds food from themselves, eats less than is healthy and restricts eating patterns in an attempt to lose weight or control body image. In some cases, individuals living with anorexia may try to exercise to keep calories off, as well. Anxiety after eating can be a symptom of anorexia, as the individual may feel guilt or distress from consuming food. Anorexia often leads to losing weight excessively, having low nutrition, and experiencing distressing physical and emotional symptoms.
Bulimia nervosa
Bulimia nervosa is an eating disorder marked by bingeing periods followed by purging (vomiting). These individuals might also use medical aids like laxatives, enemas, and water pills to offset a binge. Exercise may also be used after bingeing. Binge eating is often defined as eating a significant amount of food in a short period.
Binge eating disorder (BED)
Binge eating disorder involves periods of bingeing on food, not followed by purging behaviors. Binge eating disorder may also not be accompanied by a preoccupation with weight, although an individual may experience shame from weight gain if it occurs. With this condition, an individual may believe they cannot stop bingeing and cannot control their eating. After a binge, they may experience significant guilt or shame.
Signs you or someone you love might have an eating disorder
Below are a few potential signs of eating disorders, not limited to one diagnostic category:
- Frequently talking about losing weight
- Hyper-focus on one's body, weight, or physical characteristics
- Skipping meals or coming up with excuses not to eat
- Tooth enamel loss due to purging
- Exercising more than appropriate
- Noticing marks on fingers, fingernails, and knuckles from inducing vomiting
- Hiding food or wrappers to hide a binge from others
- Suicidal thoughts or urges
- Guilt and shame after eating
- Using laxatives or water pills to promote weight loss
- Taking part in online pro-anorexia or bulimia websites
- Looking at the bodies of others online for "inspiration"
- Partaking in a restrictive diet
- Isolating
- Withdrawing from previously enjoyed activities
- Getting up during meals to use the bathroom to purge or avoid eating
- Feeding food to one's pets or throwing it away
- Wearing baggy clothing to hide one's body
If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.
Ways to cope with an eating disorder
Seeking professional treatment for eating disorders may be the most effective way to experience symptom remission. However, you may use a few lifestyle changes or activities to reduce symptoms, including but not limited to the following.
Journal
Write out the thoughts, feelings, and actions associated with the eating disorder and its symptoms. Studies show that journaling and other forms of expressive writing are associated with improved mental and physical health.
Incorporate a healthy diet and exercise routine into your days
If you struggle with eating, working with a nutritionist to devise a plan may be helpful. In addition, a nutritionist or doctor can help you learn what a moderate and healthy level of exercise can be like. While going through this process, avoid weighing yourself or tracking your progress.
Cut down on substances
Alcohol causes disrupted sleep, and sleep disruption may be caused by some of the symptoms of eating disorders. 70% to 80% of people with eating disorders have substance use challenges, so work with a therapist if you struggle to control your substance intake.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
Reduce isolation
To combat the emotional symptoms of an eating disorder, try to avoid isolating yourself and get together with friends and family. If you don't have a healthy social network, consider participating in local group activities to make new friends. You may also attend support groups for others with eating disorders.
Consider what you do and don't have control over
Control is often an aspect of eating disorders. To cope with these symptoms, list what you have control over and what you want to learn to cope with. Make a list of manageable steps to work toward and remove the items you can't control from the list.
Avoid stressors
If possible, avoid the situations, people, places, and ideas that cause stress, not including eating food. Identify situations that cause you to participate in disordered behaviors. Once you know what incites these symptoms, consider working with a professional to learn techniques to minimize stress levels.
Practice healthy social behaviors
Learn to express your feelings and let a trusted person know when you are experiencing distressing symptoms. In addition, consider the following tips:
- Learn techniques to be assertive and get your needs met.
- Learn to tell a trusted person that you are thinking of acting BEFORE you act.
- Learn the art of expressing yourself and asking for help when needed.
- Consider what it would mean to set healthy boundaries and stick to them.
- Learn when you are taking on too much and practice saying "no."
- Do not continue to partake in activities you don't want to partake in.
Practice self-care
Below are a few self-care decisions you might make for yourself:
- Schedule 30 to 60 minutes each day to focus on self-care.
- Start the day with coffee, a paper, a podcast, or another enjoyable activity.
- Go for a jog or do yoga to control your nervous system.
- Read a book.
- Take a hot bath or shower.
- Spend time in nature.
- Try meditation.
- Look into effective relaxation techniques for anxiety and stress.
Connect with a professional
Eating disorders commonly require professional treatment. Mental health professionals are trained to help people recover from these illnesses and find local resources. Still, some people experiencing disordered eating may struggle to reach out for in-person support. They might be ashamed of their behavior or feel nervous about discussing their symptoms with strangers.
In these cases, online therapy through a platform like BetterHelp may be a comfortable alternative to traditional therapy. Online therapy is often more convenient, as it can be attended from home. In addition, clients can choose between phone, video, or live chat sessions with their provider for a sense of control over their treatment.
According to researchers in the field of mental health, online therapy has the potential to treat eating disorders effectively. A recent study showed no differences between in-person and online therapy regarding outcomes for individuals with bulimia. The study also demonstrated that online therapy is associated with higher rates of continued improvement post-treatment than traditional counseling.
Takeaway
Which type of eating disorder has the highest rate of death?
Out of all eating disorders, anorexia nervosa has the highest rate of death. In fact, this condition has the highest mortality rate out of all mental disorders. While all eating disorders can carry an increased risk of death, the severe and prolonged starvation associated with anorexia can carry a risk of life-threatening complications including:
- Heartrate irregularities
- Cardiovascular damage
- Immune system dysfunction
- Electrolyte imbalances
- Hypoglycemia (low blood sugar)
In addition to these dangers, anorexia (and all eating disorders) are associated with a substantially increased risk of suicide. Death by suicide is 18 times more common among individuals with anorexia than in the general population.
If you’re having suicidal thoughts, you can contact the Suicide & Crisis Lifeline (online or by dialing 988) or the Crisis Text Line (text HOME to 741741). You can reach trained and empathetic volunteers who will assist you in getting the help you need.
How does cognitive theory explain eating disorders?
Models of eating disorders based on cognitive theory explain these mental illnesses as resulting from dysfunctional ways of thinking about things like diet, body weight, control, and relationships. In some cases, they may involve early maladaptive schemas, which are self-defeating patterns of thought and behavior developed in childhood as a way to safeguard against the pain of unmet emotional needs.
According to cognitive theory, people with eating disorders may have unrealistic ideas about themselves and how they relate to others. Possible examples include:
- “No one will like me if I’m fat.”
- “If I don’t control my food intake, I’ll be ugly.”
- “Gaining weight is a sign of mental weakness.”
- “I can’t control how I eat.”
- “I’m never skinny enough.”
- “The way I eat is disgusting.”
Cognitive theories of mental illness predict that developing more realistic and constructive ways of thinking about weight, diet, and control will lead to a reduction in eating disorder symptoms.
What factors are involved in causing eating disorders?
Several different types of factors may play causal roles in eating disorders, including:
- Sociocultural attitudes such as idealization of thinness and stigmatization toward people with higher body weights
- Personality traits like perfectionism, desire for control, and a tendency toward negative emotions
- Adverse experiences in childhood, particularly neglect and sexual abuse
- Genetic and epidemic factors — having family with eating disorders may be a significant risk factor
What happens to your brain when you don’t eat enough?
A person who doesn’t eat enough for long periods may experience significant negative effects on the brain. This can be observed in eating disorders — individuals with anorexia nervosa show a loss of brain volume over time, particularly in areas associated with functions like:
- Attention and focus
- Impulse control
- Social interaction
- Behavioral management
- Reward processing and habit formation
Many of these changes may be reversed when the individual regains a healthy weight. However, this may require time and a sustained commitment to recover.
What eating disorders can lead to obesity?
Research suggests that the eating disorders most likely to be associated with obesity are binge eating disorder (BED) and night-eating syndrome (NES). BED involves recurrent episodes of excessive, uncontrolled eating, while NES is characterized by consistent overeating at night.
Unwanted weight gain can be a symptom of both of these conditions. In time, this may lead to obesity, along with numerous associated health problems such as diabetes.
On the other hand, obesity may also contribute to the development of eating disorders such as anorexia and bulimia. Habits like self-starvation, excessive exercise, or induced vomiting might emerge as reactions to an unhealthy body weight.
What is a distorted body image?
In psychological terms, a distorted body image means a skewed, inaccurate internal conception of what your body looks like. It may also be called body dysmorphia. Although the term “body image” might suggest a mainly visual problem, body image distortion can include feelings of physical discomfort as well as negative emotions and thoughts in response to perceiving or thinking about your body.
A distorted body image frequently plays a part in eating disorders. People with these conditions may believe that they are heavier or fatter than they really are, and this idea may persist even when contradicted by reflections or images of themselves. However, it’s also possible to have other kinds of body dysmorphia, such as believing you are more or less muscular than you are.
What not to say to someone with body image issues?
When talking with someone who appears to have difficulty with their body image, it can be important to avoid talking in ways that reinforce weight-related beauty standards. For instance, if someone says “I’m so fat,” it’s often counterproductive to say things like:
- “No way, you’re really skinny.”
- “Look how much bigger I am.”
- “That’s not true, you’re so pretty/handsome.”
While they may be well-intentioned, phrases like these can strengthen the mental connection between thinness and beauty. It may be best to avoid discussing appearance as much as possible.
It can also be uncomfortable to try to force them to talk about their bodies when they don’t want to. Even if you’re trying to get them to think more positively, it may cause them distress and deepen their sense of shame about their appearance. For the same reasons, it’s likely a bad idea to try to urge them to eat more or say positive things about how they look.
How to help someone with body image issues?
Here are a few strategies that may help you be a supportive influence for someone wrestling with their body image:
- Give non-physical compliments. By talking positively about the other person’s values, achievements, and personality, you can often help build up their self-esteem without reinforcing the importance of beauty.
- Ask questions. When someone expresses negative feelings about their body, it may help to ask why they feel that way instead of contradicting them. You may also want to ask about other areas of their life — you may discover sources of emotional difficulty that have nothing to do with weight and appearance.
- Practice active listening. If your friend or family needs to express negative feelings, listening without contradicting or dismissing what they have to say could be helpful. You can ask for details and invite them to talk rather than pushing them to think a certain way.
- Help them think about other things. Conversations about things other than weight, food, and body image may help the other person stop fixating so much on these issues. Activities that don’t center around food, such as watching a movie, playing a game, or simply hanging out and chatting, could also turn their mind to other things.
- Let them know how you feel. While waving away the other person’s concerns about their body may not be helpful, you can express feelings like sadness, concern, or confusion when you hear them talking negatively about themselves or displaying unhealthy behaviors. Emphasizing that your feelings are coming from a place of love and care can help remind them that they have people on their side.
- Support them in seeking treatment. When someone expresses a desire to get help for eating disorders, speaking encouragingly about the benefits of therapy may help encourage them to pursue treatment. If you’ve had positive experiences with mental health care, discussing them might also be useful.
When do most eating disorders begin?
Eating disorders can develop at any age. However, they appear to be most likely to emerge in adolescence and young adulthood. A 2022 review of more than 190 mental health surveys from around the world reported that the most common age of onset for eating disorders was approximately 15-16 years old. Over 80% of people with eating disorders had developed them by age 25.
Disordered eating behaviors may begin even earlier, however. Researchers at the University of Montreal described cases of children as young as 8 years old who were engaging in actions such as deliberate vomiting or restricted eating.
How are eating disorders treated?
Eating disorders are generally treated with various forms of psychotherapy. Currently, the treatment options with the strongest evidence base include:
- Cognitive-behavioral therapy (CBT). This approach involves working with a therapist to identify and reframe destructive patterns of thought about food and weight, as well as practicing positive habits related to eating.
- Interpersonal psychotherapy (IPT). IPT is a brief form of therapy that encourages clients to rethink their social relationships and self-image, potentially helping them to de-emphasize the idea that they need to look a certain way to be accepted.
- Family therapy. This method works with the entire family to address the complicated relationship dynamics and emotions that may create and sustain unhealthy attitudes toward eating. It may be especially effective at treating child and adolescent eating disorders.
In severe cases of eating disorders, medical care and supervision may be needed to help manage nutrition and weight gain. For example, people with anorexia recovering from prolonged starvation may be at risk of refeeding syndrome if they’re not assisted by a trained physician. This could lead to a serious medical emergency. It’s often best to develop a treatment plan with a primary care doctor.
If you’re wondering where to find treatment, you may want to visit the website of the National Eating Disorders Association (NEDA). They offer a tool for locating trained care providers as well as a variety of informational resources on how to approach eating disorder recovery.
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