What Are Eating Disorders? Common Diagnoses And Treatment
Eating disorders affect an estimated 30 million people in the US, 95% between 12 and 25. This type of disorder can severely affect physical and mental health and carries the highest risk of death from any mental illness. That's why understanding the common characteristics of various eating disorders can be helpful, so you can recognize if you or a loved one may be experiencing such a condition and seek professional help if so. Read on for a brief overview of some of the most prevalent eating disorders and treatment options.
Suppose you or a loved one is experiencing an eating disorder. In that case, contact the National Eating Disorder Association Helpline for support and resources at 1-800-931-2237 (M–Th from 9 AM–9 PM EST and Fri 9 AM–5 PM EST).
What are eating disorders?
Eating disorders are serious illnesses that impact an individual's eating habits, thoughts, and feelings about food. They are considered to be both mental and physical illnesses. There's a common misconception that eating disorders are a lifestyle choice; however, they're clinical disorders that almost always require treatment to overcome. This class of disorders is more common in women and younger people but can affect anyone of any gender, age, race, or another identifier. It's not unusual for them to be comorbid with other mental illnesses, such as mood or substance use disorders.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
The most common types of eating disorders
The DSM-5 lists several different eating disorders and their symptoms. Read on for a brief overview of a few of these.
Avoidant restrictive food intake disorder
Most people have certain foods they don't enjoy, but someone with avoidant restrictive food intake disorder (ARFID) will strictly limit themselves to consuming only a few foods. Restricted eating may qualify as ARFID if it leads to nutritional deficiencies and low weight and if the prospect of eating other foods is met with distress. A person with ARFID may avoid foods outside of their specific repertoire for various reasons, from a lack of interest in eating to issues with the smell, taste, or textures of food to concerns about getting sick or having an allergic reaction a new food. Unlike many other eating disorders, ARFID is unrelated to body image concerns.
Binge eating disorder
According to the National Eating Disorder Association, binge eating is the most common eating disorder in the United States. This disorder involves regularly binging or eating large amounts of food in a short time. It's also commonly characterized by feelings of not having control while binging and guilt or shame afterward. An individual experiencing a binge eating disorder will typically not feel compelled to induce vomiting, engage in rigorous exercise, or otherwise "counteract" the binge afterward, differentiating it frome other eating disorders.
According to the DSM-5, binging behavior must be associated with at least three of the following to be classified as a binge eating disorder:
- Eating more quickly than normal
- Eating until uncomfortably full
- Eating when not feeling hungry
- Eating alone to hide from other people
- Feeling disgusted, depressed, or guilty after binging
Bulimia nervosa
Bulimia nervosa is also characterized by consistent binge eating. As with binge eating disorder, individuals with bulimia nervosa frequently eat large amounts of food in short periods. During these binges, they often feel like they can't control what they're eating and will usually consume more than they need to feel complete.
What differentiates this disorder from others, like binge eating disorder, is that individuals tend to engage in "compensatory behaviors" after a binge to prevent weight gain. While many people associate bulimia with induced vomiting, individuals may also take laxatives, exercise excessively, and undergo periods of fasting after binging. The DSM-5 states that the severity of bulimia nervosa is based on the number of compensatory behaviors that an individual engages in each week, with one to three episodes per week being mild, four to seven being moderate, eight to 13 being severe, and more than 14 being extreme. These compensatory episodes are caused by concerns about one's weight and body image.
Anorexia nervosa
Individuals with anorexia nervosa restrict their calorie intake primarily because they fear gaining weight. As a result, they may be severely underweight and malnourished. In general, those with anorexia nervosa have distorted perceptions of their bodies and often do not recognize or accept their low body weight as fact, leading to a perpetuation of the disordered eating. Hiding their habits and disengaging socially, as a result, is not uncommon. Their lack of nutrients may also lead to physical symptoms such as brittle nails, digestive problems, weak muscles, and dizziness. Note also that there are two types of anorexia nervosa: restricting and binge eating/purging.
Orthorexia nervosa
While orthorexia isn't yet recognized as a clinical disorder in the DSM-5, it has become increasingly prevalent and is often associated with some level of mental distress. It's characterized by an individual's extreme focus on the 'health' of their food. This can manifest as spending hours preparing, planning, researching, and talking about food, avoiding social situations for lack of options the individual considers healthy, and having a sense of anxiety and "compensatory behaviors" such as fasting after consuming a food that they deem unhealthy. It can also have physical consequences, such as malnourishment.
What causes eating disorders
No single cause of eating disorders has been identified, but researchers in this field have come to believe that numerous factors may play a role in the development of these disorders. First, as with many illnesses, genetics are thought to be a contributing factor. An individual is often more likely to develop an eating disorder if a biological family member has experienced one. A person's environment can also influence the likelihood that they will experience an eating disorder, including the people they directly interact with, the media they consume, and their cultural context. Bullying regarding one's weight or physical appearance may also lead to a negative self-perception and one of the abovementioned disorders.
How eating disorders are treated
If you've noticed that you or a loved one has undergone significant changes in eating behaviors, considerable weight loss, and increased concerns about food and food intake, these could be signs of an eating disorder. Eating disorders are severe, but treatment and recovery are available. Depending on the condition and its severity, treatment may include evaluation and care from physical and mental health professionals, including general practitioners, nutritionists, and therapists.
Note that as these conditions can be life-threatening, it's typically recommended that an individual meets with a healthcare professional in person first for evaluation. If they recommend meeting with a therapist next, options are available for those with mild to moderate conditions. Those who would feel more supported meeting with a mental health professional in person can locate one in their area with expertise in these disorders. Those who feel intimidated about connecting with someone face-to-face may prefer to connect virtually with a therapist.
One study examined the impact of online exposure therapy on eating disorders. Results suggest that both eating disorder symptoms and eating disorder fears decreased after this type of online therapy. However, exposure therapy is just one possible way to treat the symptoms of eating disorders. Working with a licensed mental health professional is recommended to develop a specific treatment plan that works for you.
Takeaway
What are the seven types of eating disorders?
Eating disorders are serious mental health concerns, and it is important to remember that all eating concerns should be taken seriously, even if they don’t fulfill all of the criteria for a diagnosis. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, lists seven types of eating disorders:
- Anorexia nervosa is characterized by weight loss and difficulty maintaining an appropriate body weight. Those with anorexia often restrict calories far below what is required for their body to function. The restricted calorie intake is due to a fear of gaining weight due to a distorted body image.
- Bulimia nervosa is characterized by binge eating followed by one or more compensatory behaviors to purge food eaten in excess, such as vomiting, excessive laxative use, or excessive exercise. People with bulimia are typically at a normal or above-average body weight.
- Binge eating disorder is similar to bulimia, but compensatory purging behaviors aren’t present. Those with binge eating disorder often feel a lack of control over their eating and will often eat beyond feeling full.
- Avoidant-restrictive food intake disorder (ARFID) is characterized by extreme picky eating. Food avoidance is similar to what is seen in those with anorexia but is not caused by a distorted body image. Those with ARFID typically avoid food due to sensory characteristics or anxiety about the consequence of eating, such as choking, nausea, or an allergic reaction.
- Pica is an eating disorder wherein a person repeatedly eats things without nutritional value. Those with pica generally do not have an aversion to food but will often eat things like paper, hair, string, pebbles, charcoal, or almost any other object.
- Rumination disorder involves the repeated regurgitation and re-chewing of food. The regurgitation is not due to a gastrointestinal or medical problem; it is voluntary behavior.
- Other specified feeding and eating disorder is a diagnostic category that describes eating behavior that does not meet the criteria for any other diagnosis but still causes distress or impairs function. An example might be a person who has begun to demonstrate the behavioral features of anorexia but has not yet dropped below a normal body weight.
Which eating disorder is the most common for males?
Eating disorders are among some of the most gender-specific psychiatric disorders under study. In the past, it was assumed that women were far more likely to develop an eating disorder than men. However, recent research suggests that the prevalence of eating disorders in men is much higher than originally thought. Because of this, it is sometimes difficult to estimate the rate of specific eating disorders in male populations due to underreporting and underdiagnosis.
Contemporary research suggests that binge eating disorder is likely the most common eating disorder for males, with some estimates indicating that 6% of male adolescents exhibit binge eating behavior that meets the criteria of binge eating disorder. The Substance Abuse and Mental Health Services Administration describes binge eating as an episode of excessive calorie consumption where a person often feels a lack of control of their eating and may feel anxious or upset about their eating once the binge has concluded.
Which eating disorder is the least common?
Much of the research surrounding eating disorders has historically focused on anorexia nervosa, bulimia nervosa, and binge eating disorder. However, while study is still limited, evidence suggests that avoidant-restrictive food intake disorder (ARFID) is likely the least common. ARFID is characterized by an extreme aversion to food, and those with the condition often struggle to eat an appropriate number of calories. The calorie restriction is similar to what is seen in anorexia, but unlike anorexia, food avoidance is caused by something other than body image issues.
Which eating disorder is the most common?
Evidence suggests that the most common eating disorder, for both men and women, is other specified feeding or eating disorder (OSFED). One study found that OSFED accounted for 39.5% of eating disorder cases among males and 44.2% of cases among females. The one-year prevalence of the condition is estimated to be 1.18% for females and 0.27% for males.
OSFED is diagnosed when a person exhibits eating behavior that negatively impacts their life or causes distress, but the behavior does not meet the diagnostic criteria of any other eating disorder. An example is atypical anorexia nervosa, a condition where people who were previously overweight begin to exhibit food avoidance and other unhealthy eating behaviors similar to what is found in anorexia. Although the behaviors are similar, a below-normal body weight is required for a diagnosis of anorexia, and OSFED is often diagnosed when a person’s eating has not yet brought them below an average weight.
What is the deadliest eating disorder in the world?
The deadliest eating disorder in the world is anorexia nervosa, an eating disorder characterized by food avoidance and calorie restriction. Anorexia can cause serious harm and is one of the most deadly psychiatric illnesses in the world, second only to opiate addiction. Anorexia is a type of eating disorder that is fairly well-known, primarily because significant weight loss is difficult to hide from others.
Those with anorexia typically have an intense fear of gaining weight, an obsession with body size, and a distorted body image, leading to calorie restriction that is sometimes paired with purging behaviors like vomiting, laxative use, and excessive physical activity. The condition is complex, further contributing to its relatively high mortality. Research has indicated a wide range of recovery rates, with current estimates suggesting that between 35% and 85% of people will reach a full recovery.
While anorexia sometimes becomes a chronic condition, not everyone will experience long-lasting symptoms. An eating disorder specialist may be able to utilize psychotherapy and nutrition counseling to help modify distorted eating behaviors, and medical professionals are often involved to help address concerns related to malnutrition. Anorexia can also appear alongside or worsen other psychiatric disorders, such as anxiety and depression. Mood changes associated with anorexia can make it and other conditions more difficult to manage
If a person is in crisis due to an eating disorder or other condition, they can reach out to the 988 Suicide and Crisis Lifeline, formerly the National Suicide Prevention Lifeline, to speak to a crisis counselor for guidance. The Suicide and Crisis Lifeline is also a crisis text line and can be reached by texting or calling “988” from anywhere in the United States.
What is a common characteristic of all eating disorders?
Besides distorted eating that interferes with daily life, there aren’t any features that are common to all eating disorders. However, the most common disorders, anorexia nervosa, bulimia nervosa, and binge eating disorder, do have a feature in common. Each of those disorders is associated with a disturbed body image, meaning a person does not perceive their body and appearance accurately. It was previously thought that only anorexia and bulimia were associated with a distorted body image, but recent evidence suggests that body image disturbances play a central role in the development of binge eating disorder.
What are the four types of eating?
Research has identified four distinct eating behavior profiles in children, which may inform eating habits in later life. The four types of eating - avid, avoidant, happy, and typical - are summarized below:
- Avid eating is characterized by high levels of food responsiveness and emotional overeating. Food is associated with high levels of enjoyment and low levels of satiety. Large quantities of food may be consumed by avid eaters.
- Avoidant eating is characterized by high levels of pickiness, slow eating, and emotional undereating.
- Happy eating is defined by high levels of food enjoyment but low levels of slowness in eating, pickiness, emotional overeating, and emotional undereating.
- Typical eating is characterized by average eating behaviors and an absence of high or low levels of food enjoyment, responsiveness, pickiness, emotional undereating, and emotional overeating.
What is a random fact about eating disorders?
Evidence suggests that substance use is significantly higher among those with eating disorders. Tobacco and alcohol are likely the most frequently used substances. Research indicates that 36.1% of people with an eating disorder develop a tobacco use disorder, and 20.6% develop an alcohol use disorder.
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