What is an Eating Disorder?

An eating disorder is a serious mental illness characterized by highly distressing attitudes, beliefs and behaviors related to one’s food intake, body shape and weight. Eating disorders do not discriminate and affect people of all ages, races, ethnicities, genders, shapes and sizes.

Common Eating Disorders

Nearly one in ten people in the U.S. will have an eating disorder in their lifetime. [1] The more commonly known eating disorders include:

Additional eating disorders include:

Eating disorders can be fatal. Tragically, one person in the U.S. dies every 52 minutes from complications related to an eating disorder. [1]

[1] Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020.

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Do you or someone you know struggle with eating or body image issues? You’re not alone. 

 

Causes of Eating Disorders

There is no single cause of eating disorders. Eating disorders stem from a complex interplay between multiple factors, including genetic, environmental, sociocultural and psychological. No one is immune to eating disorders. Eating disorders affect people of every age, sex, gender, race, ethnicity, and socioeconomic group.

Genetic Causes of Eating Disorders

Certain genes may increase a person’s risk for developing an eating disorder. We often see eating disorder symptoms pop up across multiple generations within the same family. If someone in your family has been diagnosed with an eating disorder, you may be more likely to develop symptoms of an eating disorder. However, parents should know that you are not to blame for your child’s eating disorder.

Sociocultural Causes of Eating Disorders

Cultural influences can also increase one’s risk of developing an eating disorder. Every day, we are besieged with altered images showcasing artificial and unrealistic beauty standards. Society and the media continue to push “thin” body types with low body fat as the norm or “ideal.” Social media can play a role in one’s eating disorder risk, too, with young teenage brains lacking the developmental and coping skills necessary to process these altered images in a healthy, neutral way. Perfectionistic and high-achieving individuals may be more at risk to succumbing to cultural messages claiming that “thin is best.”

Environmental Causes of Eating Disorders

In studies of heritability, one's environment is shown to make up about 20-50% of the “cause effect” of an eating disorder. The following environmental risk factors may also contribute to the development of eating disorders:

  • Having a trauma history
  • Being pressured to look or act a certain way
  • Dealing with stringent sports performance requirements
  • Having high expectations for grades
  • Life transitions and developmental changes
  • Other challenging family dynamics

Interestingly, how a child is parented or brought up has less of an effect than how that child internalized his or her life experiences. How each person processes their own experiences has a powerful effect in determining their risk for developing an eating disorder.

Psychological Risk Factors

We are all born with certain traits and tendencies. Having a certain temperament or having pre-existing mental health concerns can increase a person’s risk of developing an eating disorder. Many times, it is a person’s drive to be perfect — to achieve his or her own personal standard of excellence — that contributes to the development of an eating disorder. Stressful life events like going to college, moving to a new town, or a major family change (divorce, death) may also increase the risk. Additionally, these traits are more commonly associated with people with eating disorders:

  • Perfectionism
  • Highly reactive to stress
  • High sensitivity
  • Low distress tolerance
  • Anxiety

Do Diets Cause Eating Disorders?

Going on a diet can be a risk factor for developing an eating disorder, particularly if an individual’s brain is affected by long periods of fasting or malnutrition. A starving brain works differently than a brain that is properly fed. Brain changes that follow severe dieting can include:

  • Cognitive changes (thinking differently)
  • Psychological changes (processing information differently)
  • Emotional changes (feeling differently)

Thankfully, the brain can recover from eating disorders. But the longer the eating disorder continues, the more serious the brain changes can be. This is why eating disorder treatment with an experienced professional is so critical and should be started as soon as an eating disorder is suspected.

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Warning Signs of Eating Disorders

Since each individual experiences an eating disorder differently, eating disorder symptoms vary from person to person. Symptoms also vary depending on the type of eating disorder. While some eating disorder symptoms are noticeable, eating disorders are inherently secretive mental illnesses. This can make the detection of symptoms quite difficult.

Physical Warning Signs of Eating Disorders

You cannot always tell if someone has an eating disorder just by looking at them. However, there are some physical warning signs of eating disorders, including:

  • Dramatic or rapid weight loss
  • Compulsive or excessive exercise
  • Visiting the bathroom immediately after each meal
  • Loss of menses
  • Frequent stomach cramps or stomach pain
  • Food wrappers in odd places or food disappearing from the house (caused by bingeing)
  • Calluses on the back of the hands and knuckles (caused by self-induced vomiting)

Emotional Warning Signs of Eating Disorders

Eating disorders typically involve extreme emotions and attitudes about food and weight. People with eating disorders tend to suffer from distressing mental health symptoms including anxiety, depression, suicidal ideation and substance abuse. The following emotional warning signs can indicate the presence of an eating disorder:

  • Behavior changes (acting differently)
  • Isolation and withdrawing from others
  • Being less interested in daily activities
  • An increase in mood swings, irritability or high anxiety
  • Plummeting grades
  • Low self-esteem
  • Emotional numbness or lack of emotion

Warning Signs of Specific Eating Disorders

Anorexia, bulimia and binge eating disorder are some of the most common, well-known eating disorders. We review signs and symptoms of these eating disorders below.

Warning Signs of Anorexia Nervosa

Anorexia is a potentially life-threatening illness characterized by the following eating disorder symptoms and signs: an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of weight or shape. People with anorexia use extreme measures to control their weight, such as excessively restricting calories, over-exercising, and laxative or diet aid abuse.

While the majority of patients with anorexia are severely underweight, normal or overweight patients can also be anorexic. These patients will present abnormal medical and lab test results that show signs and symptoms of malnourishment.

Warning Signs of Bulimia Nervosa

Bulimia is a serious, potentially life-threatening eating disorder. It is typically characterized by episodes of bingeing on large portions of food and then voiding the food through purging, excessive exercise, or the use of diet pills or laxatives. Many people with bulimia also restrict their eating during the day, which often leads to more binge eating and purging.

Many times, someone who is in the grips of bulimia will disappear to the bathroom immediately after a meal – be aware of this, as this is a red flag. It’s also important to realize that those with bulimia don’t always show outward physical signs of an eating disorder – they can be of average and larger weight and size.

Warning Signs of Binge Eating Disorder

People with binge eating disorder (BED) regularly eat too much food (binge) and feel a lack of control over their eating. Typically, they eat quickly or eat more food than intended, even when not hungry, or they may continue eating even long after they’re uncomfortably full. They may feel guilty, disgusted or ashamed by their behavior and the amount of food eaten. Many times, they overeat in private. New bouts of bingeing usually occur at least once a week. Sufferers can be normal weight, overweight or obese.

Health Risks of Eating Disorders

Eating disorders are serious illnesses accompanied by life-threatening physical and mental health complications. The health risks of eating disorders affect nearly every organ and system in the body, leading to an increased mortality rate. Thankfully, many eating disorder complications are reversible, but it is vital to seek treatment as soon as possible.

Physical Health Risks

For children, adolescents and young adults, the health risks of eating disorders can be very serious or even fatal, and include:

  • Malnutrition or developmental delays
  • Serious organ damage
  • Joint issues or muscle weakness
  • Constipation or irregular bowel movements
  • Dizziness
  • Fatigue
  • Dehydration
  • Infertility
  • Death

Tragically, a person dies every 52 minutes from an eating disorder in the U.S. [1]

[1] Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020.

Mental Health Risks

An eating disorder may start out as an attempt to lose weight. As the eating disorder behaviors continue, people with eating disorders may notice their mental health symptoms worsening. Mental health concerns affecting people with eating disorders include:

  • Anxiety
  • Depression
  • Substance abuse
  • Perfectionism
  • Obsessive compulsive disorder (OCD)
  • Suicidal ideation
  • Self-harm behaviors (cutting)

Health Risks of Specific Eating Disorders

Eating disorders can cause both long- and short-term complications, depending on the type of eating disorder, how frequent the eating disorder behaviors occur, and the length of time that a person has been living with the eating disorder.

Health Risks of Anorexia Nervosa

People with anorexia often turn to extreme measures to lose weight. These weight loss behaviors can cause significant health problems, including:

  • Gastrointestinal issues (nausea, stomach pain, bloating)
  • Hair thinning or hair loss
  • Bradycardia
  • Bone health issues including osteopenia, fractures and osteoporosis
  • Anemia
  • Cold intolerance
  • Extreme exhaustion

Additionally, people with anorexia are at an increased risk of dying due to the risks of these serious medical complications and from high rates of suicidality.

Health Risks of Bulimia Nervosa

Bulimia symptoms of bingeing (eating a large quantity of food in a short time, followed by feelings of distress) and purging (self-induced vomiting, abusing laxatives, etc.) can lead to a host of medical complications, including:

  • Gastroesophageal reflux (GERD)
  • Esophageal irritation, erosions, ulcers, bleeding and rupture
  • Pain with swallowing or trouble swallowing
  • Coughing or frequent sore throats
  • Dental issues
  • Cardiac issues
  • Fertility problems

Health Risks of Binge Eating Disorder

Binge eating disorder, which involves frequent episodes of overeating marked by distress and lack of control, is associated with a number of serious medical complications, including:

  • Weight gain
  • High blood pressure
  • High cholesterol
  • Heart disease
  • Type II diabetes mellitus
  • Feelings of embarrassment, guilt or shame
  • Worsening anxiety and depression

Eating Disorder Treatment

In eating disorder treatment, we address all existing physical and mental health concerns using supportive, evidence-based therapeutic interventions that treat the whole person — body, mind and spirit.

The Eating Disorder Treatment Team

Eating disorders are complex illnesses. Working with a multidisciplinary team offers the best outcomes for eating disorder recovery. When you enter an eating disorder treatment center, you may work with multiple experts, including:

  • Psychiatrists and physicians
  • Family therapists, individual therapists and group therapists
  • Dietitians
  • Nurses
  • Music or art therapists
  • Alumni coordinators
  • Support staff, and more

The team works collaboratively to create individualized treatment plans for each patient, offering support and a safe place to practice new skills learned in treatment.

Nutritional Healing

A nutrition program is an essential component of eating disorder treatment. Individuals that have been restricting foods, bingeing or purging are prescribed a personalized nutritional program based on their symptoms, their health status and how long the eating disorder has been present. The goal is to help each individual:

  • Develop a healthy relationship with food
  • Eat a variety of foods in balance way
  • Enjoy food in moderation

Nutritional education, assessments and meal plans are an important part of each day in treatment.

Learn more about meal planning and mealtime support in treatment.

Therapy

Psychotherapy is another integral part of eating disorder treatment. Licensed and experienced clinicians provide a number of evidence-based therapies shown to be effective and beneficial, based on clinical research studies and observations. Therapeutic work is centered around challenging and addressing unhealthy thought patterns and behaviors and learning new skills to replace them. Therapies that may be used in treatment include:

In treatment, patients may work with an individual therapist, a family therapist and group therapists. Trauma, anxiety, stress, depression, suicidality, body image concerns and other types of distress can all be addressed.

Medication

In eating disorder treatment, medications may be prescribed to address physical health concerns and complications related to the eating disorder. Medications may also be prescribed to address mental health symptoms and internal distress, including symptoms of anxiety, depression or suicidality. In treatment, psychiatrists and other medical professionals meet with patients regularly to monitor medication effectiveness and potential side effects. Nursing support is also provided in many eating disorder treatment centers.

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How are Eating Disorders Treated?

Experts typically recommend a multi-disciplinary approach to treating eating disorders that includes multiple levels of care. Here at Eating Recovery Center, we offer inpatient, residential, partial hospitalization, intensive outpatient and virtual eating disorder treatment options. Our treatment team includes psychiatrists, internists, psychotherapists, family therapists, dietitians, nurses, patient care assistants, case managers and aftercare coordinators. Along with medication treatment and supportive therapeutic interventions, family-based therapy is an important part of eating disorder treatment, helping many individuals fully recover.

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Facts & Statistics

Eating disorders are serious, chronic illnesses that greatly impact a person’s mental and physical health and quality of life. At times fatal, eating disorders are complex and can be challenging to overcome. Here are the latest eating disorder facts and statistics.

  • Between 2018-2019, nearly 2 out of 100 people in the U.S. (5.48 million people) were living with eating disorders. [1]
  • Females were more likely to be affected by eating disorders, at 2.62% (4.39 million people). [1]
  • Approximately 1.09 million males had eating disorders (0.67%). [1]
  • Looking at lifetime prevalence, nearly 1 in 10 females (8.60%) and 1 in 20 males (4.07%) will have an eating disorder during their lifetime. [1]
  • The percentage of people living with eating disorders in the U.S. is expected to rise. [1]
  • Eating disorders most commonly affect young women aged 20-24 and women aged 25-29. [1]
  • The most common eating disorder as of 2019 was Other Specified Feeding and Eating Disorder (OSFED). [1]

How Serious Are Eating Disorders?

Eating disorders are very dangerous and can be deadly.

  • One person dies every 52 minutes from an eating disorder. [1]
  • Eating disorders have the highest case fatality rates of any mental illness. [2]
  • Eating disorder mortality rates are shown to be nearly six times higher for individuals with anorexia nervosa and nearly twice as high for those with bulimia nervosa, compared to the general population. [1]
  • One in five people with anorexia nervosa die by suicide. [3]
  • People with eating disorders are 20.1% less likely to be employed than others, leading to lost wages and other setbacks. [4, 5]
  • Black, Indigenous, (and) people of color are half as likely to have their eating disorder be diagnosed or receive treatment. [1]

What are Risk Factors for Eating Disorders?

There are many reasons why people develop eating disorders. They are considered to be the result of biological, psychological, and sociocultural factors.

  • Multiple research studies have identified a number of eating disorder risk factors, including:
    • Genetics [6, 7, 8, 9]
    • Gender (particularly for anorexia and bulimia) [10]
    • Ethnicity
    • Early childhood eating and gastrointestinal problems
    • Negative self-evaluation
    • Participation in sports focusing on weight (aesthetics or requirements) [11]
    • Sexual abuse and other adverse life events [12, 13]
  • Anxiety disorders (particularly social anxiety) have been shown to commonly precede eating disorders. [14, 15]
  • In one study of nearly 300,000 college students, those identifying as LGBTQ+ reported higher rates of self-reported eating disorders and compensatory behaviors. [16]

Eating Disorder Resources

In this library of eating disorder resources, you’ll find effective resources to support your loved one’s journey.

Eating Disorder Books

Sick Enough by  Dr. Jennifer Gaudiani
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Eating Disorders: A Guide to Medical Care by Dr. Philip Mehler and Dr. Arnold Andersen
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Healthy Bodies: Teaching Kids What They Need to Know by Kathy Kater LICSW
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When Your Teen has an Eating Disorder by Lauren Muhlheim, PsyD
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By Their Side: A Resource for Caretakers and Loved Ones Facing an Eating Disorder by Lara Lyn Bell
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Loving Someone with an Eating Disorder by Dana Harron PsyD
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Skills-based Caring for a Loved One with an Eating Disorder by Janet Treasure, PhD, Gráinne Smith, and Anna Crane
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Help Your Teenager Beat an Eating Disorder, Second Edition By James Lock, MD, PhD and Daniel LeGrange, PhD
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Ed Says U Said: Eating Disorder Translator by June Alexander and Cate Sangster
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The Whole Brain Child by Daniel J. Siegel and Tina Payne Bryson
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What Say to Kids When Nothing Seems Work by Adele Lafrance
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Sources:

[1] Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020.

[2] Smink, F. R., Van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current psychiatry reports, 14(4), 406-414.

[3] Arcelus J, et al. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta- analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724–31.

[4] Alegria et al. (2016), Collaborative Psychiatric Surveys (CPES), 2001-2003.

[5] Samnaliev, M., Noh, H. L., Sonneville, K. R., & Austin, S. B. (2014). The economic burden of eating disorders and related mental health comorbidities: An exploratory analysis using the US Medical Expenditures Panel Survey. Preventive medicine reports, 2, 32-34.

[6] Hübel, C., Leppä, V., Breen, G. and Bulik, C.M., (2018). Rigor and reproducibility in genetic research on eating disorders. International Journal of Eating Disorders, 51(7), pp.593-607

[7] Polderman, T.J., Benyamin, B., De Leeuw, C.A., Sullivan, P.F., Van Bochoven, A., Visscher, P.M. and Posthuma, D., (2015). Meta-analysis of the heritability of human traits based on fifty years of twin studies. Nature genetics, 47(7), p.702.

[8] Duncan, L., Yilmaz, Z., Gaspar, H., Walters, R., Goldstein, J., Anttila, V., Bulik-Sullivan, B., Ripke, S., Eating Disorders Working Group of the Psychiatric Genomics Consortium, Thornton, L. and Hinney, A., (2017). Significant locus and metabolic genetic correlations revealed in genome-wide association study of anorexia nervosa. American journal of psychiatry, 174(9), pp.850-858.

[9] Pettersson, E., Lichtenstein, P., Larsson, H., Song, J., Agrawal, A., Børglum, A.D., Bulik, C.M., Daly, M.J., Davis, L.K., Demontis, D. and Edenberg, H.J., (2019). Genetic influences on eight psychiatric disorders based on family data of 4 408 646 full and half-siblings, and genetic data of 333 748 cases and controls. Psychological medicine, 49(7), pp.1166-1173.

[10] Weissman, R. S. (2019). The Role of Sociocultural Factors in the Etiology of Eating Disorders. Psychiatr Clin North Am, 42(1), 121-144. doi: 10.1016/j.psc.2018.10.009

[11] Neyland H, et al, (2020). Parental deployment and distress, and adolescent disordered eating in prevention- seeking military dependents. International Journal of Eating Disorders, vol 53, no. 2, pp.201-209.

[12] Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychol Bull, 130(1), 19-65.

[13] Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research Review: What we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry, 56(11), 1141-1164.

[14] Bulik, C.M., (2002). Anxiety, depression and eating disorders. Eating disorders and obesity: A comprehensive handbook, 2(1), pp.193-198.

[15] Swinbourne, J.M. and Touyz, S.W., (2007). The co‐morbidity of eating disorders and anxiety disorders: A review. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 15(4), pp.253-274.

[16] Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE. (2015). Gender Identity, Sexual Orientation, and Eating-related Pathology in a National Sample of College Students. J Adoles Health. 57(2);144-149.

[17] Eating Recovery Center (2019). Treatment Outcomes Report.

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