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Eating Disorders

This guide provides information and resources about different types of eating disorders.

What are Eating Disorders?

Eating disorders are a range of psychological conditions that cause unhealthy eating habits to develop. They might start with an obsession with food, body weight, or body shape.

In severe cases, eating disorders can cause serious health consequences and may even result in death if left untreated.

Those with eating disorders can have a variety of symptoms. However, most include the severe restriction of food, food binges, or purging behaviors like vomiting or over-exercising.

Although eating disorders can affect people of any gender at any life stage, they're most often reported in adolescents and young women. In fact, up to 13% of youth may experience at least one eating disorder by the age of 20.

Healthline

Additional Information

There are many types of eating issues, but the four eating disorders recognized in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are:

  • anorexia nervosa
  • bulima nervosa
  • binge-eating disorder
  • avoidant restrictive food intake disorder

Anorexia Nervosa

  • Food intake is limited, leading to very low body weight for one’s age and height
  • Extreme fear of weight gain and being fat or extreme measures to prevent weight gain, even though the individual is underweight
  • Issues with body image or denial that underweight condition is a serious problem

Bulimia Nervosa 

  • Eating often, eating large amounts of food, feeling out of control over eating behavior and amount of food eaten
  • Frequently purging to prevent weight gain using such methods as self-induced vomiting, laxatives or diuretics, routine fasting or overexercising.
  • Overly concerned with body weight and shape
  • Disordered eating and purging behaviors occur at least once a week for 3 months

Binge Eating Disorder 

  • Binge eating at least once a week for 3 months, plus:
  • Eating more food in a specific period of time than most people would eat in the same amount of time, and
  • Feeling out of control over eating behavior and the amount of food eaten

Plus, episodes of binge eating that involve at least three of these five behaviors:

  • Eating much faster than normal
  • Eating until uncomfortably full
  • Eating huge amounts of food even when not feeling hungry
  • Eating secretively or alone out of shame
  • Experiencing feelings of disgust, depression or extreme guilt after bingeing

Avoidant Restrictive Food Intake Disorder

  • Lack of interest or other avoidance of food due to the sensory characteristics of food, such as colors and textures. Avoidance is associated with at least one of the following: Significant weight loss or, in children, failure to reach expected weight and height, Significant nutrient deficiency, Dependence on nutritional supplements or oral feeding tube, Disruption of psycho-social functioning
  • The condition cannot be explained away by the unavailability of foods or culturally approved eating practices.
  • There are no issues with body weight or body image and avoidance is not associated with anorexia or bulimia.
  • There is no other eating disturbance or medical condition present that would explain the avoidance, or the avoidance is more extreme than would normally be associated with another condition.

Psycom

In addition to disrupting your day-to-day activities, an eating disorder can affect your mental and emotional health. You might find yourself feeling more anxious about the number of calories you consume or ashamed about your weight. You may start to isolate from friends and family who express concerns about your health, and that isolation can lead to depression.

The physical impact of an eating disorder can be significant. Over time, disordered eating behaviors can damage your digestive tract, skin, bones, and teeth, as well as the functioning of various other organs, such as your heart. Eating disorders have the highest death rate among mental health conditions, especially anorexia. In fact, the risk of early death for those with anorexia is 18 times higher than that of their peers. That’s why early recognition of symptoms and appropriate treatment are essential. 

Psycom

Anorexia Nervosa

  • Dramatic weight loss
  • Dresses in layers to hide weight loss or stay warm
  • Preoccupation with weight, food, calories, fat grams, and dieting. Makes frequent comments about feeling “fat.’
  • Resists or is unable to maintain a body weight appropriate for their age, height, and build
  • Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury

Bulimia Nervosa

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
  • Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum
  • Has calluses on the back of the hands and knuckles from self- induced vomiting
  • Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting, and tooth sensitivity 

Binge Eating Disorder

  • Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
  • Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem
  • Steals or hoards food in strange places
  • Creates lifestyle schedules or rituals to make time for binge sessions
  • Evidence of binge eating, including the disappearance of large amounts of food in a short time period or a lot of empty wrappers and containers indicating consumption of large amounts of food

OTHERWISE SPECIFIED FEEDING OR EATING DISORDER (OSFED)

Because OSFED encompasses a wide variety of eating disordered behaviors, any or all of the following symptoms may be present in people with OSFED.

  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
  • Self-esteem overly related to body image
  • Dieting behavior (reducing the amount or types of foods consumed)
  • Expresses a need to “burn off” calories taken in
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

National Eating Disorders Association

Despite the stereotype that eating disorders only occur in women, about one in three people struggling with an eating disorder is male, and subclinical eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women.

In the United States alone, eating disorders will affect 10 million males at some point in their lives. But due in large part to cultural bias, they are much less likely to seek treatment for their eating disorder. The good news is that once a man finds help, they show similar responses to treatment as women. Several factors lead to men and boys being under- and undiagnosed for an eating disorder. Men can face a double stigma, for having a disorder characterized as feminine or gay and for seeking psychological help. Additionally, assessment tests with language geared to women and girls have led to misconceptions about the nature of disordered eating in men.

Men and Body Image

There are numerous studies on male body image, and results vary widely. Many men have misconceived notions about their weight and physique, particularly the importance of muscularity. Findings include:

Most males would like to be lean and muscular, which typically represents the “ideal” male body type. Exposure to unattainable images in the media leads to male body dissatisfaction.

The sexual objectification of men and internalization of media images predicts drive for muscularity.

The desire for increased musculature is not uncommon, and it crosses age groups. 25% of normal weight males perceive themselves to be underweight and 90% of teenage boys exercised with the goal of bulking up.

Muscle dysmorphia, a subtype of body dysmorphic disorder, is an emerging condition that primarily affects male bodybuilders. Such individuals obsess about being adequately muscular. Compulsions include spending many hours in the gym, squandering excessive amounts of money on supplements, abnormal eating patterns, or use of steroids.

National Eating Disorders Association

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

  • Individual, group, and/or family psychotherapy
  • Medical care and monitoring
  • Nutritional counseling
  • Medications

Psychotherapies

Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Medications

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression. Check the Food and Drug Administration’s (FDA) website for the latest information on warnings, patient medication guides, or newly approved medications.

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including eating disorders. During clinical trials, treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Please Note: Decisions whether to apply for a clinical trial and which ones are best suited for a given individual are best made in collaboration with your licensed health professional.

National Institute of Mental Health

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