Eating Disorders

What are eating disorders?

Eating disorders are serious mental health disorders. They involve severe problems with your thoughts about food and your eating behaviors. You may eat much less or much more than you need.

Eating disorders are medical conditions; they are not a lifestyle choice. They affect your body's ability to get proper nutrition. This can lead to health issues, such as heart and kidney problems, or sometimes even death. But there are treatments that can help.

What are the types of eating disorders?

Common types of eating disorders include:

• Binge-eating, which is out-of-control eating. People with binge-eating disorder keep eating even after they are full. They often eat until they feel very uncomfortable. Afterward, they usually have feelings of guilt, shame, and distress. Eating too much too often can lead to weight gain and obesity. Binge-eating disorder is the most common eating disorder in the U.S.
• Bulimia nervosa. People with bulimia nervosa also have periods of binge-eating. But afterwards, they purge, by making themselves throw up or using laxatives. They may also over-exercise or fast. People with bulimia nervosa may be slightly underweight, normal weight, or overweight.
• Anorexia nervosa. People with anorexia nervosa avoid food, severely restrict food, or eat very small quantities of only certain foods. They may see themselves as overweight, even when they are dangerously underweight. Anorexia nervosa is the least common of the three eating disorders, but it is often the most serious. It has the highest death rate of any mental disorder.

What causes eating disorders?

The exact cause of eating disorders is unknown. Researchers believe that eating disorders are caused by a complex interaction of factors. These include genetic, biological, behavioral, psychological, and social factors.

Who is at risk for eating disorders?

Anyone can develop an eating disorder, but they are more common in women. Eating disorders frequently appear during the teen years or young adulthood. But people can also develop them during childhood or later in life.

What are the symptoms of eating disorders?

The symptoms of eating disorders vary, depending on the disorder:

The symptoms of binge-eating include:

• Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
• Eating even when you're full or not hungry
• Eating fast during binge episodes
• Eating until you're uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about your eating
• Frequently dieting, possibly without weight loss

The symptoms of bulimia nervosa include the same symptoms as binge-eating, plus trying to get rid of the food or weight after binging by:

• Purging, making yourself throw up or using laxatives or enemas to speed up the movement of food through your body
• Doing intensive and excessive exercise
• Fasting

Over time, bulimia nervosa can cause health problems such as:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth. This is caused by the exposure to stomach acid every time you throw up.
• GERD (acid reflux) and other gastrointestinal problems
• Severe dehydration from purging
• Electrolyte imbalance, which could be too low or too high levels of sodium, calcium, potassium and other minerals. This can lead to a stroke or heart attack.

The symptoms of anorexia nervosa include:

• Eating very little, to the point of starving yourself
• Intensive and excessive exercise
• Extreme thinness
• Intense fear of gaining weight
• Distorted body image - seeing yourself as overweight even when you are severely underweight

Over time, anorexia nervosa can cause health problems such as:

• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia
• Muscle wasting and weakness
• Thin, brittle hair and nails
• Dry, blotchy, or yellowish skin
• Growth of fine hair all over the body
• Severe constipation
• Low blood pressure
• Slowed breathing and pulse
• Feeling cold all the time because of a drop in internal body temperature
• Feeling faint, dizzy, or weak
• Feeling tired all the time
• Infertility
• Damage to the structure and function of the heart
• Brain damage
• Multiorgan failure

Anorexia nervosa can be fatal. Some people with this disorder die of complications from starvation, and others die of suicide.

Some people with eating disorders may also have other mental disorders (such as depression or anxiety) or problems with substance use.

How is eating disorders diagnosed?

Because eating disorders can be so serious, it is important to seek help if you or a loved one thinks that you might have a problem. Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms. It is important to be honest about your eating and exercise behaviors so your provider can help you.
• A physical exam
• Blood or urine tests to rule out other possible causes of your symptoms
• Other tests to see whether you have any other health problems caused by the eating disorder. These can include kidney function tests and an electrocardiogram (EKG or ECG).

What are the treatments for eating disorders?

Treatment plans for eating disorders are tailored to individual needs. You will likely have a team of providers helping you, including doctors, nutritionists, nurses, and therapists. The treatments may include:

• Individual, group, and/or family psychotherapy. Individual therapy may include cognitive behavioral approaches, which help you to identify and change negative and unhelpful thoughts. It also helps you build coping skills and change behavioral patterns.
• Medical care and monitoring, including care for the complications that eating disorders can cause
• Nutrition counseling. Doctors, nurses, and counselors will help you eat healthy to reach and maintain a healthy weight.
• Medicines, such as antidepressants, antipsychotics, or mood stabilizers, may help treat some eating disorders. The medicines can also help with the depression and anxiety symptoms that often go along with eating disorders.

Some people with serious eating disorders may need to be in a hospital or in a residential treatment program. Residential treatment programs combine housing and treatment services.

NIH: National Institute of Mental Health

Questions for your care team

General prompts to help prepare for your appointment.

• How does this information apply to my situation?
• Which symptoms or results need evaluation?
• Which tests are useful, and what can they tell us?
• What care options, benefits, and risks should we discuss?
• When should I seek urgent help, and whom should I call?
• When is follow-up, and how will we know whether the plan is working?