Eating Disorders

What Are Eating Disorders? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Nuna Alberts, LCSW
By Medically Reviewed by 
Reviewed:
Medically Reviewed

Watching what you eat, like most things, is good for you in moderation. To eat nutritious foods and feel comfortable in your body is certainly a good goal. But when you focus excessively on what you eat, when you eat, and how much you eat to the point where it impinges on your life and impairs your ability to function, you may have an eating disorder.

What’s Normal Eating Behavior and What Isn’t?

How can you know if your concern about your diet and your body’s shape is veering toward — or may already be — an eating disorder? You can’t just look in a mirror. Despite what many people think, you don’t have to be female or skinny — or fat — to have an eating disorder. You don’t even have to look as though anything is wrong.

“Weight can be an indicator of an eating disorder, but it certainly isn’t the only one,” says Ilene Fishman, a licensed clinical social worker in New York City and Montclair, New Jersey, who spent a decade during her adolescence battling — and eventually recovering from — her own severe anorexia.

The generalization that eating disorders mostly affect young, white, well-to-do females doesn’t always match up with reality. “Eating disorders are found across all age groups, social classes, gender, sizes, education levels, races, and ethnicities,” says Tomoko Udo, PhD, an associate professor in the School of Public Health at the University at Albany in New York, and the first author of a large-scale study on the prevalence of eating disorders.

Indeed, stereotypes about who is affected by eating disorders can be a real barrier in getting help for the people who don’t fit those stereotypes, says Dr. Udo.
The most common eating disorders that affect both genders include:

  • Anorexia This disorder is marked by extreme control over calorie intake, an intense fear of gaining weight, and often an unrealistic view of body size and shape.
  • Bulimia Also known as binge-purge syndrome, bulimia is marked by frequent, rapid overeating followed by purging to avoid gaining weight. Purging may include forced vomiting, excessive exercising, and misuse of laxatives and diuretics.
  • Binge Eating Disorder This disorder is marked by frequent out-of-control eating in a short amount of time, often until the person feels uncomfortably full. Binge eating disorder often occurs in secret because of self-disgust and embarrassment. People with this condition don’t purge.

Signs and Symptoms of Eating Disorders

You might want to consider consulting an expert if you notice any of these red flags in yourself or a friend or family member:

  • Being consumed by thoughts of food, weight, fat, or calories
  • Avoiding once-favorite foods
  • Preferring to eat alone instead of with others so that no one can judge how little or how much is being eaten
  • Exercising excessively; for example, planning the day around exercising, setting unrealistic goals or ignoring signs of injury or fatigue
  • Finding more and more fault with one’s body, or seeing it as looking very different from how other people say it does
  • Paying increased attention to other people’s bodies
  • Regularly using appetite suppressants, laxatives, diuretics, or enemas

Causes and Risk Factors of Eating Disorders

Eating disorders are complex illnesses caused by an interaction of genetic, biological, behavioral, psychological, and social factors.

Having a parent or sibling with an eating disorder, for example, may predispose a person to develop one. So, too, might having an anxiety or depressive disorder, or experiencing a trauma, such as sexual abuse.

Even being bullied in childhood can dramatically increase one’s risk, notes the National Eating Disorders Association (NEDA).

How Are Eating Disorders Diagnosed?

Doctors often diagnose eating disorders based on a person’s symptoms and habits. Additionally, a healthcare provider might perform a physical exam, a psychological evaluation, and other tests to check for underlying conditions.

The Mayo Clinic notes that eating disorder diagnoses are often based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association.

The Disorder Healthcare Providers Often Miss

Healthcare providers often overlook the signs of an eating disorder, and many even say things that could make the disorder worse. Not asking a patient who has lost a significant amount weight about his or her eating habits, and instead praising them for finally getting their weight under control, is one common scenario, says Nanci Pradas, PhD, a psychotherapist in private practice in Bedford, Massachusetts. Many doctors also prescribe medication for depression, believing that the patient’s loss of appetite is a symptom of their low mood without considering that an eating disorder might be driving their eating behavior.

The reason eating disorders fall through the cracks in doctor’s offices so easily is simple: Few doctors receive in-depth training in identifying and treating eating disorders, even in family medicine and psychiatric residency programs.

Prognosis of Eating Disorders

A person’s prognosis will depend on the type of eating disorder they have, the severity, and the treatment they receive, among other factors.

The sooner an eating disorder is treated, the better the outcome.

Duration of Eating Disorders

The duration of an eating disorder varies from person to person.

One study, which followed up with patients after roughly two decades, found about two-thirds of women with anorexia or bulimia eventually recover from their eating disorder. Investigators found recovery from bulimia tended to happen more quickly.

Treatment and Medication Options for Eating Disorders

Treating an eating disorder usually involves a team approach that includes primary care doctors, mental health physicians, and dietitians.

The specific therapies a person requires will depend on the type and severity of the disorder.

Psychotherapy

Psychotherapy, also known as “talk therapy,” helps someone with an eating disorder learn to replace harmful thoughts or habits with healthy ones. Cognitive behavioral therapy (CBT) is a common form of psychotherapy that involves encouraging patients to recognize unhealthy habits and develop more effective problem-solving and coping skills.

Nutrition Counseling

Medical experts can help you develop a healthy eating plan to fit your individual needs.

Medications

Sometimes, medications can help control anxiety, urges, or unhelpful thoughts. Antidepressants and anti-anxiety drugs may be given to someone who struggles with an eating disorder.

Hospitalization

People that develop serious health problems due to an eating disorder may require hospitalization. Additionally, some clinics offer intensive, in-patient treatment programs.

Alternative and Complementary Therapies

Some types of alternative medicine can help people with eating disorders relax and reduce stress. Yoga, massage, meditation, and acupuncture are common therapies.

Prevention of Eating Disorders

There’s no surefire way to prevent an eating disorder, but a person may be able to lower their risk by:

  • Learning about the signs, symptoms, and risks
  • Avoiding crash diets and unhealthy weight loss behaviors
  • Avoiding negative self-talk and learning to appreciate the body’s functionality
  • Seeking help if behaviors become problematic

Complications of Eating Disorders

Although many people in the grip of an eating disorder appear very high-functioning on the outside, excelling at work and at home, inside, their bodies are in crisis. Some eventually fully recover. Others cycle through periods of recovery and relapse. And some become chronically ill or die.

Eating disorders have the highest mortality rate of any psychiatric illness. An estimated 20 percent of people with eating disorders eventually die from complications such as irregular or very low heartbeat (arrhythmia), sudden cardiac arrest, severe liver disease, or suicide.


Even those who survive may face serious health issues, including but not limited to:


  • Irreversible bone loss
  • Muscle loss and weakness, including in the heart muscle
  • Anemia
  • Severe dehydration, which can lead to kidney failure
  • Dry skin and hair loss
  • Slowed digestion (gastroparesis)
  • Fainting, fatigue, and overall weakness
  • Menstrual irregularities or loss of libido
  • Depression

Research and Statistics: Who Has Eating Disorders?

Because eating disorders aren’t always obvious, they’re far more common than many of us realize. At some point in their lives, almost 29 million Americans

will experience an eating disorder — even some 10 million boys and men.

Celebrities With Eating Disorders

We also live in a culture that has, historically, valued waist size over accomplishments. Movies, television shows, and fashion magazines have perpetuated this value system by featuring unhealthy and unrealistic bodies, thus contributing to eating disorders.

But that has started to change in recent years. More and more celebrities are stepping forward to reveal the toll that the culture of thinness has taken on them, helping to increase awareness about eating disorders and reduce the stigma.

Among them are:

  • Gabourey Sidibe The Oscar-nominated star of Precious and American Horror Story: Apocalypse vividly describes how she used bulimia to cope with depression in her memoir This Is Just My Face: Try Not to Stare. “My emotions were out of control, and all I could do was cry about it for hours,” she wrote. “One day, I cried so long and hard that I started vomiting. When I was done, I wasn’t crying anymore. I wasn’t even thinking about what had made me cry to begin with. I felt empty, which was a great thing — before this, I’d felt too full of emotions. … I wasn’t even trying to lose weight — that’s not the way it works. I was trying to stop myself from crying.”

  • Kesha In an interview in Vogue, the pop star recalled what led her to seek in-patient treatment for bulimia at Timberline Knolls Residential Treatment Center in Lemont, Illinois, in 2014. “There was a lot of not eating — and I started thinking [that] being hungry to the point of feeling almost faint was a positive thing. The worse it got, the more positive feedback I was getting. Inside I was really unhappy, but outside, people were like, ‘Wow, you look great.’”

  • Lily Collins Collins suffered with anorexia and bulimia as a teenager, then risked a relapse years later by losing a significant amount of weight to play a character with anorexia in the movie To the Bone. In 2017, she told Collider that she chose to play the role to bring awareness to eating disorders. “This was something that I needed to talk about and bring to the attention of more people. … It is still considered quite taboo to talk about, and yet it’s becoming more and more prevalent within today’s society, and not just with women.”

Black and Hispanic Americans and Eating Disorders

It’s a misperception that eating disorders primarily affect young, white women. People of all ethnicities and demographics struggle with eating disorders at similar rates. And research shows that people of color — Black Americans in particular — are less likely to receive help for an eating disorder.

Some studies have suggested that Black and Hispanic teens are more likely than their peers to suffer from bulimia. Other research has shown that people of color are less likely to be asked by a doctor about eating disorder symptoms.

Related Conditions and Causes of Eating Disorders

People with eating disorders often have additional illnesses. Health conditions that often occur with eating disorders include:

Resources We Love

Concerned? The surest way to get an accurate diagnosis for yourself or someone else is to consult an eating disorder specialist. You can delve deeper and get referrals for help in your area by using the quick and confidential online screening tools offered by the National Eating Disorders Association and Mental Health America’s Eating Disorder Test.

You can find support, resources, and more information about treatment options at the National Eating Disorder Association website or by calling or texting the association’s helpline at 800-931-2237 or through their online chat.

Additional resources:

Additional reporting by Julie Marks.

Editorial Sources and Fact-Checking

Show Less