Eating Disorders: Everything You Need To Know

There are many different kinds of eating disorders and many different types of people that suffer from them every single day. This post is for anyone who has abnormal thoughts, feelings, or behaviors around food and eating, no matter if you have a formal eating disorder diagnosis or not.

Table of Contents

Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health. They are not just a “fad” or a “phase.” People do not just “catch” an eating disorder for a period of time. They are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships.
National Eating Disorders Association

Eating disorder facts and statistics

Every 62 minutes someone dies as the result of an eating disorder
An eating disorder is a mental illness, just like depression, anxiety, obsessive-compulsive disorder (OCD), bipolar disorder, etc.
Eating disorders have the highest mortality rate of any mental illness
Eating disorders can affect anyone, no matter race, gender, age, or ethnic group
Men are underdiagnosed with eating disorders due to the stigma that an eating disorder affects only women
Among the risks for an eating disorder are genetics and environmental factors
In the U.S. roughly 50% of people are either personally affected by an eating disorder, or know someone who is
Transgender individuals have eating disorders at higher rates than cisgender individuals

Facts, statistics. and treatment information on all eating disorders. #eatingdisorders #bulimia #anorexia #bingeeatingdisorder #pica #ARFID #ruminationdisorder #OSFED #UFED #recovery

Disordered eating behaviors

What is the difference between an eating disorder and disordered eating?

An eating disorder has specific criteria that need to be met for a diagnosis. Disordered eating is the abnormal behavior surrounding food and eating- for example binging, restricting, and purging.

Anorexia Nervosa

Anorexia is one of the most well-known eating disorders, however, it is not the most common. It’s characterized by self-starvation, negative body image, and extreme weight loss.

Here is the official diagnostic criteria for anorexia nervosa from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V):

Restriction of energy intake relative to requirement, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Facts about anorexia

1 in 5 anorexia deaths are from suicide
About 50% of anorexia sufferers also have a diagnosis of an anxiety disorder, such as obsessive-compulsive disorder, generalized anxiety disorder, or social phobia
Males represent 25% of people with anorexia nervosa
Males have a higher risk of death from anorexia, partly because they are often diagnosed later in their disease due to the assumption that males don’t get eating disorders
The mortality rate for anorexia is estimated at 10%

Some signs and symptoms of anorexia

Frequently making excuses to miss meals or not eat with others
Cooking large meals for others but not eating the food
Restricting, dieting, and/or limiting food intake
Frequently weighing oneself
Severe weight loss
Commenting about how fat the person feels about themself
Becoming defensive when asked about weight loss or eating habits
Isolating from others
Hiding weight loss with heavy or baggy clothes
Denial that there’s anything wrong

Extremely low blood pressure and heart rate
Dry skin, hair, and nails
Hair loss
Severe dehydration, which can cause kidney failure
Weakness and muscle loss
Damage to the heart with increased risk of heart failure
Fatigue and fainting
Amenorrhea in females (loss of menstrual cycle)
Severe constipation
Increased risk of suicide

Bulimia Nervosa

Bulimia is another well-known eating disorder, but it too is not the most common. Bulimia is characterized by eating large quantities of food in short amounts of time (binge eating) followed by compensatory behaviors in order to undo or reverse the high-calorie intake.

Here is the official diagnostic criteria for bulimia nervosa from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V):

Recurrent episodes of binge eating
Recurrent inappropriate compensatory behaviors (such as self-induced vomiting, misuse of laxatives, fasting, or excessive exercise) in order to prevent weight gain
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once per week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.
Bingeing or purging does not occur exclusively during episodes of behavior that would be common in those with anorexia nervosa.

Facts about bulimia

On college campuses, 20% of females confirm symptoms of bulimia
After a binge, people often feel extreme shame
Unlike anorexia, people with bulimia generally know they have a problem and feel embarrassed about their behavior
The feelings of shame can perpetuate a binge-purge cycle as a coping mechanism for low self-esteem and uncomfortable feelings
According to the NEDA website, only about 6% of people suffering from bulimia receive treatment because the symptoms often are unidentified

Some signs and symptoms of bulimia

Frequently and obsessively weighing oneself
Extreme increases and/or decreases in weight
Negative, critical comments about one’s weight and size
Fasting, dieting, restricting or limiting food intake for a specified amount of time, followed by binging
Eating in secret
Hoarding food
Eating until the point of feeling sick or in pain
Frequently leaving for the bathroom following a meal
Avoiding mealtimes in fear of being seen losing control and binging in public
Lying about food or hiding food
Irritability or defensiveness when confronted about weight or eating behaviors
Withdrawal from friends, family, or social interactions

Severe dehydration and electrolyte imbalance which can cause irregular heart rate, heart failure, or even death
Peptic ulcers and pancreatitis
Chronically inflamed and sore throat, gastroesophageal reflux disease (GERD)
Inflamed and possible rupture of the esophagus
Possible stomach rupture
Chronic intestinal issues like constipation, irregular bowel movements, and stomach cramps
Fluid retention/swelling
Dizziness and fainting
Dental problems from stomach acid due to vomiting
Difficulty concentrating
Dry skin, hair, and nails

Binge Eating Disorder (BED)

Eating Disorders Everything You Need To Know

Binge eating disorder is the most common eating disorder. This is the eating disorder I am so “lucky” to have. BED is characterized by eating large quantities of food in a short amount of time (bingeing). During the binge, the person feels out of control and is unable to stop eating.

BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis.
-National Eating Disorder Association

Here is the official diagnostic criteria for binge eating disorder from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V):

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (for example, within any two-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
The binge-eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty afterward
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least once a week for three months.
The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder.

Facts about BED

BED is THREE TIMES more common than anorexia and bulimia combined
40% of people with binge eating disorder are men
BED is severe and life-threatening, but treatable
More common than HIV, breast cancer, and schizophrenia
Symptoms often begin in the late teens or early 20’s
3 out of 10 people seeking weight-loss treatment have signs of BED
2/3 of people with BED are overweight

Some signs and symptoms of BED

A feeling of lack of control when eating certain foods
Eating throughout the day with no set meals, eating smaller meals, and/or sporadic fasting
Weight fluctuations, both up and down
Low self-esteem
Fear of eating in front of others or in public
Frequently dieting
Excessive concern for weight and body shape
Eating in secret/alone out of embarrassment about the amount and type of food eaten
Feeling depressed, disgusted, and/or shameful after eating a large quantity of food
Hoarding food for binges

Related: Why Do You Overeat?

Weight gain and obesity
GI problems like constipation and abdominal pain
Obesity-related illnesses such as:
- Sleep apnea (pauses in breathing during sleep)
- Type 2 diabetes
- Cancer
- Heart disease
- Arthritis
- High blood pressure
Depression
Anxiety

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant restrictive food intake disorder, or ARFID, used to be called “selective eating disorder”. This eating disorder is similar to anorexia, except that one isn’t afraid of weight gain or body image issues.

Here is the official diagnostic criteria for avoidant restrictive food intake disorder from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V):

An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

Facts about ARFID

It is most common in children and young teens
Boys may be affected more often than girls
It often occurs alongside other psychiatric problems like anxiety or obsessive-compulsive disorder (OCD)
People with ARFID often become malnourished due to the limited foods they will eat
People with autism, ADHD, and other intellectual disabilities are much more likely to develop ARFID

Some signs and symptoms of ARFID

Excessive weight loss
Excessive restriction of food types and/or textures
Decreased interest in food and lack of appetite, becoming worse over time
Constipation
Low energy
Complaints of stomach pain or feeling full around mealtimes
Fear of vomiting or choking

Difficulty concentrating
Dizziness and/or fainting
Feeling cold all the time
Dry skin and nails
Thinning, dry and brittle hair on head
Fine hair on body (lanugo)
Decreased wound healing
Stomach cramps and GERD
Irregular menstrual cycle in females
Electrolyte imbalance which can affect the heart

Pica

Pica is an eating disorder in which people crave and eat substances that are not food, like dirt, sand, or hair. The diagnosis for pica is made from taking a clinical history. Testing can be done for things like anemia, toxic substances in the blood like lead, or imaging for issues such as intestinal blockage.

Signs and symptoms of pica

Eating non-food items that have no nutritional value over the period of at least 1 month
Ingesting the non-food substances is not worrisome for the person
The most common items eaten in pica are paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice

Eating non-food items that are toxic can lead to learning disabilities, brain damage or even death
Intestinal blockage and/or constipation from undigested matter, such as stones or metal
Nutritional deficiency from not eating real food
Tearing of the digestive tract from eating sharp objects
Serious infections caused by parasites or bacteria can lead to kidney or liver damage

Rumination Disorder

Rumination disorder is when someone regularly regurgitates (spits up) swallowed food 15-30 minutes after eating. While regurgitating their food, people with this eating disorder generally are not stressed, disturbed, or disgusted. Spitting up is not the same as vomiting, it’s less forceful and not uncomfortable.

Here is the official diagnostic criteria for rumination disorder from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V):

Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
The repeated regurgitation is not due to a medication condition (e.g., gastrointestinal condition).
The behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, BED, or avoidant/restrictive food intake disorder
If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention.

Weightloss
Tooth decay and bad breath
Stomach aches
Indigestion
Chapped or raw lips

Other Specified Feeding or Eating Disorder (OSFED)

OSFED used to be known as Eating Disorder Not Otherwise Specified, or EDNOS. This category was developed to include individuals who don’t meet the specific strict criteria for anorexia or bulimia. OSFED is just as serious as any other eating disorder and can be fatal if left untreated.

Specific examples of OSFED from the NEDA website are:

Atypical Anorexia Nervosa: All criteria are met for anorexia nervosa, except, despite significant weight loss, the individual’s weight is within or above the normal range.
Binge Eating Disorder (of low frequency and/or limited duration): All of the criteria for BED are met, except at a lower frequency and/or for less than three months.
Bulimia Nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months.
Purging Disorder: Recurrent purging behavior to influence weight or shape in the absence of binge eating.
Night Eating Syndrome: Recurrent episodes of night eating. Eating after awakening from sleep, or by excessive food consumption after the evening meal. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment. The behavior is not better explained by another mental health disorder (e.g. BED).

Unspecified Feeding or Eating Disorder (UFED)

UFED is diagnosed when a person’s symptoms don’t meet all of the criteria for one of the other eating or feeding disorders, or if there isn’t enough information to make a more definitive diagnosis. This category includes people with extremely disordered thoughts and behaviors toward food and body image which are severe and cause significant stress to the individual.

Orthorexia

Although not officially recognized as an eating disorder (yet), in the DSM-V, I wanted to include orthorexia in this post. Another term for orthorexia is “clean eating”.

Facts about orthorexia

The term “orthorexia” was formulated in 1998
Defined as an obsession with healthy eating
Many people with orthorexia also have OCD

Signs and symptoms of orthorexia

Extreme stress when “clean” or healthy foods aren’t available
Obsessing about what food might be served at social gatherings
Eating foods only in specific categories (such as only fruits and vegetables)
Cutting out increasingly more food groups, such as sugar, animal products, grains, etc.
Constantly checking nutritional labels and ingredients
Increasing worry about what is considered healthy

Many of the same health problems exist with orthorexia as with anorexia.

Treatment for eating disorders

The first and hardest step is admitting you need help. Once you do that, the healing can begin.

Members of your treatment team

It’s important for you to have a team of specialists to help you with your eating disorder. Usually, the members of your treatment team include, but are not limited to:

Mental health professionals such as:
- A therapist
- A psychiatrist who can determine if medication would be beneficial in coping with your eating disorder, or for co-occurring conditions such as depression, anxiety, etc.
A nutritionist/dietician to help develop and maintain a food plan
A medical doctor to help with any physical problems resulting from your eating disorder
Your family, partner, and/or friends for emotional support day-to-day outside of seeing a member of your professional support team

Eating disorder treatment levels of care

The American Psychiatric Association Level of Care Guidelines for Patients with Eating Disorders can be found here. It explains the criteria used to determine what the best treatment is for you.

The following explains eating disorder treatment levels of care. They are listed in order from least to most involved.

Outpatient/Intensive outpatient

This is used when you are medically and psychiatrically stable, don’t need daily monitoring, have symptoms under satisfactory control, and can continue to make progress in recovery.

Partial hospitalization/full-day outpatient care

This is used when you are medically stable but:

The eating disorder gets in the way of functioning, without an immediate risk
You need daily physical and mental checks

You are psychiatrically stable but you:

Are unable to function in normal social, educational, or vocational situations
Engage in daily binge eating, purging, fasting or very limited food intake, or other pathogenic weight control techniques

Residential

When you are medically stable but psychiatrically impaired and you don’t respond to the previous two levels of care.

Inpatient

This is when you are medically unstable as evidenced by:

Abnormal vital signs
Critical lab findings
Complications from co-occurring medical conditions like diabetes

Psychiatrically unstable as evidenced by:

Symptoms worsening quickly
Suicidal and safety is at risk

Final thoughts on eating disorders

Eating disorders are life-threatening and should be taken extremely seriously. Admitting you can’t do it on your own is incredibly brave, and the first step to recovery. There are people out there who can help you get better. Tell someone you trust, when you’re ready.

I hope this guide to eating disorders gives you the information you are searching for.

For more help with eating disorders and/or mental health disorders, please visit this page for resources.

If you know someone who would benefit from this information, please share it! (Pin is below.)

Disclaimer: I am not a mental health expert. If you have concerns about your health, either mental or physical, please contact your doctor or medical provider.

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