Eating Disorders

Overview

Many people are concerned about their health, weight, or appearance at times. Some people become obsessed with weight loss, body weight or shape, and controlling their food intake. These may be signs of an eating disorder.

Eating disorders are not a choice. They affect people of all ages, racial and ethnic backgrounds, body weights, and sexes. Even people who appear healthy can have eating disorders and be extremely ill. People with eating disorders can be underweight, average weight, or overweight.

Common Eating Disorders

Common types of eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder (BED), and avoidant restrictive food intake disorder (ARFID).

Anorexia Nervosa

People with anorexia nervosa do not eat enough because they are afraid of gaining weight. They may be dangerously underweight but think they are overweight. Some people with anorexia nervosa also have binge eating and purging episodes.

People with anorexia nervosa may show these signs and symptoms:

• Extremely restricted eating
• Intense and excessive exercise
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a healthy weight
• Intense fear of gaining weight
• Distorted body image or self-image
• Denial of the seriousness of low body weight

People with anorexia nervosa are at risk for

• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia
• Muscle wasting and weakness
• Delayed puberty
• Severe constipation
• Low blood pressure
• Slowed breathing and pulse
• Damage to the structure and function of the heart
• Feeling tired all the time
• Infertility
• Brain damage
• Multiple organ failure

Anorexia nervosa can be fatal. It has an extremely high death rate compared with other mental disorders. People with anorexia nervosa are at risk of dying from medical complications associated with starvation. Suicide is a leading cause of death for people diagnosed with anorexia nervosa.

Bulimia Nervosa

People with bulimia nervosa regularly binge eat and then purge to prevent weight gain. People with bulimia nervosa may be average weight or overweight. People with bulimia nervosa are often afraid of gaining weight, want to lose weight, and are unhappy with their body.

People with bulimia nervosa may engage in the following behaviors after eating:

• Throwing up
• Taking laxatives
• Exercising excessively
• Fasting (not eating for an extended period of time)

People with bulimia nervosa are at risk for:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation
• Severe dehydration
• Electrolyte imbalance

Binge-Eating Disorder

People with binge-eating disorder eat large amounts of food. They may be overweight or have obesity. Their binge-eating episodes are not followed by purging, excessive exercise, or fasting.

People with binge-eating disorder may show these signs and symptoms:

• Eating unusually large amounts of food in a short amount of time —for example, within two hours
• Eating quickly during binge episodes
• Eating even when full or not hungry
• Eating until uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about eating
• Dieting frequently, possibly without weight loss

People with binge-eating disorder are at risk for:

• Obesity
• Type 2 diabetes — In some people, BED contributes to the development of type 2 diabetes. BED can also make it harder for people with diabetes to control their blood sugar.
• Cardiovascular problems
• Sleep problems
• Gastrointestinal symptoms such as acid reflux, bloating, and diarrhea

Avoidant Restrictive Food Intake Disorder (ARFID)

People with ARFID persistently limit the amount and types of food they eat, resulting in a failure to meet appropriate nutritional and/or energy needs. The selective eating seen in ARFID is based in part on the sensory characteristics of food and/or concern about aversive consequences of eating.

People with ARFID may show these signs and symptoms:

• Severe restriction of types or amount of food eaten
• Lack of appetite or interest in food
• Dramatic weight loss
• Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause
• Limited range of preferred foods that becomes even more limited (“picky eating” that gets progressively worse)

People with ARFID are at risk for:

• Malnutrition
• Changes to physical growth
• Functional impairments associated with academic performance, work, and relationships

Related Health Effects

People with eating disorders are at higher risk for other mental and behavioral disorders like depression, anxiety, and substance use disorders. These co-occurring conditions can make eating disorders worse. People with eating disorders are also at higher risk for suicide.

Causes and Risk Factors

The exact cause of eating disorders is not fully understood. Research suggests a combination of genetic, biological, behavioral, psychological and social factors can raise a person’s risk. An eating disorder is not a lifestyle choice.

Diagnosis

Someone can be diagnosed with an eating disorder by talking to a health professional about their psychological symptoms and eating patterns. The health professional may ask about attitude towards food, eating, exercise, and how they feel about their weight. Other psychiatric symptoms will also be evaluated, and, often, additional diagnostic testing will be required.

Treatment and Management

Eating disorders can be treated successfully. Because there are often co-occurring mental illnesses, it is critical to include treating those as part of the treatment plan.

Treatment plans for eating disorders include:

• Individual, group, or family psychotherapy to identify and change troubling emotions, thoughts, and behaviors about food
• Medical care and monitoring to treat the health consequences of an eating disorder and monitor overall well-being
• Nutritional counseling to help people eat well and reach and maintain a healthy weight
• Medicine to treat the symptoms of some eating disorders, including bulimia nervosa and binge-eating disorder, and to reduce symptoms of co-occurring anxiety or depression; There are currently no medicines approved by the U.S. Food and Drug Administration (FDA) to treat the symptoms of anorexia nervosa or ARFID

Some people with a severe eating disorder may need to be in a hospital or residential treatment program.

Living With an Eating Disorder

Recovery is possible with treatment and time. Research suggests that family-based treatment can improve eating disorder treatment outcomes, particularly for adolescents. Family members can encourage a person with eating or body image issues to seek help and can provide support during treatment.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on eating disorders

Find Treatment

If you have concerns about your or your child’s eating behavior or mental health, talk to a healthcare provider. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help you figure out the next steps.

The Substance Abuse and Mental Health Services Administration (SAMHSA) website provides resources for finding support and locating mental health services in your area.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH is funding and conducting research to understand why some people are more likely to develop eating disorders than others. This includes research that examines genetic, biological, behavioral, psychological, and social factors. NIH is also supporting research to better understand how an eating disorder behavior, such as restrictive eating, may affect a person’s brain and digestive system.

In addition, NIH is supporting research to expand the reach and effectiveness of current therapies, including research that uses technology to engage people in treatment and personalizes interventions to improve treatment response. This includes funding research into new treatment options, such as medicines and therapies that can prevent or reverse unhealthy food-related behaviors.

Researchers are studying many aspects of binge-eating disorder, including how to prevent it, effective treatments for specific populations, genetic links, and the relationship between binge-eating disorder, obesity, and Type 2 diabetes.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.  

Multimedia

Mental Health Minute: Eating Disorders