Eating Disorder Symptoms, Types, and Treatment

Learn More About Treating Patients With Eating Disorders and Disordered Eating

How Many People Have Eating Disorders?

Did you know that the National Eating Disorder Association (NEDA) estimates 28.8 million Americans will be affected by an eating disorder during their lifetime? And disordered eating doesn't discriminate: patients of all ages, races, religions, ethnicities, genders, sexual orientations, body shapes, and weights can be afflicted.

In this article:

• Eating Disorder Definition
• Eating Disorder Causes
• Eating Disorder Symptoms
• Eating Disorder Treatment

MEDICAL EXPERT: Dr. Michael Strober

Dr. Michael Strober joined the faculty of the UCLA Department of Psychiatry and Biobehavioral Sciences in 1975 and he has been recognized by both the National Eating Disorders Association and the Academy for Eating Disorders for his contributions to research, teaching, and education.

In this interview, Dr. Strober shares several insights about what causes different eating disorders, describes what recovery looks like, and addresses common misconceptions that are prevalent even among specialists in the field.

What Is an Eating Disorder?

Is an Eating Disorder a Mental Illness?

Eating disorders are a group of mental illnesses that involve abnormal and unhealthy eating behaviors, thoughts, and emotions. Eating disorders can have serious physical and psychological consequences for patients. These can include malnutrition, electrolyte imbalances, organ damage, anxiety, depression, and even death in severe cases.

Disordered Eating vs Eating Disorders: What’s the Difference?

In short, it's a matter of severity. Disordered eating refers to a wide range of abnormal eating behaviors that do not meet the criteria for a specific eating disorder.

"There is certainly a sizable number of people whose variations in eating can be problematic," notes Dr. Strober. "They lack consistency. They're erratic. And they may relate to some of the same concerns or preoccupations that you see in classic eating disorders. But they don't exhibit the features that you see in a well-recognized clinical syndrome."

• Disordered eating may be occasional or frequent. It can be caused by various factors, such as stress, poor body image, or a desire to control one's weight. Disordered eating behaviors can include skipping meals, fasting, bingeing, purging, and restrictive eating patterns.
• An eating disorder is a serious mental health condition. It is characterized by extreme and persistent disturbances in eating behavior, as well as related thoughts and emotions. It typically requires professional treatment to manage and overcome.

However, while disordered eating may not meet the diagnostic criteria for a specific eating disorder, it can still have negative physical and psychological consequences. Disordered eating can lead to nutrient deficiencies, hormonal imbalances, mood swings, and other health problems. Additionally, disordered eating can contribute to the development of an eating disorder if it isn't addressed by a medical professional.

How Many Eating Disorders Are There?

What Is the Most Common Eating Disorder?

There are several recognized eating disorders, with some—such as Binge Eating Disorder—being more regularly diagnosed than others.

• Anorexia Nervosa: A condition characterized by a fear of gaining weight, a distorted body image, and extreme food restriction.
• Bulimia Nervosa: A condition characterized by binge eating followed by purging behaviors, such as self-induced vomiting, fasting, or excessive exercise.
• Binge Eating Disorder: A condition characterized by repeated episodes of binge eating. During these episodes, an individual consumes large amounts of food in a short period of time. They also feel a lack of control over their eating.
• Pica: A condition characterized by the persistent eating of non-food items, such as hair, dirt, or chalk.
• Rumination Disorder: A condition characterized by the repetitive regurgitation and rechewing of food after eating.
• Avoidant/Restrictive Food Intake Disorder (ARFID): A condition characterized by a selective avoidance of certain foods or food groups. This can lead to malnutrition or weight loss.
• Other Specified Feeding or Eating Disorder (OSFED): A condition that includes eating disorder symptoms that do not fully meet the criteria for any of the above disorders.

It's worth noting for future medical professionals that the criteria for these disorders are continually evolving. New eating disorder types and categories may be recognized in the future as more research is done in the field.

For instance, it has not been formally recognized in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), but more and more specialists are starting to research Orthorexia, an unhealthy obsession with healthy eating or a fixation on "clean" or "pure" foods.

What Causes Eating Disorders?

According to Dr. Strober, it depends on the disorder, but in general, research indicates there are several factors at play, including early childhood development as well as inherited genetic traits:

"What we've learned in the last decade about the genetics of psychiatric disorders is that there are genes in common across major mental illnesses as well as genes that are unique to certain syndromes."

For example, Dr. Strober has found evidence of an overlap between the genes associated with anorexia nervosa and the genes tied to anxiety disorders (most notably, obsessive compulsive disorder).

He also believes that there is a potential correlation with the genes associated with low body mass: "The majority of people with anorexia nervosa have a natural, genetically-based ability to tolerate—physiologically and metabolically—long periods of time with minimal caloric intake."

There's quite a shift, however, when discussing patients with bulimia nervosa. "There are several very well conducted studies that suggest higher-than-average body weight may predispose [an individual] to weight loss which then sets off periods of binge eating to counteract the effect of calorie restriction," explains Dr. Strober.

But in addition to body weight, there are many aspects of patient's developmental circumstances that might lead to bulimia nervosa: "High stress environments, high conflict environments, a history of parental obesity, a history of parental alcoholism... these factors play a role in ways that we don't fully understand, but are part of the developmental environment for individuals who are predisposed to this condition."

To summarize, here are some of the factors that may contribute to the development of an eating disorder:

• Genetics: Studies suggest that eating disorders can run in families, and that certain genetic factors may increase the risk of developing an eating disorder.
• Environmental Factors: Certain environmental factors, such as stress, traumatic life events, and cultural pressure to conform to a certain body type, can trigger or worsen eating disorder symptoms.
• Psychological Factors: Patients with eating disorders often have co-occurring mental health conditions, such as anxiety, depression, and obsessive-compulsive disorder. Trauma, low self-esteem, and difficulty regulating emotions may also contribute to the development of an eating disorder.
• Biological Factors: Research suggests that imbalances in certain brain chemicals and hormones may play a role in the development of eating disorders.

It's important to note that the causes of eating disorders are not fully understood, and that each patient's experience with an eating disorder is unique. However, there are some commonalities for causality that Dr. Strober thinks are important, especially for anorexia nervosa.

"Many years before the weight loss and the other clinical signs of anorexia nervosa, patients exhibit a predilection to anxious worry, one of the correlates of which is significant insecurity about one's own self," he says. "I have never in 48 years seen a person with anorexia nervosa who did not have early life anxiety."

What Are the Signs of an Eating Disorder?

Eating disorders are complex mental health conditions that can cause a wide range of physical and psychological symptoms in patients. Some of the most common symptoms of eating disorders include:

• Extreme changes in weight: Rapid weight loss or weight gain.
• Distorted body image: Feeling excessively overweight even if underweight, or having a negative self-image.
• Preoccupation with food: Constant thoughts about food, calories, and nutrition.
• Abnormal eating patterns: Skipping meals, eating alone, hoarding or hiding food.
• Rigid food rules and rituals: Such as only eating certain foods, or in a specific order.
• Obsessive calorie counting and portion control: Weighing food, cutting it into small pieces, or pushing food around on a plate instead of eating.
• Purging behaviors: Such as self-induced vomiting, overuse of laxatives or diuretics.
• Excessive exercise: Engaging in intense or excessive physical activity, even when injured or ill.
• Irregular menstrual periods: Changes in menstrual cycle or loss of periods in women.
• Social withdrawal: Avoiding social situations, especially those involving food.

How to Recover From an Eating Disorder

When it comes to eating disorder treatment and recovery, medical professionals are divided. "I think people in the eating disorder field are quite confused about this," says Dr. Strober. "There are people of the opinion that a patient can never recover because they might be at risk for a relapse."

However, it ultimately comes down to how one defines recovery, he explains: "Recovery is defined as the absence of symptoms for a sufficiently long period of time. Do patients develop an eating disorder, recover from an eating disorder, and live the rest of their adult life without a return of the disorder? The answer is, they do, and that defines recovery."

Recovering from an eating disorder can be a long and challenging process, but it is possible with the right support and resources. Here are some steps that can help patients with the recovery process:

• Focus on nourishing the body: Eating a balanced diet, drinking enough water, and engaging in physical activity in a healthy way can help support a patient's physical recovery process.
• Challenge negative thoughts: It is important for patients to challenge and replace negative and distorted thoughts and beliefs about food, weight, and body image with more positive and realistic ones.
• Lean on supportive people: Patients should spend time with friends, family, and other people who will support and encourage the recovery process.
• Set achievable goals: Setting small, achievable goals can help build confidence and a sense of accomplishment in patients, which can be important in the recovery process.
• Practice self-care: Patients should engage in activities that bring joy and relaxation, such as meditation, yoga, or spending time in nature.
• Be patient: Recovery from an eating disorder is a journey, not a destination. It is important to be patient and celebrate small victories along the way.

Remember that eating disorder recovery is possible and every patient's journey is unique. It's important to have patience and perseverance in the process, acknowledging relapses, if they happen, and treating them accordingly.

What precipitates a relapse? Dr. Strober says it’s usually tied to some kind of life stress. "Sometimes patients lose weight as a result of that stressful life event, not with the intent of losing 30, 40, even 50 percent of their natural body weight. But there's some switch mechanism and the illness re-emerges."

Still, he believes recovery can be achieved and maintained over the long haul. "I've seen many, many patients who have been free of symptoms over decades of their adult life and they are fully recovered. They're leading very productive lives. They have no discomfort with their body mass."

Common Misconceptions About Disordered Eating and Eating Disorders?

There's a lot of misinformation and disagreements about eating disorders, even among specialists in the field. One of Dr. Strober's biggest issues is the fact that many professionals who specialize in eating disorders don't have a background in developmental psychopathology, which he believes is absolutely key to understanding and treating eating disorders: "If you don't understand what a psychiatric disorder is, and how it evolves, and what the risk factors are, then you will not understand eating disorders."

He also takes issue with treatment specialists who insist that if someone recovering from anorexia nervosa is less than the average weight for their age and height, that automatically puts them at risk for a relapse. "I've never seen that to be the case," he says. "What puts a patient at risk for a relapse is if they are losing too much weight."

Even worse, he says, are specialists who believe that a patient who was a heavy child must maintain an equivalent weight as an adolescent or an adult to protect their recovery from anorexia nervosa. "I've never seen any evidence of that," he insists. "And in many cases, we've seen a good bit of evidence that when you push somebody at age 15, 18, or 21 to a weight that they had when they were 6, 7, or 8 years old, you actually precipitate a deterioration during the treatment."

It all comes down to understanding the evolutionary or ancestral traits that predispose individuals with anorexia nervosa to believe that weight loss represents a "safe space," psychologically speaking. Dr. Strober clarifies: "If you study evolutionary ecology or behavioral ecology, there is literature going back a century underscoring the safety provided by low body mass in certain high-threat environments, which would suggest there are ancestral traits to which anorexia nervosa is linked."

Outside the field, more general misconceptions include the following:

• Disordered eating is a choice: Many people believe that individuals with disordered eating habits simply choose to engage in unhealthy eating patterns. However, disordered eating is often a manifestation of underlying psychological, emotional, or cultural issues.
• Only thin people struggle with disordered eating: Disordered eating can affect people of all sizes, shapes, and body types. It is not limited to those who are underweight or those who meet a culture's beauty standards.
• Disordered eating is a phase: Disordered eating is a serious and complex issue that requires proper treatment and support. It is not a phase that individuals will simply outgrow on their own.
• Disordered eating is all about food: Disordered eating often goes beyond a simple obsession with food. It can also be associated with low self-esteem, a lack of control in other areas of life, and emotional distress.
• People can't have disordered eating and be healthy: Disordered eating can have serious physical and mental health consequences, but it is possible for individuals to recover and achieve a healthy relationship with food and their body.

It's important to acknowledge that disordered eating is a complex issue, and these misconceptions can be harmful for those who are struggling. It is essential that patients seek professional support to address and overcome disordered eating patterns.

About National Eating Disorder Awareness Week

National Eating Disorder Awareness week takes place annually, usually sometime in February or March. This week-long event is designed to spotlight the lived experiences of those who have eating disorders and promote education about disordered eating in order to advocate for better understanding as well as real, impactful change across all communities. #EDAW