Eating disorders are serious conditions related to persistent eating behaviors that negatively impact your health, your emotions and your ability to function in important areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.
Most eating disorders involve focusing too much on your weight, body shape and food, leading to dangerous eating behaviors. These behaviors can significantly impact your body's ability to get adequate nutrition. Eating disorders can harm the heart, digestive system, bones, and teeth and mouth, and lead to other diseases.
Eating disorders often develop in the teen and young adult years, although they can develop at other ages. With treatment, you can return to healthier eating habits and sometimes reverse serious complications caused by the eating disorder.
Symptoms vary, depending on the type of eating disorder. Anorexia nervosa, bulimia nervosa and binge-eating disorder are the most common eating disorders.
Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is a potentially life-threatening eating disorder characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight or shape. People with anorexia use extreme efforts to control their weight and shape, which often significantly interferes with their health and life activities.
When you have anorexia, you excessively limit calories or use other methods to lose weight, such as excessive exercise, using laxatives or diet aids, or vomiting after eating. Efforts to reduce your weight, even when underweight, can cause severe health problems, sometimes to the point of deadly self-starvation.
Bulimia (boo-LEE-me-uh) nervosa — commonly called bulimia — is a serious, potentially life-threatening eating disorder. When you have bulimia, you have episodes of bingeing and purging that involve feeling a lack of control over your eating. Many people with bulimia also restrict their eating during the day, which often leads to more binge eating and purging.
During these episodes, you typically eat a large amount of food in a short time, and then try to rid yourself of the extra calories in an unhealthy way. Because of guilt, shame and an intense fear of weight gain from overeating, you may force vomiting (purging bulimia), exercise too much, or use other methods, such as laxatives, to get rid of the calories (nonpurging bulimia).
If you have bulimia, you're probably preoccupied with your weight and body shape, and may judge yourself severely and harshly for your self-perceived flaws. You may be at a normal weight or even a bit overweight.
When you have binge-eating disorder, you regularly eat too much food (binge) and feel a lack of control over your eating. You may eat quickly or eat more food than intended, even when you're not hungry, and you may continue eating even long after you're uncomfortably full.
After a binge, you may feel guilty, disgusted or ashamed by your behavior and the amount of food eaten. But you don't try to compensate for this behavior with excessive exercise or purging, as someone with bulimia or anorexia might. Embarrassment can lead to eating alone to hide your bingeing.
A new round of bingeing usually occurs at least once a week. You may be normal weight, overweight or obese.
Other eating disorders
Other eating disorders include pica, rumination disorder and avoidant/restrictive food intake disorder.
Pica is persistently eating nonfood items, such as soap, cloth, talcum powder or dirt, over a period of at least one month. Eating such substances is not appropriate for the person's developmental level and not part of a specific cultural or social practice.
Persistently eating these nonfood items can result in medical complications such as poisoning, intestinal problems or infections. Pica often occurs along with other disorders such as autism spectrum disorder or intellectual disability.
Rumination disorder is repeatedly and persistently regurgitating food after eating, but it's not due to a medical condition or another eating disorder such as anorexia, bulimia or binge-eating disorder. Food is brought back up into the mouth without nausea or gagging. Sometimes regurgitated food is rechewed and reswallowed or spit out.
The disorder may result in malnutrition if the food is spit out or if the person eats significantly less to prevent the behavior. The occurrence of rumination disorder may be more common in infancy or in people who have an intellectual disability.
Avoidant/restrictive food intake disorder
This disorder is characterized by failing to meet your minimum daily nutrition requirements because you don't have an interest in eating; you avoid food with certain sensory characteristics, such as color, texture, smell or taste; or you're concerned about the consequences of eating, such as fear of choking. Food is not avoided because of fear of gaining weight.
The disorder can result in significant weight loss or failure to gain weight in childhood, as well as nutritional deficiencies that can cause health problems.
Avoidant/restrictive food intake disorder is not diagnosed when symptoms are part of another eating disorder, such as anorexia, or part of a medical problem or other mental disorder.
When to see a doctor
Because of its powerful pull, an eating disorder can be difficult to manage or overcome by yourself. Eating disorders can virtually take over your life. If you're experiencing any of these problems, or if you think you may have an eating disorder, seek medical help.
Urging a loved one to seek treatment
Unfortunately, many people with eating disorders may not think they need treatment. If you're worried about a loved one, urge him or her to talk to a doctor. Even if your loved one isn't ready to acknowledge having an issue with food, you can open the door by expressing concern and a desire to listen.
Be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders. Red flags that may indicate an eating disorder include:
- Skipping meals or making excuses for not eating
- Adopting an overly restrictive vegetarian diet
- Excessive focus on healthy eating
- Making own meals rather than eating what the family eats
- Withdrawing from normal social activities
- Persistent worry or complaining about being fat and talk of losing weight
- Frequent checking in the mirror for perceived flaws
- Repeatedly eating large amounts of sweets or high-fat foods
- Use of dietary supplements, laxatives or herbal products for weight loss
- Excessive exercise
- Calluses on the knuckles from inducing vomiting
- Problems with loss of tooth enamel that may be a sign of repeated vomiting
- Leaving during meals to use the toilet
- Eating much more food in a meal or snack than is considered normal
- Expressing depression, disgust, shame or guilt about eating habits
- Eating in secret
If you're worried that your child may have an eating disorder, contact his or her doctor to discuss your concerns. If needed, you can get a referral to a qualified mental health provider for treatment.
The exact cause of eating disorders is unknown. As with other mental illnesses, there may be many causes, such as:
- Genetics. Certain people may have genes that increase their risk of developing eating disorders. People with first-degree relatives — siblings or parents — with an eating disorder may be more likely to develop an eating disorder, too.
- Psychological and emotional health. People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior and troubled relationships.
- Society. Success and worth are often equated with being thin in popular culture. Peer pressure and what people see in the media may fuel this desire to be thin.
Certain situations and events might increase the risk of developing an eating disorder. These risk factors may include:
- Being female. Teenage girls and young women are more likely than teenage boys and young men to have anorexia or bulimia, but males can have eating disorders, too.
- Age. Although eating disorders can occur across a broad age range — including childhood, the teenage years and older adulthood — they are much more common during the teens and early 20s.
- Family history. Eating disorders are significantly more likely to occur in people who have parents or siblings who've had an eating disorder.
- Mental health disorders. People with depression, anxiety disorder or obsessive-compulsive disorder are more likely to have an eating disorder.
- Dieting. People who lose weight are often reinforced by positive comments from others and by their changing appearance. This may cause some people to take dieting too far, leading to an eating disorder.
- Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress, which may increase your risk of an eating disorder.
- Sports, work and artistic activities. Athletes, actors, dancers and models may be at higher risk of eating disorders. Coaches and parents may unwittingly contribute to eating disorders by encouraging young athletes to lose weight.
Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely you are to experience serious complications, such as:
- Significant medical problems
- Depression and anxiety
- Suicidal thoughts or behavior
- Problems with growth and development
- Social and relationship problems
- Substance use disorders
- Work and school issues
Here's some information to help you get ready for your appointment, and what you might expect from your doctor and other health providers.
What you can do
Before your appointment, make a list of:
- Any symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment
- Key personal information, including any major stresses or recent life changes
- All medications, vitamins or other supplements that you're taking, and their doses
- Questions to ask your doctor so that you'll remember to cover everything you wanted to
Ask a family member or friend to come with you, if possible. Someone who accompanies you may remember something that you missed or forgot. A family member may also be able to give your doctor a fuller picture of your home life.
Some questions you might want to ask your doctor or other health care provider include:
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What treatments are available, and which do you recommend?
- How will treatment affect my weight?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
Don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Your doctor or other health care provider is likely to ask you several questions, such as:
- How long have you been worried about your weight?
- Do you exercise? How often do you exercise and for how long?
- Have you found any other ways to lose weight?
- Are you having any physical symptoms?
- Have you ever vomited because you were uncomfortably full?
- Have others expressed concern about your weight?
- Do you think about food often?
- Do you ever eat in secret?
- Have any of your family members ever had symptoms of or been diagnosed with an eating disorder?
Eating disorders are diagnosed based on signs, symptoms and eating habits. If your doctor suspects you have an eating disorder, he or she will likely perform physical and psychological exams and request tests to help pinpoint a diagnosis. You may see both a medical doctor and a mental health provider for a diagnosis.
Exams and tests generally include:
- Physical exam. Your doctor will likely examine you to rule out other medical causes for your eating issues. He or she may also order lab tests.
- Psychological evaluation. A doctor or mental health provider will likely ask about your thoughts, feelings and eating habits. You may also be asked to complete psychological self-assessment questionnaires.
- Other studies. Additional tests may be done to check for any complications related to your eating disorder. Evaluation and testing may also be done to determine your nutritional requirements.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for various eating disorders. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Each eating disorder has its own set of diagnostic criteria. Your mental health provider will review your signs and symptoms to see if you meet the criteria for a specific eating disorder. Some people may not meet all of the criteria but still have an eating disorder and need professional help to overcome or manage it.
Treatment of an eating disorder generally includes a team approach. The team typically includes medical providers, mental health providers and dietitians — all with experience in eating disorders.
Treatment depends on your specific type of eating disorder. But in general, it typically includes psychotherapy, nutrition education and medication. If your life is at risk, you may need immediate hospitalization.
Psychotherapy, also called talk therapy, can help you learn how to replace unhealthy habits with healthy ones. This may include:
- Cognitive behavioral therapy (CBT). CBT is commonly used in eating disorder treatment, especially for bulimia and binge-eating disorder. You learn how to monitor your eating and your moods, develop problem-solving skills and explore healthy ways to cope with stressful situations. Psychotherapy can also help improve your relationships and your mood.
- Family-based therapy (FBT). FBT is an evidence-based treatment for children and teenagers with eating disorders. The family is involved in making sure that the child or other family member follows healthy-eating patterns and maintains a healthy weight.
Weight normalization and nutrition education
If you're underweight due to an eating disorder, the first goal of treatment will be to start getting you back to a healthy weight. No matter what your weight, dietitians and other health care providers can give you information on a healthy diet and help design an eating plan to help you achieve a healthy weight and learn normal-eating habits.
If you have serious health problems, such as anorexia that has resulted in severe malnutrition, your doctor may recommend hospitalization on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.
Medication can't cure an eating disorder. However, certain medications may help you control urges to binge or purge or to manage excessive preoccupations with food and diet. Drugs such as antidepressants and anti-anxiety medications may help with symptoms of depression or anxiety, which are frequently associated with eating disorders.
When you have an eating disorder, taking care of yourself can help you feel better during and after treatment and help maintain your overall health.
Try to make these steps a part of your daily routine:
- Stick to your treatment plan — don't skip therapy sessions and try not to stray from meal plans.
- Talk to your doctor about appropriate vitamin and mineral supplements to make sure you're getting all the essential nutrients.
- Don't isolate yourself from caring family members and friends who want to see you get healthy and have your best interests at heart.
- Talk to your health care providers about what kind of exercise, if any, is appropriate for you.
- Read self-help books that offer sound, practical advice. Your health care provider may recommend some helpful resources.
- Resist urges to weigh yourself or check yourself in the mirror frequently. This may simply fuel your drive to maintain unhealthy habits.
Alternative medicine is the use of a nonconventional approach instead of conventional medicine. Complementary medicine is a nonconventional approach used along with conventional medicine.
Usually, when people turn to alternative medicine it's to improve their health. But there are numerous dietary supplements and herbal products designed to suppress the appetite or aid in weight loss, and these products may be abused by people with eating disorders. Such products can have potentially dangerous interactions with other medications.
Additionally, weight-loss supplements or herbs can have serious side effects, such as irregular heartbeats, confusion, nausea, dizziness and nervousness.
Talk with your doctor before trying any alternative medicine. Natural doesn't always mean safe. Your doctor can help you understand possible risks and benefits before you try a treatment.
Reduce stress and anxiety
Complementary treatments may help reduce anxiety in people with eating disorders. Such treatments may help people with eating disorders by reducing stress, promoting relaxation and increasing a sense of well-being.
Examples of anxiety-reducing complementary treatments include:
It's difficult to cope with an eating disorder when you're hit with mixed messages by the media, culture, and perhaps your own family or friends. Whether you or your loved one has an eating disorder, ask your doctor or therapist for advice on coping and emotional support.
Learning effective coping strategies and getting the support you need from family and friends are vital to successful treatment.
Although there's no sure way to prevent eating disorders, here are some strategies to help your child develop healthy-eating behaviors:
- Encourage healthy-eating habits and avoid dieting around your children. Family dining habits may influence the relationships children develop with food. Eating meals together gives you an opportunity to teach children about the pitfalls of dieting and encourages eating a balanced diet in reasonable portions.
- Talk to your child. Because there are numerous websites that promote anorexia as a lifestyle choice rather than an eating disorder, it's important to talk to your child about the risks of unhealthy eating choices.
- Cultivate and reinforce a healthy body image in your children, whatever their shape or size. Talk to them about their self-image and offer reassurance that body shapes can vary. Don't criticize your own body in front of your children. Messages of acceptance and respect can help build healthy self-esteem and resilience that will carry children through the rocky periods of the teen years.
- Enlist the help of your child's doctor. At well-child visits, doctors may be in a good position to identify early indicators of an eating disorder. They can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance. These visits should include checks of height and weight percentiles and body mass index, which can alert you and your child's doctor to any significant changes.
If you notice a family member or friend with low self-esteem, severe dieting, frequent overeating or dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, reaching out with compassion may encourage the person to seek treatment.
Feb. 14, 2015
- Feeding and eating disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://psychiatryonline.org. Accessed Dec. 16, 2014.
- Feed and eating disorders. American Psychiatric Publishing. http://www.dsm5.org/Pages/Default.aspx. Accessed Dec. 18, 2014.
- Complementary, alternative, or integrative health: What's in a name? National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/whatiscam. Accessed Dec. 18, 2014.
- Breuner CC. Complementary, holistic, and integrative medicine: Eating disorders. Pediatrics in Review. 2010;31:e75.
- Longo DL, et al. Harrison's Principles of Internal Medicine. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.mhmedical.com/book.aspx?bookid=331. Accessed Nov. 13, 2014.
- Campbell K, et al. Eating disorders in children and adolescents: State of the art review. Pediatrics. 2014;134:582.
- Couturier J, et al. Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders. 2013;46:3.
- Eating disorders. National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml. Accessed Dec. 18, 2014.
- Eating disorders. American Psychiatric Association. http://www.psychiatry.org/eating-disorders. Accessed Dec. 18, 2014.
- Eating disorders. American Psychological Association. http://apa.org/helpcenter/eating.aspx. Accessed Dec. 18, 2014.
- Eating disorders. National Alliance on Mental Illness. http://www.nami.org/Template.cfm?Section=By_Illness&Template=ContentDisplay.cfm&ContentID=65851. Accessed Dec. 18, 2014.
- Cook AJ. Decision Support System. Mayo Clinic, Rochester, Minn. Oct. 20, 2014.
- McElroy SL, et al. Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder: A randomized clinical trial. JAMA Psychiatry. In press. Accessed Jan. 14, 2015.
- Sim LA (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 4, 2015.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 5, 2015.
- Hensrud DD (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 8, 2015.