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.
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.