Symptoms and causes

Symptoms

Symptoms vary, depending on the type of eating disorder. Anorexia nervosa, bulimia nervosa and binge-eating disorder are the most common eating disorders.

Anorexia nervosa

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 nervosa

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.

Binge-eating disorder

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

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

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.

Causes

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.

Risk factors

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.

Complications

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
  • Death