A Guide To Eating Disorders And Treatment

Eating disorders are complex, life-changing mental illnesses that come in many forms. No eating disorder case is the same, and a person may engage in various behaviors that complicate a diagnosis. To make it easier to understand and treat eating disorders, it may be valuable to look at the symptoms of common eating disorders and possible treatments for recovery. 

Note that symptoms may result in multiple diagnoses and require personalized treatment. Consult your physician for further support if you’re concerned about an eating disorder.

What are eating disorders? 

According to the American Psychological Association (APA), eating disorders are characterized by patterns of maladaptive thoughts and behaviors surrounding food. Eating disorders can harm one’s well-being and may be life-threatening due to the impacts they can have on eating behaviors. 

People do not choose to have eating disorders. They are biologically influenced conditions often shaped by a combination of genetics, social factors, and psychological influences. The APA estimates that 20 million women and 10 million men experience an eating disorder at some point. These statistics show that eating disorders are pervasive and not confined to gender. 

A list of eating disorders

There are many types of eating disorders, and they can each impact individuals in a variety of ways. A person can also experience symptoms of multiple eating disorders at once — for example, they may experience anorexia nervosa, binge eating disorder, and bulimia nervosa. 

Below are a few of the most commonly diagnosed eating disorders in childhood, adolescence, and young adulthood. 

Anorexia nervosa

Anorexia nervosa is associated with restrictive food intake, potentially combined with excessive exercise to change body size or weight. Other symptoms of anorexia include:

• Distorted body image or self-image, dependent on perceptions of body weight

• Intense fear of gaining weight

• Denial of the seriousness of food restriction, intensive exercise, or low body weight

• Significant nutritional deficiency 

• Excessive interest in weight loss, weight checking, or body checking 

• Unwillingness to maintain a healthy weight

Due to cultural stereotypes about anorexia, diagnosing this condition can be challenging. Not everyone with anorexia nervosa is underweight, and body shape might not be a defining characteristic. Someone who “looks” healthy can be ill, so looking at the underlying thought patterns behind the symptoms can be essential. 

Bulimia nervosa

Bulimia nervosa is an eating disorder characterized by a cycle of binge eating and compensatory behaviors, according to the National Eating Disorder Association. People with bulimia may use self-induced vomiting, laxatives, or diuretics to “compensate” for eating large quantities of food.

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the main symptoms of bulimia nervosa include: 

• Recurrent binge eating episodes. An episode of “binge eating” is characterized by both of the following: 

• Eating a food quantity larger than healthy for a specific period 

• A feeling that one lacks control over their eating habits 

• Self-perception heavily influenced by body weight and shape

• Recurrent use of unhealthy behaviors to prevent weight gain, including misuse of laxatives, self-induced vomiting, fasting, or medications

People with bulimia may also undergo noticeable fluctuations in weight, including weight loss and gain. They may disappear to the bathroom or another place to purge food during meals, and they may wear baggy clothes to hide weight loss from friends and family. Due to chronic vomiting, bulimia can result in stomach and digestive issues, unusual blood tests (for example, anemia or low potassium), and dental concerns. 

Binge eating disorder

A perceived loss of control over food behaviors and the quantity of food consumed characterizes binge eating disorder. This feeling may result in recurring binge episodes, during which people eat large amounts of food. 

While people with bulimia also experience binge episodes, people diagnosed with binge-eating disorder don’t use fasting, purging behaviors, or excessive exercise after binging to rid their bodies of food. 

Common symptoms of binge-eating disorder include: 

• Eating large amounts of food rapidly during binge episodes until uncomfortably full

• Eating a food quantity that is larger than a healthy recommended meal size   

• Eating alone to avoid embarrassment or shame

• Feeling distressed or guilty about eating

• Having a history of dieting

People with binge eating disorder may also have a higher body weight due to frequent binge episodes. However, weight is not necessarily a sign of an eating disorder or poor health. 

Body dysmorphic disorder (BDD) 

While this condition often coincides with anorexia, bulimia, or another form of disordered eating, it is a distinct and specific mental illness. People with BDD have an excessive preoccupation with an imagined defect or flaw in their physical appearance or excessive concern with a slight physical anomaly. 

Often, people with BDD “check” their bodies for the perceived flaw. If a person perceives that the “flaw” can be changed through diet and exercise, their behaviors can evolve into another eating disorder. 

Not everyone with an eating disorder has BDD, but some people develop both BDD and another distinct form of eating disorder, depending on their aesthetic concerns and resulting behaviors.

Other forms of eating disorders

While some symptoms of anorexia, bulimia, and binge-eating disorder may be more “visible” or commonly diagnosed, other forms of serious eating disorders can impact the physical and mental health of those living with them, including the following. 

Avoidant restrictive food intake disorder (ARFID)

Avoidant restrictive food intake disorder or ARFID is characterized by limiting the amount or type of food eaten. However, unlike anorexia, this condition is not associated with body image concerns or extreme fear of weight gain. ARFID is common in middle childhood, although adults can also be diagnosed. This condition can prevent people from consuming enough calories for optimal functioning and may lead to anemia and other deficiencies. 

ARFID is often also associated with food aversion, which could mean feeling disgusted by or scared of certain textures, flavors, or food sizes. Some people with ARFID may be afraid of swallowing large bites or feel that food will become stuck in their throat or won’t be properly digested. They may have a few foods they feel safe eating but might forget to eat during the day or consider eating a lower priority in their daily schedule. 

Other specified feeding or eating disorders (OSFED)

OSFED is a diagnosis for a person with many or some of the symptoms of other eating disorders, but these symptoms not meet the full diagnostic criteria for the condition or conditions. An example of OSFED may be subthreshold bulimia nervosa. 

Unspecified feeding or eating disorder (UFED)

Unspecified feeding or eating disorder is used to describe a disorder that causes significant distress but doesn’t meet all the criteria in the DSM-5. 

Pica

Pica is characterized by the urge to eat non-nutritional, non-food substances, which is inappropriate for an individual’s development level. For example, someone with this condition may crave paper, ice, or another non-food substance. They may or may not eat the items they crave. 

Rumination disorder

People with rumination disorder repeatedly and unintentionally regurgitate their food. This behavior is not associated with another medical condition or intentional purging of foods consumed. The food might be vomited or re-swallowed after it regurgitates from the stomach. 

Eating disorder treatment

Because eating disorders develop differently in each person, approaches to treatment can vary. Eating disorder treatment often involves a combination of psychotherapy, medical care, physical monitoring, nutrition counseling, or medications, depending on the person’s physical and mental health state. 

For people who have experienced significant weight fluctuations or other dangerous physical changes due to an eating disorder, possible treatment goals could include the following: 

• Establishing and adhering to a nourishing meal plan

• Stopping binging or purging behaviors

• Resting more and reducing excessive exercise

• In the case of significant weight loss or gain, restoring weight to a healthy level

People with eating disorders sometimes work with a team of doctors, nutritionists, and therapists specializing in treating food-related mental health concerns. Health care providers may monitor weight and body mass index, while therapists may help patients challenge inaccurate thoughts and replace them with healthy thoughts. 

Online therapy for eating disorders 

During eating disorder recovery, therapy can be an essential tool. However, many clients may fear meeting with a therapist in person or find it inaccessible to their health needs. In these cases, digital platforms like BetterHelp can match clients with licensed therapists online, some of whom have years of experience working with eating disorders and other mental disorders, such as anxiety and obsessive-compulsive disorder (OCD).

Research indicates that online therapy for eating disorders can be as effective as traditional, in-person counseling. A 2019 review, for instance, assessed 23 scientific papers and found that digital therapies for eating disorders, primarily intended for people with bulimia and binge-eating disorder, produced significant decreases in their symptoms, as well as reduced anxiety and depression. 

Through an online platform, clients can sign up for an appointment slot with their therapist at a time that works for them and choose between phone, video, or chat sessions. These flexible options may be preferable for someone looking for patience and distance while they start exploring their eating disorder symptoms and any related sensory characteristics.