Learn About, Accept, And Find Help For Eating Disorders

Frequently asked questions

Read more below for answers to questions commonly asked about this topic.

Which type of eating disorder has the highest rate of death?

While all eating disorders can be harmful to an individual’s physical and mental health, out of all eating disorders, anorexia nervosa has the highest rate of death. In fact, this condition has the highest mortality rate out of all mental disorders. While all eating disorders can carry an increased risk of death, the severe and prolonged starvation associated with anorexia can carry a risk of life-threatening complications, including:

• Heart rate irregularities
• Cardiovascular damage
• Immune system dysfunction
• Electrolyte imbalances
• Hypoglycemia (low blood sugar)

In addition to these dangers, anorexia (and all eating disorders) is associated with a substantially increased risk of suicide. Death by suicide is 18 times more common among individuals with anorexia than in the general population. If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and is available 24/7.

How does cognitive theory explain eating disorders?

Models of eating disorders based on cognitive theory explain these mental illnesses as resulting from dysfunctional ways of thinking about things like diet, body weight, control, and relationships. In some cases, they may involve early maladaptive schemas, which are self-defeating patterns of thought and behavior developed in childhood as a way to safeguard against the pain of unmet emotional needs.

According to cognitive theory, people with eating disorders may have unrealistic ideas about themselves and how they relate to others, such as a distorted self-image or intense fear of weight gain. 

Possible examples include:

• “No one will like me if I’m fat.”
• “If I don’t control my food intake, I’ll be ugly.”
• “Gaining weight is a sign of mental weakness.”
• “I can’t control how I eat.”
• “I’m never skinny enough.”
• “The way I eat is disgusting.”
  

Cognitive theories of mental illness predict that developing more realistic and constructive ways of thinking about weight, diet, and control will reduce eating disorder symptoms and can help individuals return to healthy eating patterns. To develop healthier thinking patterns, the National Institute of Mental Health (NIMH) lists a comprehensive treatment plan that includes talk therapy, family-based treatment, and group therapy sessions. 

What factors are involved in causing eating disorders?

The exact cause of eating disorders is unknown, but current research studies cited in American Psychiatric Publishing via MedCentral reveal several different types of risk factors that may play causal roles in eating disorders, including:

• Sociocultural attitudes such as idealization of thinness and stigmatization toward people with higher body weights
• Personality traits like perfectionism, desire for control, and a tendency toward negative emotions
• Adverse experiences in childhood, particularly neglect and sexual abuse
• Genetic and epidemic factors — having other family members, including immediate and extended family members, with eating disorders may be a significant risk factor.

According to the American Psychiatric Association (APA), co-occurring mental health conditions like obsessive-compulsive disorder (OCD), mood and anxiety disorders, and alcohol and substance use disorders also play a causal role. 

What happens to your brain when you don’t eat enough?

Malnutrition can have serious health consequences for brain functioning, too. A person who doesn’t eat enough for long periods may experience significant negative effects on the brain. This can be observed in eating disorders — individuals with anorexia nervosa show a loss of brain volume over time, particularly in areas associated with functions like:

• Attention and focus
• Impulse control
• Social interaction
• Behavioral management
• Reward processing and habit formation

Many of these changes associated with brain damage may be reversed when the individual regains a healthy weight. However, this may require time and a sustained commitment to recover. Treatment adherence can also help individuals avoid serious complications to their physical health as their bodies recover. 

Eating disorders can have a significant impact on other bodily systems, too. For example, the binging and purging cycle involved in bulimia nervosa can permanently damage the stomach and intestines, leading to problems including, but not limited to, chronic acid reflux and irritable bowel syndrome. Cardiovascular issues like poor circulation, heart disease, and low blood pressure are also possible. 

What eating disorders can lead to obesity, and can counseling help?

Research suggests that the eating disorders most likely to be associated with obesity are binge eating disorder (BED) and night-eating syndrome (NES). BED involves recurrent episodes of excessive, uncontrolled eating, while NES is characterized by consistent overeating at night.

Unwanted weight gain can be a symptom of both of these conditions. In time, this may lead to obesity, along with numerous associated health problems such as diabetes.

On the other hand, obesity may also contribute to the development of eating disorders such as anorexia and bulimia. Habits like self-starvation, excessive exercise, or induced vomiting might emerge as reactions to an unhealthy body weight.

Counseling for eating disorders

Studies show mental health counseling can help people recover from eating disorders, including eating disorders treated via virtual therapy. These mental health professionals use several strategies to address eating disorder issues, help patients develop healthy relationships with food, and provide coping strategies to help individuals overcome eating disorder behaviors and other symptoms. 

Nutrition counseling may also be necessary to support individuals in areas like meal planning so they can adhere to a balanced diet within an appropriate calorie range. Counseling might include group therapy with family members or a community of other individuals experiencing varying stages of eating disorders. 

What is a distorted body image, and how can body image affect emotions?

In psychological terms, a distorted body image means a skewed, inaccurate internal conception of what your body looks like. It may also be called body dysmorphia. Although the term “body image” might suggest a mainly visual problem, body image distortion can include feelings of physical discomfort as well as negative emotions and thoughts in response to perceiving or thinking about your body. 

Body dysmorphic disorder is not the same as anorexia or other eating disorders. However, a distorted body image frequently plays a part in eating disorders. People with these conditions may believe that they are heavier than they really are, and this idea may persist even when contradicted by reflections or images of themselves. However, it’s also possible to have other kinds of body dysmorphia, such as believing you are more or less muscular than you are. Body image distortion is often the root cause of maladaptive behaviors like compulsive exercising, excessive dieting, and forced vomiting.  

What not to say to someone with body image issues?

When talking with someone who appears to have difficulty with their body image, it can be important to avoid talking in ways that reinforce weight-related beauty standards. For instance, if someone says, “I’m so fat,” it’s often counterproductive to say things like:

• “No way, you’re really skinny.”
• “Look how much bigger I am.”
• “That’s not true, you’re so pretty/handsome.”

While they may be well-intentioned, phrases like these can strengthen the mental connection between thinness and beauty. It may be best to avoid discussing appearance as much as possible to avoid contributing to an individual’s mental health problems. 

It can also be uncomfortable to try to force them to talk about their bodies when they don’t want to. Even if you’re trying to get them to think more positively, it may cause them distress and deepen their sense of shame about their appearance. For the same reasons, it’s likely a bad idea to try to urge them to eat more or say positive things about how they look.

How do you support and help someone with body image issues?

Here are a few strategies that may help you be a supportive influence for someone wrestling with their body image:

• Give non-physical compliments. By talking positively about the other person’s values, achievements, and personality, you can often help build up their self-esteem without reinforcing the importance of beauty.
• Ask questions. When someone expresses negative feelings about their body, it may help to ask why they feel that way instead of contradicting them. You may also want to ask about other areas of their life — you may discover sources of emotional difficulty that have nothing to do with weight and appearance.
• Practice active listening. If your friend or family needs to express negative feelings, listening without contradicting or dismissing what they have to say could be helpful. You can ask for details and invite them to talk rather than pushing them to think a certain way.
• Help them think about other things. Conversations about things other than weight, food, and body image may help the other person stop fixating so much on these issues. Activities that don’t center around food, such as watching a movie, playing a game, or simply hanging out and chatting, could also turn their mind to other things.
• Let them know how you feel. While waving away the other person’s concerns about their body may not be helpful, you can express feelings like sadness, concern, or confusion when you hear them talking negatively about themselves or displaying unhealthy behaviors. Emphasizing that your feelings are coming from a place of love and care can help remind them that they have people on their side.
• Support them in seeking treatment. When someone expresses a desire to get help for eating disorders, speaking encouragingly about the benefits of therapy may help encourage them to pursue treatment. If you’ve had positive experiences with mental health care, discussing them might also be useful. Individuals who are reluctant to seek treatment with a mental health care provider might be more willing to visit a primary care provider to address their physical symptoms first. 
  

When do most eating disorders begin?

Eating disorders can develop and affect people at any age. However, they appear to be most likely to emerge in adolescence and young adulthood. A 2022 review of more than 190 mental health surveys from around the world reported that the most common age of onset for eating disorders was approximately 15-16 years old. Over 80% of people with eating disorders had developed them by age 25. Disordered eating behaviors may begin even earlier, however. Researchers at the University of Montreal described cases of children as young as 8 years old who were engaging in actions such as deliberate vomiting or restricted eating.

What are some treatment and recovery options for eating disorders?

Professional help is often essential for helping people manage and overcome eating disorders. Eating disorders and their behavioral symptoms are generally treated with various forms of psychotherapy. Currently, eating disorder treatment options with the strongest evidence base include:

• Cognitive-behavioral therapy (CBT). This approach involves working with a therapist to identify and reframe destructive patterns of thought about food and weight, as well as practicing positive habits related to eating.
•  Interpersonal psychotherapy (IPT). IPT is a brief form of therapy that encourages clients to rethink their social relationships and self-image, potentially helping them to de-emphasize the idea that they need to look a certain way to be accepted. 
• Family therapy. This method works with the entire family to address the complicated relationship dynamics and emotions that may create and sustain unhealthy attitudes toward eating. It may be especially effective at treating child and adolescent eating disorders.

Medical care and supervision: Accepting help for eating disorders

In severe cases of eating disorders, medical care and supervision may be needed to help manage nutrition and weight gain and avoid additional health consequences. For example, people with anorexia recovering from prolonged starvation may be at risk of refeeding syndrome if they’re not assisted by a trained physician. This could lead to a serious medical emergency. It’s often best to develop a treatment plan with a primary care doctor to address and manage potentially serious health problems associated with eating disorders. 

Physicians might run a battery of tests to determine the potential damage the eating disorder can cause an individual. For example, they may ask about the person's medical history, including any family history of mental health problems. They might also conduct a full physical, including lab work, urine tests, and more. 

If you’re wondering where to find eating disorder treatment, you may want to visit the website of the National Eating Disorders Association (NEDA). They offer a tool for locating trained care providers and residential treatment programs, as well as a variety of informational resources on how to approach eating disorder recovery and how to seek treatment. The National Alliance for Eating Disorders also provides tools and resources, including free access to weekly therapist-led eating disorders support groups