Eating disorders are a group of conditions marked by an unhealthy relationship with food. There are three main types of eating disorders:
Anorexia nervosa. This is characterized by weight loss often due to excessive dieting and exercise, sometimes to the point of starvation. People with anorexia feel they can never be thin enough and continue to see themselves as “fat” despite extreme weight loss.
Avoidant/restrictive food intake disorder (ARFID). This condition is characterized by eating very little and/or avoiding certain foods. It usually begins in childhood. People with ARFID may avoid certain foods because of their texture or odor.
Bulimia nervosa. The condition is marked by cycles of extreme overeating, known as bingeing, followed by purging or other behaviors to compensate for the overeating. It is also associated with feelings of loss of control about eating.
Binge eating disorder. This is characterized by regular episodes of extreme overeating and feelings of loss of control about eating.
Eating disorders tend to develop during the teenage and young adult years, and they are much more common in girls and women. No one knows the precise cause of eating disorders, but they seem to coexist with psychological and medical issues such as low self-esteem, depression, anxiety, trouble coping with emotions, and substance abuse.
For some people, a preoccupation with food becomes a way to gain control over one aspect of their lives. Although it may start out as simply eating a bit more or less than usual, the behavior can spiral out of control and take over the person’s life. Eating disorders are a serious medical problem that can have long-term health consequences if left untreated.
It’s common for people with eating disorders to hide their unhealthy behaviors, so it can be difficult to recognize the signs of an eating disorder, especially early on. Keep in mind that you can't necessarily tell by how someone looks -- including their size -- if they have an eating disorder.
Here’s a more detailed look at the symptoms of anorexia, bulimia, and binge eating disorder.
Signs of Anorexia Nervosa
People with anorexia nervosa have an extreme fear of gaining weight. They often diet and exercise relentlessly, sometimes to the point of starvation. About one-third to one-half of anorexics also binge and purge by vomiting or misusing laxatives. People with anorexia have a distorted body image, thinking they are overweight when in fact they are underweight. They may count calories obsessively and only allow themselves tiny portions of certain specific foods. When confronted, someone with anorexia will often deny that there’s a problem.
The signs of anorexia can be subtle at first, because it develops gradually. It may begin as an interest in dieting before an event like a school dance or a beach vacation. But as the disorder takes hold, preoccupation with weight intensifies. It creates a vicious cycle: The more weight the person loses, the more that person worries and obsesses about weight.
The following symptoms and behaviors are common in people with anorexia:
- Dramatic weight loss
- Wearing loose, bulky clothes to hide weight loss
- Preoccupation with food, dieting, counting calories, etc.
- Refusal to eat certain foods, such as carbs or fats
- Avoiding mealtimes or eating in front of others
- Preparing elaborate meals for others but refusing to eat them
- Exercising excessively
- Making comments about being “fat”
- Stopping menstruating
- Complaining about constipation or stomach pain
- Denying that extreme thinness is a problem
Because people with anorexia are so good at hiding it, the disease may become severe before anyone around them notices anything wrong. If you think someone you care about has anorexia, it’s important to have them evaluated by a doctor right away. If left untreated, anorexia can lead to serious complications such as malnutrition and organ failure. However, with treatment, most people with anorexia will gain back the weight they lost, and the physical problems they developed as a result of the anorexia will get better.
Signs of Bulimia Nervosa
People with bulimia nervosa have episodes of eating large amounts of food (called bingeing) followed by purging (vomiting or using laxatives), fasting, or exercising excessively to compensate for the overeating.
Unlike anorexia, people with bulimia are often a normal weight. But they have the same intense fear of gaining weight and distorted body image. They see themselves as “fat” and desperately want to lose weight. Because they often feel ashamed and disgusted with themselves, people with bulimia become very good at hiding the bulimic behaviors.
The following are common signs of bulimia:
- Evidence of binge eating, including disappearance of large amounts of food in a short time, or finding lots of empty food wrappers or containers
- Evidence of purging, including trips to the bathroom after meals, sounds or smells of vomiting, or packages of laxatives or diuretics
- Skipping meals or avoiding eating in front of others, or eating very small portions
- Exercising excessively
- Wearing baggy clothes to hide the body
- Complaining about being “fat”
- Using gum, mouthwash, or mints excessively
- Constantly dieting
- Scarred knuckles from repeatedly inducing vomiting
If left untreated, bulimia can result in long-term health problems such as abnormal heart rhythms, bleeding from the esophagus due to excessive reflux of stomach acid, dental problems, and kidney problems. However, bulimia can be treated successfully through cognitive-behavioral therapy, certain anticonvulsant medicines, antidepressants, or combinations of these therapies. It’s important to seek help if you think someone you care about has bulimia.
Signs of Binge Eating Disorder
Rather than simply eating too much all the time, people with binge eating disorder have frequent episodes where they binge on large quantities of food. Like people with bulimia, they often feel out of control during these episodes and later feel guilt and shame about it. The behavior becomes a vicious cycle, because the more distressed they feel about bingeing, the more they seem to do it. Because people with binge eating disorder do not purge, fast, or exercise after they binge, they are usually overweight or obese.
Unlike other eating disorders, binge eating disorder is almost as common in men as it is in women. According to statistics from the National Institute of Mental Health, the average age at onset for binge eating disorder is 25, and it is more common in people under age 60.
Common signs of binge eating disorder include:
- Evidence of binge eating, including disappearance of large amounts of food in a short time, or finding lots of empty food wrappers or containers
- Hoarding food, or hiding large quantities of food in strange places
- Wearing baggy clothes to hide the body
- Skipping meals or avoiding eating in front of others
- Constantly dieting, but rarely losing weight
Because binge eating leads to obesity, it can have serious health consequences if left untreated. Behavioral weight reduction programs can be helpful both with weight loss and with controlling the urge to binge eat. The stimulant drug Vyvanse is FDA-approved for the treatment of binge eating disorder. Another medication, Contrave, is used as a treatment to reduce appetite. Also, because depression often goes hand in hand with binge eating disorder, antidepressants and psychotherapy may also help.
Recognizing the signs and symptoms of an eating disorder is the first step toward getting help for it. Eating disorders are treatable, and with the right treatment and support, most people with an eating disorder can learn healthy eating habits and get their lives back on track.
