Understanding Eating Disorders: Signs, Symptoms, and When To Seek Help

Eating disorders are severe behavioral conditions characterized by persistent disturbances in eating habits. Eating disorders are often accompanied by distressing thoughts and emotions. Though several eating disorders are more common among women, eating disorders can affect individuals of any gender or age (Psychiatry.org). Eating disorders co-occur with mood, anxiety, and substance use disorders. Today, eating disorders affect around 5% of the population, impacting their health, emotions, and ability to function properly in critical aspects of their lives (Mayo Clinic). Here are some of the most common eating disorders, their signs, and symptoms:

Anorexia Nervosa

Anorexia nervosa is a serious psychiatric disorder because of its high mortality rate (Demiroglu Science University), which is second only to opioid use disorder (Psychiatry.org). Anorexia nervosa is marked by self-starvation and is apparent because of the visible weight loss, leading to dangerous levels of low weight for their age and height. Individuals living with anorexia often have a body mass index (BMI) below 18.5 (Cleveland Clinic).

A defining feature among individuals is an intense fear of gaining weight or becoming fat. Many individuals claim to desire to gain weight by acting inconsistently by taking in small amounts of low-calorie foods and exercising excessively. In some cases, individuals binge eat and purge later on through vomiting or laxative misuse.

Anorexia nervosa has two subtypes, namely:

• Restricting Type: Weight loss occurs through dieting, fasting, or excessive exercise.
• Binge-Eating/Purging Type: Intermittent binge eating or purging behaviors.

Both subtypes exhibit symptoms, such as missed menstrual periods, dizziness, brittle hair and nails, cold intolerance, severe constipation, muscle weakness, heartburn, and depression. Comorbidities, which are often life-threatening, include heart rhythm abnormalities and kidney problems.

Treatment: Common treatment focuses on normalizing eating patterns to restore weight while addressing co-occurring medical or psychological conditions. Extreme cases may require inpatient or residential care.

Bulimia Nervosa

Bulimia Nervosa began to be recognized in the 1930s to the 1940s, though it wasn’t formally classified until decades later. By the 1970s, diagnostic frameworks were developed to formally identify anorexia nervosa and bulimia nervosa (NIH). However, unlike anorexia, individuals with bulimia may be underweight, have normal weight, overweight, or even obese. Signs of bulimia include disappearing food, frequent trips to the bathroom after meals, swollen salivary glands, chronic sore throat, dental decay, and recurrent diarrhea.

Cycles of dieting and binge eating, often high-calorie or “forbidden foods,” characterize bulimia nervosa. Individuals binge on food quickly and feel a loss of control, followed by shame or embarrassment. Individuals use compensatory behaviors, such as vomiting, fasting, laxative misuse, or excessive exercise, to prevent weight gain.

Bulimia may cause severe physical complications, such as esophageal tears, gastric rupture, and severe heart arrhythmias. 

Treatment: Common treatment for bulimia includes cognitive behavioral therapy (CBT), antidepressants, and family-based approaches.

Binge Eating Disorder

Binge eating disorder has only been recently recognized as a distinct psychological condition since the 19080s (DSM-5, 2013, NIH). Though specific eating habits are common with bulimia, binge eating disorder also involves consuming large food quantities with a sense of loss of control but without compensatory behaviors like vomiting or laxative misuse. Binge eating disorder leads to obesity and other health issues (namely, hypertension, diabetes, and cardiovascular disease).

Binge eating disorder symptoms include eating rapidly or eating when not hungry. Symptoms of binge eating disorder may also be eating alone due to embarrassment or having feelings of guilt and disgust after binging. Diagnosis requires episodes occurring at least weekly for three months (Psychiatry.org).

Treatment: Treating binge eating disorder includes cognitive behavioral therapy (CBT), antidepressants, interpersonal therapy, and medications, such as lisdexamfetamine.

Other Specified Feeding and Eating Disorders (OSFED)

Along with binge eating disorder, OSFED became medically recognized with the publication of the DSM-5 in 2013 (NIH), replacing EDNOS (Eating Disorder Not Otherwise Specified) to provide more specific diagnostic criteria for individuals whose eating disorders did not fully meet the criteria for other eating disorders, such as anorexia, bulimia, or binge-eating disorder, but still cause significant distress and impairment. An example of OSFED is atypical anorexia nervosa (psychiatry.org), where individuals engage in extreme weight control behaviors but are not underweight due to a higher starting weight. However, cases show individuals suffer rapid weight loss, leading to severe medical complications regardless of BMI.

Treatment: Treatment for OSFED involves addressing both the behaviors and underlying concerns.

Rumination Disorder

Along with OSFED, rumination disorder was recognized as a distinct diagnosis in 2013 instead of being a subcategory of EDNOS. Repeated regurgitation and re-chewing of food without any underlying medical cause, such as gastrointestinal issues or any other eating disorder, characterize rumination disorder (Mayo Clinic). Rumination disorder may affect anyone from any age group or gender and may co-occur with intellectual disabilities.

Treatment: Treatment typically involves behavioral therapy to address regurgitation behaviors.

Pica

Pica involves eating non-food substances, such as paper, soap, or chalk, for at least a month. Pica occurs when these behaviors are inappropriate for the individual’s developmental level and are not culturally supported. Pica is most common in children and often co-occurs with autism spectrum disorder or intellectual disabilities (WebMD). Eating non-food items comes with serious risks, such as intestinal blockages or poisoning (for instance, when ingesting lead from paint chips). 

Treatment: Treatment for Pica addresses nutritional deficiencies and often involves behavioral interventions.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder (ARFID), unlike OSFED (in many cases) or anorexia nervosa, is not linked to any concerns about body weight or shape. Nevertheless, extreme food avoidance or restriction due to low appetite, sensory sensitivities, or fear of negative consequences, such as choking or allergies, characterizes ARFID. ARFID often begins in childhood, though in some cases, this may occur at any age (NEDA). 

Symptoms of ARFID include significant weight loss, nutritional deficiencies, reliance on supplements or feeding tubes, and interference with social functioning. 

Treatment: ARFD treatments involve personalized approaches with input from mental health professionals and dieticians.