Eating Disorders

Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder and avoidant restrictive food intake disorder (ARFID).

Anorexia nervosa is a condition where people avoid food, severely restrict food or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.

There are two subtypes of anorexia nervosa: a "restrictive" subtype and a "binge-purge" subtype.

• In the restrictive subtype of anorexia nervosa, people severely limit the amount and type of food they consume.
• In the binge-purge subtype of anorexia nervosa, people also greatly restrict the amount and type of food they consume. In addition, they may have binge-eating and purging episodes—eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what was consumed.

Anorexia nervosa can be fatal. It has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.

Bulimia nervosa is a condition where people have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise or a combination of these behaviors. There is no one body type for people with bulimia; people with bulimia nervosa may be slightly underweight, normal weight or overweight.

Binge-eating disorder is a condition where people lose control over their eating and have recurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological and social factors. Researchers are using the latest technology and science to better understand eating disorders. Co-occuring mental health disorders linked to eating disorders include obsessive-compulsive disorder (OCD), depression, anxiety and trauma. Additionally, frequent dieting and restrictive eating, including constantly fluctuating weight, are risk factors for developing eating disorders. 

One approach involves the study of human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights and genders. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological and social factors. Researchers are using the latest technology and science to better understand eating disorders.

One approach involves the study of human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

Co-occuring mental health disorders linked to eating disorders include obsessive-compulsive disorder (OCD), depression, anxiety and trauma. Additionally, frequent dieting and restrictive eating, including constantly fluctuating weight, are risk factors for developing eating disorders. 

If you feel like you cannot control your food behaviors or body image–related self talk, work with your medical or mental health provider to complete a screening. Questions similar to the below will be asked:

• Are you satisfied with your eating patterns?
• Do you ever eat in secret?
• Does your weight affect the way you feel about yourself?
• Have any members of your family suffered from an eating disorder?
• Do you make yourself sick because you feel uncomfortably full?
• Do you worry you have lost control over how much you eat?
• Do you believe yourself to be fat when others say you are thin?
• Would you say that food dominates your life?

The field of eating disorders prevention has grown rapidly in the past two decades with the addition of a number of successful eating disorders prevention programs that typically focus on modifying specific factors known to identify high risk for developing eating disorders (ED). Factors that have been identified as risk factors to ED development include belief in the cultural thin-ideal (called thin-ideal internalization), perceived pressure to be thin, body dissatisfaction, self-reported dieting and symptoms of depression. 

A comprehensive meta-analysis from 2007 reported that half of eating disorders prevention programs led to reductions in risk factors like body dissatisfaction and thin-ideal obsession. If risk factors are reduced, cases of EDs are reduced or prevented in tandem, and EDs will not develop. The most promising prevention tool is to reduce current ED symptoms or prevent new symptom development. 

If you feel like you cannot control your food behaviors or body-image-related self talk, work with your medical or mental health provider to complete a screening. 

Questions similar to the below will be asked:

• Are you satisfied with your eating patterns?
• Do you ever eat in secret?
• Does your weight affect the way you feel about yourself?
• Have any members of your family suffered with an eating disorder?
• Do you make yourself sick because you feel uncomfortably full?
• Do you worry you have lost control over how much you eat?
• Do you believe yourself to be fat when others say you are thin?
• Would you say that food dominates your life?

The field of eating disorders prevention has grown rapidly in the past two decades, with the addition of a number of successful eating disorders prevention programs, which typically focus on modifying specific factors known to identify high risk for developing eating disorders. Factors that have been identified as risk factors to ED development include belief in the cultural thin-ideal (called thin-ideal internalization), perceived pressure to be thin, body dissatisfaction, self-reported dieting and symptoms of depression. 

A comprehensive meta-analysis from 2007 reported that half of eating disorders prevention programs led to reductions in risk factors like body dissatisfaction and thin-ideal obsession. If risk factors are reduced, cases of EDs are reduced or prevented in tandem, and EDs will not develop. The most promising prevention tool is to reduce current ED symptoms or prevent new symptom development. 

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

• Individual, group and/or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications

Family-based therapy, a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appears to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Evidence also suggests that medications such as antidepressants, antipsychotics or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression. The U.S. Food and Drug Administration (FDA)’s website has the latest information on medication approvals, warnings and patient information guides.

Clinical trials are research studies that look at new ways to prevent, detect or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at the National Institute of Mental Health (NIMH) and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your healthcare provider about clinical trials, their benefits and risks, and whether one is right for you.

Family-based therapy, a type of psychotherapy where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appears to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Evidence also suggests that medications such as antidepressants, antipsychotics or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression. The Food and Drug Administration’s (FDA) website has the latest information on medication approvals, warnings and patient information guides.

Clinical trials are research studies that look at new ways to prevent, detect or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your healthcare provider about clinical trials, their benefits and risks, and whether one is right for you.