Eating Disorders Overview
What Are Eating Disorders?
While most people are concerned about what they eat, the American Psychological Association (APA) states that people with eating disorders have abnormal eating habits that can be harmful to their health and even their life.1 Although it is hard to get an exact statistic of how many people are suffering with an eating disorder, it is often cited by researchers that in the United States up to 20 million women and 10 million men will battle an eating disorder in their lifetime.2 Eating disorders are most common in female adolescents but they can occur in men and women at any point in their life.3
There is no one cause of eating disorders and each disorder should be addressed individually. However, most forms of eating disorders do seem intimately related with body dissatisfaction.4 For example, a recent study revealed that when women with eating disorders look in a mirror, they are more likely to focus on the parts of their body that they do not like compared to women without an eating disorder.5 Additionally, there are multiple risk factors that can also increase the chances of a person forming an eating disorder.
Several biological influences may contribute to the risk factors of an eating disorder developing. Genetics seem to play a role in eating disorders as a person is more at risk to develop an eating disorder in their lifetime if one of their parents has had an eating disorder.6 In addition, research also shows people are at a higher risk of developing an eating disorder if one of their parents (especially their mother) has been diagnosed with a bipolar affective disorder, a personality disorder, or anxiety/ depression.7 Some evidence supports a relationship with eating disorders and both the neurotransmitters serotonin, which has a role regulating appetite8, and dopamine, which has a role regulating pleasure but current research has shown mixed results and much more research needs to be done.9
There are certain psychological factors that can raise the risk of developing an eating disorder. Certain personality traits found in an individual seem to put them more at risk for developing an eating disorder. Specifically, it is common for a person with an eating disorder to derive most or all of their self-worth from their shape and weight. Often making a whole self-judgment on one small part of their life (body weight) while ignoring so many other important parts of their life (such as other traits and relationships).10 Also people with the personality traits of negative self-evaluation, low self-esteem, and perfectionism are more at risk.11
The culture a person lives in or grew up in can put them more at risk for an eating disorder. Specifically, if the culture emphasizes an “idealization of thinness” (as modern Western culture often does), the risk of developing an eating disorder increases.11 Also spending time with people who follow strict diets predicts higher body dissatisfaction, use of unhealthy weight control behaviors, and binge eating11. Lastly, eating disorders can often directly follow a stressful life event such as an experience of failure, separation from parents or a loss of a loved one.12
These are all things that can put someone more at risk for developing an eating disorder but they can affect people of all age, gender, and walks of life.
Because there is no single cause for an eating disorder and both the severity and underlying reasons vary, treatment can be difficult. Not only does each eating disorder have its own treatment, but a specific treatment plan for a specific individual is often necessary.28 Generally, when treating an eating disorder the first goal is to correct the dangerous eating pattern as quickly as possible by taking actions such as ceasing compensatory behaviors or beginning a healthy consistent diet and bringing the individual back to a healthy weight. Secondly, address the underlying psychological, biological and situational factors to maintain a long term outcome.15
Due to the varying causes of eating disorders, it is often necessary to have a multidisciplinary team which includes: a psychologist, psychiatrist, social worker, nutritionist, and primary care physician. This team should be coordinated by a trusted health professional with expertise and experience in dealing with eating disorders.28 Treatment usually involves psychotherapy, family therapy and/or cognitive behavioral therapy.3 Antidepressant medications may also be prescribed to specific eating disorders (notably bulimia nervosa).3 In extreme cases, hospitalization may be necessary.28
Types of Eating Disorders
There are many types of eating disorders and it is important to remember this list does not cover every eating disorder. Often you do not need to have every symptom in the disorder to be diagnosed and it possible to have symptoms from two or more different eating disorders.31
Anorexia nervosa is characterized by severe weight loss and starvation.1 According to the APA, persons with anorexia have a severely distorted body image and tend to believe they are heavier than they actually are, even if they are dangerously thin in reality. Often people with anorexia refuse to eat, exercise compulsively, and develop unusual habits such as refusing to eat in front of others.1 Approximately one percent of adolescent American women are suffering with anorexia13 and it is one of the most common psychiatric diagnoses in young women.14
Bulimia nervosa is characterized by episodes of overeating, also known as binge eating, followed by “compensatory behaviors.” These behaviors most commonly include forced vomiting or the misuse of laxatives.15 Approximately four percent of college aged women have bulimia13 and 80 percent of overall bulimia cases are in women.16
Binge Eating Disorder is the most common eating disorder in the United States, and affects an estimated 2.8 million adults in the US alone.17 Binge eating disorder, like bulimia, is characterized by frequent episodes of out-of-control eating. However, unlike bulimia, these episodes are not followed by compensatory behaviors.1
Diabulimia is an eating disorder in which patients with Type 1 Diabetes deliberately skip and/or restrict their insulin in order to cause extreme weight loss. People with this condition often also suffer from bulimic behaviors.18
Orthorexia nervosa is characterized by an unhealthy obsession with food quality and purity to the point that the person’s health suffers and other activities in their life are interfered with.19
Pica is characterized by the persistent eating of non-food items, such as paint or dirt.20
Rumination Disorder is most common in infants and is characterized by the regurgitation of already swallowed food. The regurgitated food is then often re-swallowed or spit out. 21,22
Sleep Eating Disorders
Sleep Related Eating Disorder is characterized by persistent episodes of compulsive binge eating after waking up in the middle of the night.23
While not traditionally thought of as an eating disorder, body dysmorphic disorder is an obsessive preoccupation of a perceived or imagined defect or flaw in personal appearance that others do not see.24
What to Do If You Are Suffering from an Eating Disorder
The road to recovery from an eating disorder may be a long one, but the first step is admitting to yourself you have an eating disorder. The next step is opening up and gaining support from someone you trust. It is important to not bottle up your feelings, you may be feeling ashamed, guilty or embarrassed but remember that eating disorders are a type of disease and you are surrounded by people who care and want to help you. When deciding who to openly talk to it is important to choose someone who will understand that this is a disease and will offer you support and empathy without judgement. Some people find this support in family members, friends, religious leaders, school counselors, online support groups, and some people find it easiest to talk to someone who has a large knowledge of eating disorders like a counselor or nutritionist.25Eating disorders are complex, and hard to overcome by yourself, therefore you should consider seeking help from an eating disorder treatment specialist. Professionals who understand what you are going through and will offer you a lot of the support and help you need without judgment or criticism. To find a specialist either ask though your general practitioner, your school counselor, or call the numbers on our “Important Phone Numbers/Resources.” As eating disorders are also closely related to body image please see our “Improving Your Body Image” article and our “18 Steps to Improving Your Body Image” article.
What to Do If a Loved One Has an Eating Disorder
If you believe a loved one is suffering from an eating disorder there are some things that you may be able to do to help. Firstly, try to educate yourself on the eating disorder, you probably won’t be able to fully understand what they are going through, but try to learn as much as you can on what they may be going through.26 The next step is talking with them openly and honestly about what they are going through. And while this may sound simple, it’s possible they just aren’t ready to talk or don’t want to talk. If this is the case, don’t force them to just make sure they know you care for them and will always be there to talk if at some point they want to. If they are willing to talk, your biggest role is to listen to what they have to say. Be caring, supportive and gentle but don’t try to offer too much advice. Remember, your main role is to listen and only when they specifically ask for your thoughts and opinions should you tell them your thoughts which should be honest and caring.27 For more detail on things you can doto help, and how to spot signs your loved one may be suffering from an eating disorder, please see our article, “If Someone You Know Has an Eating Disorder.”
The Effects of Eating Disorders and Relationships
Both having an eating disorder and having a partner with an eating disorder can have a strong effect on the relationships sex life. Since eating disorders are strongly intertwined with a negative self-body image and low self-esteem, being comfortable intimately with a partner can be hard (if not impossible).29 Additionally, a 2011 study, eating disorders are also associated with a decreased sexual desire and increased sexual anxiety and a higher prevalence of loss of libido.30 So, before any sexual intimacy, the partners must build trust and safety through both time and open communication to make sure everyone involved is comfortable being intimate. See our article, “Building Trust” and “Looking Past Body Image To Enjoy Your Sex Life” for tips on how to work on opening the communication within a relationship!
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8. Yu, L., & Pao-Yen, L. (2010). Association between serotonin transporter gene polymorphism and eating disorders: A meta-analytic study. International Journal Of Eating Disorders, 43(6), 498-504.
9. Davis, C., Levitan, R. D., Yilmaz, Z., Kaplan, A. S., Carter, J. C., & Kennedy, J. L. (2012). Binge eating disorder and the dopamine D2 receptor: Genotypes and sub-phenotypes. Progress In Neuro-Psychopharmacology & Biological Psychiatry, 38(2), 328-335. doi:10.1016/j.pnpbp.2012.05.002
10. Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive Behavioral Therapy for Eating Disorders. The Psychiatric Clinics of North America, 33(3), 611–627.
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23. Sleep Eating Disorder: Overview & Facts. Sleep Education. Retrieved April 21, 2016, from
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29. Scheel, J., Ph.D. (2014, June 19). Sexual Satisfaction and Eating Disorders. Retrieved April 21, 2016.
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31. If You Think You May Have An Eating Disorder." Eating Disorders Victoria. N.p., 17 June 2015. Web. 8 May 2016