Eating Disorders

Learn about the signs, risk factors, treatment, recovery and social supports for anorexia, bulimia, binge-eating, and other eating disorders.

Learn more about eating disorders:

Definition

Eating disorders are complex mental disorders. They are serious and can be life-threatening. Eating disorders are not just a phase, trend, or lifestyle choice. They can harm physical health, mood, social ties, and functioning in daily life.

Eating disorders involve problematic behaviors with an emotional basis. The person has excessive fear and anxiety about eating, body image, and weight gain. This leads them to do things that can have serious health effects. A person with an eating disorder needs specialized care. With early treatment, the person is more likely to recover.

Anorexia nervosa, bulimia nervosa, and binge-eating disorder are three common eating disorders. Many people may have serious problems related to eating and body image, but not one of these three disorders.

Signs and Symptoms

Anorexia Nervosa

Anorexia nervosa—also called anorexia, which means “not eating”—has three key features. The person eats less, is afraid of gaining weight or becoming fat, and has a distorted body image (seeing oneself as fat or overweight). The person may weigh less than what is normal for their age, sex, and health. But the person may not have low weight.

Young people with anorexia, and some adults, may not know or admit they fear gaining weight. They may weigh themselves often, look at themselves in the mirror, and monitor their size. Parents and friends may notice that the person starts to favor low-calorie foods, eats special diets, or is preoccupied with dieting and exercise. Anorexia has the highest death rate of any mental disorder. A person may die from starvation, metabolic collapse, or suicide.

Symptoms of anoxia include:

  • Excessive exercise
  • Severe or rigid dieting, or very restrictive eating
  • Extreme thinness or constant pursuit of thinness
  • Strong fear of gaining weight
  • Distorted body image, low self-esteem tied to body weight and shape, and denial of the seriousness of low body weight
  • Depression and anxiety

Anorexia can lead to health problems. These vary in severity and differ among people with anorexia. Health concerns include:

  • Lethargy, sluggishness, or feeling tired all the time
  • Iron deficiency (anemia)
  • Low body temperature, so the person often feels cold
  • Dry, yellowish skin
  • Growth of fine hair all over the body
  • Brittle hair and nails
  • Skipping or no longer having monthly menstruation
  • Infertility
  • Muscle wasting and weakness
  • Low blood pressure, with slow breathing and pulse
  • Severe constipation and abdominal pain
  • Thinning of the bones (osteopenia or osteoporosis)
  • Damage to the heart, including slow heart rate and possible heart rhythm problems
  • Brain damage or multi-organ failure

Also, a person with anorexia may have dehydration. They may have fainting, increased urination, or low back pain. They may lose interest in sex, have sleep problems, be sensitive to loud noise and bright lights, or have problems concentrating.

Bulimia Nervosa

Bulimia nervosa, also called bulimia, involves binge eating plus unhealthy behaviors to compensate for overeating. Binge eating means eating an unusually large amount of food, which most people would see as excessive, while feeling out of control. Compensation for binge eating may include forced vomiting; taking medications such as laxatives, diuretics, or diet pills; and heavy exercise, fasting, or other methods to make up for calorie intake.

People with bulimia often stay at a normal weight or are overweight. The person often goes to the bathroom right after eating meals. They are often ashamed of their eating problems. They may try to hide their actions from others. Bulimia can cause life-threatening problems.

Symptoms of bulimia include:

  • Repeated binge eating (eating an unusually large amount of food, compared to what most people would eat), while feeling unable to stop eating and a loss of control
  • Repeated unhealthy actions to prevent weight gain, such as forced vomiting (purging); abuse of laxatives, diuretics, or other medications; fasting; heavy exercise; or a combination of these
  • Excessive worry about how their body looks and their weight (poor self-image, with an overemphasis on body shape or weight)

Bulimia may cause health concerns, including:

  • Inflamed and sore throat
  • Swollen salivary glands (in the neck and jaw area)
  • Worn tooth enamel and sensitive, decaying teeth due to stomach acid
  • Acid reflux disease and other gastrointestinal problems
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration from purging
  • Electrolyte imbalance (low or high levels of sodium, calcium, potassium, and other minerals) that can lead to stroke, heart failure, or death

Also, a person with bulimia may have inflammation, swelling of hands and feet, rupture of the esophagus, gum disease, or irregular menstrual cycles. They may have fatigue, headaches, depression, anxiety, or problems concentrating.

Binge-Eating Disorder

Binge-eating disorder is the most common eating disorder in the United States. It does not mean occasional overeating. It involves eating large amounts of food (often quickly, and causing discomfort) and feeling unable to stop eating.

Binge-eating disorder is similar to bulimia in the amount of food eaten. But it does not involve regular purging, heavy exercise, or fasting. People with this disorder often feel embarrassed and ashamed. They tend to hide their eating from family and friends. Parents and friends may notice that the person is preoccupied with dieting and fitness. People with binge-eating disorder often are overweight, but some are not. They struggle with negative views of their body and weight, and may have depression, anxiety, and thoughts of suicide.

Symptoms of binge-eating disorder include:

  • Repeated binge eating, feeling a lack of control over eating, and feeling distressed by it
  • Eating alone due to embarrassment
  • Eating large amounts when not physically hungry
  • Eating more rapidly than normal
  • Eating until uncomfortably full
  • Feeling disgust, sadness, or guilt after binge eating

Binge-eating disorder may cause health concerns, including:

  • Weight gain, obesity, or weight cycling
  • Bloating
  • Restricted food intake
  • Dehydration
  • Problems getting along with friends and family
  • Stress
  • Feeling underappreciated
  • Feeling dissatisfied with life
  • High blood pressure, high cholesterol, diabetes, and other medical conditions

Avoidant/Restrictive Food Intake Disorder (ARFID)

Some people have problems with eating and food but do not have an eating disorder. They may have avoidant/restrictive food intake disorder (ARFID). The symptoms typically start in infancy or childhood and may last into adulthood. Symptoms may include avoiding certain colors or textures of food, eating very small portions, or having no appetite. The person may be afraid to eat after a frightening event that caused choking or vomiting.

Risk Factors

Eating disorders often start in adolescence or young adulthood, but can occur in childhood or later in adulthood. The symptoms are the same in males and females.

About 1% of Americans have anorexia. About 90–95% of people with anorexia are female. About 25% of children with anorexia are boys.

Bulimia affects 1–2% of adolescents and young adults. Of those with bulimia, 80% are female.

Binge-eating disorder affects 1–5% of the general population. Rates of binge-eating disorder are similar in males and females.

Some men with eating disorders have muscle dysmorphia. This involves concern about becoming more muscular.

No single risk factor is likely to cause an eating disorder. Research suggests that multiple factors lead to eating disorders.

Genetics

Heredity may play a role. Eating disorders are more likely in people who have one or more family members with an eating disorder. Researchers are studying genetic factors linked to eating disorders. No single genetic factor causes eating disorders.

Brain Function

Changes in brain functions related to eating and emotions may help explain why some people develop eating disorders. Imaging studies have linked eating disorders to brain activity patterns.

Social Factors

These include being teased or ridiculed often about one’s weight, participating in a sport that requires low weight or a certain body image, or being surrounded by negative messages about food and body. Frequent dieting can increase the risk of eating disorders.

Trauma

Traumatic events and major life stressors, especially in childhood, such as sexual assault or other abuse, may be a risk factor for an eating disorder.

Psychological Factors

Having another mental disorder can make an eating disorder more likely. Also, personality traits such as being a perfectionist, feeling inadequate, having low self-esteem, and rigid thinking are linked to increased risk of an eating disorder.

For more information on rates of eating disorders, visit these websites from the National Institute of Mental Health (NIMH):

Evidence-based Treatments

People with eating disorders can recover with care that deals with behavioral, emotional, and physical symptoms. Treatment can help people stop harmful behaviors, stay at a healthy weight, and learn to accept their bodies. The treatment plan should consider each person’s needs and choices. Treatments generally include one or more of these:

  • Individual, group, or family psychotherapy (sometimes called “talk” therapy)
  • Nutritional counseling
  • Medications
  • Functional rehabilitation to help the person resume their roles (school, work, relationships)

A person should consult a healthcare professional when choosing the right treatment and consider his or her own gender, race, ethnicity, language, and culture.

Psychotherapy

Psychotherapy can help people change their eating and deal with emotions related to the eating disorder. Psychotherapy involves working with a professional one-on-one or in a group. Several therapies are helpful for treating eating disorders. Some target symptoms directly. Others focus on changing a person’s thoughts, environment, or problems that affect their actions and ability to change their actions. Visit Psychotherapies from NIMH to learn about psychotherapies.

Cognitive behavioral therapy helps adults with bulimia and binge-eating disorder. The person learns skills to help stop binge eating or using compensatory behaviors to control weight. This therapy can reduce unhealthy eating and negative thoughts the person may have about their body.

The Maudsley approach is a family-based therapy. It helps people with anorexia or bulimia achieve a normal weight, address problem behaviors, and function better. Parents learn to manage their child’s dieting, exercising, binging, and purging.

Medications

Psychotropic medications can help manage some symptoms of bulimia and binge-eating disorders. Antidepressants or mood stabilizers can help control some symptoms for people with bulimia and binge-eating disorders. These medications may also help with symptoms of anxiety or depression.

Medications should be used with care in children and adolescents. A psychiatrist or other prescriber must consider many factors in deciding if treatment should include medication.

For basic information about medications, visit the National Institute of Mental Health Mental Health Medications webpage. For up-to-date information on medications, side effects, and warnings, including those for children and adolescents, visit the Food and Drug Administration website.

Levels of Care

Several levels of specialty care may be best for people with eating disorders. The goal is to help the person get to a normal weight and normal eating. The best treatment option depends on the severity of the disorder and the person’s past response to treatment. The best treatment may not be available in some areas.

Inpatient medical stabilization may be needed to deal with serious physical problems such as dehydration or heart problems.

Inpatient psychiatric treatment can provide intensive services for medical stabilization and psychological support.

Day treatment or partial hospitalization can deal with medical conditions and psychological support. This can be done as a transition from inpatient to outpatient care. It can also be an alternative to inpatient care.

Outpatient care may be best for people who are not severely malnourished and don’t need medical stabilization.

Complementary Therapies and Activities

Complementary therapies and activities can help people improve their well-being, and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, access the National Center for Complementary and Integrative Health.

Approaches that may help people with eating disorders include:

Cognitive remediation therapy helps a person improve their attention span, memory, problem solving, organization, and planning.

Self-monitoring therapies help a person record their actions or thoughts. They can look for patterns and situations that tend to cause problems.

Apps for general health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, see the Federal Government Mobile App Directory.

Recovery and Social Support Services and Activities

Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This includes:

  • Overcoming or managing one’s condition(s) or symptoms
  • Having the ability to seek additional information
  • Having a stable and safe place to live
  • Conducting meaningful daily activities, such as a job, school, volunteerism, and family caretaking
  • Having relationships and social networks that provide support, friendship, love, and hope

Recovery helps a person develop resilience, increasing the ability to cope with adversity and adapt to challenges or change. To learn more, visit the SAMHSA Recovery and Recovery Support topic.

Self-help and support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local support groups. Peer and family support services can help foster hope and promote outreach and engagement for those with mental health conditions. This includes both peer-to-peer and family-to-family supports provided by a trained and certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills.

Researchers are studying whether self-help approaches, such as audiovisual materials or manuals based on cognitive behavioral therapy, may help people with eating disorders.

Here are resources for people with eating disorders and their families:

Future Directions in Research and Treatment

Researchers are studying causes and features of eating disorders, and new treatments. Studies are looking for ways to:

  • Identify genetic factors
  • Find genetic and environmental factors that affect risk
  • Use new preventive and treatment methods that focus on thoughts, emotions, or social interactions

Finding Treatment

Consult a healthcare professional who has training and experience working with eating disorders. For general information on mental disorders and to locate treatment services in your area, contact SAMHSA’s National Helpline, 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the National Institute of Mental Health Help for Mental Illnesses webpage have more information and resources.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Last Updated: 05/12/2017