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National Institute of Mental Health (NIMH)

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Overview

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Signs and symptoms

Risk factors

Treatments and therapies

Join a study

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Learn about eating disorders, including types (e.g., anorexia nervosa, bulimia nervosa), signs and symptoms, risk factors, and treatments and therapies.

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Last Updated: September 25, 2023

We all struggle with weight and body image issues to some degree. After all, our society places so much importance on being thin. Between the diets, "lose weight quick" schemes, and magazine covers telling us to lose weight, it's hard to feel comfortable in your own skin.

However, there are some people who struggle more than others and ultimately develop an unhealthy relationship with food and their body - leading to harmful eating habits.

Eating disorders are real, complex, and devastating conditions that have serious consequences on a person's health, lifestyle, and relationships. They're not a fad, phase, or lifestyle choice. Eating disorders are serious, potentially life-threatening conditions that affect a person's physical and emotional well-being.

What Is Anorexia Nervosa?

Anorexia nervosa, sometimes simply referred to as anorexia, is one of the most common eating disorders. Anorexia is a potentially life-threatening eating disorder characterized by self-starvation, excessive weight loss, fear of gaining weight, distorted body image, and at times, excessive exercising.

For many people, restricting their food is a way to control areas of their life that feel out of control. In turn, they allow their body image to define their entire sense of self-worth. It can also be a way of expressing emotions that feel too complex or overwhelming such as pain, stress, or anxiety.

Being aware of the signs and symptoms of anorexia can make a huge difference in the duration and severity of the illness. The warning signs of anorexia can be physical, psychological, and behavioral. Not every person experiences every symptom, and it's possible for someone to display a combination of these symptoms.

Some of the most common symptoms include (but are not limited to):
Physical signs:

Rapid weight loss or frequent changes in weight

Fainting or dizziness

Lethargy and low energy

Facial changes, such as pale skin and sunken eyes

Psychological signs:

Preoccupation with food, eating, body shape, and weight

Feeling anxious or irritable around normal meal times

Depression and anxiety

Having a distorted body image (example: seeing themselves as fat when in reality they're underweight)

Behavioral signs:

Eating in private and avoiding meals with other people

Extreme dieting behavior

Deliberate misuse of laxatives, appetite suppressants, enemas, and diuretics

Evidence of binge eating

5 Facts About Anorexia Nervosa
Anorexia nervosa is a complex disease, and the cause isn't fully known. However, some of the factors that may lead to eating disorders include genetics, psychological health, environment, trauma, and biology.

There are two types of anorexia: restricting and binge eating/purging. People with anorexia nervosa restricting subtype place a severe restriction on the amount and type of food they consume. People with anorexia nervosa binge eating/purging subtype also restrict their food intake, but they also engage in binge eating/purging behavior.

Only one out of every 10 people with anorexia will ever seek treatment. Part of the problem is that the general population believes that anorexia isn't a real disease. In turn, people are afraid to ask for help because they feel ashamed or don't feel as though they'll be taken seriously.

Men Make Up 10% Of Those Suffering From Anorexia Nervosa

Although anorexia is far more common in women, men make up approximately 10% of those suffering from the disease. All too often, men are under and undiagnosed with anorexia because of its prevalence in females.

Recovery from anorexia is possible, even for someone who has been living with the disease for many years. Anorexia is often treated in an outpatient setting, but hospitalization may be necessary in some situations. The path to recovery can be long and challenging, but having the right team supporting you can make all the difference.
If you or someone you know is struggling with an eating disorder, contact the Orlando Recovery Center at 833.620.2266

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5 Facts About Anorexia Nervosa | Orlando Recovery Center

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Anorexia is a potentially life-threatening eating disorder characterized by self-starvation, excessive weight loss, fear of gaining weight, distorted body image, and at times, excessive exercising.

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Who does it affect?

Women have anorexia at rates three times higher than males: 0.9% of the population versus 0.3% of the population.

Men make up approximately 20% of all people with anorexia.

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Emma's* parents, Mr and Mrs James*, were worried about their 16 year old; for over a year she had been on a diet that didn't seem to stop. They didn't understand why she was on a diet because she had never been overweight, and it didn't seem as though she had secured any happiness from her diet.

Emma's dieting behaviours made her more withdrawn, depressed and anxious. Every time her parents expressed their concerns, she burst into tears or shouted at them. She had stopped eating with the family and spent most of her time in her bedroom. She was still going to school and doing extremely well in her exams, but her friends were worried about her. Emma's parents had repeatedly suggested that she went to see the doctor but she insisted that there was nothing wrong with her, asking them why they couldn't just leave her alone. Mr and Mrs James had started to disagree about how to handle Emma's behaviour and argued frequently. As a result of this, Emma's younger brother and sister were very angry with her and wouldn't talk to her.

Finally, Mr and Mrs James received a phone call from school to say that Emma had fainted and was in hospital.

She was discharged a short while later but with the recommendation that they saw an eating disorders specialist. Emma's parents took her to the GP who referred her to Priory's eating disorder service. She was immediately admitted to a Priory hospital as an inpatient because her weight was dangerously low. Emma also had a very low heart rate (bradycardia) and a low temperature (hypothermia).

After a thorough assessment of not only her physical condition, but also her mental health, Emma had repeated blood tests and an electrocardiogram (ECG). Because of her bradycardia and hypothermia she was nursed on bed rest with 24-hour care. She was prescribed a gradually increasing diet by the dietitian, and was supported to increase her dietary intake to improve her physical health and weight.

As her weight went up, Emma's condition improved. She began participating in Priory's intensive therapy programme and was allocated an individual therapist.

Once Emma's physical health had improved, she began to participate in group therapy which involved anxiety treatment, body image, cognitive behavioural therapy (CBT) and psychoeducational nutrition groups. Emma and her family also received regular family therapy sessions. In her individual therapy, Emma was able to address a number of life events and issues which had caused her considerable distress prior to the onset of her eating disorder. Emma and her family were also supported to have meals together on the unit and the dietitian advised her family on how to manage her meal plan when she went home. Emma's parents also attended the parents' support group.

When Emma was ready for weekend leave, she related much better to her family. They all believed that the family therapy had helped, as well as the carer support group and education sessions.

Emma was pleased that she was supported by the unit and her school to continue studying for her AS levels during her stay at Priory, and held on to her dream of going to university.

16 weeks later, on discharge, Emma had gained control over her eating disorder, dealt with a number of significant life issues and was looking forward to relating more appropriately with her friends again. Her family were more relaxed as they knew how to help Emma, and no longer felt helpless or fearful for the future.

*Names have been changed to protect patient identity.

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Emma's* parents, Mr and Mrs James*, were worried about their 16 year old; for over a year she had been on a diet that didn't seem to stop. They didn't understand why she was on a diet because she had never been overweight, and it didn't seem as though she had secured any happiness from her diet.

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Glee - Marley Rose eating disorder clips

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Eating disorder hotlines are dedicated helplines offering assistance, information, and support for individuals dealing with eating disorders. Staffed by trained professionals, they provide a safe space to discuss struggles, seek guidance, and receive referrals for treatment options and emotional support.

Eating Disorder Helplines

The Alliance for Eating Disorders Awareness Helpline

The Alliance for Eating Disorders Awareness Helpline offers support and resources for individuals dealing with eating disorders. Whether someone is struggling with anorexia, bulimia, binge eating disorder, or body image issues, the helpline is there to provide compassionate assistance on the journey towards recovery and healing.

Mental Health Hotlines

Mental health hotlines aim to ensure that individuals in need have a safe space to talk about their feelings, receive guidance, and access appropriate help and resources for their mental well-being.

Crisis Text Line

Crisis Text Line is a confidential support service that provides help and resources to individuals in crisis. Through text messaging, trained crisis counselors offer a listening ear, emotional support, and information on available resources.

Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline

SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. They work to promote behavioral health, provide access to treatment and recovery services, and support prevention and early intervention efforts.

National Alliance on Mental Illness (NAMI) Helpline

The NAMI helpline offers information, resources, and compassionate assistance for individuals seeking help for mental health concerns. Staffed by trained volunteers and professionals, the NAMI Helpline provides a safe space to discuss mental health challenges, access resources, and receive referrals to local support services.

National Domestic Violence Hotline

The National Domestic Violence Hotline is dedicated to empowering survivors of domestic violence and raising awareness about the issue to promote safety, healing, and prevention.

LGBTQ+ National Hotline

The LGBTQ+ National Hotline addresses a wide range of concerns, including coming out, relationships, mental health, and more. It aims to provide an affirming and inclusive space for individuals to share their stories and find understanding and assistance on their journeys.

Veterans Crisis Line

The Veterans Crisis Line is a confidential support service provided by the U.S. Department of Veterans Affairs (VA) for veterans, service members, and their families. The goal of the Veterans Crisis Line is to ensure that veterans and their loved ones receive the help and support they need during difficult times, fostering a safe and supportive space for those who have served our country.

Academy of Nutrition and Dietetics' Food and Nutrition Hotline

Whether someone has questions about meal planning, special dietary needs, weight management, or general nutrition, the Food and Nutrition Hotline serves as a trusted resource to promote informed and healthy food choices for individuals and families.

Association for Size Diversity and Health (ASDAH)

ASDAH is a non-profit organization dedicated to promoting size-inclusive healthcare, body respect, and ending weight stigma. They advocate for the Health at Every Size (HAES) approach, emphasizing the importance of holistic health and well-being independent of body size. Their website offers resources, webinars, and information on body positivity and HAES principles.

National Eating Disorders Association (NEDA)

NEDA is a non-profit organization dedicated to supporting individuals affected by eating disorders. While not solely focused on body positivity, they promote body acceptance and work towards eliminating body image issues. They offer helplines, resources, and educational materials on eating disorders and body image concerns.

The Body Positive

The Body Positive is a non-profit organization that empowers individuals to cultivate self-love and a positive body image. They offer workshops, educational programs, and online resources to promote body acceptance and resilience. Their approach emphasizes self-care, self-compassion, and body neutrality.

Be Nourished

Be Nourished is a body trust organization that offers workshops, trainings, and resources centered around body acceptance and healing from disordered eating. They emphasize the importance of body autonomy, intuitive eating, and challenging diet culture.

The Center for Mindful Eating

The Center for Mindful Eating is a non-profit organization that promotes mindful eating practices to support a healthy relationship with food and body. They offer resources, webinars, and professional training to promote a compassionate and non-judgmental approach to eating.

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Eating Disorder Hotlines for 24/7 Crisis Help

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NEDA no longer maintains an eating disorder hotline - Get help now - Eating Disorder Hope provides several helplines and online resources

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Bulimia is an eating disorder that stems from a loss of control over eating habits and a longing to stay thin. Many people associate the condition with throwing up after eating. But there is much more to know about bulimia than this one symptom.
Here are 10 facts about bulimia to change misconceptions you may have about this dangerous eating disorder.
1. It's rooted in compulsive habits.

If you have bulimia or another eating disorder, you may be obsessed with your body image and go to severe measures to alter your weight. Anorexia nervosa causes people to restrict their calorie intake. Bulimia causes binge eating and purging.

Bingeing is consuming a large portion of food in a short period of time. People with bulimia tend to binge in secret and then feel immense guilt. These are also symptoms of binge eating disorder. The difference is that bulimia includes purging by behaviors such as forced vomiting, excessive use of laxatives or diuretics, or fasting. People with bulimia may continue to binge and purge for a while, and then go through periods of not eating.

If you have bulimia, you may also exercise compulsively. Regular exercise is a normal part of a healthy lifestyle. But people with bulimia may take this to the extreme by exercising for several hours a day. This can lead to other health problems, such as:

body injuries

dehydration

heatstroke

2. Bulimia is a mental disorder.

Bulimia is an eating disorder, but it can also be referred to as a mental disorder. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), eating disorders such as bulimia are the most fatal mental conditions in the United States. This fact is attributed to long-term health problems, as well as suicide. Some patients with bulimia also have depression. Bulimia can cause people to feel shame and guilt about their inability to control compulsive behaviors. This can worsen preexisting depression.

3. Societal pressure can be a cause.

There is no proven cause of bulimia. However, many believe there's a direct correlation between the American obsession with thinness and eating disorders. Wanting to adapt to beauty standards can cause people to engage in unhealthy eating habits.

4. Bulimia may be genetic.

Societal pressures and mental disorders such as depression are just two of the possible causes of bulimia. Some scientists believe that the disorder may be genetic. You may be more prone to developing bulimia if your parent has a related eating disorder. Still, it's not clear whether this is due to genes or environmental factors at home.

5. It affects men, too.

While women are the most prone to eating disorders, especially bulimia, the disorder is not gender specific. According to ANAD, up to 15 percent of people being treated for bulimia and anorexia are male. Men are often less likely to exhibit noticeable symptoms or seek appropriate treatments. This can put them at risk for health problems.

6. People with bulimia can have normal body weights.

Not everyone with bulimia is ultra-thin. Anorexia causes a large calorie deficit, leading to extreme weight loss. People with bulimia can experience episodes of anorexia, but they still tend to consume more calories overall through bingeing and purging. This explains why many people with bulimia still retain normal body weights. This can be deceptive to loved ones, and can even cause a doctor to miss the diagnosis.

7. Bulimia can have serious health consequences.

This eating disorder causes more than just unhealthy weight loss. Every system in your body is dependent on nutrition and healthy eating habits to function properly. When you disrupt your natural metabolism through binging and purging, your body can be seriously affected.

Bulimia can also cause:

anemia

low blood pressure and irregular heart rate

dry skin

ulcers

decreased electrolyte levels and dehydration

esophageal ruptures from excessive vomiting

gastrointestinal problems

irregular periods

kidney failure

8. Bulimia can inhibit healthy reproduction.

Women with bulimia often experience missed periods. Bulimia can have lasting effects on reproduction even when your menstrual cycle goes back to normal. The danger is even greater for women who get pregnant during episodes of "active" bulimia.

Consequences can include:

miscarriage

stillbirth

gestational diabetes

high blood pressure during pregnancy

breech baby and subsequent cesarean delivery

birth defects

9. Antidepressants may help.

Antidepressants have the potential to improve bulimic symptoms in people who also have depression. According to the Office on Women's Health in the U.S. Department of Health and Human Services, Prozac (fluoxetine) is the only FDA-approved medication for bulimia. It has been found to help prevent binges and purges.

10. It's a lifelong battle.

Bulimia is treatable, but symptoms often come back without warning. According to ANAD, only 1 out of 10 people seek treatment for eating disorders. For the best chance at recovery, identify your underlying cues and warning signs. For example, if depression is your trigger, then pursue regular mental health treatments. Seeking treatment can help prevent relapses in bulimia.

Outlook

The real solution for long-term weight maintenance is a sensible diet and exercise plan. Bulimia ultimately disrupts normal weight maintenance, which sets up the body for greater challenges as the eating disorder progresses. Working to develop a healthy body image and lifestyle is a must. See a doctor right away if you or a loved one needs help treating bulimia.

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Bulimia is an eating disorder that stems from a loss of control over eating habits and a longing to stay thin. Many people associate the condition with throwing up after eating. But there is much more to know about bulimia than this one symptom.

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psychotherapy

medical care and monitoring

nutritional counseling

medications

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Bulimia Nervosa is an eating disorder characterized by binge eating followed by purging. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. Bulimia means to 'eat like an ox', although people have been known to 'eat like an ox' from antiquity, it was not until 1979 that a London psychiatrist, Gerald Russell, identified 40% of his Anorexia Nervosa patients with an 'ominous variation' of the disorder - the variation being that they from time to time went on binges.

In this case study I sought to give an insight into Cognitive Behavioural Therapy (CBT) treatment for Bulimia Nervosa (BN). It was important to back up my assessment in the first session with a G.P report which contained Complete blood count;

Chem-20 panel which measures electrolytes, vitamins, liver and pancreatic function, adrenal glands, (levels of cortisol and adrenaline produced in times of stress);

Thyroid and parathyroid pane l which indicates level of metabolic functions.

**Ask permission from your client to get the report.

Suitability for treatment was formally measured using the Safron and Segal (1990) Suitability for Short-term Cognitive Therapy Rating Scale. (aspects of the cognitive therapy process are rated on a scale of 0-5). High Rating indicate a good prognosis and low ratings indicate a poor one.

Client History

Jessica (pseudonym) aged 22 presented to the centre with a four-year history of binge eating, vomiting and laxative use. Jessica stated that at the age of 18, following the break-up of a one-year relationship with her boyfriend (she did not want to become intimate with him). She had begun to eat excessively at times (comfort eating) as a way of coping with the heartache it caused.

Jessica put on some extra weight, approximately 4 kg over the course of a few months and was very upset when she discovered that some of her outfits were not fitting her, especially in the run up to a summer holiday.

Jessica had known about people vomiting as a means of weight control and recalled some of her school friends telling her it was a handy way not to put on weight. However, she had never really considered doing this herself, as she thought it was a 'disgusting thing to do'.

She stated that one evening after a particularly large bout of over eating, she felt very uncomfortable and thought that if she could only vomit it would at least relieve the discomfort. Using her forefinger, she stuck it down the back of her throat and began vomiting.

Afterwards she felt unwell, her throat was raw and her stomach sore, but she admitted feeling some relief from the feeling of guilt and regret of having eaten too much. She vowed at the time never to do it again. A few evenings later after a night out with friends and having consumed 'a few too many' alcoholic beverages she engaged in what she described as a 'feeding frenzy ', eating almost anything she could get her hands on in the fridge and cupboard.

It seemed easier to vomit this time and the next day she bought a packet of laxatives, to clear out the system, taking 3 times the recommended dose.

Jessica tried starving herself over the next few days, feeling determined to try and get her weight under control and start a 'new chapter in her life'. This lasted until day 3 when weak with hunger and coming home from a late night at work, she could not resist the temptation to stop off at a local Chinese restaurant as she passed by it. They had a buffet-style service that meant she could keep going back up to eat whatever she wanted. Having left feeling stuffed and very guilty, vomiting seemed the obvious option and laxatives were used the following day.

Over the course of the next few months a pattern developed whereby she would attempt any and every new diet, she lasted 2 to 4 days and this would end up in bingeing and purging behaviour.

Jessica Weight was 9st-8lbs and her Height was 5ft-3ins

None of Jessica's family or friends were aware of her difficulties, although they know she was constantly dieting. Jessica felt very unhappy with life, the thought of suicide had occasionally crossed her mind but it always occurred after a night out drinking followed by a binge and purging episode. Jessica was taking 40 mg of Fluoxetine (Prozac) when she attended therapy.

Personal background

Jessica was raised the eldest the eldest of 5 children. She had 1 sister and 3 brothers, her parents divorced when she was aged 16 yrs, mainly due to her father's drinking.

Jessica felt close to her Mum who had a history of been treated for depression by her G.P.

Jessica disclosed that from the age of 12 to 14 she was sexually abused by a neighbour, she never told her parents until she reached the age of sixteen after they moved back to Ireland. Leaving school at sixteen she managed to secure employment in a marketing company and had worked her way up the firm, taking several professional examinations along the way.

Diagnosis

The main DSM-V criteria for Bulimia Nervosa that Jessica was displaying were as follows;

Eating a large amount of food with a short space of time

Bingeing three to four times per week

She also experiences a sense of lack of control over eating, a feeling that she cannot stop.

She was taking laxatives at least twice a week

Over-evaluation or concern about shape, weight and appearance

Secretive behaviour

Vomiting three to four times per week

Co-morbidity features - depression, alcohol misuse

CBT Treatment
Phase 1: Sessions 1 to 4
Establishing a sound therapeutic relationship. Setting treatment goals, setting homework. Explaining the CBT model of Bulimia Nervosa, including discussing predisposing, precipitating and perpetuating factors which resulted in an initial formulation been established. Motivation for Change (Pros and Cons of changing)

Psychoeducation, educating Jessica on the adverse consequences of bingeing and purging behaviour and explained the blood sugar imbalance, glycemic index (GI), foods that have high and low GI and how neurotransmitters influence hunger and mood.

Explaining the importance of introducing a regular eating pattern of 3 meals and 2 snacks/day (gave her a detailed specific food dairy). Disrupting the vicious cycle of bingeing and purging behaviour, noting particular triggers. Identifying the connection between thoughts, feelings and behaviour within the context of the Eating Disorder.
Phase 2: Sessions 5 to 15
This phase is at the heart of therapy for Jessica. It involved addressing the maintaining factors listed below:

Negative Body Image

Cognitive Distortions

Feelings, (regret, guilt, low mood, shame etc.)

Lifestyle activities, Self -Esteem

Physiology (blood sugar, stimulants)

Relationships

Food Scripts

Stress

Habit

Addictive Process (bingeing/purging alcohol misuse)

Interventions and homework worksheets in treating the above was carried out in the sessions.
Phase 3 (Final): Sessions 16 -19
Relapse Management Skills discussed.

What made her vulnerable to developing the problem in the first place?

What has she learned in Treatment?

What areas leave her vulnerable?

What strategies can undermine these vulnerabilities?

Dealing with a setback

What are her personal strengths?

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Case Study of Bulimia Nervosa (BN) - Mind & Body Works

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Bulimia Nervosa is an eating disorder characterized by binge eating followed by purging. This case study gives some insight on the disorder.

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-mental, physical, and emotional health

-weight

-brain

-heart

-digestive system

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EDA meetings are open to anyone looking for support for their recovery process.

Most meetings are also open to observers such as family, friends, students, and professionals. EDA meetings are held in-person, on Zoom or with a hybrid method of in-person/zoom. The type of meeting is noted in the meeting listing, such as literature studies, speaker meetings, topic meetings, men's meetings, etc.

All meetings are listed in Eastern Time with the site location time listed in parenthesis. If the meeting is in-person only, the time noted is the time zone of the location.
ZOOM MEETING DETAILS
All Zoom meetings require a passcode. Some Zoom meetings have waiting rooms. If you find yourself in a waiting room, you may need to wait for a host to admit you. If you are in a meeting that does not have a host, please reach out to wm@eatingdisordersanonymous.org.

EDA offers a chatroom meeting each day of the week. These meeting are held on Discord and are led by volunteers. If you'd like to try this meeting format, learn more about the meetings here.

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Most meetings are also open to observers such as family, friends, students, and professionals. EDA meetings are held in-person, on Zoom or with a hybrid method of in-person/zoom. The type of meeting is noted in the meeting listing, such as literature studies, speaker meetings, topic meetings, men's meetings, etc.

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ANAD- ANOREXIA NERVOSA & ASSOCIATED DISORDERS