Anorexia is a serious mental health condition that involves persistent disturbances in eating behaviours and thoughts. These disorders can drastically impact physical health, emotions and the ability to function in key areas of life. In the United States alone, an estimated 28.8 million people will have an eating disorder at some point in their lives.
As someone who has struggled with anorexia myself, I know firsthand how all-consuming and isolating these conditions can feel. But I also know recovery is possible with proper support and treatment. In this article, we’ll look into the different types of anorexia, common symptoms to watch for, underlying causes and risk factors and the treatment options available.
Types of Eating Disorders
While many eating disorders share core features like a preoccupation with food, weight and body size or shape, they manifest in different ways:
Anorexia Nervosa
Anorexia nervosa involves severely restricted eating and intense fear of gaining weight, often accompanied by a distorted body image. People with anorexia may limit calories, avoid certain foods or use extreme methods to lose weight like excessive exercise or purging. Over time, this self-starvation can lead to dangerous complications like brittle bones, organ damage and heart problems.
There are two main subtypes of anorexia:
- Restricting type: Weight loss is primarily achieved through dieting, fasting or over-exercising
- Binge-eating/purging type: Episodes of consuming large amounts of food followed by purging behaviors
Bulimia Nervosa
Bulimia nervosa is characterized by recurrent episodes of binge eating (consuming unusually large portions in a short timeframe while feeling a loss of control) followed by compensatory behaviors to prevent weight gain. These may include self-induced vomiting, fasting, laxative or diuretic misuse or compulsive exercising.
Like anorexia, bulimia involves a negative body image and self-worth overly influenced by weight and shape. Cycles of bingeing and purging take a serious toll, with potential complications like digestive problems, dehydration, electrolyte imbalances and severe tooth decay.
Binge Eating Disorder (BED)
Binge eating disorder involves regular episodes of consuming large food portions quickly and to the point of discomfort, without the compensatory purging seen in bulimia. Binges are often planned in advance and may involve “special” binge foods. Feelings of distress, shame and guilt often follow these secret eating episodes.
BED is the most common eating disorder in the U.S. and can occur in people of all sizes and weights. (Reference: https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627) Left unchecked, it can fuel weight gain and serious health consequences like diabetes and heart disease.
Other Specified Feeding and Eating Disorders (OSFED)
This category includes eating disorders that cause significant distress or impairment but do not meet the full diagnostic criteria for anorexia, bulimia or binge eating disorder. Examples include atypical anorexia (weight is not abnormally low despite significant weight loss), purging disorder (regular purging without binge eating) and night eating syndrome (excessive food consumption after the evening meal).
OSFED is a serious mental illness, not just a passing phase or minor issue. The commonality among all OSFED examples is that eating patterns are disturbed and unhealthy, but the specific symptoms do not precisely fit into another established eating disorder. Treatment is critical for both physical and psychological health.
Signs and Symptoms of Eating Disorders
Eating disorders manifest differently for each individual, but there are some common warning signs to watch for:
Physical symptoms:
- Significant weight changes (up or down) or intense fear of gaining weight.
- Abnormal lab results like anemia, low hormone levels or slow heart rate.
- Feeling cold all the time, even in warm weather.
- Dizziness, fainting or fatigue.
- Thinning hair, hair loss or lanugo (fine hair growth on the body).
- Dental problems, calluses on the knuckles or puffy cheeks from purging.
Behavioral signs:
- Preoccupation with weight, food, dieting, calories, carbs or fat grams.
- Refusal to eat certain foods or entire categories of foods (like no carbs).
- Food rituals like excessive chewing, not allowing foods to touch or eating in rigid patterns.
- Skipping meals, making excuses not to eat or only eating alone.
- Cooking meals for others without eating or cutting food into tiny pieces.
- Withdrawing from normal social activities.
- Frequently checking the mirror for perceived flaws or wearing baggy clothes to hide the body.
- Maintaining excessive, rigid exercise regimens despite fatigue, illness or injury.
It’s important to note that a person does not need to be underweight or “look sick” to be struggling with an eating disorder. Eating disorders affect people of all body shapes and sizes. If you notice several of these signs in yourself or a loved one, consider reaching out for professional help. Early intervention significantly improves the chances of recovery.
Causes and Risk Factors for Eating Disorders
Eating disorders are complex mental health conditions with no single, clear-cut cause. Rather, a combination of biological, psychological and environmental factors may contribute to their development. While the exact mechanisms are still being researched, some potential influences include:
- Genetic predisposition: Studies suggest certain genes may increase susceptibility to eating disorders. Having a close relative with an eating disorder raises an individual’s risk.
- Brain chemistry: Imbalances in brain chemicals like serotonin and dopamine, which regulate mood, thinking and appetite, are seen in people with eating disorders.
- Personality traits: Psychological factors like low self-esteem, perfectionism, impulsiveness and trouble coping with stress are linked with eating disorders.
- Cultural pressures: Societal emphasis on achieving the “perfect body” or “ideal weight” can fuel body dissatisfaction and disordered eating. Unrealistic media images and weight-based stereotypes are pervasive.
- Trauma or stressful life events: Traumatic experiences like sexual assault, death of a loved one or a major transition can trigger eating disorders in susceptible individuals.
Eating disorders commonly co-occur with conditions like depression, anxiety disorders or substance abuse. Treating these illnesses is crucial for eating disorder recovery. (References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928448/)
It’s important to remember that eating disorders are not a choice – they are serious biologically-influenced illnesses. Risk factors may increase susceptibility, but they do not predict with certainty who will develop an eating disorder. With comprehensive treatment, full recovery is possible for anyone.
Treating Eating Disorders: A Multifaceted Approach
Eating disorder treatment is highly individualized based on the specific disorder, symptoms and co-occurring conditions. However, most treatment plans involve a combination of the following evidence-based approaches:
Psychotherapy
Psychotherapy or “talk therapy,” is a fundamental component of eating disorder treatment. Several therapeutic approaches have proven effective:
Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and change distorted thoughts and beliefs that fuel disordered eating behaviors. Through structured sessions, patients learn to modify negative self-talk, improve body image and develop healthy coping mechanisms.
Interpersonal Psychotherapy (IPT): IPT focuses on resolving interpersonal problems that may contribute to or maintain eating disorders. By improving communication skills and relationship dynamics, patients build a stronger support system for recovery.
Family-Based Treatment (FBT): FBT, also known as the Maudsley Method, empowers family members to take an active role in their loved one’s recovery. This approach is particularly effective for children and adolescents with anorexia nervosa. (Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637873/)
Medical Care and Monitoring
Eating disorders can lead to serious medical complications, making ongoing medical care a critical part of treatment. Regular check-ups with a primary care physician or specialist (e.g., cardiologist, endocrinologist) may be necessary to monitor vital signs, electrolyte levels, bone density and organ function. In severe cases, hospitalization may be required for medical stabilization and refeeding.
Nutritional Counseling
Registered dietitians or nutritionists specializing in eating disorders play a vital role in treatment by providing nutrition education and guidance. They work with patients to establish regular eating patterns, meet nutritional needs and challenge food fears. Nutritional counseling may also involve meal planning, grocery shopping strategies and cooking skills to foster a healthy relationship with food.
Medications
While there is no single medication that cures eating disorders, certain drugs may be prescribed to manage co-occurring conditions or alleviate specific symptoms. For example, antidepressants like fluoxetine (Prozac) can help reduce binge eating and purging in bulimia nervosa. Olanzapine (Zyprexa), an atypical antipsychotic, may be used to treat severe anorexia by reducing anxiety around eating and promoting weight gain.
Levels of Care
Eating disorder treatment is offered at varying levels of intensity based on the severity of the condition and individual needs:
- Outpatient care: Regular visits with a therapist, dietitian and physician while living at home. Appropriate for medically stable individuals with adequate support systems.
- Intensive outpatient/partial hospitalization: Structured programs with several hours of treatment per day, often including supervised meals. Allows patients to practice recovery skills while still living at home.
- Residential treatment: 24/7 care in a non-hospital setting. Indicated for medically stable patients who require ongoing behavioral monitoring and support.
- Inpatient hospitalization: Round-the-clock medical and psychiatric supervision. Necessary when eating disorders are severe and potentially life-threatening.
Recovery from an eating disorder is a gradual process that requires patience, commitment and a strong support network. With proper treatment and ongoing care, however, most people are able to restore their health and find freedom from disordered eating thoughts and behaviors. If you or someone you love is struggling with an eating disorder, know that help is available and recovery is within reach.
Levels of Care for Eating Disorder Treatment
Eating disorder treatment is not one-size-fits-all. The appropriate level of care depends on the severity of the disorder, medical stability and individual needs. Treatment options range from outpatient therapy to intensive inpatient programs:
Outpatient treatment: This is the least intensive level of care, involving regular visits with a mental health professional, dietitian and/or physician. Outpatient treatment is appropriate for individuals who are medically stable, psychiatrically safe and have adequate support and structure at home.
Intensive outpatient programs (IOP): IOPs provide several hours of programming per day, often including therapy, nutrition education and supervised meals. Patients can practice recovery skills while still living at home and maintaining work or school commitments. IOPs are suitable for individuals who need more support than outpatient care but do not require 24/7 supervision.
Partial hospitalization programs (PHP): PHPs, also known as day treatment, offer 5-7 days per week of programming in a structured environment. Patients participate in therapy, groups and meal support during the day and return home in the evenings. PHPs are indicated for individuals who need intensive treatment but are stable enough to spend nights at home.
Residential treatment: Residential programs provide 24/7 support in a non-hospital setting. Treatment often includes daily therapy, medical monitoring and supervised meals. Residential care is appropriate for medically stable individuals who require round-the-clock behavioral support and structure.
Inpatient hospitalization: This is the highest level of care, offering 24/7 medical and psychiatric supervision in a hospital setting. Inpatient treatment is necessary when eating disorders are severe and potentially life-threatening. The goal is to stabilize acute medical and psychiatric symptoms and restore sufficient eating patterns. Average length of stay is 2-4 weeks. (References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560343/)
Recovery and Relapse Prevention
Eating disorder recovery is an ongoing journey that extends beyond formal treatment. While there is no quick fix, most people who receive evidence-based care are able to achieve and maintain recovery. Some key components of the recovery process include:
Developing a balanced relationship with food: Recovery involves making peace with all foods, letting go of rigid food rules and giving yourself unconditional permission to eat according to your body’s needs. Intuitive eating principles, which emphasize listening to hunger and fullness cues, can be a helpful guide.
Challenging distorted thoughts: Eating disorders thrive on black-and-white thinking patterns like “I’m good if I restrict, bad if I eat.” Identifying and reframing these distortions is crucial for building self-compassion and resilience. Therapeutic tools like cognitive restructuring and positive self-talk can help.
Building a meaningful life outside the eating disorder: As eating disorder thoughts and behaviors decrease, it’s important to fill that space with activities that bring joy, purpose and connection. Exploring hobbies, strengthening relationships and setting non-appearance-related goals can provide a sense of identity outside the illness.
Maintaining a support network: Ongoing support from family, friends and professionals is essential for navigating the ups and downs of recovery. Surrounding yourself with people who encourage healthy behaviors and provide emotional validation can make all the difference.
Relapse prevention planning: Slips and setbacks are a normal part of the recovery process. Having a solid relapse prevention plan can help you identify warning signs early and take proactive steps to get back on track. This may involve regular check-ins with a therapist, self-monitoring of thoughts and behaviors and a list of coping strategies to use in high-risk situations.
Conclusion
Eating disorders are serious but treatable mental illnesses that can affect anyone regardless of age, gender, ethnicity or body size. While the path to recovery is rarely linear, healing is possible with comprehensive care and support. If you or someone you love is struggling with disordered eating, reaching out for help is a sign of strength, not weakness. With commitment, compassion and evidence-based treatment, freedom from eating disorders is within reach.