Eating Disorders 101

Eating disorders are complex illnesses with biological, genetic, psychological, social, and developmental roots. They come in all shapes and sizes and they do not discriminate between age, gender, race, class, sexual orientation, socioeconomic background, or ethnicity. It is impossible to know whether a person suffers from an eating disorder, or its severity, solely on the basis of appearance.

Eating disorders are not a choice.
They are real, life-threatening illnesses with potentially fatal consequences.

With 1 death every 52 minutes occurring in the U.S. as a direct result of an eating disorder, eating disorders have the second highest mortality rate of any mental illness.

With early intervention, full recovery is possible.
With treatment, the mortality rate of people with serious eating disorders falls from 20% to 2-3%.

Disordered eating vs eating disorders:
Disordered eating behaviors (including dieting) can be precursors to eating disorders.  Disordered eating may include (and is not limited to) a rigid food and exercise regime; feelings of guilt or shame when unable to maintain said regime; a preoccupation with food, body, and exercise that has an impact on quality of life; compulsive eating; compensatory measures to ‘make up for’ food consumed (i.e.:  excessive exercise, food restriction, fasting, purging, and laxative or diuretic use); and weight loss supplement use. Checking-in with intentions behind and behaviors around food and exercise may be helpful in determining if it is an unhealthy relationship. Eating disorders may include the behaviors mentioned but they are complex psychiatric illnesses with biological components and they can be life-threatening. When an individual is struggling with an eating disorder, they generally engage in multiple behaviors with more frequency and intensity. The level of obsession with food, exercise, and body thoughts and behaviors can distinguish disordered eating from an eating disorder. These thoughts are generally all-consuming and may include (but are not limited to) fixation on calories; good and bad foods; ingredients; measurement; taste; body size and shape; type and frequency of exercise; feelings of failure when unable to sustain these behaviors; and avoidance of social activities.

While awareness of “typical” signs/symptoms of the more “familiar” eating disorders is critical, it is also important to note that there is a spectrum of maladaptive behaviors (some close to becoming official diagnoses and some not close enough), and that disordered eating and eating disorder symptoms can manifest at different times and overlap.

Physical signs & symptoms

Marked weight loss, gain, or fluctuations
Malnourished (regardless of weight)
Significant changes on growth chart, including slowed growth
Delayed pubertal progression
Cold intolerance
Fatigue or lethargy
Muscle cramping, poor motor control
Muscle, organ, and/or cerebral atrophy
Hot flashes, sweating episodes

Oral trauma/lacerations
Dental erosion and dental caries
Parotid enlargement

Chest pain
Heart palpitations
Shortness of breath

Epigastric discomfort
Early satiety, delayed gastric emptying
Gastroesophageal reflux
Hemorrhoids and rectal prolapse

Amenorrhea or irregular menses
Loss of libido
Low bone mineral density and increased risk for fractures

Memory loss/poor concentration
Insomnia or difficulty sleeping
Depression/anxiety/obsessive behavior
Suicidal ideation/suicide attempt

Lanugo hair
Hair loss
Dry skin and hair
Brittle nails
Yellowish discoloration of skin
Callus or scars on the dorsum of the hand (Russell’s sign)
Poor healing

Psychological/behavioral signs & symptoms

All eating disorders may include some or all of these symptoms
Eating alone
High level of shame, guilt, disgust, embarrassment
Mood swings, feeling worthless, unloved, or unaccepted
Think about food often throughout the day and distress about food behaviors
Comparison to others and/or distorted body image
Difficulty concentrating and sleep disturbance
Defensiveness when eating behavior is addressed
Feeling out of control and shame over how much eating
Self-esteem and self-worth tied heavily to body shape and weight
Withdrawal from ‘normal’ activities/routines
Failing performance in work, school, etc

Specific to Binge Eating Disorder (BED)
Feel a lack of control around food
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts of food even when not feeling physically hungry
Hiding/hoarding food
BED behaviors may be the result of not eating enough food (restrict/binge cycle)

Specific to Anorexia Nervosa (AN)
Obsession and rigidity with food, weight/shape/size, calories, dieting, and/or exercise
Intense fear of gaining weight
Frequent weighing and body checking
Calorie restriction
Denial of hunger or weight loss – lack of insight of severity of condition
Withdrawal from usual friends and activities, avoids public eating

Specific to Bulimia Nervosa (BN)
Consuming large amounts of food in a short period of time
Use of compensatory behaviors after consuming calories including laxative/diuretic/enema use, self-induced vomiting, excessive exercise, use of diet pills, restricting/fasting, and chewing and spitting
Fear of gaining weight

Specific to Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant due to sensory sensitivity
Aversive due to fears
Restrictive due to lack of interest or extreme pickiness
Not due to a drive for thinness
More common in children and young adolescents
Often associated with psychiatric comorbidity (especially anxious and obsessive-compulsive features of Autism Spectrum Disorder)

About Other Specified Feeding and Eating Disorders (OSFED)
Individuals suffering from maladaptive thoughts and behaviors related to food, eating, and body image but who do not meet all of the diagnostic criteria.  The category was developed to encompass those individuals who did not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder.  Research into the severity of OSFED shows that the disorder is just as severe as other eating disorders.  Examples include:  Orthorexia (the harmful obsession with the quality or purity of food and ‘healthy’ eating), over exercise/exercise compulsion, Body Dysmorphic Disorder, and Diabulimia

If this list causes any level of concern, or thoughts about food, weight, exercise routine, body shape or size are taking a predominant role, seeking professional help for early detection is strongly encouraged. 

Getting help:
Not sure where to start?  That’s what we are here for!  If you or a loved one are in need of support, please call our Helpline (828.337.4685) or email us at [email protected] and we will provide resource and referral information – and support.

When it comes to clinical care or a higher level of care, connection with an eating disorder professional or treatment center can help provide you with the experienced and educated support needed to learn what is the best fit for you. CRC for ED Treatment Directory

CRC for ED’s Medical Provider Resource is a wonderful reference for essential information about eating disorders.

***The AAP Guidelines for the Treatment and Prevention of ‘Obesity’ was released in early 2023.  The recommendations include a focus on BMI as a diagnostic tool, restrictive diet programs, weight loss medications, and bariatric surgery for children.  We have concerns of the harmful impacts these guidelines are having on young people, particularly those with marginalized identities. In response to the new guidelines, Carolina Resource Center for Eating Disorders teamed up with Sunny Side Up Nutrition to create a Parent Resource to support families in navigating their children’s medical care.  Please feel free to use this resource and share it.  Parent Resource AAP Guidelines