Eating Disorders 101

Eating disorders are:
Complex illnesses with biological, psychological, and social roots.  They involve extreme emotions, attitudes, and behaviors surrounding weight/size, food, and exercise.  There is never a single cause, the onset often follows some sort of traumatic or distressing event, and they affect both physical and mental health.

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

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.  It is also vital to have an understanding that eating disorders come in all shapes and sizes, they do not discriminate between age; gender; race; class; sexual orientation, and ethnic groups, and you cannot tell if someone is struggling on the basis of appearance.

Signs/Symptoms:
This list is intended as a general overview of some of the signs that may indicate a serious problem:

  • Behaviors and attitudes that indicate that weight loss, dieting, and control of food and food rituals are becoming primary concerns
  • Limited range of preferred foods that become narrower over time (i.e.: picky eating that progressively worsens)
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An increase in concern about the health of ingredients; an inability to eat anything but a narrow group of foods that are deemed ‘clean,’ ‘healthy,’ or ‘pure’
  • Self-esteem overly related to body image
  • Extreme concern with body size and shape
  • Expresses a need to “burn off” calories taken in
  • Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury
  • Intense anxiety, depression and/or distress if unable to exercise
  • Dry skin and hair, and brittle nails
  • Fine hair on body (lanugo)
  • Muscle weakness
  • Poor wound healing
  • Difficulties concentrating
  • Feeling cold all the time
  • Noticeable fluctuations in weight, both down and up
  • Feelings of disgust, depression, or guilt after eating, and/or feelings of low self-esteem
  • Evidence of binge eating, including the disappearance of large amounts of food in short periods of time; feeling lack of control over the ability to stop eating. Sometimes including behaviors to prevent weight gain, such as self-induced vomiting, use of laxatives/diuretics, or excessive exercise.
  • Cuts and calluses across the top of finger joints and dental problems such as enamel erosion (a result of inducing vomiting)
  • Swelling around the area of salivary glands
  • Withdrawal from usual friends and activities

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. Without treatment, up to 20% of people with serious eating disorders die. With treatment though, the mortality rate falls to 2-3%.

DSM-5 – Eating Disorder Assessment Guidelines:
Anorexia Nervosa:  characterized as a serious medical and mental health disorder that can be life-threatening.  AN presents with food restriction, low body weight, fear of gaining weight or becoming overweight, lack of realizing the seriousness of extremely low body weight, and body dysmorphia.

Bulimia Nervosa:  characterized by recurrent episodes of binge eating and practicing inappropriate compensatory behaviors in an effort to prevent weight gain:  self-induced vomiting, frequent use of laxatives, diuretics, and excessive exercise.  Patients with BD can appear average or even overweight.  BN can be life-threatening.

Binge Eating Disorder:  expressed by recurrent episodes of binge eating and a feeling of loss of control.  BED is not associated with recurrent compensatory behaviors as with AN and BN but is observed in connection with physical and emotional distress.

Avoidant/Restrictive Food Intake Disorder:  similar to AN in that both disorders involve limitations in the amount and/or types of food consumed, but unlike AN, ARFID does not involve any distress about body shape or size.  ARFID is eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs.

Other Specified Feeding and Eating Disorders:  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:  Atypical AN (all criteria met except despite significant weight loss, the individual’s weight is within or above the normal range), BED (of low frequency and/or limited duration), BN (of low frequency and/or limited duration), Purging Disorder (recurrent purging behavior to influence weight or shape in the absence of binge eating), Night Eating Syndrome (recurrent episodes of night eating… eating after awakening from sleep or by excessive food consumption after the evening meal)… and although not formally recognized in the Diagnostic and Statistical Manual, Orthorexia (the harmful obsession with the quality or purity of food and ‘healthy’ eating).

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 a higher level of care, connection with an eating disorder professional 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