We’ve all done it … used food at one time or another to comfort ourselves. Or eating that extra portion when we were already full and regretted it later. We may tell ourselves that next time we’ll take control of our food instead of letting our food control us. We might change our eating habits or not worry if we gain a pound or two.

But for people with an eating disorder, their relationship with food is different and the consequences are far more serious. Eating disorders are among the deadliest of mental illnesses, second only to opioid overdose. An eating disorder such as anorexia can affect every organ system in the body. Teens and young adults with anorexia have 10 times the risk of dying compared to their peers.

The Changing Face of Eating Disorders

Eating disorders are more widespread than you might think. National surveys estimate that 9 percent of the U.S. population –20 million women and 10 million men – will have an eating disorder at some point in their lives. Unfortunately, the COVID-19 pandemic has only made this situation worse. Hotline calls to the National Eating Disorders Association have increased 70 to 80 percent in recent months.

It used to be thought that eating disorders were largely an illness of adolescent white females. However, recent studies reveal that black teenagers are 50 percent more likely than white teenagers to demonstrate bulimic behavior, such as binging and purging (throwing up their food). And Hispanics are significantly more likely to suffer from bulimia than their non-Hispanic peers. Yet, people of color are much less likely to be screened for eating disorders by their doctors.

Types of Eating Disorders

The most common eating disorders with psychiatric DSM-5 diagnoses include anorexia, bulimia, and binge eating disorder. Other DSM-5 eating disorders include purge disorder, rumination disorder, pica disorder, avoidant/restrictive food intake, and night eating syndrome. Information on each of these disorders can be found in the Eating Disorders section of our Mental Health Library. Following is information on the leading types of eating disorders:

• Anorexia Nervosa – Commonly referred to as simply “anorexia,” this condition mostly affects adolescents, occurring at least 10 times more often in females than in males. Anorexia is characterized by a person being significantly underweight for their age and sex, with an intense fear of gaining weight. The individual has a distorted view of their body, does not see themselves as underweight, and values thinness as one of their few or only sources of self-esteem. Approximately half of the anorexic people will lose weight by drastically reducing their food intake. The other half will also engage in binge eating and purging (throwing up their food after eating).
• Bulimia Nervosa – Commonly referred to as simply “bulimia,” this condition is more prevalent than anorexia, affecting up to 4 percent of young women. As with anorexia, the goal of those with bulimia is to be thin. Unlike anorexic persons, however, an individual with bulimia typically maintains normal body weight. Binge eating occurs when they either give in to hunger pangs or use food as a way to self-medicate during times of emotional distress. In either case, they will follow their binge eating with compensatory behaviors to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
• Binge Eating Disorder – Individuals diagnosed with binge eating disorder eat an abnormally large amount of food during a short period of time. Unlike bulimia patients, however, they do not compensate in any way after eating through behaviors such as purging or using laxatives to prevent weight gain. People diagnosed with binge eating disorder will quickly eat large amounts of food even when they are not hungry to the point of being uncomfortably full. They will also eat alone and feel guilty or upset about the episode afterward. Binge eating disorder is the most common type of eating disorder. It appears in approximately 25 percent of individuals who seek help for obesity. 

Symptoms of Eating Disorders

People with eating disorders can show a variety of different signs and symptoms. Some of the common symptoms include:

• Frequent dieting and preoccupation with weight, food, and calories.
• Noticeable fluctuations in weight.
• Skipping meals or taking small portions of food at regular meals.
• Extreme concern with body size and shape.
• Frequent checking in the mirror for perceived flaws in appearance.
• Appears uncomfortable eating around others.
• Withdrawal from usual friends and activities.
• Extreme mood swings.
• Feelings of low self-esteem.

An eating disorder may also lead to different physical symptoms as the body suffers from limited food intake and poor nutrition. These can include stomach cramps, menstrual irregularities, difficulties concentrating, dizziness, thyroid problems, feeling cold all the time, sleep difficulties, muscle weakness, dental problems, impaired immune functioning, and more.

Psychology Behind Eating Disorders

What leads to an eating disorder?  A growing consensus suggests a range of biological, psychological, and sociocultural factors are involved. Understanding the psychology behind eating disorders may prove most useful in preventing and treating them.

When it comes to anorexia, psychologists believe that adolescents may unconsciously starve themselves as a way to demonstrate control over their bodies and independence from their parents. Psychotherapists who treat anorexic patients generally agree that these young patients have been unable to separate psychologically from their mothers. Other mental health disorders are often in the picture also. Depression is associated in 65 percent of anorexic patients, social phobia in 35 percent of cases, and obsessive-compulsive disorder (OCD) in 25 percent of cases.

Individuals affected by bulimia tend to be high achievers and respond to societal pressures to be slender. As with anorexic patients, many individuals with bulimia are depressed and have higher rates of depression in their families. However, the families of patients with bulimia are generally less close and have more conflict than the families of those with anorexia. Individuals with bulimia describe their parents as neglectful and rejecting instead of overbearing. Those with binge eating disorders tend to do more emotional eating and have higher rates of other mental health conditions. For many, eating is a coping mechanism tied to stress.

Treatments for Eating Disorders

Treatments for eating disorders differ according to the specific patient and situation. Anorexic patients require a comprehensive treatment plan, including hospitalization if necessary.  Both individual and family therapy are recommended. Cognitive-behavioral therapy (CBT) is often effective, and in many cases, medication may be needed. Participation in support groups, such as those provided by the National Association of Anorexia Nervosa and Associated Disorders, may also be helpful.

For bulimia and binge eating disorders, the most effective treatment is usually a combination of psychotherapy and antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). CBT is the most effective type of psychotherapy for treating either disorder. Exercise has also shown a reduction in binge eating when combined with CBT. Two other types of effective treatment for binge eating include interpersonal psychotherapy (therapy focused on interpersonal problems) and participation in self-help groups such as Overeaters Anonymous.

Eating disorders are much more than an abnormal way of relating to food. They can sabotage a person’s mental and physical health and detrimentally affect their entire life. Whichever eating disorder a person may have, the chance for recovery increases the earlier an eating disorder is detected. If you’re wondering if you or someone you love may have an eating disorder, the National Eating Disorders Association (NEDA) offers an eating disorders screening tool. NEDA also offers an eating disorders helpline with telephone and chat support.

Harmony United Psychiatric Care provides comprehensive outpatient mental health care in Florida. If you need help with an eating disorder, depression, anxiety, or other condition, we can help. Visit our Book Appointments page to schedule an appointment today.