Eating disorders: Types, symptoms, causes, and treatments

 Key takeaways:

• Eating disorders are mental health disorders that affect how people eat, how they exercise, their body image, and the things they do after eating. 
• Anorexia nervosa, bulimia nervosa, and binge eating disorders are among the most common types of eating disorders. But they aren't the only types. Some other eating disorders don't fit into any of these three categories. 
• Eating disorders are treatable and can be managed with the help of loved ones, therapists, and physicians.

Diet is an important aspect of human life. What humans eat, why they eat, how they eat, when they eat, and how much they eat can impact their physical, physiological, and psychological health, such that if not done right, one can develop a health condition linked to their dietary habits. So, as simple as it may sound, an eating disorder can impact every part of a person’s life.

Research has reported increasing rates of eating disorders, with a 2019 study highlighting an increase from 3.5% to 7.8% between 2000 and 2018. According to another study published in Current Opinion in Psychiatry, more than three million people worldwide die every year due to eating disorders. These conditions affect the way you eat food, the way you think about your weight in relation to food, harmful practices after eating food, your body image, and your physical and mental health. 

 What is an eating disorder?

An eating disorder is a complex mental health condition characterized by abnormal eating habits, thoughts, and behaviors that significantly impact a person's physical and emotional well-being, says Marissa Moore (MA), a licensed professional counselor, therapist, and mental health consultant writer at Mentalyc.

These conditions manifest as disturbing eating behaviors that cause people who are affected to have unhealthy emotions. The more common ones, like anorexia nervosa, bulimia nervosa, and binge eating disorders, affect more women than men.

Eating disorders are not simply about food or weight; they reflect underlying emotional, cognitive, and interpersonal issues that require comprehensive treatment and support, Moore adds.

 Types of eating disorders

Different types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, pica, rumination disorder, and other specified feeding and eating disorders.

 1. Anorexia nervosa

Anorexia nervosa is a condition in which people eat as little food as possible because of their fears of gaining weight. People with this condition often eat low-calorie foods in reduced quantities, exercise excessively, and still believe their size is bigger than it actually is.

Anorexia nervosa usually affects young people and can cause early death from suicide or complications of the disorder.

 Symptoms of anorexia nervosa

Symptoms of anorexia nervosa include:

• Weight loss and extreme thinness
• Brittle nails and hair
• Reduced eating
• Irregular menstrual periods
• Not eating around people
• Weakness 
• Fixation on weight
• Distorted body image
• Low self-esteem
• Leaving for the toilet immediately after eating

 2. Binge eating disorder

People with binge eating disorders eat a lot of food within a short period of time. They keep eating despite being full because they have little to no control over their eating habits. For most of them, after eating, they end up feeling ashamed and guilty. 

Binge eating disorders are the most common eating disorders in the United States. Obesity, depression, diabetes mellitus, digestion problems, sleep disorders, and suicidal thoughts are some of the health conditions associated with this condition. 

 Symptoms of binge eating disorder

Symptoms of binge eating disorder include:

• Eating very large amounts of food in less than 2 hours
• Eating despite being full
• Feeling disgusted with yourself while eating 
• Eating alone because you're ashamed 

 3. Bulimia nervosa

Bulimia nervosa is a combination of binge eating and anorexia nervosa. It involves binge eating, feeling guilty, and being afraid of gaining weight.

It is also often accompanied by negative thoughts about one's body shape, leading to them trying to force their bodies to get rid of the food through self-induced vomiting, taking medications like laxatives and diet pills (which are all acts of purging), and starvation to prevent weight gain.

People with bulimia nervosa may be underweight, overweight, or have a normal weight. This depends on the eating pattern they practice more often.

Bulimia nervosa can cause gastrointestinal and heart problems.

 Symptoms of bulimia nervosa

Symptoms of bulimia nervosa include:

• Overfeeding
• Throwing up after large meals
• Gastroesophageal reflux
• Sore throat (often caused by constant vomiting)
• Overly sensitive teeth from exposure to stomach acid after vomiting
• Diarrhea

 4. Avoidant-restrictive food intake disorder (ARFID)

People with ARFID eat reduced quantities and fewer types of food. Because of this, they end up not getting enough nutrients needed for growth and development. 

ARFID is often seen in children and often manifests as them being picky eaters. ARFID can also occur in adults, causing them to experience constant weakness, such that they can't perform basic activities. 

 Symptoms of avoidant-restrictive food intake disorder

Common symptoms of avoidant-restrictive food intake disorder include:

• Reduced appetite
• Lack of interest in food
• Picky eating that progressively worsens
• Fears about the harm food may cause, like vomiting, diarrhea, constipation, and food poisoning

 5. Pica

Pica is an eating disorder that involves craving and eating things that aren't considered food and have no nutritional value, e.g., chalk, hair, and sand. Most times, before pica is diagnosed, eating such things has to occur consistently and for more than one month. 

A study carried out in Sudan indicated that pica affects pregnant women and children the most. More than 80% of people with pica eating disorder eat clay and sand; some eat ice, and others eat flour. These harmful substances may cause damage to organs like the esophagus and stomach.

 Symptoms of Pica

Pica typically causes symptoms like:

• Eating non-food items like clay
• Abdominal pain from eating harmful items

 6. Rumination disorder

Rumination disorder involves bringing up into the mouth, food that has already been chewed and swallowed (regurgitation) and then chewing and swallowing it again or spitting it out. 

The regurgitant (the food that's brought back up) often doesn't taste bad for them, as the acid in the stomach hasn't acted on it yet.

 Symptoms of rumination disorder

Rumination disorder presents as:

• Repeated chewing without any food in sight
• Mouth constantly moving in a chewing manner
• Pressure in the belly or belly pain, often relieved after regurgitating
• Nausea and vomiting 

 7. Other specified feeding and eating disorders (OSFED)

OSFED are disorders that do not fit into the diagnostic criteria for the disorders mentioned above. This could be because the effects, such as weight loss, are less severe than what's expected, like in atypical anorexia nervosa. 

Some examples of specified feeding and eating disorders are purging disorders and atypical anorexia nervosa.

 Symptoms of OSFED

OSFED can present with symptoms such as:

• Weight loss
• Obesity
• Low self-esteem 
• Sore throat
• Secretive behavior around food
• Recurrent purging behavior
• Constantly eating excessive food late at night
• Body dissatisfaction and negative body image
• Compulsive exercising
• Isolation and social withdrawal 

 Causes and risk factors for eating disorders

Eating disorders can be caused by a combination of factors, including genetics and psychological factors like low self-esteem or perfectionism, says Sarah Boss (MD), a clinical director, psychiatrist, psychotherapist, and somatic experiencing practitioner at The Balance Luxury Rehab.

Other possible contributors include societal pressures to be thin, trauma or abuse, and certain personality traits, Dr Boss adds.

• Genetic causes: If one person in your family has an eating disorder, you may be at an increased risk of having it. Researchers are still working on finding out the exact DNA changes that could be responsible for this. 
• Biological causes: Research shows that up to 39% of women and 15% of men with type 1 diabetes will develop an eating disorder. Extreme dieting also plays a role in this.
• Psychological causes: Being discontent with how your body looks, having a mental issue like anxiety disorder, being unable to control your emotions, and being a perfectionist may contribute to the development of eating disorders. 
• Social causes: Emotional abuse, isolation, loneliness, being bullied and discriminated against because of weight can increase your risk of having eating disorders. 

 Diagnosis of eating disorders

Physicians are in the right position to diagnose and treat eating disorders. They typically start with taking a patient’s medical history, doing a physical examination, doing some tests, and using tools like the SCOFF questionnaire to ask them questions about their symptoms.

• Medical history: When taking a medical history, a doctor may ask questions about the foods you eat, how frequently you eat them, the portions you eat, and how much exercise you do. They may also ask about symptoms like vomiting, the use of diet pills, and a family history of eating disorders. 
• Physical examination: They will typically take your weight and height measurements, your vital signs like blood pressure and heart rate, and calculate your BMI (body mass index) from your weight and height since eating disorders can affect metabolism and weight. 
• Tests: Diagnosis of eating disorders may include running tests like blood tests, urine tests, kidney function tests, and thyroid function tests. 

 Treatment for eating disorders

Eating disorder treatment is tailored to each individual's specific needs and the severity of their illness, and it requires a multidisciplinary approach (different healthcare professionals and different treatment approaches). Psychotherapy, treatment of complications, monitoring, and medications may be needed to treat eating disorders. 

• Psychotherapy: Family-based therapy is a form of psychotherapy that gives your family some responsibility over your feeding habits. 
• Cognitive-behavioral therapy (CBT): CBT is another form of psychotherapy that may be used to treat eating disorders. This form of therapy teaches patients to identify triggers or harmful thoughts that affect their eating habits and what to do about them.
• Treatment of symptoms and complications: Doctors treating eating disorders also treat complications and symptoms, like gastrointestinal esophageal reflux disorders, heart problems, and excessive or low weight.
• Monitoring: Family and friends also have a role to play to help a person going through an eating disorder treatment. They can help by keeping an eye on you, encouraging you to eat well, and letting your healthcare team know how well you are doing with your treatment program. 
• Medication: Some medicines, like antidepressants and mood stabilizers, help in managing an eating disorder.  

 When to seek help for eating disorder concerns

Eating disorders are serious problems, but they can be managed if you acknowledge them, seek help, and get support from family, friends, and healthcare professionals.  

If you do seek help for an eating disorder, these are some of the healthcare professionals who may be involved in treating you:

• Primary care physicians
• Nurses
• Psychiatrists 
• Registered dietitians
• Psychotherapists

You should seek help for yourself or your loved ones if you're overly concerned about your eating habits, weight, and body image.