What Are Eating Disorders? Types, Symptoms, and Treatment

Eating disorders are illnesses defined by disturbances in eating patterns¹ and food intake. They also include a preoccupation with body image, calories, and weight. People of any age, sex, gender, and background can develop an eating disorder. Someone with an eating disorder (also called ED) may avoid certain foods or restrict their diet, exercise excessively, use laxatives, or vomit after eating. 

Eating disorders are often an expression of the emotional pains in conditions like depression, trauma, and anxiety. Someone may develop an ED as a way to punish or gain control over themselves. Eating disorders can also develop due to genetic predispositions and social factors. Someone with an ED runs a higher risk of physical health complications, mental health decline, death, and suicide. 

A blend of therapy, weight restoration, and nutritional counseling can not only treat symptoms of an eating disorder, but heal its underlying causes for life-long recovery.

Listen to our podcast to learn more about eating disorder and addiction recovery from Recovery.com’s Chief of Staff, Amanda Uphoff. 

What Are The Causes of Eating Disorders?

Multiple factors can cause eating disorders¹, including genetic predispositions, peer influence, mental health conditions, and bullying. Behaviors and personality dispositions can also lead to an eating disorder and affect what types of eating disorders may develop.

Types of Eating Disorders

Eating disorders take many forms, from restricting diets, purging, and a blend of both. Healing exists for each kind of eating disorder and its potential health complications.

Anorexia Nervosa

Anorexia nervosa causes someone to restrict their food intake², exercise compulsively, and intensely fear weight gain. Someone with anorexia will often have a distorted body image, leading them to feel constantly overweight and in a pursuit of thinness. Anorexia has a very high mortality rate compared to other mental illnesses due to the health effects of emaciation (extreme thinness) and risk for suicide.

Anorexia is more common in females² and occurs most often in adolescence or early adulthood. Someone with anorexia often won’t recognize their low weight, which can make it difficult for them to understand the severity of their condition and agree to treatment. As they progressively lose weight, severe health complications and other symptoms can arise, including:

• Feeling cold all the time
• Irregular periods or no periods at all, which can lead to infertility
• Constipation
• Tiredness and fatigue
• Low and irregular heart rate
• Shallow breathing or feeling out of breath
• Dry skin and brittle nails
• Bone thinning
• Organ failure
• Heart and brain damage

Co-occurring conditions like depression and anxiety often contribute to the development of anorexia², as does growing up overweight, having parents or blood relatives with anorexia, and being body shamed by peers or loved ones. Suicide is the second leading cause of death for people with anorexia¹, following death from health complications caused by undereating and excessive exercise.

Early intervention, weight restoration, and therapy can reverse the effects of anorexia and teach the coping tools needed for long-term recovery, helping patients navigate day-to-day stressors and heal their relationships with food—and themselves.

Bulimia Nervosa

Bulimia nervosa is defined as a pattern of binge eating and purging³. Binge eating involves eating large meals or many high-calorie foods in one sitting, often with the inability to stop. Purging is used to compensate for the binge and prevent weight gain. Someone may purge through self-induced vomiting, using laxatives, excessive exercise, or fasting. Binge-purging can quickly become a self-feeding cycle.

Bulimia nervosa occurs most commonly in young women¹. It can develop due to brain abnormalities, social influence, and mental health conditions. Bulimia can lead to weight loss and symptoms like:

• Irregular periods
• Throat and mouth pain from the stomach acid in vomit
• Tooth damage and erosion, also from stomach acid
• Stomach pain and bloating
• Fatigue
• Dehydration from purging
• Imbalanced electrolytes

Unlike anorexia, someone with bulimia may not appear underweight; they can even look overweight. That’s why clinical evaluations and examinations are important for diagnosis and treatment of bulimia. A doctor will check their patient’s vital signs, ask questions related to binge or purging behaviors, and check for inflammation in the mouth and throat to diagnose bulimia nervosa and start treatment.

Therapy can address the underlying causes of bulimia and teach skills to manage binge-eating, while weight restoration and nutritional care can improve physical health.

Binge-Eating Disorder

Someone with binge-eating disorder will binge on food, but not purge afterwards¹. Binge-eating often includes a lack of control and inability to stop eating, which can cause someone to eat large meals. They may feel sick after binging and gain weight over time, potentially becoming obese. 

Binge-eating disorder can affect men and women of all ages. It can lead to extreme weight gain, shame, and secretive habits to conceal binging behaviors. Other symptoms include:

• Eating very quickly
• Eating despite feeling full or not hungry
• Stomach pain due to overeating
• Eating alone or in a secret location to hide eating habits
• Lying about eating habits
• Frequent dieting to try to control weight gain
• Bloating

Therapy can help someone with binge-eating disorder learn to control binging and find comfort in other activities. Personalized eating plans and exercise regimes can also reduce weight at a safe, comfortable pace.

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID causes avoidant or restrictive eating habits⁴. Someone with ARFID may avoid certain food groups, like carbs, or specific foods, like ice cream. They may also restrict their eating and not meet their required calorie intake. ARFID differs from other eating disorders in that body image and fear of weight gain don’t contribute to food habits; rather, someone may avoid or restrict food simply because they don’t like it.

ARFID was commonly thought of as a childhood disorder, like a more severe version of picky eating. But physicians saw adults experiencing symptoms too, and moved to shift the diagnosis to both children and adults. 

Symptoms of ARFID include:

• Avoiding food groups or types of food suddenly and dramatically
• Eating much less than usual
• Eating fewer and fewer foods because they no longer sound appetizing
• Weight loss
• Reduced interest in food and meal times
• Low/no appetite
• Stomach and digestive problems

Treatment for ARFID often includes therapy to work through food avoidance and identify foods someone will enjoy eating. Weight restoration and nutritional care may be needed, but not always. 

Other Specified Eating or Feeding Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED)

You can think of OSFED as a mix of eating disorder symptoms⁵ that don’t fall under anorexia nervosa, bulimia nervosa, or binge-eating disorder. A patient with this diagnosis may partially meet the requirement for one or more ED diagnoses. OSFED recognizes disordered behaviors and negative relationships with food as a hindrance on daily living, mental health, and physical health.

Similarly, UFED encapsulates eating disorder behaviors and symptoms that may not have a distinct classification. Some scholars and physicians debate the helpfulness of UFED and OSFED⁵, and instead suggest a singular term of ‘mixed eating disorders’. This term could offer more clarification for those diagnosed with it.

The symptoms of OSFED and UFED can vary widely, but typically include:

• Restrictive diets; not eating certain foods
• Purging behaviors (vomiting, excessive exercise, using laxatives)
• An obsession with size and weight
• Body dysmorphia

Therapy and possible weight restoration can help someone with OSFED or UFED heal short and long-term.

Pica

Pica is defined as eating non-food items or substances⁶, like mud or chalk. To diagnose, the person must be older than 2 and eating non-foods outside of cultural or societal norms. Pica can accompany disorders like schizophrenia, obsessive compulsive disorder (OCD), or trichotillomania (compulsively pulling out hair). It commonly occurs in intellectually impaired patients, children, and pregnant women. One study found 28% of pregnant women experienced pica⁶ during their pregnancy. 

Pica doesn’t have a direct cause⁶, though it’s been theorized that iron and zinc deficiencies can cause cravings for non-foods⁷. Pica can also be fueled by curiosity—most people may wonder about eating non-foods or want to, but they realize they shouldn’t. Intellectually impaired people and children may lack this reasoning and eat non-foods regularly. Children may also resort to non-foods to survive in neglectful or abusive environments.

Common pica ‘foods’ include:

• Dirt and clay
• Ice
• Charcoal
• Coffee grounds
• Eggshells
• Paper
• Flaking paint (which can lead to lead poisoning)
• Rocks, bricks, and cement
• Plastic (plastic bags, containers, chunks)

Rumination

Rumination syndrome describes habitually regurgitating food⁸ and swallowing it or spitting it out. It usually happens 10-15 minutes after eating and can last up to two hours. Unintentional stomach and diaphragm tension can cause regurgitation. It happens without nausea and retching, but can cause stomach pain. Once someone learns how to do it, it can become habitual, like burping.

Symptoms of rumination syndrome include:

• Weight loss
• Malnutrition
• Teeth erosion
• Electrolyte imbalances
• Abdominal pain

Rumination can co-occur with conditions like depression, anxiety, obsessive compulsive disorder (OCD). It can be a symptom of an eating disorder or occur alongside one. Treatment often includes breathing exercises to relax the diaphragm, behavioral therapies, and other relaxation methods to practice after meals. Staying relaxed can prevent the over-tightening of the stomach and diaphragm that allows rumination.