Eating Disorders

What Are Eating Disorders?

Eating disorders are serious mental health conditions characterized by persistent disturbances in eating behaviors and the thoughts and emotions that drive them. They are not lifestyle choices, phases, or matters of willpower. They are clinically recognized illnesses that affect people of every age, gender, race, body size, and socioeconomic background.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), approximately 28.8 million Americans will experience an eating disorder at some point in their lives. Eating disorders carry one of the highest mortality rates of any psychiatric condition, which is why early identification and treatment are so important.

There are several recognized types of eating disorders, each with distinct features:

Anorexia Nervosa is characterized by restricted food intake leading to significantly low body weight, an intense fear of gaining weight, and a distorted perception of body shape or size. People with anorexia often do not recognize the severity of their condition. There are two subtypes: the restricting type, where weight loss is achieved primarily through dieting, fasting, or excessive exercise, and the binge-purge type, where periods of restriction alternate with episodes of binge eating or purging.

Bulimia Nervosa involves recurring episodes of binge eating — consuming large amounts of food in a short period while feeling a loss of control — followed by compensatory behaviors to prevent weight gain. These behaviors may include self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise. Unlike anorexia, people with bulimia are often at a normal or above-normal weight, which can make the disorder less visible to others.

Binge Eating Disorder (BED) is the most common eating disorder in the United States. It involves recurrent episodes of eating large quantities of food, often quickly and to the point of discomfort, accompanied by a sense of loss of control and significant distress afterward. Unlike bulimia, binge eating disorder does not involve regular compensatory behaviors. People with BED frequently experience shame, guilt, and emotional pain related to their eating patterns.

Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by a persistent failure to meet nutritional or energy needs, but without the body image distortion seen in anorexia. People with ARFID may avoid food based on sensory characteristics such as texture, color, or smell, fear of negative consequences like choking or vomiting, or a general lack of interest in eating. ARFID can lead to significant weight loss, nutritional deficiencies, and impaired daily functioning. It is most commonly diagnosed in children and adolescents but can persist into adulthood.

Other Specified Feeding or Eating Disorders (OSFED) is a diagnostic category for individuals who experience significant eating disorder symptoms that cause distress and impairment but do not meet the full criteria for anorexia, bulimia, or BED. OSFED is just as serious as other eating disorders and requires the same level of clinical attention.

Signs and Symptoms

Eating disorders manifest in physical, behavioral, and emotional ways. Because many people with eating disorders go to great lengths to conceal their behaviors, recognizing the warning signs can be challenging.

Behavioral signs may include:

• Preoccupation with food, calories, dieting, or body weight
• Refusing to eat certain foods or entire food groups
• Skipping meals or making excuses to avoid eating
• Eating in secret or hoarding food
• Disappearing to the bathroom after meals
• Excessive or compulsive exercise, even when injured or unwell
• Wearing loose or layered clothing to hide weight changes
• Withdrawing from friends and social activities, especially those involving food
• Rigid food rituals such as cutting food into very small pieces or arranging food on the plate

Physical signs may include:

• Noticeable weight changes, either loss or gain
• Gastrointestinal problems such as bloating, constipation, or acid reflux
• Dizziness, fainting, or chronic fatigue
• Feeling cold all the time or developing fine body hair (lanugo)
• Dental erosion, calluses on knuckles, or swollen salivary glands (signs of purging)
• Menstrual irregularities or loss of menstrual period
• Dry skin, brittle nails, and thinning hair

Emotional and psychological signs may include:

• Intense fear of gaining weight or becoming fat
• Distorted body image or persistent dissatisfaction with appearance
• Feelings of shame, guilt, or disgust related to eating
• Mood swings, irritability, or difficulty concentrating
• Low self-esteem closely tied to weight or appearance
• Anxiety around mealtimes or social eating situations

What Causes Eating Disorders?

Eating disorders do not have a single cause. Research points to a complex interplay of genetic, biological, psychological, and sociocultural factors.

Genetics and biology play a significant role. Studies of twins and families show that eating disorders are highly heritable, with genetic factors accounting for 50 to 80 percent of the risk for anorexia nervosa. Differences in brain chemistry, particularly in serotonin and dopamine pathways, may influence appetite regulation, reward processing, and impulse control in ways that contribute to disordered eating.

Psychological factors are frequently involved. Perfectionism, low self-esteem, difficulty managing emotions, and a need for control are commonly observed in people who develop eating disorders. Co-occurring conditions such as anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder are highly prevalent and may either precede or develop alongside the eating disorder.

Trauma and adverse life experiences are significant risk factors. Research published in the journal Psychological Medicine has found that individuals who have experienced physical abuse, sexual abuse, emotional neglect, or bullying are substantially more likely to develop an eating disorder. The disorder may function as a coping mechanism — a way to manage or numb overwhelming emotions.

Sociocultural influences contribute to the development of eating disorders, though they are not the sole cause. Cultural idealization of thinness, exposure to diet culture, weight stigma, and appearance-focused social media content can reinforce body dissatisfaction and disordered eating behaviors, particularly in vulnerable individuals.

Life transitions and stress such as puberty, starting college, relationship changes, or career pressure can act as triggering events, especially in individuals with other risk factors already in place.

Evidence-Based Treatments

Eating disorders are treatable, and recovery is possible. The most effective treatment approaches are backed by decades of clinical research. Because eating disorders affect both physical and mental health, treatment typically involves a multidisciplinary team including a therapist, a physician, and a registered dietitian.

Enhanced Cognitive Behavioral Therapy (CBT-E) is considered the leading evidence-based treatment for bulimia nervosa, binge eating disorder, and many cases of anorexia nervosa. Developed by Dr. Christopher Fairburn, CBT-E addresses the core psychological mechanisms that maintain eating disorders, including overvaluation of weight and shape, dietary restraint, and mood-driven eating behaviors. Treatment typically lasts 20 to 40 sessions and focuses on normalizing eating patterns, challenging distorted beliefs about food and body image, and developing healthier coping strategies.

Family-Based Treatment (FBT), also known as the Maudsley Method, is the first-line treatment for adolescents with anorexia nervosa and is increasingly used for adolescents with bulimia. FBT empowers parents to take an active role in restoring their child's nutrition and weight. The treatment unfolds in three phases: weight restoration (where parents take charge of meals), gradually returning control of eating to the adolescent, and addressing broader developmental issues. Research published in the Archives of General Psychiatry has shown that FBT leads to full remission in approximately 50 percent of adolescent patients by the end of treatment.

Dialectical Behavior Therapy (DBT) is particularly effective for individuals whose eating disorder is closely linked to emotional dysregulation. DBT teaches skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. It has shown strong outcomes for bulimia nervosa and binge eating disorder, especially when these conditions co-occur with self-harm, impulsivity, or borderline personality features.

Interpersonal Psychotherapy (IPT) focuses on improving interpersonal functioning and resolving relationship problems that contribute to eating disorder symptoms. It has been found effective for binge eating disorder and bulimia nervosa, particularly for individuals whose symptoms are closely tied to relationship difficulties.

Medication can play a supportive role in treatment. Fluoxetine (Prozac) is the only FDA-approved medication for bulimia nervosa, and lisdexamfetamine (Vyvanse) is approved for moderate-to-severe binge eating disorder. Medications are generally most effective when used alongside psychotherapy. For anorexia nervosa, no medication has been shown to reliably promote weight restoration, though medications may be used to treat co-occurring conditions such as anxiety or depression.

Levels of Care

Eating disorder treatment is available across a spectrum of intensity, and the appropriate level depends on medical stability, symptom severity, and the individual's ability to function in daily life.

• Outpatient treatment involves regular therapy sessions (typically one to two times per week) while the person lives at home. This level is suitable for individuals who are medically stable and have mild-to-moderate symptoms.
• Intensive outpatient programs (IOP) provide structured treatment several days per week, often including group therapy, individual therapy, and supervised meals, while allowing the person to live at home.
• Partial hospitalization programs (PHP) offer full-day treatment five or more days per week and are appropriate for individuals who need more support than outpatient care provides but do not require 24-hour supervision.
• Residential treatment provides 24-hour care in a non-hospital setting and is designed for individuals with serious symptoms who need a structured, supportive environment to stabilize and begin recovery.
• Inpatient hospitalization is the highest level of care, reserved for individuals who are medically unstable, at acute psychiatric risk, or unable to maintain adequate nutrition. Inpatient treatment focuses on medical stabilization before transitioning to a lower level of care.

Moving between levels of care as needs change is a normal and expected part of the treatment process. Recovery is not always linear, and stepping up in care when needed is a sign of strength, not failure. For a detailed breakdown, see our guide to eating disorder treatment centers and levels of care and our broader overview of levels of care in mental health treatment.

Recovery: What to Expect

Recovery from an eating disorder is a gradual process that unfolds over months and often years. It involves much more than changes in eating behavior or weight. True recovery means developing a healthier relationship with food, your body, and yourself.

Early recovery often involves working to normalize eating patterns, restore nutritional health, and interrupt compensatory behaviors. This phase can be physically and emotionally uncomfortable. Many people experience heightened anxiety, digestive changes, and intense emotions as they begin to eat in a more structured way.

As recovery progresses, the focus typically shifts to addressing the underlying psychological drivers of the eating disorder, such as perfectionism, trauma, low self-worth, or difficulty tolerating emotions. Building alternative coping strategies and strengthening relationships are central to sustaining long-term recovery.

Relapse is common and does not mean that treatment has failed. Research suggests that approximately 30 to 50 percent of individuals experience a relapse at some point, but each episode of treatment builds skills and self-awareness that support future recovery. Having a relapse prevention plan and ongoing support are important components of long-term wellness.

When to Seek Help

If you or someone you care about is struggling with food, eating, or body image, it is important to reach out for professional help. Consider seeking support if you notice:

• Preoccupation with food, weight, or body shape that dominates daily thinking
• Eating patterns that feel out of control or cause significant distress
• Physical symptoms such as dizziness, fainting, hair loss, or menstrual changes
• Withdrawal from social activities, especially those involving food
• Using food restriction, binge eating, or purging to cope with emotions
• A loved one expressing concern about your eating or weight

Early intervention significantly improves outcomes. You do not need to meet a specific weight threshold or experience every symptom to deserve help. If your relationship with food is causing distress, that alone is reason enough to reach out. If you are unsure whether your current level of support is enough, read about the signs you may need a higher level of care.

If you are in crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988, or reach the Crisis Text Line by texting "HELLO" to 741741.

Frequently Asked Questions