What Are Eating Disorders? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Watching what you eat, like most things, is good for you in moderation. To eat nutritious foods and feel comfortable in your body is certainly a good goal. But when you focus excessively on what you eat, when you eat, and how much you eat to the point where it impinges on your life and impairs your ability to function, you may have an eating disorder.

What’s Normal Eating Behavior and What Isn’t?

How can you know if your concern about your diet and your body’s shape is veering toward — or may already be — an eating disorder? You can’t just look in a mirror. Despite what many people think, you don’t have to be female or skinny — or fat — to have an eating disorder. You don’t even have to look as though anything is wrong.

“Weight can be an indicator of an eating disorder, but it certainly isn’t the only one,” says Ilene Fishman, a licensed clinical social worker in New York City and Montclair, New Jersey, who spent a decade during her adolescence battling — and eventually recovering from — her own severe anorexia.

• Anorexia This disorder is marked by extreme control over calorie intake, an intense fear of gaining weight, and often an unrealistic view of body size and shape.
• Bulimia Also known as binge-purge syndrome, bulimia is marked by frequent, rapid overeating followed by purging to avoid gaining weight. Purging may include forced vomiting, obsessive exercising, and misuse of laxatives and diuretics.
• Binge-Eating Disorder This disorder is marked by frequent out-of-control eating in a short amount of time, often until the person feels uncomfortably full. Binge-eating disorder often occurs in secret because of self-disgust and embarrassment. People with this condition don’t purge.

The duration of an eating disorder varies from person to person.

Although many people in the grip of an eating disorder appear very high-functioning on the outside, excelling at work and at home, inside, their bodies are in crisis. Some eventually fully recover. Others cycle through periods of recovery and relapse. And some become chronically ill or die.

According to NEDA, eating disorders have the highest mortality rate of any psychiatric illness. An estimated 20 percent of people with eating disorders eventually die from complications such as irregular or very low heartbeat (arrhythmia), sudden cardiac arrest, severe liver disease, or suicide.

Even those who survive may face serious health issues, including but not limited to:

• Irreversible bone loss
• Muscle loss and weakness, including in the heart muscle
• Anemia
• Severe dehydration, which can lead to kidney failure
• Dry skin and hair loss
• Slowed digestion (gastroparesis)
• Fainting, fatigue, and overall weakness
• Menstrual irregularities or loss of libido
• Depression

Celebrities With Eating Disorders

We also live in a culture that has, historically, valued waist size over accomplishments. Movies, television shows, and fashion magazines have perpetuated this value system by featuring unhealthy and unrealistic bodies, thus contributing to eating disorders.

But that has started to change in recent years. More and more celebrities are stepping forward to reveal the toll that the culture of thinness has taken on them, helping to increase awareness about eating disorders and reduce the stigma.

Among them are:

• Gabourey Sidibe The Oscar-nominated star of Precious and American Horror Story: Apocalypse vividly describes how she used bulimia to cope with depression in her memoir This Is Just My Face: Try Not to Stare. “My emotions were out of control, and all I could do was cry about it for hours,” she wrote. “One day, I cried so long and hard that I started vomiting. When I was done, I wasn’t crying anymore. I wasn’t even thinking about what had made me cry to begin with. I felt empty, which was a great thing — before this, I’d felt too full of emotions. … I wasn’t even trying to lose weight — that’s not the way it works. I was trying to stop myself from crying.”
• Kesha In an interview in Vogue, the pop star recalled what led her to seek in-patient treatment for bulimia at Timberline Knolls Residential Treatment Center in Lemont, Illinois, in 2014. “There was a lot of not eating — and I started thinking [that] being hungry to the point of feeling almost faint was a positive thing. The worse it got, the more positive feedback I was getting. Inside I was really unhappy, but outside, people were like, ‘Wow, you look great.’”
• Lily Collins Collins suffered with anorexia and bulimia as a teenager, then risked a relapse years later by losing a significant amount of weight to play a character with anorexia in the movie To the Bone. In 2017, she told Collider that she chose to play the role to bring awareness to eating disorders. “This was something that I needed to talk about and bring to the attention of more people. … It is still considered quite taboo to talk about, and yet it’s becoming more and more prevalent within today’s society, and not just with women.”

• Anxiety
• Depression
• Obsessive compulsive disorder (OCD)
• Borderline personality disorder (BPD)
• Substance abuse disorders

Concerned? The surest way to get an accurate diagnosis for yourself or someone else is to consult an eating disorder specialist. You can delve deeper and get referrals for help in your area by using the quick and confidential online screening tools offered by the National Eating Disorders Association and Screening for Mental Health. You can find support, resources, and more information about treatment options at the National Eating Disorder Association website (MyNEDA.org) or by calling the association’s helpline at 800-931-2237.

• National Eating Disorder Association
• National Association of Anorexia Nervosa and Associated Disorders
• The Alliance for Eating Disorders Awareness
• Orthorexia
• Learn more about additional resources and support for Eating Disorders

Additional reporting by Julie Marks.