There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Anorexia nervosa
Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.
There are two subtypes of anorexia nervosa: a restrictive subtype and a binge-purge subtype.
Restrictive: People with the restrictive subtype of anorexia nervosa severely limit the amount and type of food they consume.
Binge-Purge: People with the binge-purge subtype of anorexia nervosa also greatly restrict the amount and type of food they consume. In addition, they may have binge-eating and purging episodes—eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what was consumed.
Anorexia nervosa can be fatal. It has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.
Symptoms include:
- Extremely restricted eating
- Extreme thinness (emaciation)
- A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight
- Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
Other symptoms may develop over time, including:
- Thinning of the bones (osteopenia or osteoporosis)
- Mild anemia and muscle wasting and weakness
- Brittle hair and nails
- Dry and yellowish skin
- Growth of fine hair all over the body (lanugo)
- Severe constipation
- Low blood pressure
- Slowed breathing and pulse
- Damage to the structure and function of the heart
- Brain damage
- Multiorgan failure
- Drop in internal body temperature, causing a person to feel cold all the time
- Lethargy, sluggishness, or feeling tired all the time
- Infertility
Bulimia nervosa
Bulimia nervosa is a condition where people have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or overweight.
Symptoms include:
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration from purging of fluids
- Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) can lead to stroke or heart attack
Binge-eating disorder
Binge-eating disorder is a condition where people lose control over their eating and have reoccurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorders often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.
Symptoms include:
- Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
- Eating even when you're full or not hungry
- Eating fast during binge episodes
- Eating until you're uncomfortably full
- Eating alone or in secret to avoid embarrassment
- Feeling distressed, ashamed, or guilty about your eating
- Frequently dieting, possibly without weight loss
Avoidant restrictive food intake disorder (ARFID)
Avoidant restrictive food intake disorder (ARFID), previously known as a selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.
Symptoms include:
- Dramatic restriction of types or amount of food eaten
- Lack of appetite or interest in food
- Dramatic weight loss
- Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause
- Limited range of preferred foods that becomes even more limited (“picky eating” that gets progressively worse)
Other Specified Feeding or Eating Disorders (OFSED)
OSFED may apply to individuals who do not meet the full criteria for anorexia, bulimia, or binge eating disorder. They may experience clinically significant symptoms that are problematic and distressing in how they manage their relationship with food. This may include disordered eating similar to other eating disorders or eating behaviours that are associated with distress, impairment, and risk of pain, death, or disability.
It is important to stress that OSFED is no less serious of an issue than other eating disorders. Individuals affected by OSFED may present with emotional distress and impairment compared with those who do not have an eating disorder. Consequently, they may require ongoing support and treatment to manage their difficulties.
Subtypes of OSFED include:
- Atypical anorexia nervosa: A person develops all of the criteria for anorexia, except that, despite significant weight loss, a person may be within or above the normal weight range.
- Bulimia nervosa of low frequency/limited duration – A person may meet the criteria for bulimia, though binge eating or compensatory behaviours may occur, on average, less than once a week and/or for less than 3 months.
- Binge eating disorder of low frequency/limited duration – A person may meet the criteria for binge eating disorder, though binge eating occurs, on average, less than once a week and/or for less than 3 months.
- Purging disorder: A person may use purging behaviours to change their weight or shape, in the absence of binge eating.
- Night eating syndrome: A person may experience recurrent episodes of night eating. This may occur following excessive consumption of food following an evening meal. Night time eating is not explained by external factors (medication, sleep cycle, other medical disorders) in a person’s life and may cause significant distress and impairment in functioning.