Eating Disorders: Signs, Symptoms, and Treatment

Eating disorders like anorexia nervosa and bulimia nervosa are complex mental health conditions that can be serious – even fatal – without intervention. More than lifestyle choices, eating disorders are characterized by severely disrupted eating patterns and related thoughts and emotions.[1]

Anyone with an eating disorder is at risk for adverse or life-threatening consequences. Fortunately, proper treatment and support can be effective at treating eating disorders and restoring healthy relationships with food and body image.

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    What Is an Eating Disorder?

    Eating disorders are behavioral conditions characterized by severe and persistent disturbances in eating behaviors.[2] Preoccupation with food, body weight, and shape may be part of an eating disorder, as well as unregulated emotions.

    The main types of eating disorders are:

    Anorexia Nervosa

    Anorexia nervosa is an eating disorder that’s characterized by an intense fear of gaining weight, severe restriction of food intake, and a distorted body image. People with anorexia may be underweight but perceive themselves as overweight.

    There are two subtypes of anorexia nervosa:
    The restrictive subtype is characterized by severely limiting the amount and type of food consumed.

    The binge-purge subtype is characterized by severely limiting the amount and type of food consumed, but people with this subtype may engage in binge-eating and purging episodes using vomiting, laxatives, or diuretics.[3]

    The symptoms of anorexia nervosa may include:

    • Extremely restricted eating
    • Emaciation
    • An extreme desire to be thinner than a healthy weight
    • Intense fear of weight gain
    • Distorted body image

    Over time, this can develop into more serious symptoms like:

    • Thinning of the bones
    • Mild anemia
    • Muscle wasting and weakness
    • Brittle hair and nails
    • Dry and yellowed skin
    • Abnormal hair growth
    • Severe constipation
    • Slowed breathing and pulse
    • Low blood pressure
    • Damage to the heart
    • Organ failure
    • Brain damage
    • Low body temperature
    • Infertility
    • Lethargy[4]

    Binge Eating Disorder

    Binge eating disorder is characterized by periods of binge eating followed by feelings of guilt, shame, and distress. People with binge eating disorder will consume large amounts of food even when they’re not hungry and often feel out of control of their own food intake. Purging is not common with binge eating.

    The symptoms of binge eating include:

    • Eating unusually large amounts of food in a short period of time
    • Eating when not hungry
    • Eating quickly during binge episodes
    • Eating past the point of being full
    • Eating alone or hiding eating habits out of shame
    • Feeling ashamed or guilty about eating
    • Frequent dieting, with or without weight loss[5]

    Bulimia Nervosa

    Bulimia nervosa is characterized by episodes of binge eating followed by purging behaviors, such as vomiting or using laxatives. People with bulimia often have a distorted body image and a fear of weight gain like anorexia, but the behaviors they engage in differ.

    Bingeing and feeling out of control of food intake and repeated use of compensatory, self-induced purging behaviors like vomiting, laxative or diuretic abuse, and extreme exercise to avoid weight gain.

    The symptoms of bulimia nervosa include:

    • Chronic sore throat
    • Worn tooth enamel from exposure to stomach acid
    • Swollen salivary glands
    • Intestinal distress and irritation
    • Acid reflux disorder and other GI problems
    • Severe dehydration
    • Electrolyte imbalance[6]

    Avoidant Restrictive Food Intake Disorder

    Avoidant restrictive food intake disorder (ARFID), known as selective eating disorder, involves limiting the amount or type of food eaten. There’s usually not a fear of gaining weight or a distorted body image with ARFID. Typically, ARFID has an earlier onset than other eating disorders.

    The symptoms of ARFID include:

    • Dramatic restriction of the types or amount of food eaten
    • Dramatic weight loss
    • Lack of appetite or interest in food
    • Upset stomach, abdominal pain, or other Gi issues
    • Limited range of preferred foods
    • Increasingly picky eating[7]


    Pica is an eating disorder that involves eating things that are not food or offer no nutritional value, such as pebbles, charcoal, metal, clay, paper, paint, or soap. Typically, people with pica will eat normal food. Pica often occurs in childhood, but it can occur in adolescence or adulthood.

    Pica has a single symptom – eating non-food items, but it may have symptoms of associated complications:

    • Anemia
    • Roundworm infection
    • Electrolyte imbalance
    • Lead poisoning
    • Constipation
    • Bowel obstruction[8]

    Rumination Disorder

    Rumination disorder involves the repeated regurgitation and re-chewing of food. The food is either regurgitated into the mouth and re-chewed and swallowed or spit out. It is usually voluntary, but it can become a learned involuntary behavior with time.

    The symptoms of rumination disorder include:

    • Occurs repeatedly over a one-month period
    • Regurgitation doesn’t occur because of a medical problem
    • Doesn’t occur because of a different eating disorder
    • Must be severe enough to be addressed on its own, not as a symptom of a mental disorder[9]

    Other Specified Feeding and Eating Disorders

    Other specified feeding and eating disorders are disturbances of eating patterns that do not fit into other eating disorder categories. This could be because the symptoms don’t meet the diagnostic threshold or the weight criteria.

    For example, atypical anorexia nervosa is often considered other specified feeding and eating disorder because a person may lose a lot of weight and display distorted body image, but they are not yet considered underweight because they started out overweight.[10]

    Eating Disorder Statistics

    Eating disorders are a prevalent problem:

    • Eating disorders affect at least 9% of the population worldwide
    • 9% of the US population, or 28.8 million Americans, will have an eating disorder in their lifetime
    • Less than 6% of people with eating disorders are medically diagnosed as underweight
    • 28% to 74% of risk for eating disorders is through genetic heritability
    • Eating disorders are among the deadliest of mental health conditions, second only to opioid overdose
    • 10,200 deaths each year are a direct result of an eating disorder
    • About 26% of people with eating disorders attempt suicide

    Larger body size is both a risk factor for developing an eating disorder and a common outcome for people with bulimia and binge eating disorder[11]

    Eating disorders often occur simultaneously with addiction

    Eating Disorder and Addiction

    Eating disorders often occur simultaneously with addiction, or substance use disorders, which are co-occurring disorders. In addition, the bingeing and purging behaviors characteristic of some eating disorders increase the risk of developing a substance use disorder.[12]

    In some cases, addiction may develop from the person’s desire to cope with the stress, shame, or guilt of eating or weight, or they may misuse substances to decrease their appetite. Some of the substances may include caffeine, tobacco, marijuana, or amphetamines, as well as prescription medications like thyroid medications or insulin.[13] Using these substances to suppress appetite or assuage guilt can unintentionally lead to tolerance and addiction.

    In some cases, the situation is reversed. Substances can be a trigger for eating disorder behaviors, such as alcohol or marijuana use and binge eating.

    Cost of Dual Diagnosis Treatment for Eating Disorders

    Dual diagnosis eating disorders and substance abuse treatment can vary in cost according to the facility and your individual treatment plan. Fortunately, many insurance companies cover treatment for both substance use disorders and eating disorders. Contact us today to find out if your insurance provider is in network.

    Dual Diagnosis Eating Disorder Treatment

    Dual Diagnosis Eating Disorder Treatment

    Eating disorders and substance use disorders are commonly co-occurring but treating them individually leads to poor outcomes and a high rate of relapse.[14] The relationship between the two disorders can vary based on the specific eating disorder and substance use disorder, making individual treatment challenging.
    Specialized dual-diagnosis treatments that address both eating disorders and substance use disorders dramatically improve the likelihood of recovery. Often, this involves medical stabilization and hospital or inpatient treatment options that include a range of therapies.

    Dual diagnosis eating disorder treatment centers are equipped to offer an integrated approach with behavioral therapy and medication in both inpatient and outpatient settings, including therapies like:

    • Cognitive behavioral therapy (CBT): A long-term treatment option that focuses on identifying, understanding, and challenging thinking and behavioral patterns.
    • Dialectical behavior therapy (DBT): An evidence-based psychotherapy that focuses on analyzing behaviors and learning healthier responses and changing maladaptive or negative thoughts.

    Medications: Several medications may be used to treat either the substance use disorder or the eating disorder, including antidepressants, atypical antipsychotics, mood stabilizers, and opioid partial antagonists.[15]

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    Frequently Asked Questions About Eating Disorders

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