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 behaviors and related thoughts and emotions.[1]

Individuals with eating disorders may face 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.

WRITTEN Review by:

Amanda Stevens, BS

On: Dec 12, 2023
Medical Review by:

Dr. Po Chang Hsu MD, MS

On: May 7, 2024
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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 severely limits the amount and type of food consumed.

    The binge-purge subtype may also severely limit the amount and type of food consumed. However, 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 food intake. Purging is not common with binge eating.

    The symptoms of binge eating include:

    • Eating unusually large amounts of food in a short 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 in which people eat things that are not food or offer no nutritional value, such as pebbles, charcoal, metal, clay, paper, paint, or soap. Typically, people with pica eat normal food. Pica often occurs in childhood, but it can also occur in adolescence or adulthood.

    Pica is primarily characterized by eating non-food items. While this is the core symptom, individuals with pica may also experience complications such as anemia, gastrointestinal blockages, and poisoning, depending on the substances ingested.

    Rumination Disorder

    Rumination disorder involves the repeated regurgitation and re-chewing of food. The food is either regurgitated into the mouth, re-chewed, swallowed, or spit out. It is usually voluntary but 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
    • It must be severe enough to be addressed on its own, not as a symptom of a mental disorder

    Other Specified Feeding and Eating Disorders

    Other specified feeding and eating disorders (OSFED) represent a category of eating disturbances that do not meet the full criteria for other defined disorders. Reasons may include symptoms that do not match all diagnostic criteria or do not meet specific severity or frequency thresholds.

    For example, atypical anorexia nervosa is often considered other specified feeding and eating disorders because a person may lose a lot of weight and display a distorted body image. However, they are not yet considered underweight because they started being overweight.

    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
    • 10,200 deaths each year are a direct result of an eating disorder

    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[8]

    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 binging and purging behaviors characteristic of some eating disorders increase the risk of developing a substance use disorder.[9]

    In some cases, individuals may turn to substance use as a coping mechanism for the stress, shame, or guilt associated with eating disorders or body image concerns. Substances like appetite suppressants, stimulants, or depressants may be misused to manage weight or emotional distress, potentially leading to addiction. Some of the substances may include caffeine, tobacco, marijuana, or amphetamines, as well as prescription medications like thyroid medications or insulin.[10] Using substances to suppress appetite or alleviate feelings of guilt can increase the risk of developing tolerance and subsequent 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 determine if your insurance provider is in the 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.[11] 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 treatment approach that focuses on identifying, understanding, and modifying dysfunctional thinking and behavioral patterns. Depending on individual needs, CBT can be adapted to short-term or long-term treatment plans.
    • Dialectical behavior therapy (DBT): An evidence-based psychotherapy that focuses on analyzing behaviors, 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.[12]

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    Frequently Asked Questions About Eating Disorders

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