Eating Disorders Explained: Anorexia, Bulimia, BED, ARFID, and Beyond
What is an Eating Disorder?
An eating disorder involves more than just food. It's a complex relationship involving emotions, self-worth, culture, bodies, and eating that impacts a person on every level. We all use food sometimes to help us to manage our feelings. When a person has an eating disorder, this process takes over.
There are several different eating disorder diagnoses including ARFID (avoidant and restrictive food intake disorder), anorexia, binge eating disorder, bulimia, other specified eating disorders (OSFED) such as orthorexia and unspecified eating disorders (USFED).
What may be more important than the diagnostic labels attached to an eating disorder, however, are the disordered behaviors that accompany them. These can include restriction (not eating enough for your body’s needs), purging (trying to get rid of food or calories you’ve had), bingeing (having much more than your body needs in one sitting), and emotional eating (having more than your body needs in order to meet your emotional needs). They can also include behaviors that are not specifically tied to eating such as overexercise or substance abuse for the purpose of body manipulation, and even attitudes such as moralizing weight and food.
Eating disorders impact physical health, emotional well-being, and social interactions. It's not just about eating habits, but the deeper feelings and struggles that come with them. Understanding this complexity helps us support those affected with empathy and compassion, promoting healthier relationships with food and self-image.
What Causes Eating Disorders?
Eating disorders aren’t caused by just one thing. They stem from a mix of genetic, psychological, and societal factors, making each person's experience unique. Anorexia in particular can be significantly hereditary, meaning that if a close relative has anorexia you are more likely to develop it than another person. Other eating disorders are likely genetically linked as well, but unfortunately they haven’t been researched as robustly as anorexia has.
Psychological factors play a huge role in eating disorders, influencing how individuals view themselves and their relationship with food. Issues like low self-esteem, perfectionism, anxiety, and depression often contribute to the development and maintenance of these disorders.
Trauma and difficult life experiences can also trigger unhealthy eating behaviors as a way to cope. It's essential to recognize that these struggles are deeply personal and complex, not just about the food itself. By understanding the psychological roots, we can offer more compassionate support, helping individuals build a healthier relationship with food and a more positive self-image.
Social factors significantly contribute to the development of eating disorders. Societal pressures and cultural ideals about body image often drive individuals to unhealthy eating behaviors in an attempt to fit in or meet perceived standards. The influence of social media, with its often unrealistic portrayals of beauty, can exacerbate feelings of inadequacy and fuel disordered eating. Peer pressure and family dynamics may play a role as well.
Who is at Risk for Eating Disorders?
Eating disorders can affect anyone, but certain groups are at higher risk. Adolescents and young adults, particularly females, are more commonly diagnosed and treated. People with a family history of eating disorders or other mental health conditions, such as anxiety or depression, are at greater risk. Those who have experienced trauma, abuse, or significant life changes may also be more vulnerable. Additionally, participation in activities that emphasize appearance or weight, like modeling, athletics, or dance, can increase the risk.
Eating disorders do not discriminate and can affect anyone regardless of age, gender, race, or background. While adolescent and young adult females are often highlighted, eating disorders are also prevalent among males, older adults, and people of all ethnicities and socioeconomic statuses. Differences in the data often have more to do with who is getting diagnosed and treated than who is actually affected.
How Can We Prevent Eating Disorders?
As adults, we need to model body love and healthy eating for children as much as we can. Don’t forget that we are in this culture too, though, and so we will not be able to do this perfectly. Modeling healthy eating for children begins with setting a positive example at mealtimes. Having dinner together as a family when possible can be a good idea.
Parents and caregivers can use this time to show kids that balanced nutrition is about variety and enjoyment, not restriction or guilt. It’s also important to make sure there isn’t too much anxiety and stress around food, and instead allow food to be one important place in your family’s life.
Involving children in meal planning and preparation helps them understand the importance of different food groups and encourages them to try new foods. Discussing the benefits of nutritious choices in an upbeat and non-pressuring way fosters a healthy relationship with food. It's also important to avoid labeling foods as "good" or "bad" and instead focus on how different foods make us feel and fuel our bodies. By creating a positive and inclusive food environment, we help children develop lifelong healthy eating habits.
But this isn’t enough. Because our culture is highly image-driven, we need to do what we can to help our children to develop media literacy. They need to understand that many of the images that they see are photoshopped or otherwise manipulated. They also need to understand the function and impact of advertising. We need to actively work to change our culture’s obsessive focus on weight and appearance (often driven, one way or another, by companies profiting by people feeling badly about themselves).
If you are in any position of power, work to make sure that photoshopped images are accurately labeled. Teach media literacy so that children know not to believe everything that they see. Stand up when you see weight bias and weight stigma happening.
Eating Disorder Behaviors
The general consensus at Monarch is that eating disorder diagnoses are a necessary evil. Eating disorders often have comorbidities and switch throughout someone’s lifetime, and they can present very differently from one person to the next. For this reason, we prefer to focus on the disordered behaviors, thoughts and feelings that someone is dealing with. Since behaviors are the most obvious and clear-cut, we can begin there. Because eating disorder diagnoses are commonly used to help professionals and laypeople understand one another, and for insurance companies to allow reimbursements, we will cover those as well further below.
Restriction
Restriction is a hallmark of anorexia but people with any eating disorder diagnosis are prone to it as well. Restriction is not having enough food to meet your nutritional needs. A person can restrict food overall, such as by counting calories or limiting intake by other means, or they can restrict specific foods such as carbs or sugars.
Source- Unsplash.com
Effects of Restriction
Restriction is very hard on the body. Common issues resulting from restriction include:
Low energy
Irritability
Hair Loss
Difficulty feeling your hunger
Anxiety
Poor sleep
Orange cast to the skin
Dry, grayish, cakey looking skin
Always being cold
Tailbone pain when sitting
Thinking about food all the time
Obsessing over recipes and cooking
Obsessing over calories consumed and burned
Feeling spacey and out of touch
Difficulty concentrating
Loneliness (unable to attend food-based social functions)
Poor immune system
Hair falling out
Not getting your period
Poor vaginal lubrication
Lowered sex drive
Not being able to have children
Bone density loss
Heart Attacks
Recovery From Restriction
A skilled eating disorder therapist can help you to let go of restrictive habits. Often the eating disorders therapist works as part of a team that includes a dietician, who helps you to increase your calorie intake in a way that works for you and your body. At the same time, an eating disorders therapist helps you to understand the thoughts and feelings that contribute to wanting to restrict even though it’s bad for your body. We’ll cover eating disordered thoughts and feelings in a bit.
Bingeing
Bingeing means eating a great deal of food within a short period of time. A person may feel totally out of control during a binge episode, and they often feel badly about it afterward. Binges are sometimes preceded by periods of restriction, in a viscous loop known as the binge-restrict cycle.
Effects of Bingeing
Gastric dilation (enlarged stomach)
Stomach expansion
Gastric tearing
Acid reflux
Flatulence and eructation (trapped air coming out)
Reduced gut motility
Stomach cramping
Malnourishment (see list above)
Dehydration
Severe blood sugar swings
Sleep Issues
Joint pain
Hormone imbalances
Insulin resistance
Acne
Bingeing is hard on the body because the body expects for food to be somewhat measured out across time. When one binges on food, it causes sudden, rapid and extreme changes in the body. On top of this, for some people (but not all) bingeing may mean that their body weight is much higher than their genetically determined set point, or the point the body fights to maintain and at which it is optimally healthy. There can be effects from this as well.
Recovery From Binge Eating
Recovering from binge eating really does require a good deal of support. The most important guideline (and maybe one of the most difficult suggestions to take in) is not restricting during the time when you are not binge eating. It’s also very important to drink enough water. A trained therapist can help you to understand your behavior on a deeper level and get to the root cause of this issue for you, further discussed below
Purging
Purging is a term for attempting to get rid of calories. There are many ways that people do this. The effect of the purging on the body depends somewhat on the way in which a person attempts to purge, but some common problems are listed below.
Effects of Purging
Although there are different methods of purging that each have their own associated issues, the following problems are common to most methods that people tend to use.
Heart attacks
Heart arrhythmias
Erosion of tooth enamel
Swollen parotid glands (chipmunk cheeks)
Slowed metabolism
Joint pain
Hormone imbalances
Insulin resistance
Fluid retention
Low blood pressure/orthostasis
Knuckle calluses (Russel’s sign)
Low blood sugar
Hair loss
Malnutrition
Recovery From Purging
Recovery from binge eating involves understanding the emotional and psychological reasons why you purge in order to find other ways to get your needs met. A skilled therapist can help you to see your needs as important, and also avoid self-destructive ways of meeting those needs.
Compulsive Overeating
Compulsive overeating is similar to binge eating in many ways. People eat not because of their nutritional needs, but because the food is serving a psychological function for them. However, unlike binge eating, compulsive eating does not take place in one day. Instead, food is consumed in multiple sittings throughout the day, often when a person is feeling angry, lonely or anxious.
Effects of Compulsive Overeating
Not being able to know when you are hungry or full
Not being able to recognize your emotions
Acid reflux
Stomach pain
Heart problems
Slowed metabolism
Joint pain
Insulin resistance
Energy fluctuations
Chronic fatigue
Sleep apnea
Constipation
Blood sugar irregularities
Recovery from Compulsive Eating
Recovery from compulsive eating means connecting to the feelings you have been trying to avoid through food. It also rests on being compassionate with yourself as you work to understand why you have been eating in the way you have; our culture’s misguided ideas about “willpower” and “discipline” make it easy to moralize food choices but a skilled eating disorder therapist will help you to avoid falling into this trap.
Source- Unsplash.com
Eating Disorder Diagnoses
Anorexia Nervosa
Anorexia is an eating disorder characterized by restriction (discussed above), fear of gaining weight, and distorted body image. People with anorexia often see themselves as overweight, even when they are underweight. Many people with anorexia occasionally binge or engage in a “subjective binge” (it seems like a lot to the person with the disorder but it isn’t according to nutritional standards). Anorexia affects both physical and mental health, making it a serious condition that requires comprehensive treatment.
Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder where individuals avoid certain foods or restrict their intake due to sensory issues, fear of choking, or a lack of interest in eating. Unlike many other eating disorders, ARFID is not driven by concerns about weight or body image. This disorder can lead to significant nutritional deficiencies, weight loss, and difficulties in day-to-day functioning. ARFID impacts both physical health and overall well-being, requiring specialized treatment to address the restrictive eating behaviors.
Bulimia Nervosa
Bulimia is an eating disorder marked by episodes of consuming large amounts of food, followed by efforts to counteract the eating due to intense feelings of guilt or fear of weight gain. People with bulimia may feel trapped in a cycle of overeating and distress, which can lead to serious health problems like electrolyte imbalances, gastrointestinal issues, and heart complications. The disorder has significant effects on both physical and emotional health, requiring comprehensive treatment for recovery.
Binge Eating Disorder (BED)
Binge Eating Disorder is characterized by recurrent episodes of eating large amounts of food in a short period of time, often accompanied by a sense of loss of control. Unlike bulimia, individuals with binge eating disorder do not engage in behaviors to "undo" the eating. These episodes can lead to feelings of guilt, shame, and distress, but are not tied to concerns about body image in the same way other eating disorders might be. The disorder can result in both physical and emotional challenges, and effective treatment focuses on addressing the underlying triggers and improving overall well-being.
Otherwise Specified Eating Disorder (OSFED)
Other Specified Feeding or Eating Disorder (OSFED) is a diagnosis for individuals whose eating disorder symptoms don’t fit into specific categories like anorexia or bulimia but still cause significant harm. OSFED includes several types of disordered eating patterns, such as:
Atypical Anorexia Nervosa: All the symptoms of anorexia, but without being underweight.
Purging Disorder: Purging behaviors (such as vomiting) without binge eating.
Night Eating Syndrome: Recurrent episodes of eating at night, often after waking from sleep.
Binge Eating Disorder of Low Frequency: Binge eating episodes occur, but less frequently than required for a full binge eating disorder diagnosis.
Bulimia Nervosa of Low Frequency: Bulimic behaviors, such as bingeing and purging, but occurring less often than in bulimia.
Even though these disorders may not meet the full criteria for more well-known eating disorders, they are still serious and can have significant impacts on physical and emotional well-being. Treatment is essential to address these patterns and improve overall health.
Unspecified Eating Disorder (USFED)
Unspecified Feeding or Eating Disorder (UFED) is a diagnosis used when someone’s eating disorder symptoms don’t meet the criteria for specific disorders like anorexia, bulimia, or OSFED, but still cause significant distress or impairment. UFED is often used when there’s not enough information for a more detailed diagnosis, but immediate attention is needed. This diagnosis ensures that individuals still receive care, even if the specific nature of their disorder isn’t fully clear yet.
Orthorexia: An obsessive focus on "pure" or "healthy" eating that leads to severe restriction, malnutrition, and health complications, but doesn’t fit into any specific DSM-5 category as they are written right now
Muscle Dysphoria: A subtype of body dysmorphic disorder where individuals become preoccupied with not being muscular enough, leading to compulsive exercise or restrictive eating, often with severe consequences.
Unexplained Restrictive Eating: Restricting food intake without meeting the criteria for anorexia or ARFID, yet causing significant harm or distress.
Irregular Bingeing or Purging: Occasional binge eating or purging behaviors that don’t meet the frequency or severity required for bulimia or binge eating disorder.
Body Image Concerns with Disordered Eating: Disordered eating driven by body image issues that don’t fit into a specific disorder like anorexia or bulimia.
Picky Eating in Adults: Extremely selective eating that interferes with nutrition and functioning, but doesn’t meet ARFID criteria.
Cultural or Religious-Based Eating Practices: Restrictive eating based on cultural or religious practices that lead to health issues but don’t align with recognized eating disorders.
Intermittent Eating Disorders: Disordered eating behaviors that occur sporadically, without a consistent pattern, but cause harm.
Emotion-Driven Eating Behaviors: Eating behaviors linked to emotional distress (e.g., stress eating) that impact health, without meeting criteria for bulimia or binge eating disorder.
Subclinical Forms of Existing Disorders: Early or milder forms of anorexia, bulimia, or binge eating disorder that don’t meet full diagnostic criteria.
Chewing and Spitting: A behavior where individuals chew food and spit it out to avoid calorie intake while still experiencing the taste.
Extreme Exercise with Disordered Eating: Compulsive exercise behaviors driven by a desire to alter body shape or size, often combined with disordered eating.
Thoughts and Feelings Associated with Eating Disorders
Eating disorders are often driven by complex thoughts and feelings that go far beyond food. Individuals may experience an intense preoccupation with body image, weight, or control, leading to feelings of anxiety, guilt, and shame. There’s often a deep fear of gaining weight or a persistent feeling of not being "good enough," which can fuel restrictive eating, bingeing, or purging behaviors.
For many, eating disorders provide a sense of control when life feels overwhelming, even though this control comes at a cost. The emotional toll is heavy, with thoughts of self-worth tightly bound to eating patterns, making it hard to break free from the cycle without support. With the right support, however, these patterns can be adjusted to come more into line with reality so that a person begins to be able to listen to their own inner voice, not just the constant criticisms of their eating disorder.
Source- Unsplash.com
Eating Disorder Comorbidities
Anxiety Disorders
Conditions like generalized anxiety disorder (GAD), social anxiety, and obsessive-compulsive disorder (OCD) share genetics with eating disorders and can also contribute to their development. Anxiety can lead to eating disorders, and serve to maintain them as well.
Depression
Major depressive disorder is highly prevalent among individuals with eating disorders, often exacerbating the emotional struggles tied to disordered eating behaviors. Like anxiety, depression can be both a predisposing factor and a byproduct of the eating disorder effects themselves.
Substance Use Disorders
People with eating disorders may engage in substance abuse. They may use such as alcohol or drugs in order to change their hunger and fullness, alter their metabolism, or deal with the effects
Trauma (PTSD and C-PTSD)
Many individuals with eating disorders have experienced trauma, and PTSD is a common co-occurring condition, particularly in those with a history of abuse or significant emotional distress.
Eating Disorder Recovery & Treatment
So, what does recovery from an eating disorder look like? It depends somewhat on the type and extent of the eating disorder, but there are a few hallmarks of good eating disorder treatment that should always be in place.
Eating Disorder Treatment Team
Eating disorder treatment is best done with a collaborative team. At the core of the team are the psychotherapist and the dietician. These professionals must have particular experience and expertise specifically in the field of eating disorders - eating disorders really are their own creature and level of care decisions require a knowledge base that a generalist provider typically does not have.
Eating Disorder Therapist: The role of the eating disorder therapist is to help you to manage your thoughts and feelings around the eating disorder. Often eating disorders lead people to think in ways that may be off base from reality. Black and white thinking, catastrophizing, and personalizing are common. The eating disorder therapist also helps you to deal with some of the feelings that eating disorders can cause (and be caused by) like not feeling good enough, being angry, or living in a state of constant jealousy.
Eating Disorder Dietician: The dietician on an eating disorder team must be a Registered Dietician. The term “nutritionist” is not regulated and while there likely are very many knowledgeable and skilled nutritionists around, there is no guarantee of that whatsoever. On the other hand, registered dieticians must complete an educational training program and an internship, and they must pass a qualifying examination. Even so, it’s important to choose a dietitian with specific eating disorder experience. Much of the training that dieticians receive that may be appropriate for the general population is actually counterproductive for a person with an eating disorder.
Psychiatrist or Psychiatric Nurse Practitioner (PNP): A psychiatrist or psychiatric nurse practitioner may prescribe medications to help with mood and appetite regulation or other issues. It is difficult to find a professional who is also familiar with eating disorders but it can be very important to try, or at the least to ensure that they will be responsive to feedback from the eating disorder team particularly as it pertains to changes in weight and appetite as a result of medication.
Physician: There are some physicians who specialize in eating disorders, and if it is at all possible it is best to work with one of these providers. They will be more knowledgeable about what medical concerns are most likely to result from eating disorders and will understand the impact of eating disorder behavior on the whole body system. Additionally, physicians who are not trained to work with people who have eating disorders may give advice or respond to clients in ways that are counterproductive and, at times, even harmful.
Additional Professionals: When possible, additional professionals can help to round out the treatment team by ensuring that the whole person is receiving care and support. These can include eating-disorder knowledgeable movement coaches, yoga instructors, acupuncturists, massage therapists, and others. Sometimes multiple or overlapping conditions mean the team should include a gastroenterologist, fertility specialist.
Levels of Care for Eating Disorder Treatment
Outpatient: Monarch therapists are outpatient providers. This means that the client attends therapy and sees their other eating disorder professionals while living at home and having independent say over their food choices. At the outpatient level of care, the assumption is that the person is able to be medically stable and that they are cognitively able to fight back against their eating disorder enough to meet their nutritional needs.
Intensive Outpatient Program (IOP): An IOP program can be a wonderful source of additional support when somebody is struggling at the outpatient level. These programs typically meet three or four days a week in the evening, often for dinner and a therapy group afterwards. They help to make sure a client is able to meet their nutritional needs while they are working with their outpatient team as well.
Partial Hospitalization Program (PHP): A PHP is when you work recovery as if it is your job or school life. They are typically Mondays through Fridays during the day, and include one or two meals and a snack. These programs are often used after a stay in residential treatment to help a person to readjust to having more independence.
Residential: The residential level of care means that a person goes and stays at a facility, day and night. Someone needing to readjust their relationship with food in a way that requires a great deal of support is typically appropriate for the residential level of care. Additionally, the residential level of care is a common option for people who need medical monitoring but do not have medical issues so severe as to require the inpatient level of care.
Inpatient: The inpatient level of care occurs at a hospital setting. This is required when an eating disorder has so harmed the body that medical intervention is required. People at the inpatient level of care may need ongoing monitoring, might require a feeding tube, or might have other medical complications that make it necessary to have a full suite of medical interventions available on-site.
Where to Start Getting Help for an Eating Disorder
There is no pre-set entry point for healing when you are ready to fight back against your eating, but a qualified eating disorder therapist like the ones at Monarch are certainly a good start. An eating disorder therapist can help you to figure out what level of care is most appropriate for you and can make recommendations about how to assemble a team. If you aren’t sure if you are ready to let go of your eating disorder yet, we can help you to understand that.
Reach Out
If you think that you might be interested in healing, please reach out to schedule a consultation. There is no fee and no commitment; just click on the button below to schedule. You can also call or text us at 202-656-3681 or send us an email.
Freedom is possible. Give yourself the chance you deserve.