Eating Disorders

What are eating disorders?

Eating disorders are serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights. The three most common eating disorders among youth are anorexia nervosa, bulimia nervosa, and binge eating disorder. Eating disorders have the second highest fatality rate of all mental health conditions. 

It’s common for other mental health conditions to co-occur with eating disorders:

  • Anxiety disorders including generalized anxiety disorder, social anxiety, phobias, panic disorder, post-traumatic stress disorder, and obsessive-compulsive disorder

  • Depression and other mood disorders

  • Substance use disorders

  • Impulse Control Disorders (risky sexual behaviors, driving while intoxicated, shoplifting, gambling, compulsive spending, etc.)

  • Self-injurious behaviors (cutting and other forms of self-harm without suicidal intent)

  • Suicidality 

Causes of Eating Disorders

Eating disorders are complex mental illnesses that affect people from diverse backgrounds. There is no single cause of an eating disorder. Rather, it is a complex combination of biological, psychological, and sociocultural factors that converge and set off an individual’s predisposed genetic vulnerability.

Biological Risk Factors for Eating Disorders

  • Having a close relative with an eating disorder

  • Having a close relative with a mental health condition

  • History of dieting

  • Type 1 (insulin-dependent) diabetes

  • Research has found that up to 39% of women and 15% of men with type one diabetes will develop an eating disorder. The most common pattern is skipping insulin injections, known as diabulimia, which can be deadly.

Psychological Risk Factors for Eating Disorders

  • Perfectionism

    • One of the strongest risk factors for an eating disorder is perfectionism, especially a type of perfectionism called self-oriented perfectionism, which involves setting unrealistically high expectations for yourself.

  • Impulsivity

    • Being prone to impulsivity or taking actions without consideration of the consequences, especially when experiencing negative emotions

  • Emotional dysregulation

  • Avoidance motivation

  • The tendency to avoid thinking, feeling or doing things that are distressing or that may lead to punishment are associated with elevated rates of eating disorders.

  • Body image dissatisfaction

  • Personal history of a mental health condition

  • Personal history of a substance use disorder

Social Risk Factors for Eating Disorders

  • Weight stigma

    • Weight stigma is discrimination or stereotyping based on a person’s weight and is damaging and pervasive in our society. The message that thinner is better is everywhere. 

  • Teasing or bullying

    • Being teased or bullied – especially about weight – is emerging as a risk factor in many eating disorders.

  • Appearance ideal internalization

    • Buying into the message of the socially-defined “ideal body” may increase the risk of an eating disorder by increasing the likelihood of dieting and food restriction.

  • Acculturation

    • People from racial and ethnic minority groups, especially those who are undergoing rapid Westernization, may be at increased risk for developing an eating disorder due to complex interactions between stress, acculturation, and body image.

  • Limited social networks

    • Loneliness and isolation can be a big component to the development of an eating disorder. People struggling with an eating disorder report having fewer friends and social activities, and less social support.

  • Personal experiences of trauma

    • Studies have found that a significant subset of people with eating disorders have experienced past trauma, such as physical, sexual, or emotional abuse and that childhood trauma can be a risk factor for the development of all types of eating disorders.

Types of Eating Disorders:

Anorexia Nervosa

What is Anorexia Nervosa?

  • Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children).

  • Difficulties maintaining an appropriate body weight for height, age, and stature 

  • Distorted body image. 

  • People with anorexia nervosa generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat. 

  • Although people with anorexia may appear thin, some may be of normal weight. 

Symptoms of Anorexia Nervosa

Please note that even though these are common symptoms not everyone with anorexia nervosa displays all of these emotional and behavioral symptoms.

Emotional and Behavioral Signs and Symptoms:

  • Dramatic weight loss

  • Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight

  • Dresses in layers to hide weight loss and/or stay warm

  • Is preoccupied with weight, food, calories, fat grams, and dieting

  • Refuses to eat certain foods, and often eliminates whole food groups (carbohydrates, fats, etc.)

  • Makes frequent comments about feeling “fat” or being a higher weight despite weight loss

  • Has intense fear of weight gain, even though underweight

  • Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

  • Denies feeling hungry

  • Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)

  • Uses excessive amounts of condiments, spices, and artificial sweeteners

  • Consumes large amounts of water, diet beverages and caffeine drinks to fluid load and reduce hunger.

  • Cooks meals for others without eating

  • Makes excuses to avoid mealtimes or situations involving food

  • Expresses a need to “burn off” calories taken in

  • Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury

  • Withdraws from friends and previously pleasurable activities and becomes more isolated and secretive.

  • Has limited social spontaneity

  • Resists or is unable to maintain a body weight appropriate for their age, height, and build

  • Displays rigid and inflexible thinking style and has difficulty adapting to change

Bulima Nervosa

What is Bulimia Nervosa?

  • Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating. 

  • Other purging behaviors include excessive exercise and misuse/abuse of diet pills and/or laxatives. 

  • People with bulimia nervosa may appear thin, but more often are average weight or possibly a little overweight. 

Signs & Symptoms of Bulimia Nervosa:

Please note that even though these are common symptoms not everyone with bulimia nervosa displays all of these emotional and behavioral symptoms.

Emotional and Behavioral Signs and Symptoms:

  • Preoccupied with weight, shape and appearance leading to restriction/dieting behaviors to promote weight loss

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

  • Appears uncomfortable eating around others

  • Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)

  • Skips meals or takes small portions of food at regular meals

  • Engaging in fad diets, the elimination of whole food groups, vegetarianism/veganism in service of weight loss.

  • Engages in episodes of binge eating large amounts of food in a short period of time, often in secret

  • After episodes of binge eating, frequently engages in compensatory behaviors such as self-induced vomiting, diuretic/laxative use, fasting/restricting, excessive exercise or manipulation of insulin dosage

  • Withdraws from friends and previously pleasurable activities and becomes more isolated and secretive

  • Fear of eating in public or with others

  • Steals or hoards food in strange places

  • Drinks excessive amounts of water or non-caloric beverages

  • Uses excessive amounts of mouthwash, mints, and gum

  • Hides body with baggy clothes

  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories

  • Creates lifestyle schedules or rituals to make time for binge-and-purge sessions

  • Withdraws from usual friends and activities

  • Frequent checking in the mirror for perceived flaws in appearance

  • Extreme mood swings

  • Evaluates self-worth based on weight, shape and appearance

  • Experiences shame, guilt, and despair after episodes of binge- eating and compensatory behaviors

  • Frequently experiences low self-esteem

Physical Signs and Symptoms:

  • Noticeable fluctuations in weight, both up and down

  • Body weight is typically within the normal weight range, however some individuals are in larger bodies

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

  • Difficulties concentrating

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, electrolyte imbalances, low potassium, low blood cell counts, slow heart rate)

  • Dizziness

  • Fainting/syncope

  • Sleep problems

  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)

  • Dental problems due to purging include erosion of enamel; bleeding gums/periodontal disease; temperature sensitivity; cavities; discoloration of teeth; dry mouth; enlarged parotid/submandibular glands and swallowing problems.

  • Dry skin

  • Dry and brittle nails

  • Muscle weakness

  • Yellow skin (in context of eating large amounts of carrots)

  • Menstrual irregularities

Binge Eating Disorder (BED)

What is BED?

Please note that even though these are common symptoms not everyone with binge eating disorder displays all of these emotional and behavioral symptoms.

Emotional and Behavioral Signs and Symptoms:

  • Engages in episodes of binge eating large amounts of food in a short period of time, often in secret

  • Avoids eating in public or with others and often feels embarrassed about the quantity of food consumed

  • Steals or hoards food in strange places

  • Repeated failure to sustain weight loss through dieting, increased activity, or the use of weight loss medications

  • Creates lifestyle schedules or rituals to make time for binge sessions

  • Withdraws from friends and previously pleasurable activities and becomes more isolated and secretive

  • Shows extreme concern with body weight and shape

  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting

  • Manipulation of insulin dosage to accommodate binge episode

  • Experiences shame, guilt and despair after binge-eating episodes

  • Fluctuations in weight

  • Frequently experiences low self-esteem

Physical Signs and Symptoms:

  • Noticeable fluctuations in weight, both up and down

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

  • Difficulties concentrating

Helping a Loved One with an Eating Disorder

Friends and family are often key to encouraging loved ones with eating and/or body image issues to seek help. Whether they are unaware that there is a problem, they are afraid or ashamed to seek help, or they are ambivalent about giving up their concerning behaviors, many people with eating and/or body image concerns find it difficult to seek help. Family and friends can play an important role in identifying symptoms to the person struggling and encouraging them to seek help.

If you are concerned about the eating habits or body image of someone you care about, we understand that this may be a very difficult and scary time for you. It’s not always easy to discuss eating concerns, especially with someone you are close to. However, identifying your concerns and seeking more information is essential. Many individuals now in recovery from an eating disorder say the support of family and friends was crucial to them seeking help and getting well.

Tips for How to Talk to a Loved One

  • Learn as much as you can about eating disorders.

    • Read books, articles, and brochures. Know the difference between facts and myths about weight, nutrition, and exercise. Knowing the facts will help you reason with your loved one about any inaccurate ideas that may be fueling their disordered eating patterns.

  • Rehearse what you want to say.

    • This may help reduce your anxiety and clarify exactly what you want to say. Some have found writing out their main points helpful.

  • Set a private time and place to talk.

    • No one wants to have personal issues announced in front of a crowd, so make sure you find a time and place where you will have time to discuss your concerns without being rushed or in front of a crowd.

  • Be honest.

    • Talk openly and honestly about your concerns with the person who is experiencing eating or body image problems. Avoiding it or ignoring it won’t help!

  • Use “I” statements. 

    • Focus on behaviors that you have personally observed, such as “I have noticed that you aren’t eating dinner with us anymore,” or “I am worried about how frequently you are going to the gym.” 

    • It’s easy to sound accusatory (“You’re not eating! You’re exercising too much!”), which can cause a person to feel defensive. Instead, stick to pointing out what you’ve observed. 

    • If you can, also point out behaviors not related to eating and weight, which may be easier for the person to see and accept.

  • Stick to the facts. 

    • Raising concerns about a potential eating disorder can bring up lots of emotions, and it’s important not to let those run the show. Instead, talk about behaviors and changes you have observed and calmly point out why you are concerned (“I have seen you run to the bathroom after meals and feel worried you might be making yourself throw up.”).

  • Be caring but be firm. 

    • Caring about your friend or family member does not mean being manipulated by them. Your loved one must be responsible for their actions and the consequences of those actions. 

    • Avoid making rules, promises, or expectations that you cannot or will not uphold. For example, “I promise not to tell anyone.” Or, “If you do this one more time, I’ll never talk to you again.”

  • Remove potential stigma. 

    • Remind your loved one that there’s no shame in admitting you struggle with an eating disorder or other mental health issue. Many people will be diagnosed with these issues during their lifetimes, and many will recover.

  • Avoid overly simplistic solutions.

    • Being told “Just stop” or “Just eat” isn’t helpful. It can leave the person feeling frustrated, defensive, and misunderstood.

  • Be prepared for negative reactions. 

    • Some may be glad that someone has noticed they are struggling. Others may respond differently. Some may become angry and defensive, insisting that you are the one with the problem. Others may brush off your concerns or minimize potential dangers. 

    • All of these responses are normal. Reiterate your concerns, let them know you care, and leave the conversation open.

  • Encourage them to seek professional help. 

    • The recommended strategy to deal with an eating disorder is to seek professional help. Offer help finding a physician or therapist if they don’t have one or attend an appointment where the eating disorder is discussed. 

    • Getting timely, effective treatment dramatically increases a person’s chances for recovery. 

  • Tell someone. 

    • It may seem difficult to know when, if at all, to tell someone else about your concerns. Addressing body image or eating problems in their beginning stages offers your loved one the best chance for working through these issues and becoming healthy again. 

    • Don’t wait until the situation is so severe that your friend or family member’s life is in danger. Your loved one needs a great deal of support and understanding.

  • This may be a challenging and emotional time for you as well and important to take care of your own mental health. Talk with trusted family members, friends, or even consider seeing a therapist to help you during this difficult time. 

  • Even if you don’t feel the discussion was well-received or that you got through to your loved one, don’t despair. You shared your concern and let them know that you care and are there for them. You may also have planted a seed that they should seek help. The seed may not take root immediately, but over time, the concern of friends and family can help

Note: If you suspect a medical or psychiatric emergency, such as threats of suicide or medical complications from eating disorder behaviors (such as fainting, heart arrhythmias, or seizures), seek medical attention or call 911 immediately.

Finding Treatment

There are different ways to find treatment for someone who is struggling with an eating disorder. You can talk to the youth’s primary care physician who may provide a referral, connect with a mental health professional who may be able to assist with treatment options/referrals or utilize online databases to locate treatment options. 

Important to note – if a youth needs inpatient treatment for an eating disorder, it is common that they will have to go out of state. West Virginia does not have any inpatient treatment centers for eating disorders.

The following websites offer treatment location options for eating disorders:

Rebecca White