Eating Disorders 101: Warning Signs, Risk Factors, and Treatment

Nearly 30 million Americans experience an eating disorder in their lifetime. The vast majority, however, do not receive care due to stigma, misinformation, and access barriers. Increasing our understanding of these serious illnesses is crucial to improving early detection and intervention. In this blog, we provide a general overview of eating disorders, including the types, risk factors, and warning signs, as well as the importance of multidisciplinary treatment.  

What Are Eating Disorders?

Eating disorders are complex mental health conditions characterized by disturbances in eating behaviors and thoughts about food and weight. Neither a diet nor a lifestyle choice, they are all-consuming, serious illnesses that significantly impair psychosocial functioning and physical health. Left untreated, they can be deadly. Eating disorders have the second-highest mortality rate of all mental illnesses, and it’s estimated that one American dies every 52 minutes as a direct result of an eating disorder.

Eating disorders fall under five primary diagnoses, respectively characterized by the following criteria:

• Anorexia nervosa: An inability to eat enough food to maintain weight and/or growth trajectories; exceptionally low body weight; an obsessive concern with weight gain; and a distorted body image
• Bulimia nervosa: Recurrent binge eating episodes and persistent, inappropriate compensatory behaviors with the hope of avoiding weight gain. 
• Binge eating disorder (BED): Recurrent binge eating episodes that are accompanied by marked distress, a sense of lack of control, and feelings of self-loathing, disgust, or guilt. 
• Avoidant Restrictive Food Intake Disorder (ARFID): A persistent failure to meet appropriate nutritional and/or energy needs as a result of eating or feeding disturbances such as an apparent lack of interest in food, avoidance due to the sensory qualities of food, and/or concern over adverse consequences of eating food.
• Other Specified Feeding and Eating Disorders (OSFED): Eating disorder symptoms that cause significant distress and impair social or occupational functioning and/or have significant medical consequences, but do not meet the full diagnostic criteria for anorexia nervosa, bulimia nervosa, binge eating disorder, or ARFID.

Eating disorders know no social boundaries; they affect people of all ages, sexes, genders, races, abilities, socioeconomic statuses, and cultural backgrounds. Once thought of as a “thin young white women’s disease,” the illness leaves no part of the population untouched. Some segments are, however, disproportionately affected and undertreated. For example:

• Transgender individuals experience eating disorders at significantly higher rates than cisgender individuals (NEDA). 
• Black teenagers are 50% more likely than white teenagers to experience bingeing, purging, and other bulimic behaviors (Goeree, Sovinsky, & Iorio, 2011).
• BIPOC with eating disorders are half as likely to be diagnosed or to receive treatment (STRIPED, Academy for Eating Disorders, & Deloitte Access Economics). 

What Causes Eating Disorders?

Eating disorders are not a choice but rather biological, brain-based illnesses impacted by complex psychological and social factors. The biopsychosocial factors differ from person to person, but often include components such as:

Biological:

• Genetics and epigenetics
• Puberty/menopause
• Dieting or changes in food exposure/security
• Gut health

Psychological/Traits:

• Anxiety, depression
• Substance use
• Trauma
• Stressors, including life transitions, relationship changes, or major illness or injury
• Self-image

Social/Environmental:

• Weight/appearance pressures
• Comments or teasing related to weight, size, or other aspects of appearance (e.g., height, developing early or late)
• Media, including social media

No single component causes eating disorders. Instead, a combination of risk factors may increase the likelihood of an eating disorder in someone whose biology has predisposed them to develop one. It takes a perfect storm—multiple biopsychosocial factors converging at the same time. Once an eating disorder develops, it is maintained by changes in an individual’s biology and psychology. The illness takes hold as it actually changes brain shape and function, damage exacerbated by a lack of nutrition.

What Are the Warning Signs of Eating Disorders? 

The warning signs of eating disorders aren’t always obvious. There is no one eating disorder “look,” and even individuals who appear healthy may be experiencing serious distress and impairment. Our culture’s obsession with weight and dieting further complicates the ability to separate disordered eating from a potential eating disorder. Behaviors like restrictive eating and excessive exercise are often dismissed, overlooked, or even celebrated.  

There are some key signs to look out for, however. Prominent indications of an eating disorder include:

• Dramatic weight loss or weight gain
• An obsessive preoccupation with food or body image
• Changes in food intake
• Purging, restricting, or binge eating
• Excessive exercise
• Misuse of diet pills or laxatives
• Eating in secret or hiding food
• Feeling out of control with food
• Co-occurring mental health conditions such as substance use disorder, anxiety, depression, or trauma
• Medical complications, including dizziness or fainting, menstrual irregularity, heart disease, and digestion issues

How Are Eating Disorders Treated?

Eating disorders require a multidisciplinary treatment team that can address the medical, psychological, and nutritional components of the illness. Each member of the care team plays an important role in developing and delivering comprehensive treatment.  

• Medical: Physicians, physician assistants, nurses, and other medical professionals provide medical monitoring, intervention, and management. They monitor vital signs and symptoms, as well as examine and treat the physical complications of eating disorders, including gastrointestinal/refeeding concerns and cardiac issues.
• Psychological: Licensed therapists and other members of the therapeutic team provide individual, family, and group therapy to help patients acquire the skills, behavior, and knowledge to challenge their eating disorder. Leveraging a variety of approaches including Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family-Based Treatment (FBT), this team engages and coach patients in therapeutic interventions.
• Nutritional: Registered dietitians and dietetic technicians provide guidance and education on nutrition, challenging the eating disorder’s food rules and restrictions. Among their responsibilities are developing nutrition assessments and supporting therapeutic meals and snacks with patients and their families.

Alongside specialty providers, families and other support systems also play a pivotal role in eating disorder recovery and treatment. These support people know a patient best and can help them carry out treatment recommendations in their home environments.

Though eating disorders are complex, serious, and potentially life-threatening illnesses, recovery is possible. It starts with the right care at the right time. Find more information about Veritas Collaborative’s full continuum of care for children, adolescents, and adults online or by calling 1-855-875-5812.