Terry Passano
University Dietitian
Eating disorders can and do develop at any stage of life. But it’s during the college years that risk, especially for women, is greater. The added pressures of college life, layered on top of underlying feelings of anxiousness and the stress of a new environment, increase vulnerability to disordered eating patterns and possible development of an eating disorder.
What is disordered eating vs an eating disorder diagnosis, and what leads to eating disorders? Read more to learn about the top eating disorders and their signs and symptoms in addition to treatment options and how to talk to someone you think may be practicing disordered eating.
Many people have concerns about their health, weight, and eating habits. While most navigate these areas without experiencing significant issues, some may find themselves facing challenges related to body image and eating habits. Some may develop an eating disorder.
The National Association of Eating Disorders (NEDA) estimates that between 10-20% of college women and 4 – 10% of college men suffer from an eating disorder, and rates are on the rise. LGBTQIA+ adults and teens experience an even greater incidence of eating disorders.
Eating Disorders in LGBTQIA+ Populations
RISK FACTORS
Eating disorders can develop from harmful thought patterns about food and body image. These can lead to disordered eating behaviors such as restrictive eating, compulsive eating, or irregular or inflexible eating patterns. Even dieting can be disordered eating and lead to an eating disorder. Eating disorders can vary in severity and may never develop into severe health issues. However, the behaviors may affect physical and mental health, and disordered eating is a risk factor for developing a serious eating disorder. Early intervention is essential and may prevent the progression of an eating disorder diagnosis.
If you have concerns that may border disordered eating, please know that it’s always good to reach out for help. Eating disorders can be successfully treated.
Restricting the amount of food you eat challenges the body. As the body works to defend itself and adjust to inadequate nutrients, metabolism slows (the rate at which energy is burned). This can lead to overeating at a following meal and binge eating patterns. Long-term serious nutrient deficiencies occur.
Skipping just one meal can lead to a drop in blood sugar, making you feel tired, dizzy, sluggish, and shaky. This can lead to fatigue, poor concentration, and irritability. Metabolism slows as your body works to conserve energy. Hunger can grow and lead to overeating or making less-than-optimal food choices when you decide to eat. Chronically skipping meals can lead to serious nutrient deficiencies, bone density challenges, and slowed metabolism. The body goes into survival mode.
It’s essential to understand that eating disorders are not merely lifestyle choices or typical concerns about health, nutrition, or appearance. They are serious conditions that involve problematic eating habits and distorted body images, and they can lead to significant nutrient deficiencies and health risks. These disorders may result in various health issues affecting the hair, skin, nails, teeth, heart, kidneys, liver, brain, lungs, gastrointestinal system, metabolism, skin, hormones, blood, and bones. In severe cases, they can even be life-threatening.
Eating disorders can affect anyone, regardless of age, size, ethnicity, gender, or socioeconomic status. While they are most commonly seen in women during their teenage or early adult years, men and children can also experience these challenges, which may persist into later stages of life. The causes of eating disorders are complex. Eating disorders are referred to as biopsychosocial disorders because they are influenced by genetic, biological, environmental, and social elements.
The key here is that eating disorders are treatable. There is hope, and support is available. Full recovery is possible, especially when seeking and receiving the right help. Embracing the possibility of recovery is an empowering step toward a healthier relationship with food and body image.
The three most common eating disorders
There are many different types of eating disorders. The three most common in the U.S. include binge-eating disorder, bulimia, and anorexia. Note that one person can experience multiple eating disorders over time.
Binge-eating disorder
Binge-eating disorder is the most common eating disorder in the U.S. It occurs when eating feels out of control, like there is no ability to stop. Eating is excessive and continues well after the stomach is full. Binge eating results in feelings of physical discomfort, often followed by guilt, shame, and distress. Binge eating can lead to weight gain, obesity, and related medical conditions, including diabetes, cardiovascular disease, and gastrointestinal issues such as bloat, reflux, and diarrhea.
Bulimia nervosa (binging-purging)
Bulimia nervosa is the second most common eating disorder in the U.S. Bulimia occurs when episodes of binge eating are followed by purging. Purging is trying to make the binged food leave the body to prevent weight gain (e.g., by making themselves throw up, using laxatives, etc.). People with bulimia may appear to be overweight, normal weight, or underweight. Bulimia can lead to chronic inflammation of the throat, tooth decay and worn enamel, severe dehydration, electrolyte imbalances, and intestinal distress.
Anorexia nervosa
Anorexia nervosa is the third most common eating disorder in the U.S. It is characterized by weight loss and difficulty maintaining weight. Food is severely restricted in calories and types of food consumed. This often occurs along with a relentless pursuit of thinness and feelings of being overweight, even when the affected person is malnourished and underweight. They do not see themselves as thin. People experiencing anorexia may feel the need to suppress the body’s cravings for food. Anorexia can become very serious, even life-threatening. It can lead to bone loss, muscle wasting and weakness, severe constipation, and fatigue. It can create infertility and damage the heart and brain.
Other diagnoses include Avoidant-Restrictive Food Intake Disorder (AFRID)
People with AFRID limit the variety of food they eat due to anxiety or fear of eating it or to disliking a food’s characteristics, such as its texture or appearance. The resulting limited intake can present health challenges like skipping meals or restricting calories. AFRID may lead to unhealthy weight loss with malnutrition and gastrointestinal issues such as stomach pain and GI upset.
Other diagnoses include Specified Feeding or Eating Disorder and Unspecified Feeding or Eating Disorder.
Eating disorders are complex and sometimes do not meet diagnostic criteria; however, they must be taken seriously.
Signs and symptoms of eating disorders
Many of us are concerned about our health, weight, and nutrition. This in no way means that there is an eating disorder. One of the main differences is that people with eating disorders become fixated and obsessed with their weight and body shape. They may deny, minimize, rationalize, or hide their symptoms and the seriousness of the disorder.
These disorders may or may not be linked to a person’s weight or body shape. They may also not be connected with rapid weight changes. Simply put, there is more to diagnosing an eating disorder than a person’s appearance— one’s thoughts, feelings, perceptions, and behaviors contribute significantly.
A healthcare provider can diagnose eating disorders using medical history, physical exams, and other tests (e.g., blood, urine, electrocardiogram, kidney function, etc.). Different eating disorders have different signs and symptoms.
Signs of binge-eating disorder include:
- Uncontrollably eating large amounts of food in a short time
- Eating when not hungry or after feeling full
- Eating very quickly
- Continuing to eat until fullness becomes uncomfortable
- Eating alone or in secret
- Feeling distressed, ashamed, or guilty about eating
- Frequently going on diets
Signs of bulimia nervosa can include any of the binge-eating symptoms above plus one or more of the following:
- Purging (making oneself throw up or using laxatives, diuretics, diet pills, or enemas)—and the frequent bathroom trips and medications associated with this behavior
- Participating in intensive and excessive exercise
- Periods of fasting
Signs of anorexia nervosa include:
- Skipping meals or eating minimal amounts of food during meals
- Repeatedly weighing themselves and a profound fear of gaining weight
- Participating in intensive and excessive exercise
- Extreme thinness and low body weight
- Denial of the seriousness of very low body weight
Eating disorders are often associated with mental health challenges such as mood disorders, depression, anxiety, obsessive-compulsive disorder, impulse control disorder, and/or substance use.
When and where to get help for eating disorders
Make no mistake, there is help! NEDA Screening Tool
Remember that disordered eating involves extreme food behaviors that are not the result of fads, phases, or lifestyle choices. No one chooses to have an eating disorder. If, at any point, it feels that thoughts and behaviors about food, weight, and body shape are taking over one’s life, it’s time to seek out help.
The goal of treating an eating disorder is to restore physical and mental wellness. This may include:
- Restoring optimal levels of vitamins, minerals, and other nutrients
- Moving toward a more healthful weight
- Ensuring exercise is at a level that promotes health
- Stopping bingeing and/or purging behaviors
- Changing how we talk to ourselves
How are these goals achieved? Eating disorders may be successfully treated in many different ways. They may involve one or more of the following: medical care, medicine, psychotherapy, and/or nutritional counseling.
Psychotherapy
Psychotherapy (talk therapy) may involve individual, group, or family counseling. It can help identify and change negative thoughts and behaviors about food and weight. Psychotherapy can also help build coping skills to manage situations that trigger disordered eating. Cognitive behavioral therapy or other types of counseling may also be involved.
Medical care
Eating disorders may cause severe medical complications of the heart, kidneys, liver, brain, thinning of bones, and more. Medical care is essential for diagnosing and treating eating disorders and treating any related medical conditions or symptoms.
Nutrition Counseling
If an eating disorder is diagnosed or suspected, professional nutrition counseling is essential. An effective nutrition strategy must be personalized to achieve optimal nutrient levels and promote healthy eating habits and weight management goals. This is why consulting with a licensed nutrition professional is necessary for successful treatment.
Medicines
Depending on symptoms, people with eating disorders may be treated with medications that can also help with weight management, mood disorders, or other conditions related to disordered eating.
How to Help Someone with an Eating Disorder
Friends and family often play a significant role in identifying concerning behaviors in loved ones and encouraging them to seek help.
NEDA provides some valuable tips for talking to a loved one here.
Bottom line
Eating disorders are serious health concerns that can be successfully treated.
A healthcare professional can help to confirm whether an eating disorder exists and, if so, which disorder it is. Once an informed diagnosis is obtained, getting a personalized treatment plan is key. The goal is to restore nutrition, prevent or treat other related conditions, move toward a healthier weight, and provide coping skills and behavioral modification for long-term health.
If you’re feeling uncertain about your relationship with food or if you’re experiencing any signs of disordered eating, reaching out for support is a valuable step. Remember, eating disorders are treatable, and taking that first step can lead you toward a path of healing. Salisbury University offers support through Health Services, The Counseling Center, and myself, the University Dietitian
Wondering how to distinguish between food and weight concerns and disordered eating? Want support toward embracing more health-promoting and nutritious eating and lifestyle habits? Book an appointment with me today.
References and more information
NEDA – National Eating Disorders Association
ANAD – National Association of Anorexia Nervosa and Associated Disorders
https://www.nimh.nih.gov/health/topics/eating-disorders Eating disorder information page
https://www.nimh.nih.gov/news/media/2020/mental-health-minute-eating-disorders NIH Health Minute