The Different Types of Eating Disorders—What They Are and What You Need to Know About Them
It's estimated that 30 million people in the US will have an eating disorder at some point in their lives.
An estimated 20 million US women (and 10 million US men) will have an eating disorder at some point in their lives, says the National Eating Disorders Association (NEDA). While the exact cause of eating disorders is unknown, they are believed to develop out of a combination of biological, psychological, and sociocultural factors.
Every eating disorder has its own set of symptoms and side effects. Here, clinicians provide a rundown of recognized eating disorders that you should know about.
An anorexia nervosa diagnosis involves three main components. One, a person has limited eating so much that they have a significantly low body weight for their age and height. Two, even though they are underweight, a person is really scared of gaining weight or becoming overweight. (Andrea Vazzana, PhD, a clinical psychologist at NYU Langone Health's Department of Psychiatry, tells Health that the more weight they lose, the more that fear increases). And three, there is a disturbance in the way a person experiences their own body weight or shape. This last part could mean that they are viewing themselves as heavier than they are, they aren't recognizing that they are very thin, they're over evaluating what their body weight and shape is so that it becomes the primary concern in how they view themselves and judge their self-worth, or they're not recognizing the seriousness of their weight.
Vazzana describes two types of anorexia nervosa: a restricting type, where the main way to lose weight is by severe diet restriction, and a binge eating/purging type, where on top of restricting caloric intake, the person binges and/or purges. Someone who engages in this behavior doesn't gain weight because the binges aren't frequent enough or their binging is followed by purging via self-induced vomiting, diuretics, laxatives, or enemas.
The main symptom of anorexia nervosa is a significant weight loss—usually around 15% of a person's body weight, according to Vazzana. Unfortunately, she says, the rates of anorexia nervosa are increasing, and the disorder seems to be affecting people at younger ages than ever before (which may be due to puberty now happening at younger ages).
People with bulimia nervosa also overevaluate their shape and weight; to control both, they engage in binging and purging. The eating binges happen in a 2- to 3-hour time period and involve an amount of food that is larger than what most people would eat in that same time period. During the binge, a person may feel a loss of control of what they are eating—or of not being able to stop. After a binge, people typically feel extremely guilty and are afraid of gaining weight. To offset the food they just ate, they engage in self-induced vomiting or excessive exercising, or they use laxatives, diuretics, or enemas. On average, someone with bulimia nervosa will participate in this cycle at least once a week for three months.
"A fair number of people engage in some level of binges," but not with that frequency or length of time, Vazzana says. "So to distinguish between normal behavior vs atypical behavior, we have that frequency and duration criteria."
Bulimia nervosa can have really harmful health consequences, including dehydration (from vomiting) or an electrolyte imbalance (from all the fluids from the laxatives), Vazzana says. An electrolyte imbalance might even lead to a heart attack or a coma. When a person is not having binges or purges, Vazzana says that they might be undereating and having lots of rules about what or when they should eat.
Other specified feeding or eating disorders (OSFED)
OSFED is a category that was developed for people who don't meet the strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still have a significant eating disorder, NEDA explains. Some of these disorders include:
People with atypical anorexia restrict their food intake and may have lost a lot of weight, but not to the point where they are at a minimally normal weight (like in anorexia nervosa). As Vazzana explains it, maybe they started off as overweight or obese but are not considered underweight from a medical standpoint, even after losing 20, 30, or 40 pounds; still, they have all the other symptoms of anorexia nervosa.
"A lot of times people think that's not necessarily problematic," Vazzana observes. "But we actually know it's still associated with a really high rate of distress, with high levels of impairment with how to function in daily life," she says. "They're still malnourished based on where they might have normally been, only they're not underweight. It's associated with high rates of suicidality, even, and feelings of guilt and shame."
Purging disorder occurs when a person is purging but not engaging in binges. "It might be that they're having what we think of as a subjective binge where, after having a normal meal or snack, they feel guilty or that there's some sort of emotion that's driving them to feel dysregulated, and so they engage in vomiting in response to that," Vazzana says. "They're purging, but there has been no binge ahead of time."
Night eating syndrome
People with this disorder, for a minimum of two nights a week, have at least a quarter of the day's calories—so the equivalent of a full meal—after dinner and before bed and/or eat in the middle of the night, according to Kasey Goodpaster, PhD, a clinical psychologist and director of Behavioral Services for the Bariatric & Metabolic Institute at Cleveland Clinic. Someone with night eating syndrome, which is more common in people with insomnia, will typically skip meals earlier in the day. This makes them hungrier at night, leading to overeating. When they wake up, they are not hungry for breakfast, and the cycle repeats.
Night eating syndrome can contribute to weight management difficulties, Goodpaster says. The food is eaten before bed, and it is hard for the body to burn off the food in your sleep, so, overall, the risks of night eating syndrome are similar to the risks of obesity.
Binge eating disorder (BED)
Similar to bulimia nervosa, BED is characterized by episodes of binge eating, which is eating an amount of food in a certain time period that is more than what most people would eat in that same time frame. According to the NEDA, during these binges—which happen, on average, at least once a week for three months—people feel as though they don't have control over their eating. But unlike bulimia nervosa, the binge is not followed by acts meant to offset the binge, such as self-induced vomiting.
NEDA cites several warning signs of BED. For instance, someone with BED might make room in their schedule for binge sessions. Or, they may also steal fool or horde it in strange places. Physical signs of BED include noticeable weight fluctuations and gastrointestinal complaints, like stomach cramps.
Eating healthily is key to living a healthy life. But when someone obsesses over clean eating to the point where it negatively impacts their overall quality of life, that person might have orthorexia. "These are patients who are overly perfectionistic with their health-imposed goals, and so they have marked distress or shame when they don't follow those rules," Goodpaster tells Health.
By excluding food groups, someone with orthorexia might be malnourished or have nutritional deficiencies. And, according to Goodpaster, clinical observations suggest that when orthorexia becomes extreme, the complications can be similar to those of anorexia. Someone with orthorexia might also experience social isolation because they're not able to eat and follow their strict food goals while hanging out with other people.
Avoidant/restrictive food intake disorder (ARFID)
A lot of kids might go through picky eating phases, but those with ARFID are picky to the point where the limit on the amount or type of food they're eating affects their growth. If it's not treated, ARFID can continue into adulthood, Vazzana says. Adults with ARFID may have a hard time maintaining basic body function, which can cause them to lose weight. There's also the social impact the disorder can have.
"For an adult, if [ARFID] persists, that can mean going on dates or going out to a work dinner can be very problematic because you're not able to eat the types of food that are being served there. So it can cause a lot of impairment at those times," Vazzana says. "That's usually when people will present for treatment to try to work on that."
People with pica will repeatedly consume non-nutritive, non-food substances, such as rocks or dirt. According to Helen Burton Murray, PhD, a psychology researcher in the Division of Gastroenterology and Eating Disorders and Clinical Research Program at Massachusetts General Hospital. They're driven by urges and cravings to consume these substances.
"There can be significant health effects, including gastrointestinal obstruction where the items may get lodged or not pass through the gastrointestinal tract, sometimes requiring surgery. There could be other problems, like perforation of the esophagus, the stomach, or the bowels. So there are definitely significant consequences that can result that can require acute care," she tells Health. If someone's diet is limited besides the non-food substances they are eating, there could be nutritional problems as well, such as malnourishment.
Although research is limited, pica seems to be more common in those who are younger, who have developmental disabilities, or who are pregnant, Burton Murray says. Having iron-deficiency anemia or malnutrition can also cause pica, NEDA points out.
Regurgitating food means bringing swallowed food up again to the mouth. People with rumination disorder repeatedly regurgitate their food and then re-chew, re-swallow, or spit it out.
Burton Murray says the regurgitation aspect of the disorder can cause esophageal damage and dental erosion. Rumination disorder can also affect someone's weight and social life. "People might avoid or restrict certain food to try to prevent the rumination from occurring; that may be one reason they lose weight," Burton Murray says. "But it also can disturb their quality of life if they're not able to eat all of the foods they would like to, or they might be afraid of having these episodes while with others so they may not eat in public because the fear of embarrassment."
Unspecified feeding or eating disorders (UFED)
If someone has symptoms of a feeding or eating disorder, but there is not enough information to make a definitive diagnosis, such as in an emergency room setting, the term UFED can apply, Burton Murray explains.
Can eating disorders be prevented?
According to Burton Murray, yes, some of these disorders may be preventable. Adds NEDA: "Scientists believe that if they can reduce the risk factors for eating disorders, then they can reduce the chances that a person will go on to develop an eating disorder."
Prevention can include reducing negative risk factors, like body dissatisfaction, or depression, or appearance-based self-esteem, or increasing protective factors, like giving appreciation for the body's functionality.
What are some of the health consequences of eating disorders?
Just as the disorders themselves widely vary, so do their potential health consequences. Many of the disorders above have an impact on weight, which affects every system of the body. So people with eating disorders can experience a range of problems in different parts of their body, including their heart, liver, kidneys, brain, and reproductive system. "There's really no system of the body that's safe," Vazzana says.
Fortunately, most of these consequences are temporary and will reverse once a person receives treatment, Vazzana says. There are exceptions, though. One eating disorder health consequence that isn't recoverable is a change in the musculoskeletal system. For example, people who had anorexia nervosa as adolescents and whose bone growth was affected because of it are at increased risk for osteopenia and osteoporosis later in life, Vazzana says.
In addition to the physical impact, eating disorders can also have psychological complications, such as the development or worsening of other mental health conditions. Eating disorders have a big overlap with obsessive compulsive disorder and anxiety, Goodpaster says. And as Vazzana points out, being malnourished—a common symptom of many eating disorders—in and of itself is likely to increase anxiety and depression in someone. The disorders can also have social consequences, like isolation.
I had an eating disorder when I was younger. Am I in the clear now?
Although Vazzana says an eating disorder can affect someone at any age, there are certain ages when an eating disorder is more likely to develop—for instance, around 13 or 14 and again around 17 or 18 for anorexia nervosa; around 18 or 19 for bulimia nervosa; and around 21 or 22 for binge eating disorder.
Regardless of when an eating disorder develops, though, the earlier it is diagnosed, the better chance there is for recovery. Still, according to Goodpaster, eating disorders are hard to treat. Sometimes, when someone is treated for one eating disorder, it can develop into a different disorder (for instance, anorexia transitioning to orthorexia). "There's not a timeline for how long it may take a person, but it might present differently over a long period of time," Goodpaster says.
Thankfully, there are effective treatments to help with in the recovery. The treatment plan usually includes physicians, psychologists, and dietitians who can provide psychiatric medication if needed, cognitive behavioral or interpersonal therapy, and nutrition education, according to Goodpaster.
Vazzana says that about half of patients have a really good recovery. But even those who have recovered may still be susceptible to relapses later on in life, especially during stressful times or times of transition. "I kind of think of it as similar to a sports injury, [like] some sort of knee injury," she says. "You recover from that knee injury, but then there's a vulnerability there, where if you're going to go skiing, maybe you're going to wear a knee brace to support and shore that up."
For example, pregnancy might be a time of vulnerability for someone who had an eating disorder when they were younger because of the weight gain and the increased body images concerns that they might be experiencing during those months. A wedding, when there's an increase in attention to your appearance, can also be a trigger for an eating disorder, as can a stressful event like divorce. "You want to make sure you are being well-supported, that you are aware of a slippery slope into eating disorder behaviors—and catch them early rather than having them persist," Vazzana explains.
What should I do if I think I have one of these eating disorders?
If you think you have an eating disorder, the first step would be to go to somebody that you trust and tell them about it, Goodpaster says: "There's a lot of internalized shame with eating disorders, and the motivation for getting support can wax and wane, but if you tell somebody that you love and trust about it, they can make sure you do get the professional help you need."
If you're not sure which eating disorder specialist to go to, your primary care physician is a good first step. He or she can provide you with referrals to a specialist who can help even more.
What should I do if someone I know has an eating disorder?
If you think that somebody that you know has an eating disorder, start the conversation by asking some broad questions about how they have been feeling, Goodpaster suggests. This should be done without judgment. You can then get more specific about the concerns that you noticed and the worries that you have about their health and overall well-being. "Just letting them know that you care and that you want to support them in getting help can go a long way," she says.
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter