Eating Disorders: Definition, Detection, and Treatment

Caesar Djavaherian, MD, MS, FACEP
March 18, 2021
7 min

We’ve all had thoughts about the way we eat before. Thoughts about being hungry, about what we eat, and about how much we eat. But when do these thoughts start to cross a line into potentially being harmful? When do we stop and think about whether these thoughts are really helpful to us, or are just turning our bodies—the amazing, beautiful vessels that carry us through our lives—against us?

It can be difficult to truly know, but if you think you might be struggling with an eating disorder, you’ve come to the right place. First and foremost, know that you are not alone and this is not your fault. Because the truth is, it’s estimated that 20 million women and 10 million men in America will suffer from an eating disorder at one point in their lives. This is a significant number of Americans who could be struggling with a potentially life-threatening condition, and who need support. 

And eating disorders can affect anyone. Any person of any age, gender, ethnicity, and socio-economic status can be at risk. That’s why we’re addressing the types of eating disorders, the signs and symptoms associated with each type, and how different eating disorders are treated.

The more we can provide information on these issues, the more we can normalize talking about difficult topics and breaking stigmas so that people feel empowered to seek the help they deserve and start loving their bodies. And if you can, one of the most important first steps in overcoming any disordered eating is telling someone in your life about it. If you can't find someone you know who you trust, scroll to the bottom to find helplines and resources or reach out to a trained therapist.

Common Types of Eating Disorders

Eating disorders as defined by the American Psychiatric Association are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions. To further clarify: an eating disorder is a serious yet treatable mental illness, not a choice or a lifestyle.

Below are common types of eating disorders, including warning signs of each. 

Anorexia Nervosa

Individuals who struggle with anorexia nervosa persistently restrict calories and energy intake relative to their body weight. People struggling with this eating disorder often see themselves as overweight, despite being severely underweight. And the National Institutes of Health (NIH) reports that because so many people with anorexia die from complications of starvation or suicide, more people die of anorexia than any other mental disorder.

Signs and symptoms of anorexia nervosa:

  • Extremely restricted eating
  • Extreme thinness (emaciation)
  • A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
  • Intense fear of gaining weight
  • Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

The NIH reports that over time, symptoms of anorexia often also include conditions from osteoporosis, brittle hair and nails, and anemia, to low blood pressure, heart damage, infertility, and even brain damage.

Binge-eating

Binge-eating is the most common eating disorder in the country. Defined by habitual episodes of eating a large volume of food, often so quickly the behavior causes discomfort, binge-eating results in the feelings of shame and distress from loss of control during the episode. Unlike bulimia nervosa, a person with binge-eating disorder does not compensate by forcing a purge. 

Critical for diagnosis, the National Eating Disorder Association (NEDA) considers a binge-eating episode to include two factors:

  1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is larger than what most people would eat in a similar period of time under similar circumstances.
  2. A sense of a lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

Episodes engaged in by this common eating disorder are associated with several behaviors, including eating faster than normal, eating until uncomfortably full, eating a lot despite not experiencing physical hunger, eating alone due to embarrassment, and feeling guilty or ashamed of eating behaviors. 

Bulimia Nervosa

Different from anorexia nervosa, bulimia nervosa occurs when a person engages in recurring episodes of binge-eating followed by a forced purge to compensate for the over-eating episode. Binge-eating is defined as eating larger portions than most people would eat during a period of time. Purges can include vomiting, use of laxatives, fasting, excessive exercise, or a combination of such behaviors.

Symptoms of bulimia nervosa, according to the NIH, include:

  • Chronically inflamed and sore throat
  • Swollen salivary glands in the neck and jaw area
  • Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
  • Acid reflux disorder and other gastrointestinal problems
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration from purging of fluids
  • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

Anorexia Athletica

This disorder is also commonly referred to as compulsive exercise. While this form of disordered behavior isn’t officially recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM, 5th Edition) by the American Psychiatric Association, many people suffer from associated symptoms. And the consequences of anorexia athletica can be significant, including bone density loss, chronic bone and joint pain, loss of menstrual cycle for females, or a combination of all three often referred to as the female athlete triad.

NEDS lists the following warning signs of compulsive exercise, or anorexia athletica:

  • Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications
  • Intense anxiety, depression, irritability, feelings of guilt, and/or distress if unable to exercise
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
  • Discomfort with rest or inactivity
  • Exercise used to manage emotions
  • Exercise as a means of purging (needing to “get rid of” or “burn off” calories)
  • Exercise as permission to eat
  • Exercise that is secretive or hidden
  • Feeling as though you are not good enough, fast enough, or not pushing hard enough during a period of exercise; overtraining
  • Withdrawal from friends and family

Orthorexia

Like anorexia athletica, orthorexia is not officially recognized by the DSM-5. And because there is no diagnostic criteria to define its characteristics, orthorexia is generalized as an obsession with healthy eating to the point that the behavior damages one’s own wellness. Because a person with orthorexia restricts what they eat in both amount and variety, this disorder often appears to overlap with anorexia nervosa.

Warning signs and symptoms of orthorexia can include (and are not limited to):

  • Compulsively reviewing nutritional labels
  • Restricting consumption of certain food groups, such as dairy, meat, and all carbs
  • Severe concern and distress about availability of healthy food being served at restaurants or events
  • Obsession with health food blogs and Instagram accounts focused on “healthy lifestyles”

Pica

This form of eating disorder is diagnosed by a patient’s history of eating items not usually considered food. People with pica commonly ingest things like dirt, hair, and paint chips, despite the lack of nutritional value. 

When people are diagnosed with pica, it’s important to accompany diagnostics with tests to address commonly associated symptoms and conditions, including anemia, lead poisoning (in the instance of eating paint chips), and to check for intestinal blockages. 

Treatment for Eating Disorders at Carbon Health

Because we understand and acknowledge that eating disorders are mental illnesses that also physically affect the body, our providers use a holistic treatment plan that usually includes a combination of psychological counseling, nutritional support and education, as well as medical monitoring. 

But there’s no single cure for all patients. The road to recovery from an eating disorder, like any mental illness, is unique to the individual. Carbon Health’s healthcare providers are here to help support you and anyone you love through your own recovery journey. Book an appointment today to talk to a provider about what you’re going through. We’re always here to understand and to help.

Resources for Eating Disorders

If you or someone you love is struggling with an eating disorder, there are many additional resources to help provide support in addition to seeking professional help. 

These include:

The Body Project: A group-based intervention and support system providing a space for high school girls and college-aged women to discuss unrealistic appearance ideals and develop a healthy body image and self-esteem. 

https://www.nationaleatingdisorders.org/get-involved/the-body-project

NEDA Helpline: Provides phone and chat support for individuals struggling with any eating disorder. 

1-800-931-2237

Overeaters Anonymous: Provides additional support to individuals struggling with compulsive eating and food disorders. 

1-505-891-2664

National Association of Anorexia Nervosa and Associated Disorders: Provides free community resources and support services from peers struggling with eating disorders. 

1-630-577-1330



Caesar Djavaherian, MD, MS, FACEP

As Carbon Health’s Chief Innovation Officer, Caesar Djavaherian, MD, MS, FACEP, guides clinical innovation through product development, service expansion, and partnerships with transformative companies working to improve the healthcare ecosystem. He is an emergency medicine physician, a former high school teacher, and a reformed academic researcher. Caesar co-founded Direct Urgent Care to deliver technology-enabled urgent care throughout the San Francisco Bay Area. He has practiced at New York-Presbyterian Hospital, the University Hospital of Columbia, and Weill Cornell Medicine. In his spare time, Caesar advises healthcare startups, cheers on the Warriors, tries various HIIT workouts, and daydreams about what the future of health will look like.


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