WHat Are EatINg DiSOreRs?

Eating disorders are serious but treatable mental health conditions. They are characterized by unhealthy and distorted thoughts, feelings, and behaviors related to food, weight, and body shape. Eating disorders are not just about food. They affect every area of life.

doeS tHis affeCt me?

Eating disorders and disordered eating affect people of all identities from all backgrounds.

Everyone

Everyone is affected by or knows someone affected by an eating disorder.
In the United States alone, 28.8 million people will have an eating disorder at some point in their life.

Athletes

Many athletes experience eating disorders. In fact, 41.5% of female high school athletes in aesthetic sports (i.e. gymnastics, dance, cross country, track, figure skating, etc.) reported disordered eating.
Male athletes in sports that emphasize a certain body type, such as cross country, track, gymnastics, wrestling, rowing, and equestrian, are at an increased risk for developing an eating disorder.
Studies show that athletes may be less likely than non-athletes to get help because of stigma, accessibility, and sport-specific barriers.

Youth

Youth of all ages and genders experience eating disorders.
By age 6, girls begin expressing concern about their weight and body. Between 40-60% of elementary girls (age 6-12) reported worrying about their weight or becoming “too fat”.
Of those surveyed, 81% of 10-year-old children were afraid of being fat.
These concerns that develop in youth endure throughout life.

Boys & Men

Many boys and men have eating disorders. Stereotypes about eating disorders only occurring in girls and women only reveal part of the picture. About one in three people with an eating disorder is a cisgender boy or man.

LGBTQIA+

Members of the LGBTQIA+ community face stressors that contribute to eating disorder risk.
LGBTQIA+ adolescents experience eating disorders and disordered eating at higher rates than their heterosexual and cisgender peers. Almost nine out of ten (87%) LGBTQ youth reported body dissatisfaction.
About 54% of LGBT adolescents have diagnosed eating disorders.

BIPOC

Eating disorders affect people from all ethnicities and races at similar rates, studies show that people of color,— particularly Black people— are less likely to be given help or to be asked about eating disorder symptoms in the first place.
BIPOC with eating disorders are half as likely to be diagnosed or to receive treatment.

People with Disabilities

Women and girls with physical disabilities are more likely than women and girls without physical disabilities to experience an eating disorder.

People in Larger Bodies

One common myth about eating disorders is that all people with eating disorders look the same. In reality, people with bodies of all shapes, sizes, compositions, and weights experience eating disorders. It’s important to remember that you can’t always see an eating disorder. 
Less than 6% of people with eating disorders are considered “underweight.”
People in larger bodies are half as likely as those labeled as at a “normal weight” or “underweight” to be diagnosed with an eating disorder.

WHat Do sympToms
loOk LIke?

Eating disorders have many symptoms, and they are often divided into the two broad categories below.

*Keep in mind that these lists are not exhaustive and that every eating disorder is different.

Emotional and Behavioral Symptoms

Preoccupation with weight and food
Cutting out certain foods or food groups
Engaging in food rituals (e.g. cutting food into tiny pieces, not allowing different foods to touch, etc)
Eating alone or appearing uneasy when eating with other people
Stealing or hoarding food
Skipping meals
Secret episodes of binge eating, followed by feelings of guilt
Withdrawal from friends, family, and activities
Checking body for perceived flaws in appearance
Mood Swings

Physical Symptoms

Weight gain or loss
Stomach aches cramps and other gastrointestinal issues (constipation, diarrhea, cramps, acid reflux)
Loss or irregularity of period or only having periods when taking hormonal contraceptives
Concentration issues
Abnormal lab results (e.g. low hormone and thyroid levels, anemia, low potassium, low white and red blood cell counts, other electrolyte imbalances, etc)
Dizziness and/or fainting
Sensitivity to cold
Sleep issues
Injuries on fingers from induced vomiting
Dry skin and hair, hair loss, and brittle nails
Development of a soft coating of hair on the body, called lanugo 
Weak bones often resulting in stress fractures in athletes
Swelling near salivary glands that can make cheeks look swollen
Dental issues, such as cavities, tooth discoloration, or damage to enamel caused by vomiting 
Muscle weakness
Impaired immune functioning 
Heart failure, irregular heartbeat, and other cardiac problems

How do I geT hElp?

For Myself

If you think you might have an eating disorder, the first step—which is often one of the scariest—is asking for help. Confide in a trusted adult, such as a parent, caregiver, relative, counselor, or teacher. Let them know that you want to speak to a mental health professional about your mental health.
Check out our “Speaking to a Trusted Adult Script” for some ideas on how the conversation might go.

For a Friend or Family Member

Having a supportive network of friends and family makes a big difference when it comes to getting help for an eating disorder. It can be really hard to ask for help, and family and friends can play a critical role in noticing concerning behaviors, encouraging loved ones to get help, and offering support throughout recovery.
- To prepare to help a friend or family member, learn about eating disorders.
- Next, practice what you are going to say. Set up a time to talk with your loved one in a space that feels safe, private, and comfortable for both of you.
- Communicate your concerns using “I” statements to point out behaviors you have witnessed. For example, you might say, “I am worried about how much you eat,” or “I noticed that you don’t eat breakfast anymore.” Remember to be compassionate and loving but also firm. Remind your loved one that, even though it is scary, it is okay to ask for help and that many people struggle with eating disorders.
- Remember, everyone reacts differently when asked about their eating behaviors. Some people may willingly accept or ask for help, and other people may not feel ready. Sometimes, they express this through anger or by brushing off your concerns. This is normal too. If this happens, be clear that you still are concerned and make sure they know you are there when they are ready to talk.

WHat dOes tReaTment lOok like?

Eating disorder treatment looks different for everyone, but there are a few things you can expect.

Asking for help

Before you’re able to get treatment, you have to be ready to ask for help. See [script] for ideas on how to do this.

Connect with a mental health professional

Schedule an appointment with a mental health professional who has experience in eating disorder recovery. It can take awhile to get an appointment or find someone who is the right fit for you; try not to lose hope! You will find the right person, it just might take a little time.

Go to your appointment

At your first appointment with your mental health professional, you can expect to go over some of the basics. Your therapist will ask you questions about yourself, your life, and your eating disorder. Your therapist will tell you about different options for your recovery. In this appointment, you can also ask questions.

Treatment plan

After you have had some time to think it over, work with your therapist and the supportive adults in your life to choose a treatment path that is right for you. Remember, sometimes this means choosing an option that sounds really scary. That can be hard to do. It’s okay to be open and honest about your fears.
Your therapist will suggest one of many types of treatment options. These can include

Out-patient therapy

 - Seeing a therapist at their office once or twice a week


Intensive Out-Patient or Partial Hospitalization Programs

1. Attending a program for people recovering from eating disorders for a couple hours a day during the week and then going home at night.

2. After completing these programs, you will then receive out-patient therapy. 


Residential Care

1. Temporarily moving into a treatment facility for people with eating disorders where you receive treatment, eat meals, and get any other care you need. 

2. Residential care is typically followed by partial hospitalization and/or intensive outpatient programs. 


Hospitalization

1. Sometimes, people with eating disorders need to be hospitalized. The reasons for this vary from person to person, but sometimes, urgent medical complications need to be treated right away to keep you safe and alive.

2. Hospitalization is often followed by residential, partial hospitalization, intensive outpatient, or outpatient therapy. 

Begin treatment

The treatment and recovery journey looks different for everyone. There are always challenges along the way, but remember—a happy and full life without an eating disorder is possible, and you deserve to heal!

Live life in recovery

After completing the more intense parts of treatment, you will work with your therapist to adapt to life in recovery from your eating disorder.
You will use knowledge, skills, and techniques you learned in treatment and incorporate them into your daily life. Ups and downs are normal because life is never perfect!

Sometimes, people relapse

It is common for people with eating disorders to relapse. Sometimes this happens right away after treatment is over, and sometimes it doesn’t happen for many years. People may be afraid to talk about relapse because they are ashamed or feel like “they failed.” In reality, many people relapse, and it has nothing to do with you as a person—it has to do with the fact that eating disorders are diseases, and like with most diseases, sometimes relapse happens.
Remember, if you relapse, it is not your fault and you deserve help to get back on the path to recovery.
Reconnect with a mental health professional if you are no longer in touch with one, and make a plan together!  

Common Questions

How do I know if someone might have an eating disorder? Are there any warning signs?

OPTION 1: Every eating disorder is different, but there are often emotional, behavioral, and physical warning signs. Here are some common ones.

Keep in mind that these lists are not exhaustive and that every eating disorder is different.


- Emotional & Behavioral Warning Signs: preoccupation with weight and food; cutting out certain foods or food groups; food rituals; frequent dieting; eating alone; spending a lot of time in the bathroom, especially after meals; stealing or hoarding food; skipping meals; withdrawal from friends, family, and activities; body checking; mood swings.

- Physical Warning Signs: weight loss or gain; gastrointestinal issues; loss of period; difficulty concentrating; dizziness; fainting; getting cold easily; sleep issues; dry skin; hair loss; brittle nails and hair; cuts or scrapes on fingers (from vomiting); a soft coat of hair growing on the body; frequent injuries and stress fractures; muscle weakness; fatigue. 
ALTERNATIVE OPTION: Every eating disorder is different, but there are some common warning signs you might notice if someone is experiencing an eating disorder. These include:

- Restrictive eating (not eating enough)

- Avoidance of certain foods

- Binge eating

- Purging by vomiting, laxative misuse, or compulsive/excessive exercise

How common are eating disorders?

Eating disorders are quite common, and at least one in ten people in the U.S. is diagnosed with an eating disorder in their lifetime. Researchers suggest that the numbers are actually even higher than reported due to under-diagnosis and lack of eating disorder screening and access to care. Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.

What causes eating disorders?

There isn’t one clear cause of eating disorders. Some of the factors that can lead to eating disorders are:

- Genetics

- Caregivers’ relationships with food

- Dieting

- Bullying

- Childhood abuse, neglect, or abandonment

- Trauma

- Hormones

- Relationships

- Temperament (e.g. perfectionism)

- Identities (gender identity, sexuality, body size, race, immigration status, religion, ability, etc) and oppression based on these identities (transphobia/homophobia, fatphobia, racism, ableism, etc)

What are the different kinds of eating disorders?

There are many types of eating disorders, including Anorexia Nervosa, Avoidant/Restrictive Food Intake Disorder, Binge Eating Disorder, Bulimia Nervosa, Orthorexia, OSFED, Pica, and Rumination Disorder.

- Anorexia: An eating disorder characterized by an intense fear of gaining weight, a distorted body image, and an obsessive desire to become thin. People with anorexia nervosa typically restrict their food intake, often to the point of starvation, and may engage in other harmful behaviors such as excessive exercise or purging through vomiting or the use of laxatives.

- ARFID: A type of eating disorder that involves an extreme avoidance or restriction of certain foods, leading to weight loss, nutritional deficiencies, and other physical and emotional problems. People with ARFID do not have a distorted body image or a fear of gaining weight. Instead, they may avoid certain foods because of their texture, color, smell, taste, or other sensory characteristics, or because of past negative experiences such as choking or vomiting.

- Binge Eating Disorder: An eating disorder characterized by recurrent episodes of eating large amounts of food in a short period of time and feeling a loss of control over the eating behavior. People with BED often experience intense feelings of guilt, shame, and distress after binge eating episodes, which can lead to additional cycles of binge eating. 

- Bulimia: Eating large quantities of food (binging) followed by compensatory behaviors such as vomiting, taking laxatives or diuretics, fasting, or exercising excessively (called purging). People with bulimia nervosa often experience a sense of loss of control during a binge episode, consuming large amounts of food in a short period of time. They may then feel ashamed, guilty, or disgusted with themselves, and engage in purging or other behaviors to try to eliminate the calories consumed during the binge.

- Orthorexia: An unhealthy obsession with eating only "pure" or "clean" foods, which can lead to a restrictive and rigid diet that may result in nutritional deficiencies and other health problems. It is not currently recognized as a separate eating disorder in the DSM-5, but many healthcare professionals consider it to be a type of disordered eating.

- OSFED: OSFED stands for Other Specified Feeding or Eating Disorder. OSFED is a diagnosis that is used to describe a range of eating disorders that do not meet the full criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder. Some examples of eating disorders that fall under the OSFED category include atypical anorexia nervosa (where an individual has a low body weight but does not meet the full criteria for anorexia nervosa), purging disorder (where an individual engages in purging behaviors but does not binge eat), and night eating syndrome (where an individual consumes the majority of their daily calories at night).

- Pica: An eating disorder characterized by the persistent and compulsive consumption of non-food substances with no nutritional value over a period of at least one month. These substances may include items such as dirt, paper, ice, hair, paint chips, or clay.

- Rumination Disorder: An eating disorder characterized by the repeated regurgitation and re-chewing of food that has already been swallowed, followed by either re-swallowing or spitting out the food.

What are the barriers to eating disorder recovery?

Research suggests that only 10% of people diagnosed with eating disorders in the United States receive treatment in their lifetime. There are a few categories of barriers that prevent people from getting the care that they need: systemic, cultural, healthcare, financial, logistical, and personal.

Systemic

- Historically, treatment has been researched on and designed for white adolescent cisgender girls with Anorexia Nervosa.

- Lack of diversity among treatment providers.

- Explicit and implicit biases such as fatphobia, transphobia, ageism, racism, ableism, and sexism among eating disorder providers.

- Weight requirements in the DSM-5 to receive an Anorexia Nervosa or ARFID (Avoidant/Restrictive Food Intake Disorder) diagnosis. 

- Weight discrimination in admission criteria for higher levels of care.

- Gendered admission criteria in treatment.

- Treatment plans and medical records based on sex assigned at birth.

- Lack of weight-inclusive furniture and medical equipment at treatment centers.

- Lack of eating disorder research that includes marginalized communities and identities. 

- Lack of eating disorder research funding.


Cultural

- Social stigma; idealization of thinness; endemic fatphobia (schools, social media, families, etc); lack of accurate media representation


Healthcare

- Health insurance and benefits are complicated and confusing; insurance doesn’t cover all levels of care; health insurance often denies insurance coverage for needed treatments; people are often discharged from treatment before they are ready due to insurance requirements; insurance tends to cover “evidence-based care” only, but the evidence this care is based upon is often outdated, limited, and based on inaccurate stereotypes; many primary care physicians do not screen for eating disorders. 


Financial

- Most eating disorder treatment is expensive; high costs even with insurance; difficulty paying the bills when taking off work or school for treatment


Logistical

- Living far away from treatment centers; language barriers; difficulty finding a provider; lack of reliable technology for virtual providers; inability to take time off from work or school for treatment;


Personal

- Shame; denial; lack of social support; difficulty healing when surrounded by an idealization of thinness, dieting, and fitness; fear of giving up eating disorder; inaccurate self-diagnosis; past treatment trauma.

Do eating disorders cause medical problems?

Yes. Eating disorders can affect every organ and system in the body. These include: damage to heart, kidneys, liver, teeth, skin, and hormones; damage to the endocrine reproductive, urinary, neurological, gastrointestinal, and skeletal systems; delayed or stunted growth; weakened immune system; and others. Together, these effects may lead to serious medical complications, including cardiac arrest and death. 

I think one of my friends has an eating disorder but won’t get help. What can I do?

You can’t make someone else pursue recovery, but there are a few things you can do to let your friend know that you are there for them. See [script for talking to friend] for more information on how to have this conversation!

I think I have an eating disorder. What should I do?

The first step is reaching out for help. Talk to a trusted adult, and let them know that you want to speak with a mental health professional.
Check out our “Speaking to a Trusted Adult Script” under the help button for some ideas on how the conversation might go.
Do I need to call 9-1-1?
Eating disorders are serious and can lead to medical complications. Before anything else, it’s important to make sure you’re safe. If you are thinking of hurting yourself or someone else, then you should call 9-1-1.
What will happen if I call 9-1-1?
Crisis Intervention officers, medical first responders, or others may arrive. They will help you decide the best next steps. If you decide that you need to go to the ER, first responders will have your loved ones drive you, arrange for an ambulance, or drive you themselves depending on your comfort. 

At the ER, you will likely have a physical and mental health assessment. You will receive medical care and monitoring to ensure you are physically healthy. People with eating disorders frequently experience medical side effects that require tests and monitoring. You will also make a plan for addressing your eating disorder. This may feel extreme, but it is normal.
What will happen after?
Once you’re out of crisis, you should connect with medical and mental health providers to come up with a treatment plan. This looks different for everybody but might include temporarily moving into a treatment facility, attending a program for a couple hours a week, or seeing a therapist at their office once or twice a week.
Ask for help
If you think you might have an eating disorder, be struggling with disordered eating, or just have questions about eating, you can talk to a trusted adult using the following script.
What if that doesn't work?
Sometimes, even the people you love the most don’t respond the way you hoped they would when you share something personal. Usually, this is because they are surprised or scared. Just remember that if you think there is something going on, it’s important to trust your gut and insist on speaking with a mental health professional. Advocate for yourself. You deserve help!
Thank you!

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