People with Anorexia Nervosa restrict their food intake relative to their needs, leading to significantly low body weight for their age, sex, level of development or general health. Often there is intense fear of gaining weight or becoming fat, even though one might be underweight. There is also typically a disturbance in the way in which one’s body weight or shape is experienced, excessive importance placed on weight or shape, or denial of the seriousness of the low weight despite the risk or presence of medical complications. Binge eating or purging may also occur during Anorexia Nervosa.
Individuals with ARFID limit or avoid eating certain foods (for example, avoiding foods with specific sensory qualities or due to fear of negative consequences other than weight gain),often resulting in significant weight loss and/or nutritional deficiencies. ARFID does not involve the disturbance in the way in which one’s body is experienced or fear of weight gain that is typically seen in Anorexia Nervosa.
This disorder involves engaging in repeated episodes of binge eating. Binge eating consists of eating a large amount of food, more than most people would eat, in a discrete period of time and feeling out of control while eating. In Binge Eating Disorder, binging episodes typically include eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not feeling physically hungry, eating alone, and/or feeling guilty or disgusted after eating. The diagnosis is not made on the basis of weight.
Bulimia Nervosa involves engaging in repeated episodes of binge eating followed by compensatory behaviors that are attempts to alleviate or avoid the psychological or physical effects of binging (e.g., weight gain). Binge eating refers to eating a large amount of food, more than most people would eat, in a discrete period of time and feeling out of control while eating. Compensatory behaviors may include self-induced vomiting, laxative or diuretic misuse, or excessive exercise. Bulimia may or may not result in weight gain.
This term describes feeding or eating behaviors that interfere with proper nutrition intake and cause distress or impairment in daily living but do not meet full diagnostic criteria for any of the other eating disorders. These behaviors may involve multiple features of one disorder or features of several disorders, and may lead to inability to maintain weight. Conditions categorized as OSFED still can be so severe that they warrant treatment with an eating disorders professional, or management in higher levels of care than traditional outpatient treatment.
Depression is a mood disorder that causes constant feelings of sadness and loss of interest. It impacts how an individual thinks, feels, and behaves, leading to numerous interrelated emotional and physical problems. A 2018 research review shows that depression and anorexia nervosa frequently occur together. Additionally, a study from 2021 reveals that people with depression often experience more severe anorexia symptoms, including weight loss or low body weight, increased hospitalizations, and a longer time living with the eating disorder. Furthermore, a 2019 study concludes that for binge eating disorder, depression symptoms reduce self-control and decision-making ability.
Anxiety describes a form of restlessness or the need to react to some kind of stressor combined with a failure to take action and resolve or remove the stressor. More often than not, anxiety and eating disorders go hand-in-hand. One study found that two-thirds of individuals with eating disorders also suffer from anxiety, with 42 percent of that group developing anxiety as a child which may be well before the start of their eating disorder.
Self-injuring behaviors for eating disorder patients include self-induced vomiting, diuretic or laxative misuse, excessive exercise, cutting, pinching, hitting, severe calorie restriction, or binge eating until discomfort or pain. One study found that 27.3 percent of individuals with an eating disorder also report self-injuring behavior, with the percentage being even higher for individuals with bulimia nervosa (32.7 percent). Another study revealed that four out of five individuals with self-injuring tendencies reported at least one eating disorder behavior in the past week, with binge eating being the highest (57.6 percent).
Obsessive-compulsive disorder (OCD) is the most common anxiety disorder to be linked to eating disorders, with one in six people with an eating disorder also having OCD (15 to 18 percent). Furthermore, people diagnosed with eating disorders are up to 69 percent more likely to develop OCD. Individuals suffering from both conditions tend to develop compulsive rituals connected to their food, such as weighing food before a meal, moving it around on their plate in a particular way, or cutting it into tiny pieces.
The correlation between post-traumatic stress disorder (PTSD) and eating disorders is well-documented. Individuals with traumatic histories often feel a sense of powerlessness or loss of control, and purposefully starving themselves, binging, or purging their meals is a way for them to regain authority over their lives. In a 2013 study, researchers found that 23.1 percent of patients with anorexia nervosa and 25.5 percent of those with bulimia nervosa also suffered from PTSD. Furthermore, more traumatic exposure directly links to more severe eating disorder symptoms.
Up to 50 percent of people with eating disorders also struggle with substance abuse of drugs and/or alcohol, which is a rate five times higher than the general population. These individuals may begin using substances before, at the same time as, or after eating disorder symptoms appear. The substances most commonly abused by eating disorder patients are alcohol and nicotine. A 2022 study revealed that the combination of an eating disorder with substance abuse is particularly deadly because the risks of death from one are compounded with the other.
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