What are eating disorders?
According to the American Psychiatric Association, eating disorders are illnesses in which people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become preoccupied with food and their body weight.
The numbers
From the National Association of Anorexia Nervosa and Associated Disorders, except where another source is named:
- Every 52 minutes, at least one person dies as a direct result of an eating disorder.
- Anorexia has the highest case mortality rate, and the second-highest crude mortality rate, of any mental illness.
- In a study of 289,024 US college students, rates of a self-reported eating disorder diagnosis in the past year were 15.8% among transgender students, 3.5% among cisgender sexual minority women, and 2.1% among cisgender sexual minority men, compared with 1.9% among cisgender heterosexual women and 0.6% among cisgender heterosexual men. (Diemer et al., Journal of Adolescent Health, 2015.)
- Eating disorders affect all races and ethnic groups.
- Genetics, environmental factors, and personality traits all combine to create risk for an eating disorder.
Watch: Anorexia nervosa — causes, symptoms, diagnosis, treatment & pathology (Osmosis, YouTube).
In their words
How Travel Has Shaped My Eating Disorder Recovery
“As we approach the first summer in five years that my feet may not stray from the pathways that have become my mundane, I question what it is to travel with an eating disorder… Wherever I travel, my eating disorder is there with me.”
How to survive the holidays with an eating disorder
“’Tis the season of robust turkey and latkes and decadent mashed potatoes… Yet, for millions across America who have eating disorders, the holiday season is their greatest fear.”
Eating Disorders: More than skin deep
“Earlier this month, Mary Cain, one of the most heralded middle distance runners of the 21st century, shared a shocking revelation. In a New York Times video op-ed, Cain detailed years of alleged abuse… And while Cain's story is certainly illuminating in what it tells us about eating disorders, it is hardly unique.”
The chemistry behind eating disorders
Problems in dealing with rewards
Among people with eating disorders, something goes askew in the brain's reward center — the region that processes the good feelings that come with smiles, gifts, or compliments by releasing dopamine. Pathways carrying that signal seem to be miswired in people with eating disorders, studies show. Research also shows people with anorexia tend to be extra sensitive to rewards — even the basic process of eating can be overwhelming and trigger anxiety — and restricting food appears to make that sensitivity stronger, changing how the brain processes rewards and making it even harder to eat normally again. People with bulimia, in contrast, seem to be under-stimulated by rewards.
Brain differences
The size and shape of certain brain regions differ in people with eating disorders. The orbitofrontal cortex — a region between the eyes that includes a structure important in regulating how much we eat — is larger than typical in young people and adults with anorexia nervosa and bulimia nervosa, including people who have recovered. The insula, which connects taste to pleasure and integrates how we feel about our bodies, is also enlarged. Whether these altered regions help trigger eating disorders or are caused by them remains unknown — but the studies show these illnesses have a strong basis in brain biology. As researcher Guido Frank puts it: “It's not ‘just the fear of weight gain’… It's also something clearly biological that makes it really hard for them to go back to normal.”
How does treatment help?
Eating disorder treatment depends on the particular disorder and its symptoms — typically a combination of psychological therapy, nutrition education, medical monitoring, and sometimes medication. A treatment team can include a mental health professional, a registered dietitian, medical or dental specialists, and family members.
- Psychological therapy is the most important component — cognitive behavioral therapy, family-based therapy, or group CBT, lasting from months to years.
- Nutrition education builds regular eating patterns and a plan toward a healthy weight.
- Medications can't cure an eating disorder, but antidepressants may help with binge-eating or purging behaviors and co-occurring depression or anxiety.
- Hospitalization, day programs, or residential treatment may be needed for serious physical or mental health complications.
- Ongoing care addresses health problems like electrolyte imbalances, heart and digestive problems, dental damage, and low bone density.
You are the most important member of your treatment team. There's a lot of misinformation about eating disorders on the web — reputable places to learn more include the National Eating Disorders Association (NEDA) and F.E.A.S.T.
Books that portray eating disorders
The Art of Starving, by Sam J. Miller
A darkly funny, moving story of body image, addiction, friendship, and love: Matt believes the less he eats, the more he seems to have… powers. Review · Buy the book
Not All Black Girls Know How to Eat, by Stephanie Covington Armstrong
A moving first-person narrative of a Black woman's struggle with a disorder consistently portrayed as a white woman's problem. Review · Buy the book
Celebrities who advocate
Taylor Swift
“My relationship with food was exactly the same psychology that I applied to everything else in my life: If I was given a pat on the head, I registered that as good. If I was given a punishment, I registered that as bad.”
Read the article (Variety)
Russell Brand
“Around the age of 11 he started binge-eating and vomiting. ‘It was really unusual in boys, quite embarrassing…’ As an adult, when he was in rehab, the bulimia briefly returned. ‘It was clearly about getting out of myself and isolation.’”
Read the article (The Guardian)
A note from the team
We are not experts and do not seek to diagnose or act in place of professional psychiatric treatment. We are an organization seeking to raise awareness. If you have concerns about any of this material, please email us.
Sources
- American Psychiatric Association — What are eating disorders?
- ANAD — Eating disorder statistics (citing Deloitte Access Economics, 2020)
- Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE — Gender identity, sexual orientation, and eating-related pathology in a national sample of college students, Journal of Adolescent Health 57(2):144–149, 2015 (the college-student figures)
- Science News Explores — Eating disorders: the brain's foul trickery (the chemistry section)
- Mayo Clinic — Eating disorder treatment: know your options (the treatment section)