About Eating Disorders

The Academy for Eating Disorders is committed to disseminating information regarding these disorders to educate, prevent and help assist those in need. Below are facts about eating disorders for concerned friends, family members, healthcare providers, and individuals struggling with their eating. Eating disorders affect individuals irrespective of age, weight, gender, and race/ethnicity. It is important to keep in mind that there is significant symptom overlap among the eating disorder categories listed below, and that individuals can move from one diagnostic category to another over time.

For information on treatment options, please click here. For further reading materials, please see our reading list.

See also, Fast Facts on Eating Disorders.

Anorexia Nervosa (AN) 

  • Characterized by failure to maintain an adequate body weight, body image disturbance, and excessive dietary restriction (1)
    • May be accompanied by periodic binge eating and purging (e.g., self-induced vomiting, laxative use) 
  • Affects ~.05% of the population (2,3) 
  • 3:1 female to male ratio, but this may be an underestimate as males are less likely to seek treatment and healthcare providers may fail to assess or diagnose eating disorders in males (2)
  • Typical age of onset is early- to mid-adolescence (4) 
  • Related medical conditions include bone loss, difficulties with temperature regulation, loss of menstrual periods, low heart rate, low blood pressure (5)
  • Related psychological conditions include anxiety, depression, social isolation, perfectionism (6)
  • Warning signs include sudden weight loss, extreme dieting, food rituals (e.g., taking very small bites, eating foods in a certain order), hair loss, dry skin or hair, brittle nails, growth of fine, downy hair on the face and body
  • ~50-60% of individuals with AN recover over time, with better recovery rates observed in younger patients and those with a shorter duration of illness when diagnosed (7)
    • Risk of death in AN is increased due to medical complications and suicide (7)
  • For adolescents with AN, a form of family-based treatment has been shown to be successful in improving recovery from the illness (8) 

Bulimia Nervosa (BN)

  • Characterized by recurrent binge eating (consuming large amounts of food while feeling out of control) accompanied by compensatory behaviors to prevent weight gain, and body image disturbances (1) 
    • Compensatory behaviors may be purging (self-induced vomiting, laxative, diuretic, or enema use) or non-purging (excessive exercise, fasting)
  • Affects ~1-2% of the population (2,3)
  • 3:1 female to male ratio, but this may be an underestimate as males are less likely to seek treatment and healthcare providers may fail to assess or diagnose eating disorders in males (2)
  • Typical age of onset is mid- to late-adolescence (9)
  • Related medical conditions include electrolyte imbalance, esophageal ulcers, tooth decay (5)
  • Related psychological conditions include anxiety, depression, substance use, difficulties with impulse control (6) 
  • Warning signs include the disappearance of large amounts of food, frequent trips to the bathroom after meals, calluses on knuckles from using fingers to induce vomiting, swelling of the face
  • ~70% of individuals with BN recover over time, and patients with fewer accompanying psychiatric problems seem to fare better (7) 
  • Risk of death is increased in BN, particularly death due to suicide (10)
  • For adults with BN, cognitive-behavioral therapy has been successful in improving recovery from the illness (11)
    • The anti-depressant medication fluoxetine has been FDA-approved for the treatment of adults with BN (12)

Binge Eating Disorder (BED) 

  • Characterized by recurrent binge eating without compensatory behaviors (1)
  • Affects ~2-3% of the population (2)
  • 3:2 female to male ratio (2) 
  • Typical age of onset is adolescence or young adulthood, but most individuals don’t present for treatment until middle adulthood (3,13)
  • Related medical conditions include obesity (14) and related conditions (e.g., type II diabetes, hypertension), gastric problems (15) 
  • Related psychological conditions include anxiety, depression, substance use (6)
  • Warning signs include sudden weight gain, disappearance of large amounts of food
  • ~70-80% of individuals with BED recover over time, and those with fewer interpersonal problems appear to have a better likelihood of recovery (7)
  • For adults with BED, cognitive-behavioral and interpersonal treatments have been successful in increasing recovery from the illness while behavioral weight loss treatment may be helpful with weight loss (16) 

Eating Disorder Not Otherwise Specified (ED-NOS) or Feeding or Eating Disorders Not Elsewhere Classified (FED-NEC)

  • Characterized by disturbances in eating behavior that don’t fit exactly with the disorders described above (1)
    • Behaviors may be less frequent or qualitatively different than those seen in the primary eating disorder, but are just as distressing
    • Examples include:
      • Restrictive eating resulting in substantial weight loss despite normal weight status (atypical AN)
      • Binge eating and compensatory behaviors occurring less frequently than required for a diagnosis of BN (subthreshold BN)
      • Purging without binge eating (purging disorder)
      • Recurrent episodes of night eating, defined by eating after awakening from sleep or excessive food consumption after the evening meal (night eating syndrome)
  • Most common eating disorder diagnosis; affects ~4-5% of the population (17) 
  • ~4:1 female to male ratio (17)
  • Typical age of onset is adolescence or young adulthood (18)
  • Related medical and psychological conditions are similar to those for the other eating disorders
    • These complications are just as severe for those with ED-NOS as for those with full-syndrome eating disorders (19)
  • Warning signs are similar to those for related eating disorder diagnoses
  • ~70% of individuals with ED-NOS recover over time, with the best outcomes observed for individuals with high social support (7)
  • Some data suggest an increased risk of death in ED-NOS (10), but more research is needed on this understudied group

If you are interested in learning more about eating disorders, please visit our bookstore. If you are concerned that you or someone you know might have an eating disorder, please use our “Find a Professional” function.

 

References 

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, text revision. 4th ed. Washington, DC: American Psychiatric Association; 2000.
2. Hudson JI, Hiripi E, Pope HG, Jr., Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61(3):348-358.
3. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. 2011;68(7):714-723.
4. Keski-Rahkonen A, Hoek HW, Susser ES, et al. Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry. 2007;164(8):1259-1265.
5. Fairburn CG, Harrison PJ. Eating disorders. Lancet. 2003;361(9355):407-416.
6. Berkman ND, Lohr KN, Bulik CM. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007;40(4):293-309.
7. Keel PK, Brown TA. Update on course and outcome in eating disorders. Int J Eat Disord. 2010;43(3):195-204.
8. Stiles-Shields C, Hoste RR, Doyle PM, Le Grange D. A review of family-based treatment for adolescents with eating disorders. Rev Recent Clin Trials. 2012;7(2):133-140.
9. Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14(4):406-414.
10. Crow SJ, Peterson CB, Swanson SA, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009;166(12):1342-1346.
11. Hay PP, Bacaltchuk J, Stefano S, Kashyap P. Psychological treatments for bulimia nervosa and binging. Cochrane Database Syst Rev. 2009;7(4):CD000562.
12. Aigner M, Treasure J, Kaye W, Kasper S. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders. World J Biol Psychiatry. 2011;12(6):400-443.
13. Spurrell EB, Wilfley DE, Tanofsky MB, Brownell KD. Age of onset for binge eating: are there different pathways to binge eating? Int J Eat Disord. 1997;21(1):55-65.
14. de Zwaan M. Binge eating disorder and obesity. Int J Obes Relat Metab Disord. 2001;25 Suppl 1:S51-55.
15. Cremonini F, Camilleri M, Clark MM, et al. Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study. Int J Obes (Lond). 2009;33(3):342-353.
16. Wilson GT. Treatment of binge eating disorder. Psychiatr Clin North Am. 2011;34(4):773-783.
17. Le Grange D, Swanson SA, Crow SJ, Merikangas KR. Eating disorder not otherwise specified presentation in the US population. Int J Eat Disord. 2012;45(5):711-718.
18. Milos G, Spindler A, Schnyder U, Fairburn CG. Instability of eating disorder diagnoses: prospective study. Br J Psychiatry. 2005;187:573-578.
19. Thomas JJ, Vartanian LR, Brownell KD. The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychol Bull. 2009;135(3):407-433.