Eating disorders

Each eating disorder has its own pattern, though symptoms often overlap and can shift over time:

• Anorexia nervosa: restricting food intake, intense fear of gaining weight and a distorted view of body weight or shape. It can occur at any body size, including in people who don't look underweight.
• Bulimia nervosa: recurrent episodes of binge eating followed by behaviors to compensate, such as vomiting, misusing laxatives, fasting or excessive exercise.
• Binge eating disorder: repeated episodes of eating large amounts of food with a sense of loss of control, followed by shame or distress, without regular compensatory behaviors.
• ARFID (avoidant/restrictive food intake disorder): limiting the amount or variety of food because of sensory sensitivities, fear of choking or vomiting, or lack of interest in eating, not because of body image concerns.
• Other specified feeding or eating disorders (OSFED): significant eating problems that don't fit neatly into one category but are just as serious.

Disordered eating is a broader term for unhealthy patterns, such as chronic dieting or skipping meals, that may not meet the criteria for a disorder but still deserve attention.

Warning signs can be emotional, behavioral and physical. They're often hidden, and people may deny there's a problem.

Behavioral and emotional signs:
- Preoccupation with food, calories, weight or body shape
- Rigid food rules, cutting out whole food groups or skipping meals
- Eating in secret, hoarding food or disappearing after meals
- Compulsive or excessive exercise, even when ill or injured
- Withdrawing from social events that involve food
- Strong mood swings, anxiety or irritability around eating

Physical signs:
- Noticeable weight changes, in either direction, or frequent fluctuations
- Dizziness, fainting, feeling cold or constant tiredness
- Stomach problems, dental damage or sore throat from vomiting
- Missed periods, dry skin or hair thinning

An eating disorder test or online screening quiz can be a starting point, but it can't diagnose anything. If you recognize several of these signs in yourself or someone else, speak with a doctor or mental health professional.

Eating disorders arise from a complex interaction of factors, and no one is to blame:

• Biological: genetics, temperament and changes in brain systems involved in appetite and reward.
• Psychological: perfectionism, low self-esteem, anxiety, depression, difficulty coping with emotions, or a history of trauma.
• Social and cultural: pressure to be thin or muscular, weight stigma, diet culture, bullying about appearance and social media comparison.
• Life events: transitions, loss, illness or stress can act as triggers.

Dieting is a common starting point, though most people who diet don't develop an eating disorder. Athletes in weight- or appearance-focused sports, people with type 1 diabetes, and those with certain neurodevelopmental conditions may be at higher risk.

Eating disorders are not a choice or a phase. They are illnesses that affect both mind and body.

Treatment is most effective when it starts early and involves a team that may include a physician, a psychologist or psychiatrist, and a registered dietitian. The level of care depends on physical and psychological needs, from outpatient therapy to intensive or inpatient programs when health is at risk.

Approaches with good evidence include:

• Cognitive behavioral therapy, including an enhanced version designed specifically for eating disorders (CBT-E).
• Family-based treatment, especially for children and teenagers, in which parents play an active role in restoring regular eating.
• Specialist supportive clinical management and other structured therapies for adults with anorexia.
• Dialectical behavior therapy skills for emotional regulation, particularly with binge eating or bulimia.
• Nutritional rehabilitation and regular medical monitoring.

A psychiatrist may recommend medication for some eating disorders or for co-occurring depression or anxiety. In the first appointment, expect questions about eating habits, weight history, emotions and physical health, plus a medical check to assess safety.

Eating disorders can have serious physical consequences, so it's best not to wait. Seek medical care promptly if you or someone you know shows signs of an eating disorder, especially rapid weight loss, frequent vomiting or laxative use, or reduced food and fluid intake.

Get urgent help, by calling 911 in the US or your local emergency number, if there is:

• Fainting, chest pain, an irregular or very slow heartbeat
• Confusion, severe weakness or inability to keep fluids down
• Signs of severe dehydration

If you are having thoughts of suicide or self-harm, call or text 988 (Suicide & Crisis Lifeline, US), call Samaritans at 116 123 (UK and Ireland), or call your local emergency number.

If you are worried about a loved one, choose a calm, private moment to share your concern without commenting on their weight or appearance. Focus on how they seem to be feeling and offer to help them find support.

Recovery is a process, often with ups and downs. Alongside treatment, these steps can help:

• Follow the meal plan agreed with your treatment team, even when it feels hard.
• Reduce exposure to content that promotes dieting, weight loss or body comparison.
• Practice naming emotions and finding ways to cope that don't involve food.
• Lean on trusted people and let them know how they can help.
• Avoid weighing yourself frequently unless your team recommends it.

Families play an important role, especially with young people. Learning about the illness, staying patient and separating the person from the disorder can make a real difference. Caregivers also need support themselves, and talking to a therapist or joining a family group can help them stay steady.

If symptoms return or worsen, reach out to your team early. Asking for help again is part of recovery, not a sign that it has failed.