Eating disorders are complex illnesses that affect all kinds of people and in different ways. Two people with the same eating disorder may have differing perspectives, experiences and symptoms. Those who struggle with eating disorders often report feeling disconnected not only from food and their bodies, but also from others.

Most eating disorders involve an obsessive focus on weight, body shape and food, as well as intense over-exercise. Unhealthy food and exercise behaviors usually develop in adolescence, but can start in the very young—leading to physical and mental health problems as the child develops. 

Thought to be more common in girls than boys, recent research shows more boys suffer from eating disorders than previously known. It may be harder to detect in boys, as weight loss is often covered up by sports, like wrestling, and by a proclivity to eat.

During childhood and adolescence, self-esteem and body consciousness can be precarious and fixate on weight. Children or teens often try to keep their unhealthy eating habits and behaviors a secret. Yet, parents, teachers and other adults may discern differences between normal behavior and behavior indicating a possible eating disorder.

Causes

There is no known, exact cause of an eating disorder, nor a way to predict who will develop an eating disorder. Researchers have found broad similarities in understanding major risks, which may involve a complex interaction of biological, psychological and environmental factors. 

– Genetic risk factors: Research has confirmed 40-60% of the risk for eating disorders arises from genetic influence. 

• • This does not imply a single eating-disorder gene or that genes cause eating disorders, however. It could instead be due to a family’s modeling of eating disorder-linked behaviors (observing extreme dieting, e.g.).
  • Individuals may inherit traits—such as anxiety, fear, perfectionism or moodiness—associated with developing eating disorders. Gene variations contribute to traits that, in turn, increase or decrease risk.

– Environmental risk factors: An individual can be affected by events and such influences as diet culture, media, trauma and weight teasing. Influences such as gender, ethnicity or religious and spiritual practices can strengthen or lessen other environmental factors. These factors can negatively affect some young people trying to navigate between overeating and starving. 

– Tripartite model: Exposure to media, peer and parental messages contribute to whether a young person idealizes thinness and engages in social comparison. Idealization and social comparison may potentially lead to poor body image and various forms of disordered eating.

Health Risks

Dangerous eating behaviors can have significant impact on the body’s ability to get appropriate nutrition and can harm the heart, digestive system, bones, teeth and mouth—and lead to related psychological distress. Neither “fads” nor “phases,” these real, complex and devastating conditions can have serious consequences for health, productivity and relationships. 

Left untreated, pediatric obesity poses immediate and future health risks. Eating disorders can be life-threatening, leading to fatal medical problems and a high rate of suicide. According to research:

• Overall, people with anorexia nervosa have a six-fold increase in mortality compared to the general population. 
• Reasons for death include starvation, substance abuse and suicide. 
• An increased rate of death from “natural” causes, such as cancer. 

Similarly to anorexia, studies indicated elevated mortality risks for bulimia nervosa (along with a high suicide rate) and non-specified eating disorders.

Read more on religion and eating disorders.

Effective Treatments

Such disorders can affect every organ system in the body. Children and adolescents struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery. 

Fortunately, there are effective treatments for eating disorders. The earlier a disorder is treated, the more likely an individual will recover. Early intervention:

• Can result in significant reductions in symptoms and avoidance of future relapse 
• Contribute to living a more fulfilling and satisfied life 
• Contribute to better functioning at home, school or work

After completing treatment, clients report feeling happier, more in control and being a better family member and friend.

Eating disorders covered here:

• Body dysmorphic disorder (BDD) or distorted body image: Extreme, distorted self-perceptions of appearance that persist, despite reassurance from family and friends.
• Fixated on appearance: Young people who are overly focused on their appearance as a measure of self-worth. 
• Anorexia nervosa or extreme dieting: Characterized by self-imposed starvation in an otherwise high-functioning young person—the most common eating disorder. Also includes atypical anorexia nervosa.
• Bulimia nervosa or overeating: Unmanageable eating offset by fasting, extreme exercise or purging—the second most common eating disorder.
• Bulimarexia: As in yo-yo dieting, involves oscillations between strong cravings for and aversions to food.
• Pediatric obesity: When a child is well above the normal or healthy weight for age and height.
• Pica somatic symptoms disorder: The compulsive eating of nonfood items with no nutritional value, possibly leading to serious health consequences.
• Somatic symptom disorder: Individuals with eating disorders may also have an excessive focus on physical (or somatic) symptoms, as a way of refusing or circumventing treatment 

Assessment & Treatment

Because of strong research over the past 20 years, there has been progress in understanding and treating eating disorders. Evidence-based cognitive and behavior treatments help children and adolescents return to healthier eating habits and sometimes reverse serious complications caused by the eating disorder. 

Eating disorders are complex, with biological, genetic, psychological, social and developmental roots. They are serious—but treatable, with professional help. Untreated problems can lead to great psychological stress, physical problems or fatality. 

Assessment

The first step toward recovery is diagnosis, based on an assessment from both a primary care provider and a mental health professional. Assessments also help determine risk factors that may lead to eating disorders, such as:

• Family history. Eating disorders are significantly more likely to occur in people who have parents or siblings with an eating disorder.
• Other mental health disorders. People with an eating disorder often have a history of an anxiety, depression or obsessive-compulsive disorder (OCD).
• Dieting and starvation. Starvation and weight loss affects the brain and influences mood changes, rigid thinking, anxiety and appetite reduction. Evidence suggests such symptoms are actually symptoms of starvation.
• Stress. Stressful life events—moving, going to college, a new job, or family/relationship issues—may increase the risk of an eating disorder.

Based on signs, symptoms and eating and exercise habits, diagnoses generally involve:

• Physical exam. A medical doctor performs an examination and orders lab tests to rule out other medical causes for eating issues.
• Psychological evaluation. A mental health professional asks about thoughts, feelings and eating habits—and possibly requests completion of a psychological self-assessment questionnaire.

• Other studies. Additional tests may be done to check for complications related to the eating disorder.

Treatment

Treatment is more effective before the disorder becomes chronic, but even people with longstanding eating disorders can and do recover. 

Treatment plans involve psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment needs to attend to the psychological, biological, interpersonal and cultural forces that contribute to or maintain the eating disorder.  

At the same time, it’s important not to exert control over those with eating disorders. Young people can be skilled at overriding control by pooling resources to hide their behavior. Tricks of the trade include over-exercising, claiming to have eaten at a friend’s house when they haven’t, hiding food in the bedroom or car to binge on later or waiting for parents to leave to binge and purge without getting caught. Some in-patients are known to hide laxatives between their toes.

Eating disorder treatments offered at CFI

• Family-based treatment (FBT) promotes recovery by focusing on treating the entire family to help with nutrition, exercise, pediatric obesity and stress management.

• Enhanced cognitive behavioral therapy (CBT-E) and adolescent-focused therapy (AFT) are treatments oriented to long-term, sustainable improvements.  
• Nutrition and exercise counseling are geared to even the youngest children with obesity or other risks for developing eating disorders. 
• Biofeedback is a mind-body therapy that measures the body’s physical responses and feeds them back to clients to help them gain control of these functions and change attitudes and behaviors. 
• Medication, especially used with behavior therapy

Prevention and Treatment at home

Research suggests prevention can only result by changing circumstances that promote, initiate or intensify eating and weight problems before they arise. 

• Since the 1950s, Americans have steadily increased dieting for weight loss and have paid more attention to the food they eat and their body size and shape. 
• These physical, emotional and social factors all play a role in the development of eating disorders. 

Scientists believe by reducing risk factors, they can reduce the likelihood of a person developing an eating disorder. Such efforts involve:

• Reducing negative risk factors, like body dissatisfaction, depression or basing self-esteem on appearance
• Increasing protective factors, like defining oneself not based on appearance and replacing dieting and body critiquing with intuitive eating and appreciation for how the body functions

Prevention programs

While evidence does not yet support prevention programs reducing rates of diagnosable eating disorders, they can alter knowledge, attitudes and behaviors associated with eating disorders and disordered eating. Many such programs:

• Have successfully discouraged development of eating problems in children, adolescents and young adults 
• Show benefits in reducing risk factors, such as fasting, purging and other unhealthy weight loss behaviors, as well as in decreasing disordered eating

More prevention research is needed, especially to learn what’s effective for children, males and people from ethnic groups.

Behaviors that influence and moderate excess weight gain

Parents, guardians and teachers can help children maintain a healthy weight by teaching them:

• Healthy eating habits and limiting calorie-rich foods
• Encouraging them to be physically active
• Reducing screen time 
• Getting adequate sleep

Treatment Settings

Outpatient or residential treatment

• Day treatment programs are highly structured, requiring attendance several hours a day and days a week, and can include medical care; group, individual and family therapy; structured eating sessions; and nutrition/exercise education.
• Residential treatment programs are for those who may need long-term care for mental and physical health reasons or who have not yet shown improvement after frequent hospitalizations.

Hospitalization 

The goal of hospitalization is to stabilize acute medical symptoms by helping normalize eating and weight and by beginning the process of young people gaining some control over their lives. Hospitalization:

• May be necessary for those with serious mental or physical health problems or, due to anorexia, are unable to eat or gain weight. 
• Is not usually necessary for treatment of bulimia, because those with bulimia must learn to eat normally in their own environment.
• May be needed to treat and monitor types of health problems depending on types and severity of the eating disorder. These may include:

• Electrolyte imbalances interfering with functioning of muscles, heart and nerves
• Heart problems, high blood pressure
• Digestive problems, nutrient deficiencies
• Dental cavities and erosion of teeth surfaces from frequent vomiting (bulimia)
• Low bone density (osteoporosis) as a result of irregular or absent menstruation or long-term malnutrition (anorexia)
• Stunted growth caused by poor nutrition (anorexia)
• Lack of menstruation and problems with infertility and pregnancy

CONNECT TO CARE

References

Adolescent-Focused Therapy for Anorexia Nervosa: A Developmental Approach, by James Lock

Association for Behavioral and Cognitive Therapies (ABCT)

Centers for Disease Control

Eating Disorder HOPE

Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.)

Harvard Health Publishing

Healthline.com

Mayo Clinic

National Eating Disorders Association (NEDA)

Renfrew Center