What is an Eating Disorder?

Eating disorders are serious but treatable mental and physical illnesses that can affect people of every age, sex, gender, race, ethnicity, and socioeconomic group. National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives.

While no one knows for sure what causes eating disorders, a growing consensus suggests that it is a range of biological, psychological, and sociocultural factors.  

How Do I Know if I Have an Eating Disorder?

Check out NEDA’s screening tool if you think you might have an eating disorder.

What Are Eating Disorders?

Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years. 

Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

DIAGNOSTIC CRITERIA

To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:

  1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
  2. Intense fear of gaining weight or becoming fat, even though underweight.
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

WARNING SIGNS & SYMPTOMS OF ANOREXIA NERVOSA

Emotional and behavioral

  • Dramatic weight loss
  • Dresses in layers to hide weight loss or stay warm
  • Is preoccupied with weight, food, calories, fat grams, and dieting
  • Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
  • Makes frequent comments about feeling “fat” or overweight despite weight loss
  • Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  • Denies feeling hungry
  • Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)
  • Cooks meals for others without eating
  • Consistently makes excuses to avoid mealtimes or situations involving food
  • Expresses a need to “burn off” calories taken in 
  • Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury 
  • Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive
  • Seems concerned about eating in public
  • Has limited social spontaneity
  • Resists or is unable to maintain a body weight appropriate for their age, height, and build 
  • Has intense fear of weight gain or being “fat,” even though underweight
  • Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight
  • Postpuberty female loses menstrual period
  • Feels ineffective
  • Has strong need for control
  • Shows inflexible thinking
  • Has overly restrained initiative and emotional expression

Physical 

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
  • Difficulties concentrating
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  • Dizziness
  • Fainting/syncope
  • Feeling cold all the time
  • Sleep problems
  • Menstrual irregularities—amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)
  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity
  • Dry skin
  • Dry and brittle nails
  • Swelling around area of salivary glands
  • Fine hair on body (lanugo)
  • Thinning of hair on head, dry and brittle hair 
  • Cavities, or discoloration of teeth, from vomiting
  • Muscle weakness
  • Yellow skin (in context of eating large amounts of carrots)
  • Cold, mottled hands and feet or swelling of feet
  • Poor wound healing
  • Impaired immune functioning

HEALTH CONSEQUENCES OF ANOREXIA NERVOSA

In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally.  Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

Bulimia Nervosa

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

DIAGNOSTIC CRITERIA

According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.

WARNING SIGNS & SYMPTOMS OF BULIMIA NERVOSA

Emotional and behavioral 

  • In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns 
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food  
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics 
  • Appears uncomfortable eating around others 
  • Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch) 
  • Skips meals or takes small portions of food at regular meals 
  • Disappears after eating, often to the bathroom
  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
  • Fear of eating in public or with others
  • Steals or hoards food in strange places  
  • Drinks excessive amounts of water or non-caloric beverages  
  • Uses excessive amounts of mouthwash, mints, and gum  
  • Hides body with baggy clothes  
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories  
  • Shows unusual swelling of the cheeks or jaw area  
  • Has calluses on the back of the hands and knuckles from self- induced vomiting 
  • Teeth are discolored, stained  
  • Creates lifestyle schedules or rituals to make time for binge-and-purge sessions  
  • Withdraws from usual friends and activities 
  • Looks bloated from fluid retention  
  • Frequently diets  
  • Shows extreme concern with body weight and shape  
  • Frequent checking in the mirror for perceived flaws in appearance
  • Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating  
  • Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)  
  • Extreme mood swings

Physical 

  • Noticeable fluctuations in weight, both up and down 
  • Body weight is typically within the normal weight range; may be overweight
  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) 
  • Difficulties concentrating 
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 
  • Dizziness 
  • Fainting/syncope 
  • Feeling cold all the time 
  • Sleep problems 
  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)
  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity 
  • Dry skin 
  • Dry and brittle nails 
  • Swelling around area of salivary glands 
  • Fine hair on body 
  • Thinning of hair on head, dry and brittle hair (lanugo) 
  • Cavities, or discoloration of teeth, from vomiting 
  • Muscle weakness 
  • Yellow skin (in context of eating large amounts of carrots) 
  • Cold, mottled hands and feet or swelling of feet 
  • Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period) 
  • Poor wound healing 
  • Impaired immune functioning

Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

  • Self-injury (cutting and other forms of self-harm without suicidal intention)
  • Substance abuse
  • Impulsivity (risky sexual behaviors, shoplifting, etc.)
  • Diabulimia (intentional misuse of insulin for type 1 diabetes)

HEALTH CONSEQUENCES OF BULIMIA NERVOSA

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.  

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

Binge Eating Disorder

Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.

BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis. 

DIAGNOSTIC CRITERIA

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 
    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
  • The binge eating episodes are associated with three (or more) of the following: 
    • Eating much more rapidly than normal.
    • Eating until feeling uncomfortably full.
    • Eating large amounts of food when not feeling physically hungry.
    • Eating alone because of feeling embarrassed by how much one is eating.
    • Feeling disgusted with oneself, depressed, or very guilty afterward.
  • Marked distress regarding binge eating is present.
  • The binge eating occurs, on average, at least once a week for 3 months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

WARNING SIGNS & SYMPTOMS OF BINGE EATING DISORDER

Emotional and behavioral 

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
  • Appears uncomfortable eating around others 
  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
  • Fear of eating in public or with others
  • Steals or hoards food in strange places  
  • Creates lifestyle schedules or rituals to make time for binge sessions  
  • Withdraws from usual friends and activities 
  • Frequently diets  
  • Shows extreme concern with body weight and shape  
  • Frequent checking in the mirror for perceived flaws in appearance
  • Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating  
  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting
  • Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, and not allowing foods to touch).
  • Eating alone out of embarrassment at the quantity of food being eaten
  • Feelings of disgust, depression, or guilt after overeating
  • Fluctuations in weight
  • Feelings of low self-esteem

Physical 

  • Noticeable fluctuations in weight, both up and down 
  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) 
  • Difficulties concentrating

HEALTH CONSEQUENCES OF BINGE EATING DISORDER

The health risks of BED are most commonly those associated with clinical obesity, weight stigma, and weight cycling (aka, yo-yo dieting). Most people who are labeled clinically obese do not have binge eating disorder. However, of individuals with BED, up to two-thirds are labelled clinically obese; people who struggle with binge eating disorder tend to be of normal or higher-than-average weight, though BED can be diagnosed at any weight.

Orthorexia

Although not formally recognized in the Diagnostic and Statistical Manual, awareness about orthorexia is on the rise. The term ‘orthorexia’ was coined in 1998 and means an obsession with proper or ‘healthful’ eating. Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being.

Without formal diagnostic criteria, it’s difficult to get an estimate on precisely how many people have orthorexia, and whether it’s a stand-alone eating disorder, a type of existing eating disorders like anorexia, or a form of obsessive-compulsive disorder. Studies have shown that many individuals with orthorexia also have obsessive-compulsive disorder. 

WARNING SIGNS & SYMPTOMS OF ORTHOREXIA

  • Compulsive checking of ingredient lists and nutritional labels
  • An increase in concern about the health of ingredients
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Unusual interest in the health of what others are eating
  • Spending hours per day thinking about what food might be served at upcoming events
  • Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
  • Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
  • Body image concerns may or may not be present

HEALTH CONSEQUENCES OF ORTHOREXIA

Like anorexia, orthorexia involves restriction of the amount and variety of foods eaten, making malnutrition likely. Therefore, the two disorders share many of the same physical consequences. 

Other Specified Feeding or Eating Disorder (OSFED)

Other Specified Feeding or Eating Disorders (OSFED) was previously known as Eating Disorder Not Otherwise Specified (EDNOS) in past editions of the Diagnostic and Statistical Manual. Despite being considered a ‘catch-all’ classification that was sometimes denied insurance coverage for treatment as it was seen as less serious, OSFED/EDNOS is a serious, life-threatening, and treatable eating disorder. The category was developed to encompass those individuals who did not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder. In community clinics, the majority of individuals were historically diagnosed with EDNOS.

Research into the severity of EDNOS/OSFED shows that the disorder is just as severe as other eating disorders based on the following:

  • Children hospitalized for EDNOS had just as many medical complications as children hospitalized for anorexia nervosa
  • Adults with ‘atypical’ or ‘subclinical’ anorexia and/or bulimia scored just as high on measures of eating disorder thoughts and behaviors as those with DSM-diagnosed anorexia nervosa and bulimia nervosa
  • People with EDNOS were just as likely to die as a result of their eating disorder as people with anorexia or bulimia

EVALUATION & DIAGNOSIS

Changes to the latest edition of the DSM were meant to clarify definitions of anorexia, bulimia, and binge eating disorder to more accurately diagnose eating disorders. Although this reduced the number of OSFED diagnoses, it remains a common diagnosis. In the DSM-5, a person must present with feeding or eating behaviors that cause clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders.

A diagnosis might then be assigned that addresses the specific reason why the presentation does not meet the specifics of another disorder (e.g., bulimia nervosa – low frequency). The following are further examples for OSFED: 

  • Atypical Anorexia Nervosa: All criteria are met, except despite significant weight loss, the individual’s weight is within or above the normal range.
  • Binge Eating Disorder (of low frequency and/or limited duration): All of the criteria for BED are met, except at a lower frequency and/or for less than three months.
  • Bulimia Nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months.
  • Purging Disorder: Recurrent purging behavior to influence weight or shape in the absence of binge eating.
  • Night Eating Syndrome: Recurrent episodes of night eating. Eating after awakening from sleep, or by excessive food consumption after the evening meal. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment. The behavior is not better explained by another mental health disorder (e.g. BED).

WARNING SIGNS & SYMPTOMS OF OSFED

Emotional and behavioral 

  • In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns 
  • Dramatic weight loss
  • Dresses in layers to hide weight loss or stay warm
  • Is preoccupied with weight, food, calories, fat grams, and dieting
  • Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
  • Makes frequent comments about feeling “fat” or overweight despite weight loss
  • Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  • Denies feeling hungry
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food  
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics 
  • Appears uncomfortable eating around others 
  • Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch) 
  • Skips meals or takes small portions of food at regular meals 
  • Disappears after eating, often to the bathroom
  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
  • Fear of eating in public or with others
  • Steals or hoards food in strange places  
  • Drinks excessive amounts of water or non-caloric beverages  
  • Uses excessive amounts of mouthwash, mints, and gum  
  • Hides body with baggy clothes  
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories  
  • Shows unusual swelling of the cheeks or jaw area  
  • Has calluses on the back of the hands and knuckles from self- induced vomiting 
  • Teeth are discolored, stained  
  • Creates lifestyle schedules or rituals to make time for binge-and-purge sessions  
  • Withdraws from usual friends and activities 
  • Looks bloated from fluid retention  
  • Frequently diets  
  • Shows extreme concern with body weight and shape  
  • Frequent checking in the mirror for perceived flaws in appearance
  • Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating  
  • Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)  
  • Extreme mood swings

Physical 

  • Noticeable fluctuations in weight, both up and down 
  • Body weight is typically within the normal weight range; may be overweight
  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) 
  • Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period) 
  • Difficulties concentrating 
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 
  • Dizziness 
  • Fainting/syncope 
  • Feeling cold all the time 
  • Sleep problems 
  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)
  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity 
  • Dry skin 
  • Dry and brittle nails 
  • Swelling around area of salivary glands 
  • Fine hair on body 
  • Thinning of hair on head, dry and brittle hair (lanugo) 
  • Cavities, or discoloration of teeth, from vomiting 
  • Muscle weakness 
  • Yellow skin (in context of eating large amounts of carrots) 
  • Cold, mottled hands and feet or swelling of feet 
  • Poor wound healing 
  • Impaired immune functioning

HEALTH CONSEQUENCES OF OSFED

The health consequences of OSFED depend in part on which eating disordered behaviors are being used. It is important to recognize that OSFED is as serious as other eating disorders and should not be trivialized or underestimated. Health consequences of OSFED can be difficult to pinpoint, as it includes a number of conditions. Watch out for all of the signs already listed. The most important thing to look out for is attitudes about food and weight that conflict with a productive, satisfying life.

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously referred to as “Selective Eating Disorder.” ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.

Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.

DIAGNOSTIC CRITERIA

According to the DSM-5, ARFID is diagnosed when:

  • An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
    • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
    • Significant nutritional deficiency.
    • Dependence on enteral feeding or oral nutritional supplements.
    • Marked interference with psychosocial functioning.
  • The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
  • The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
  • The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

RISK FACTORS 

As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Researchers know much less about what puts someone at risk of developing ARFID, but here’s what they do know:

  • People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.
  • Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
  • Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.

WARNING SIGNS & SYMPTOMS OF ARFID

Behavioral and psychological 

  • Dramatic weight loss
  • Dresses in layers to hide weight loss or stay warm
  • Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  • Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause
  • Dramatic restriction in types or amount of food eaten
  • Will only eat certain textures of food
  • Fears of choking or vomiting
  • Lack of appetite or interest in food
  • Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).
  • No body image disturbance or fear of weight gain

Physical 

Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
  • Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
  • Difficulties concentrating
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  • Postpuberty female loses menstrual period
  • Dizziness
  • Fainting/syncope
  • Feeling cold all the time
  • Sleep problems
  • Dry skin
  • Dry and brittle nails
  • Fine hair on body (lanugo)
  • Thinning of hair on head, dry and brittle hair
  • Muscle weakness
  • Cold, mottled hands and feet or swelling of feet
  • Poor wound healing
  • Impaired immune functioning

HEALTH CONSEQUENCES OF ARFID

In ARFID, the body is denied the essential nutrients it needs to function normally.  Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences. The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

Laxative Abuse

Laxative abuse occurs when a person attempts to eliminate unwanted calories, lose weight, “feel thin,” or “feel empty” through the repeated, frequent use of laxatives. Often, laxatives are misused following eating binges, because the individual mistakenly believes that the laxatives will work to rush out food and calories before they can be absorbed — but that doesn’t really happen. Laxative abuse is serious and dangerous, often resulting in a variety of health complications and sometimes causing life-threatening conditions.

THE LAXATIVE MYTH

The belief that laxatives are effective for weight control is a myth. In fact, by the time laxatives act on the large intestine, most foods and calories have already been absorbed by the small intestine. Although laxatives artificially stimulate the large intestine to empty, the “weight loss” caused by a laxative-induced bowel movement contains little actual food, fat, or calories. Instead, laxative abuse causes the loss of water, minerals, electrolytes, and indigestible fiber and wastes from the colon.  This “water weight” returns as soon as the individual drinks any fluids and the body re-hydrates. If the chronic laxative abuser refuses to re-hydrate, they risk dehydration, which further taxes the organs and which may ultimately cause death.

HEALTH CONSEQUENCES OF LAXATIVE ABUSE 

  • Disturbance of electrolyte and mineral balances. Sodium, potassium, magnesium, and phosphorus are electrolytes and minerals that are present in very specific amounts necessary for proper functioning of the nerves and muscles, including those of the colon and heart. Upsetting this delicate balance can cause improper functioning of these vital organs.
  • Severe dehydration may cause tremors, weakness, blurry vision, fainting, kidney damage, and, in extreme cases, death. Dehydration often requires medical treatment.
  • Laxative dependency occurs from overuse, and can cause the colon stops reacting to usual doses of laxatives so that larger and larger amounts of laxatives may be needed to produce bowel movements.
  • Internal organ damage may result, including stretched or “lazy” colon, colon infection, irritable bowel syndrome, and, rarely, liver damage. Chronic laxative abuse may contribute to risk of colon cancer.

COMPULSIVE EXERCISE

Compulsive exercise is not a recognized clinical diagnosis in the DSM-5, but many people struggle with symptoms associated with this term. If you are concerned about your or a loved one’s relationship with exercise, please speak with a treatment professional.

WARNING SIGNS & SYMPTOMS OF COMPULSIVE EXERCISE

  • Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications
  • Intense anxiety, depression, irritability, feelings of guilt, and/or distress if unable to exercise
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
  • Discomfort with rest or inactivity
  • Exercise used to manage emotions
  • Exercise as a means of purging (needing to “get rid of” or “burn off” calories)
  • Exercise as permission to eat
  • Exercise that is secretive or hidden
  • Feeling as though you are not good enough, fast enough or not pushing hard enough during a period of exercise; overtraining
  • Withdrawal from friends and family

HEALTH CONSEQUENCES OF COMPULSIVE EXERCISE

  • Bone density loss (osteopenia or osteoporosis) 
  • Loss of menstrual cycle (in women)
  • Female Athlete Triad (in women) 
  • Relative Energy Deficiency in Sport (RED-S)
  • Persistent muscle soreness
  • Chronic bone & joint pain
  • Increased incidence of injury (overuse injuries, stress fractures, etc.)
  • Persistent fatigue and sluggishness
  • Altered resting heart rate
  • Increased frequency of illness & upper respiratory infections

Information taken from the National Eating Disorder Association