Eating disorders are psychological conditions characterized by unhealthy, obsessive, or disordered eating habits. Eating disorders come with both emotional and physical symptoms and include anorexia nervosa (voluntary starvation), bulimia nervosa (binge-eating followed by purging), binge-eating disorder (binge-eating without purging), and other or unspecified eating disorders (disordered eating patterns that do not fit into another category).
Eating disorders occur more frequently in affluent cultures than in non-affluent ones, but they are not exclusive to the well-off. A disproportionate number of those diagnosed are young women in their teens and 20s, but anyone—including young men and older adults of any gender—can develop an eating disorder. Eating disorders often become all-consuming, forcing the afflicted to focus on eating (or not eating) to the exclusion of much else in their life.
Biological factors, social and interpersonal pressures, and family history are some of the factors associated with eating disorders. Culturally mediated body-image concerns and personality traits like perfectionism and obsessiveness also play a large role in the disorders, which are often accompanied by depression or anxiety.
Treatment is rarely simple. Eating disorders may create additional medical problems and can even be acutely life-threatening, requiring hospitalization and forced nourishment. It often takes multidisciplinary teams of health professionals—including psychotherapists, medical doctors, and specialized dietitians or nutritionists—to bring about full recovery.
What Is Anorexia?
Anorexia nervosa is an eating disorder marked by an extreme obsession with weight loss or exercise. It is especially prevalent among young to middle-aged women, and increasingly among young men, but it can affect anyone at any age.
Characterized by a distorted sense of body image and extreme voluntary starvation or overexercising—and closely associated with perfectionism and depression—it is the most deadly psychiatric disorder. The most common behavioral signs of anorexia include extreme dieting, obsessive food rituals, and secretive and antisocial behavior.
Anorexia is highly resistant to treatment and is often accompanied by anxiety and depression. Treatment may include cognitive behavioral therapy, medication, nutrition education and management, and family-based therapies, all of which may take place at specialized eating-disorder centers.
If the condition becomes life-threatening, the only recourse may be hospitalization with forced feeding, which may create ethical and legal dilemmas for all caregivers involved.
What Is Bulimia?
Bulimia nervosa is an eating disorder marked by frequent cycles of binge-eating excessive amounts of food, followed by purging. Purging is usually done by self-induced vomiting but may sometimes include the use of laxatives, diuretics, or non-purging compensatory behaviors, such as fasting or overexercising.
The disorder typically begins during adolescence, but it can also develop earlier or later. Regardless of age, it can be difficult to identify because those with bulimia are often secretive about their eating and purging habits. Although many people with bulimia are overweight, they generally have an intense fear of weight gain and often suffer anxiety, depression, and poor self-esteem.
Signs of bulimia include unusual eating behaviors, constant weight fluctuation, frequent use of the bathroom, and avoidance of social events. Treatment usually includes cognitive-behavioral or other forms of psychotherapy, antidepressant medication, and nutrition counseling.
What Is Binge Eating Disorder?
Binge-eating disorder is marked by recurrent episodes of extreme overeating not accompanied by compensatory behavior; as a result, those with the disorder are often overweight or obese.
People with this disorder tend to eat much more rapidly than normal and don’t stop until feeling uncomfortably full. They may consume large amounts of food even when they’re not hungry. They often eat alone because of shame or embarrassment about their eating behaviors.
Many people experience occasional instances of overeating and may even “binge” from time to time. To be considered a disorder, then, these behaviors must occur at least two days a week for six months or more.
What Are Other Eating Disorders?
Though anorexia, bulimia, and binge-eating disorder are the most well known, eating disorders encompass a number of other conditions, too. These include avoidant/restrictive food intake disorder, rumination disorder, pica, and others.
Avoidant/restrictive food intake disorder is characterized by the avoidance or restriction of food. People with the condition may be uninterested in food—perhaps trying to avoid a negative experience they had in the past, or because they are unsettled by particular sensory characteristics of food, such as its smell or texture.
Rumination disorder is characterized by repeated regurgitation of food after eating, bringing previously swallowed food up into the mouth without displaying nausea, involuntary retching, or disgust. The food is typically then re-chewed and spit out or swallowed again.
Pica is a condition characterized by the eating of one or more nonnutritive, nonfood substances on a regular basis, such as paper, soap, or hair. Those with the disorder typically do not have an aversion to food in general.
Other eating disorders, such as night eating syndrome or atypical anorexia, may be classified under “other specified feeding and eating disorders” in the DSM-5.
Types of Eating Disorders
There are currently six eating disorders recognized in the DSM-5: anorexia nervosa, bulimia nervosa, binge-eating disorder, pica, rumination disorder, and avoidant/restrictive food intake disorder. Each has a unique set of symptoms, but treatments are often effective for people struggling with any eating disorder.
Anorexia occurs when someone does not eat enough to maintain a healthy body weight, due to an intense fear of gaining weight or feeling fat. They might have a distorted perception of their own body and fail to see the seriousness of their low weight.
Anorexia is up to 10 times more common in women than in men. It most often begins in adolescence or young adulthood, but a second peak seems to occur after age 40.
Anorexia emerges due to a combination of genetics, life circumstances such as childhood trauma, and cultural beauty ideals—which can play a role but are never fully responsible. Social comparison, especially in college, can also lay the foundation for a disorder to develop. People with anorexia tend to struggle with obsessive-compulsive tendencies, anxiety, and perfectionism; they may have a strong need for control or display rigid and inflexible thinking.
These traits manifest in how people with anorexia consume food. They may only eat at specific times of day or use specific cutlery. They may obsess over nutrition labels and measurements of their food. They may eat alone or constantly make excuses for not eating. They may restrict their consumption to the degree that they develop stomach problems, electrolyte imbalances, hair loss, brittle bones, dizziness or fainting. People with anorexia can die from the disorder and by suicde. It is the most deadly mental illness.
But through a team approach, recovery is possible. Treatment involves a nutritionist, physician, and psychologist. In an outpatient setting, effective treatments include cognitive behavioral therapy, and a version specifically designed for eating disorders called enhanced cognitive behavioral therapy (CBT-E), and family-based treatment. Recovery requires ongoing work, but continuing to forge ahead can allow individuals to create a happy, fulfilling life.
Bulimia Nervosa
Bulimia occurs when someone repeatedly binge eats and then takes steps to prevent gaining weight, such as by vomiting, taking laxatives or diuretics, fasting, or exercising. Binges encompass a lack of control and consuming an unusually large amount of food in a discrete time period.
The disorder is diagnosed when that pattern occurs once a week for at least three months. Bulimia often begins in adolescence, and the risk factors include childhood physical or sexual abuse, stressful events, childhood obesity, early puberty, mental health challenges such as low self-esteem, anxiety, and depression. A biological component is also at play.
Shame and secrecy are often enmeshed in bulimia—it’s sometimes referred to as the “secretive syndrome.” People with bulimia tend to have a typical body weight or are overweight. The disorder can elicit anxiety and shame, and purging specifically can feel like an addictive that the person finds “unwanted,” “out of control,” or “disgusting.” This shame can prevent people from seeking treatment.
Yet treatment is key because bulimia can produce medical complications in addition to deep distress. People with bulimia can become dehydrated, lose electrolytes, erode their dental enamel, and have gastrointestinal problems.
The team to treat bulimia includes a nutritionist, primary care physician, and mental health professional, so that both medical and psychiatric care can be provided. Cognitive behavioral therapy and family-based treatment are common therapeutic approaches, and patients are sometimes prescribed antidepressants to address co-occurring conditions.
Binge-Eating Disorder
Binge-eating disorder occurs when someone repeatedly binge eats, consuming an abnormal amount of food in a short time and without a sense of control. Binges can involve eating very rapidly, eating until uncomfortably full, eating a lot without feeling hungry, eating alone due to embarrassment, and feeling guilty or disgusted with oneself afterward.
It’s diagnosed when binges occur once a week for at least three months, when binges aren’t followed by purges or laxatives as in the case of bulimia, and when the experience leads to distress in the person’s life. Some people with binge-eating disorder are overweight, but not all are.
Binge-eating disorder is the most common eating disorder in the U.S. Many people also shift between different eating disorders over the years, such as struggling with anorexia at one time and binge-eating at another.
During a binge, someone might feel out of control, or even a sense of dissociation from the experience. As a result, they may function as a release, the ability to avoid difficult emotions or experiences in their world. People with binge-eating disorder often struggle with intense shame and self-criticism about it.
Binge-eating disorder is treated by addressing underlying challenges—such as poor body image, low self-esteem, perfectionism, and depression—and developing healthy coping skills. Cognitive-behavioral therapy is often used, but a variety of therapy types can be helpful.
Pica
Pica occurs when someone consistently eats things that aren’t food. This could include paper, soap, cloth, paint chips, crayons, dirt, or ice—foods that contain no nutritional value and may be dangerous to digest.
The disorder is diagnosed when the behavior has continued for at least one month, it’s incompatible with the child’s age or developmental stage, the practice isn’t typical of cultural or social norms, and it doesn’t occur in the context of another condition order, such as intellectual disability or autism. Pica is typically diagnosed only after two years old, and it particularly affects children and pregnant women.
Why would someone eat nonfoods? Some people with pica say they enjoy the taste, texture, or smell. Others say that eating certain nonfoods ease stress and anxiety. The behavior may manifest as compulsive for others. And some consume items like clay due to religion, cultural practice, or medicinal purposes (although these cultural norms would rule out a diagnosis.) Risk factors for the disorder include malnutrition, stress, abuse, and other mental health conditions.
Doctors can’t always identify when a patient is consuming nonfoods, and people often don’t tell their doctor due to shame or because they don’t believe it’s unusual. Yet pica can have dire consequences—such as choking, poisoning, and nutritional deficiencies—so it’s critical to seek treatment. Treatment can involve medically addressing complications and therapy to understand and incentivize healthy eating.
Rumination Disorder
Rumination occurs when people consistently regurgitate their food after eating. They then chew it, swallow it, or spit it out. Regurgitation occurs without a sense of disgust, nausea, or involuntary gagging.
The disorder is diagnosed when regurgitation has continued for at least one month and the behavior isn’t due to another medical problem, eating disorder, or mental health condition. The person may have weight stagnation, weight loss, or show developmental challenges.
Rumination often occurs in infancy and childhood, but it can affect adults as well. Stress and anxiety are risk factors for babies and children, while anxiety and depression are risk factors for adults.
Some people describe the condition as habitual or out of their control, and therapy may focus on interrupting and reversing those habits.
Avoidant/Restrictive Food Intake Disorder
Avoidant/Restrictive Food Intake Disorder (ARFID) occurs when someone doesn’t eat enough to get proper energy or nutrition. Someone with ARFID might avoid eating due to sensory characteristics of foods like texture or smell, fear the consequences of eating, or not show interest in eating at all. Weight loss, nutritional deficiencies, and developmental problems can occur as a result.
The disorder often emerges in infancy and childhood. It’s diagnosed when the avoidance can’t be explained by lack of food availability or cultural practice. Medical problems, eating disorders, and mental health conditions must also be ruled out. Risk factors for ARFID include anxiety, OCD, and autism as well as gastrointestinal problems.
People are often confused by the line between picky eating and ARFID. Picky eating verges into a disorder when the person fails to meet their caloric or nutritional needs. They may not be able to gain weight, have an inappropriate weight for their height, or depend on supplements. If it begins to interfere with their functioning on a daily basis, they could have a disorder.
ARFID is also distinct from anorexia; the food aversion that marks ARFID is not driven by fears around body image or gaining weight, as in the case of anorexia.
ARFID can be addressed by a nutritionist and aided by a variety of clinicians, including pediatricians, gastroenterologists, and psychologists, to understand and address the root of the disorder.
Signs and Symptoms of Eating Disorders
Eating disorders involve disturbances in how individuals eat and perceive their body and weight. But those disturbances can manifest in very different ways. In some cases they can be obvious, such as dramatic weight loss or refusing to eat. In other cases they can be subtle, such as developing rigid routines around meals—only eating specific foods or at specific times—or beginning to exercise obsessively. Still in others, signs of the disorder can be hidden, such as going to the restroom after meals in the case of bulimia or eating in private in the case of binge-eating disorder.
Mental health symptoms can also emerge from or be exacerbated by the condition. People with eating disorders may become more withdrawn, avoiding people or activities they previously enjoyed, or they may struggle with mood swings and anxiety. Although it can be difficult to discuss, recognizing an eating disorder early on can help the person seek the help they need to recover.
Signs and Symptoms of Eating Disorders
Eating disorders can involve unmistakable changes, such as severe weight loss, as well as hidden signs, such as binge-eating alone. Identifying an eating disorder as soon as possible is important because earlier treatment raises the prospect of a successful recovery.
Eating disorders encompass harmful and often dangerous patterns of eating. This behavior is often driven by—and expressed as—dissatisfaction about one’s body and weight. Common signs can include rapid weight loss, strict diets, rigid routines around eating, excessive exercise, deep concern about body image, and social withdrawal.
Each eating disorder has a specific set of symptoms:
Anorexia Nervosa: Restricting the amount of food eaten, leading to significantly low body weight, and intense fear of gaining weight.
Bulimia Nervosa: Eating an abnormally large amount of food in a given time frame, a lack of control over eating, and subsequent behaviors to prevent gaining weight such as vomiting, laxatives, and excessive exercise. This process occurs at least once a week for three months
Binge-Eating Disorder: Eating an abnormally large amount of food in a given time frame and a lack of control over eating. These episodes involve eating unusually quickly, feeling uncomfortably full, eating without being hungry, eating alone due to embarrassment, and feelings of disgust afterward. Binges occur at least once a week for three months.
Pica: Consistently eating nonfood items, such as paper, cloth, or hair, for at least one month.
Rumination Disorder: Consistently regurgitating food to chew, swallow, or spit out for at least one month.
Avoidant/Restrictive Food Intake Disorder: Not eating to the point of insufficient nutrition or energy, in the absence of anorexia or bulimia.
How can you recognize if someone has an eating disorder?
The clearest signs of eating disorders may be rapid weight loss, unusual eating patterns, and excessive exercise. But there are also more subtle signs that a disorder may be developing or underway.
A person might count or measure their food very specifically and rigidly, such as always having three carrots. They might develop inflexible routines around when or how they eat. They might only use particular dishes or cutlery. They might express intense interest in what others are eating or recently ate. They might inspect foods and nutrition labels very carefully at the supermarket.
One observable theme, as the signs above demonstrate, is the development of routines and rigidity around eating and exercise.
When do eating disorders develop?
Eating disorders often emerge in adolescence and early adulthood. The median age when anorexia and bulimia develop is 18-years-old and the median age when binge-eating disorder develops is 21-years-old, according to the National Institute of Mental Health.
It’s not uncommon, however, for an eating disorder to strike women in midlife. Stressful life changes, such as a divorce or childcare responsibilities, as well as hormonal changes might lay the groundwork for disordered eating to develop.
Who can develop an eating disorder?
There are no boundaries to who can be hurt by eating disorders. Women develop them more often than men, but eating disorders can still arise in people of any age, race, or gender.
Recent research found eating disorders affect women of ethnic minorities just as much as they affect White women. The risk factors for developing a disorder were also the same across all ethnic groups.
Are women more likely to develop eating disorders than men?
Eating disorders are more common in women than in men. The prevalence of anorexia over one’s lifetime is three times higher for women than men among adults in the U.S., according to the National Institute of Mental Health. The lifetime prevalence is five times higher for bulimia two times higher for binge-eating disorder. In adolescence, eating disorders are twice as prevalent in girls than in boys. However, men still struggle with body image, weight, and eating disorders as well.
How is an eating disorder diagnosed?
Eating disorders may be diagnosed by a mental health professional, a primary care physician, or both. The diagnosis can encompass both a physical exam and psychological questionnaires to assess a person’s eating habits and relationship to food and weight.
To determine if the person has a disorder, the doctor will follow the criteria listed in the DSM-5, which has checklists to diagnose each of the six feeding and eating disorders: anorexia nervosa, bulimia nervosa, binge-eating disorder, pica, rumination disorder, and avoidant/restrictive food intake disorder.
At what point does a diet become an eating disorder?
In today’s wellness-obsessed culture, it can be difficult to distinguish between occasional concerns around food, picky eating, a diet, and an eating disorder. Where can you draw the line between health and harm?
Signs that picky eating or a diet may be shifting into a fuller disorder may include planning meals days in advance, consulting nutritional information and weighing ingredients, feeling guilty or anxious when eating “forbidden” foods, becoming dependent on diet for self-esteem, and using moral convictions to justify rules around rigid eating to others. Overall, a disorder encompasses the inability to eat according to one’s appetite—eating patterns are instead dictated by rules and specifications.
In a clinical context, a mental health professional can determine whether someone has a disorder or not by assessing the diagnostic criteria in the DSM. But even if someone’s struggles with eating or body image don’t meet the clinical threshold, that doesn’t mean they aren’t worth understanding and addressing.
What is orthorexia?
Orthorexia is a term that describes an obsession with healthy eating. People with orthorexia may adopt strict diets, cut out entire food groups, and develop anxiety about diseases or food purity.
Orthorexia is not an official psychiatric diagnosis, but it is increasingly recognized as a troubling trend. The term was coined in the late 1990s by a physician named Stephen Bratman, who noticed that many of his patients were completely fixated on healthy or “clean” eating.
Some believe that orthorexia is distinct from other eating disorders like anorexia, because orthorexia focuses on the purity of food consumed rather than avoiding weight gain. However, recent research shows that people with orthorexia actually do prioritize weight loss over health when choosing the foods they eat, suggesting that orthorexia may mask a more traditional eating disorder.
Perhaps because focusing on healthy eating is more socially acceptable than being fixated on weight loss, orthorexia may in part function to camouflage symptoms of an eating disorder.
What Causes Eating Disorders?
There is no single cause of any eating disorder. It’s not yet understood why ostensibly voluntary behaviors associated with eating turn into disorders for some people but not for others.
A disturbed relationship with food and a sense of emotional fragility are hallmarks of all eating disorders. Eating disorders typically start out unnoticed––a person eats a little more or a little less food than usual. The urge to eat more or to eat less becomes increasingly compelling until it can become the focus of a person’s existence.
Biology also plays a role. Appetite control and the regulation of food intake is highly complex, with many hormones in the brain and the body signaling hunger and satiety. Evidence also suggests that eating disorders have genetic roots.
Culture is thought to also play a significant role, as people—women especially—are pressured to fit an ideal of beauty that is largely defined by weight. Families contribute, too; parents who emphasize looks, encourage dieting, or criticize their children’s bodies may be more likely to raise a child with an eating disorder.
Other circumstances factor in, too; the conditions can be triggered by stress, social difficulty, loneliness, depression, trauma, or by dieting itself.
What Causes Eating Disorders?
No one fully understands what gives rise to these painful and confounding illnesses. Eating disorders likely emerge from a complex relationship between genetics, personality traits, and environmental influences such as childhood experiences, social comparison, stressful or traumatic events, and cultural beauty standards. Although the roots of disordered eating will likely remain a mystery for some time, treatment can help those suffering embark on a successful recovery.
Eating disorders are connected to perfectionism, obsessive compulsive tendencies, and sensitivity to negative emotions. Low self-esteem and body dissatisfaction are risk factors, as well as mental health challenges such as anxiety and depression.
One of the strongest predictors of eating disorders among girls, research suggests, is the value peers place on weight and eating. This tendency is heightened in college, a community of individuals the same age with few older adults to provide broader perspective. The influence of peer perception may contribute to the proliferation of eating disorders on college campuses.
Are eating disorders genetic?
Research in twins, biological families, and adoptive families show that genetics can render people at greater risk of developing a disorder. People who have a family member with an eating disorder face a much greater risk of developing one themselves. For example, studies show that people are 7 to 12 times more likely to develop anorexia or bulimia if they have a relative with an eating disorder.
Those genetic underpinnings may also help explain why eating disorders often overlap with certain conditions, such as depression, anxiety, and obsessive compulsive disorder.
However, one’s genetic predisposition is only one piece of the puzzle. For most people, a triggering event would also be necessary to spur the development of a disorder.
Do stress and trauma lead to eating disorders?
Eating disorders can be spurred by life transitions as well as stressful or traumatic events. Those incidents—such as starting a new job, a sexual assault, or the death of a loved one—can lead to overwhelming and uncontrollable emotions.
Restricting food intake and regulating weight can lead people to feel a sense of control amid the chaos. And sometimes this is the only aspect of life they think they can control. In this way, a triggering event can lead to a persistent disorder.
How do culture, media, and beauty ideals influence eating disorders?
Eating disorders are prominent in Western cultures, which place a strong emphasis on thinness, weight, and beauty. This can lead young adults, especially women, to believe that their self-worth is tied to their weight.
Exposure to images of filtered, edited, and perfected bodies leads to self-comparison—a process that occurs quickly, effortlessly, and sometimes unconsciously. Constant comparison can take a heavy toll on self-esteem and body satisfaction.
Cultural and media scripts may contribute to the development of an eating disorder. However, they cannot produce the condition on their own.
How common are eating disorders?
The lifetime prevalence of eating disorders among adolescents in the U.S. is 3.8 percent for women and 1.5 percent for men, according to the National Institute of Mental Health. Among adults in the U.S., the overall prevalence of binge-eating disorder is 1.2 percent, the overall prevalence of anorexia is 0.6 percent, and the overall prevalence of bulimia is 0.3 percent.
Studies that slightly expand the diagnostic criteria find higher estimates of eating disorders, such as 5 percent of adolescent girls or nearly 8 percent of individuals overall. Eating disorders can occur at any time, but they typically develop in one’s adolescence or early twenties.
Has the prevalence of eating disorders increased over time?
Although eating disorders have existed throughout human history, they seem to be growing more widespread today. One large review study found that 3.5 percent of people suffered from an eating disorder in the years 2000 to 2006, yet nearly 8 percent suffered from one in the years 2013 to 2018.
A particularly unsettling trend is that anorexia may be increasing among children. One recent study found that anorexia had increased among 8- to 12-year-olds in the past decade, which is consistent with other research showing that the age of onset for anorexia may be decreasing.
How Are Eating Disorders Treated?
It can take a long time—sometimes years or decades—for people with an eating disorder to decide to seek help. When they do, there are numerous treatment options that can help them recover.
People with eating disorders often receive outpatient treatment, but severe cases may require hospitalization or treatment at an inpatient facility. Treatment involves a physician, a psychologist, and a nutritionist to address the different elements of the illness. Therapies for eating disorders of any type include cognitive behavioral therapy, and a version tailored to eating disorders called enhanced cognitive behavioral therapy, as well as family-based treatment.
How Are Eating Disorders Treated?
Eating disorders often involve a team of clinicians to address different elements of the illness. A physician may monitor physical changes and problems, a psychologist may address underlying thoughts and emotions, and a nutritionist may develop a plan to maintain a healthy weight moving forward. Most people can be treated in an outpatient setting, but some may need a residential or inpatient facility. Seeking treatment as early as possible raises the likelihood of a successful recovery.
It can be difficult to know how to help someone with an eating disorder; in addition to being painful to understand and discuss, the severity of the condition varies widely.
Individuals with an eating disorder should consult with a medical professional about whether they need inpatient or outpatient treatment. Doctors may assess body weight, vital signs, blood work, and other metrics to determine whether the person is physically and psychologically stable. If not, she or he will need to be admitted to an inpatient facility.
However, if you are concerned for someone’s immediate safety, such as if their physical health has deteriorated, seek medical attention or call 911.
What are different types of treatment for eating disorders?
Eating disorders treated in an outpatient setting employ a variety of therapies. Leading treatments include Cognitive Behavioral Therapy and Enhanced Cognitive Behavior Therapy as well as Family-Based Treatment. Clinicians may also practice therapies of other kinds, such as Dialectical Behavior Therapy, Acceptance and Commitment Therapy, or Psychodynamic Therapy.
What is Enhanced Cognitive Behavioral Therapy?
Eating disorders are often treated with Cognitive Behavioral Therapy or Enhanced Cognitive Behavioral Therapy. CBT-E was created specifically to treat eating disorders. It encompasses a personalized treatment approach, addressing the thoughts that maintain the disorder and leading the individual to decide for themselves to maintain a healthy weight.
CBT-E also addresses important barriers to change, such as perfectionism, low self-esteem, and relationship challenges. As some researchers have described, “The eating disorder psychopathology may be likened to a house of cards with the strategy being to identify and remove the key cards that are supporting the eating disorder, thereby bringing down the entire house.”
CBT-E treats eating disorders of any type, including anorexia, bulimia, and binge-eating disorder. There are versions for older and younger patients, and for inpatient and outpatient programs. Treatment typically involves one 50-minute session per week for 20 weeks. For those severely underweight, treatment can span a longer period such as 40 weeks and incorporate weight regain in addition to addressing problematic thought processes.
Clinical trials show that CBT-E effectively treats eating disorders; however, further research is needed to determine whether it is consistently more effective than cognitive behavioral therapy.
What Is Family-Based Treatment?
Family-Based Treatment (FBT) is a leading treatment for adolescents with eating disorders. It’s also referred to as the Maudsley method, named for the British hospital where it was created in the 1970s.
The approach incorporates the entire family. It helps parents support their children to eat and restore a healthy weight. In this process, parents assume control over the child’s eating before gradually shifting that power back to the child.
Studies have confirmed that Family-Based Treatment is effective in helping adolescents heal. Yet parents should be aware that it requires a large commitment in terms of time and energy, and that it is more appropriate for some families than others.
Do any medications treat eating disorders?
Medications may be prescribed to address relevant symptoms, such as anxiety or depression. But there are currently no drugs approved to treat eating disorders.
Some medications are known to cause weight gain, but patients won’t submit to gaining weight without addressing the underlying psychological challenges prompting the disorder. This also hinders drug discovery due to participants in clinical trials.
Will insurance cover treatment for an eating disorder?
Insurance coverage for eating disorder treatment is variable. Most insurance plans have some coverage for mental health care, but they may differ with regard to how much they reimburse for therapy or inpatient treatment. The National Association of Eating Disorders provides a list of statements that may be helpful in supporting your insurance claims.
Find a treatment center or an eating disorder specialist who takes your insurance in the Psychology Today Therapy Directory.
Someone I love has an eating disorder. How can I help?
Although the decision to seek treatment may seem extremely clear to a loved one, it can be difficult and overwhelming for the person struggling. It can help to research eating disorders to better understand the condition and empathize with their experience.
Helping someone with an eating disorder arrive at the decision to seek treatment can be a long process. It may involve asking the person about their thoughts and feelings, helping them admit that they have a problem, and reflecting on goals for their future that might make treatment feel necessary and important.
When discussing treatment, it can be valuable to share resources, such as mental health professionals in the area who take their insurance, and offer to attend an appointment with them. Encourage the person to get both psychological help and a medical exam. Later on, check in to make sure they followed through on the plan that you discussed.
How do you help someone who refuses treatment?
People may refuse treatment for numerous reasons—they may not believe they have an illness or they find the idea of confronting the disorder extremely anxiety-inducing. Continuing to support someone and encourage them to seek treatment over time can be very helpful, as can providing resources to make the next steps feel easier.
Beyond providing love and support, parents who are urgently worried about their child can consider making certain financial resources, such as a car or college tuition, dependent upon seeking treatment. For children under 18, parents can require treatment or admit them to the hospital.
For those over the age of 18, legal actions can be taken to control medical care such as a guardianship or conservatorship. Although these drastic measures are a last resort, loved ones sometimes feel they are necessary since they are dealing with a potentially deadly disorder.
The Recovery Process
Recovering from an eating disorder can be a long and winding road. And once in recovery, people must continue to observe and adapt to prevent setbacks and relapses. Treatment can provide the necessary skills to do that.
In concrete terms, recovery means that a person no longer meets the diagnostic criteria for an eating disorder, that they have healed both physically and emotionally. That experience will be different for everyone, as they develop a personalized approach to treatment, eating habits, social support, and coping skills.
Parenting a Child with an Eating Disorder
Watching a child suffer through an eating disorder can be deeply upsetting. Parents shouldn’t blame themselves for the development of the disorder, but they can take steps to provide support and help their child heal.
Different stages of the process require different actions. Those steps might include recognizing the signs of a disorder, learning about the illness, discussing it with the child, and encouraging them to seek treatment.
Parenting a Child with an Eating Disorder
Coming to the realization that your child has an eating disorder can be upsetting and overwhelming. But parents have the power to help their child begin to heal—even if the child isn’t completely ready yet. Learning the facts, discussing their experience, and encouraging them to seek treatment can put a child on the path to recovery.
How can I tell if my child has an eating disorder?
Recognizing that your child has an eating disorder can be painful and scary, but confronting the disorder is the first step toward recovery. Here are some of the signs that your child may be struggling with an eating disorder.
Signs related to eating and exercise include developing unusual routines around eating, such as wanting to eat at the same time each day or use the same plate for each meal, eating alone, leaving the table early, cooking without eating what they made, weighing themselves frequently, wearing baggy clothes, and exercising compulsively.
Signs related to physical health include rapid weight loss or weight gain, exhaustion, dizziness, fainting, stomach problems, damaged teeth, thinning hair, and feeling cold.
Signs related to mental health include becoming fixated on weight or body image, feeling stressed, anxious, or shameful about eating, and struggling with low self-esteem, isolation, and depression.
How can I prevent my child from developing an eating disorder?
Nothing can definitively prevent an eating disorder—those forces are sometimes out of a parent’s control. But cultivating a positive, accepting atmosphere around body image can help your child thrive.
Parents can do that by emphasizing that self-worth comes from personality, not appearance, and that people with all different body types can be strong and happy. Parents can avoid voicing regular concerns about their own body, weight or food choices (“I can’t believe I gained two pounds. I look horrible!”). They should also avoid commenting on their child’s weight or body.
Additionally, parents can strive to develop an open, communicative relationship so that if their child encounters challenges such as bullying or anxiety, parents can listen and address those challenges together in a healthy way.
Do parents cause eating disorders?
Parents should not blame themselves for the development of a child’s eating disorder. While researchers do not yet know why some people develop eating disorders, we do know that such disorders have a strong biological component, and that social and environmental factors contribute to the picture.
What is in a parent’s control is the ability to model healthy eating behavior and a healthy mindset about body image. (Although there are plenty of parents who do this and whose children still develop a disorder). In the case that a disorder does emerge, parents play a pivotal role in their child’s treatment and recovery.
How early can an eating disorder start?
Children as young as 5-years can develop an eating disorder. In fact, research suggests that anorexia is emerging at a younger age and that the condition has increased among children between 8 and 12 years old over the past decade.
Still, the median age when anorexia and bulimia develop is 18 and the median age when binge-eating disorder develops is 21, according to the National Institute of Mental Health.
How should I prepare for a conversation about my child’s eating disorder?
Before beginning the conversation, it can be helpful to research the condition thoroughly, as well as read accounts from those in recovery. This way parents can better understand and empathize with their child’s experience.
It’s valuable to recognize that children with an eating disorder may deny that they have a problem. This occurs for many reasons—children may struggle with shame and anxiety about the disorder, they may feel overwhelmed by the prospect of having to confront it, and younger children may not fully understand it themselves. Even if this is the case, it is important to begin discussing and confronting the disorder together.
Another line of thinking a child may have is “I’m not sick enough to get better,” in which the child recognizes a problem but doesn’t believe it’s severe enough to merit solving. Perhaps they believe the benefits outweigh the costs, fear what they might lose, can’t imagine a life without their particular relationship to food, or perceive recovery as self-indulgent. In response, parents can encourage small changes and provide perspective on what the child is missing in their current state of being.
How do I talk to my child about an eating disorder?
Approach the topic by gently expressing that you are concerned for them. Be direct and specific about what you have observed. Then ask questions about their perception and experience, and listen attentively. Be open to exploring any topic that emerges, from being bullied at school to feeling intense anxiety.
Maintain a calm tone throughout the conversation, even if you are struggling internally, so that it feels less overwhelming for your child. Whether in the first conversation or a later one, discuss concrete steps to begin treatment.
How do I encourage my child to accept treatment?
Confronting a disorder and seeking treatment will likely require many conversations. In these talks, parents should be specific about the next step, such as finding a therapist or being evaluated by an eating disorder specialist.
Stay involved in a child’s treatment, such as by attending appointments. This can allow parents to support their child and provide insight or advocacy in the treatment setting. Don’t be discouraged if the first therapist or clinic doesn’t seem to work—finding an effective treatment plan may take time.
There may come a time when a parent has to draw a strong boundary. They may decide that seeking treatment is required for them to continue paying for a child’s phone or college, or even for a child to continue living in their home. Although this can be deeply distressing, it is for the child’s safety and sometimes becomes the final straw that forces them to address the disorder.
The guidance above applies to children who need help but are not in immediate danger. If you are urgently concerned for your child’s safety, go to the hospital or call 911.
How do I find a treatment center or therapist?
Find a treatment center or an eating disorder specialist who takes your insurance in the Psychology Today Therapy Directory. Referrals from doctors or friends can also be helpful in this process.
Parents will want to research a clinic or therapist beforehand. It can be helpful to ask questions about credentials, experience, past patient outcomes, treatment strategies, how progress is measured, and insurance plans and payment options.
How do I support my child in recovery?
Recovery from an eating disorder is a continuous process, with twists and turns along the way. Parents should recognize that in addition to moving forward, children will probably also contend with setbacks or relapses.
Parents can encourage their child to stick to the treatment plan or meal schedule and continue developing coping skills. They can also remind the child of their larger life goals, such as returning to school if they took time off.
Supporting a child through an eating disorder takes time and energy, as it’s not an isolated incident but a continuous process. Therefore it’s important to set aside time to care of yourself, by finding ways to release stress and relate your own emotions to a loved one or a therapist. Maintaining central pillars of your own life is important, both for yourself and so that you can be there for your child.
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