Eating Disorders: When Food and Weight Take Control

Jane and Elizabeth are adhering to strict, low-calorie diets even though they are both dangerously underweight. Angela and Hank secretly eat huge amounts of food at one sitting, then make themselves vomit, and spend hours exercising. Evelyn and Fred eat huge amounts of food, and feel guilty and depressed afterward. What do these 6 individuals have in common? They all have some type of eating disorder.

What Exactly Are Eating Disorders?

In an effort to stay healthy, many people try to control the amounts of food they eat as well as their body weight and shape. Some people experience short-term alterations in their eating patterns as a reaction to a stressful life situation, or when dieting to improve their appearance and/or health. People with an eating disorder, however, think about food, weight, and body image constantly. They usually have medical and psychological issues as well.

In cases of serious medical complications like severe malnutrition, dehydration, or heart irregularities, hospitalization may be needed.

There are 3 primary types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. They can disrupt school, work, relationships, and cause serious health problems that may require ongoing medical care. In severe cases, they can cause permanent disability and death. In an attempt to raise awareness, binge eating disorder was included in the 2013 update of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

How Common Are Eating Disorders?

According to the National Association of Anorexia Nervosa and Associated Disorders, over 30 million Americans have some kind of eating disorder. Females aged 12-25 years account for most cases. However, eating disorders also occur in males and in people of other ages. Most people develop symptoms by age 20. Eating disorders can last from several months to many years.

Eating disorders occur in people of all racial, ethnic, and socioeconomic backgrounds. The rate of eating disorders is higher in certain occupations, such as dance, gymnastics, and modeling, where there is excessive pressure to maintain a specific weight and appearance.

What Are the Symptoms of Eating Disorders?

Anorexia Nervosa

  • Excessive weight loss or lack of normal weight gain, often to the point of starvation
  • Intense fear of gaining weight
  • Distorted body image—for example, seeing oneself as too fat even when underweight
  • Excessive or compulsive exercising
  • Absence of at least 3 consecutive menstrual periods in women
  • Obsessive controlling of calories and fat even when underweight
  • Unusual eating habits, such as cutting food into tiny bites

Some people with anorexia nervosa also binge eat and then make themselves vomit (purge) to keep their weight low.

Bulimia Nervosa

  • Frequent episodes of binge eating (eating an abnormally large amount of food within 2 hours or less)
  • Frequent episodes of self-induced vomiting or misusing laxatives or diuretics to prevent weight gain
  • Excessive concern with body weight and shape
  • Feeling out of control while binge eating
  • Attempts to control weight by excessive exercising, misusing diet pills, or fasting
  • Unusual eating habits, such as hoarding food and eating in secret

People with bulimia nervosa often maintain a fairly normal weight by purging and/or excessive dieting, exercising, or fasting.

Binge Eating Disorder

  • Frequent episodes of binge eating
  • Little or no use of behaviors to control weight, such as purging, or excessive exercising or fasting
  • Feeling guilty, depressed, or disgusted with oneself because of the binge eating and concern about being overweight
  • Eating large amounts when not hungry
  • Eating rapidly and until uncomfortably full

Many people with binge eating disorder are overweight.

What Causes Eating Disorders?

Eating disorders do not have one cause. Instead, it is often a complex interaction of genetics, family history, peer interactions, and environment. People who have eating disorders often have other psychological issues, such as mood or anxiety disorders. Eating disorders are marked by perpetual cycles of behavior and feelings, such as guilt about overeating or desire to lose more weight. Feelings are reinforced and often become way of coping with problem events or changes.

How Are Eating Disorders Treated?

An individualized treatment plan is developed for people with eating disorders, based on a thorough medical exam and psychological evaluation. Several of the following approaches are usually combined.

  • Treatment of health or medical problems —First, any medical problems are treated. Then, the psychological issues related to the eating disorder are explored. Nutrition counseling is provided to help reestablish healthy eating and meal planning practices. Medication may also be prescribed. Support groups for people with eating disorders and for their family and friends can also be helpful.
  • Psychotherapy —Several different types of psychotherapy may be used in individual, group, or family sessions. Cognitive behavioral therapy can help to develop healthy ways of thinking and patterns of behavior, especially with food and relationships. Other kinds of psychotherapy focus on underlying psychological issues, such as self-esteem. In some cases, a combination of more than one type of psychotherapy is the most successful approach.
  • Medication —The most widely used medications for eating disorders are antidepressants. They are particularly helpful with bulimia and binge eating disorder because they treat mood-related symptoms and suppress the craving to binge. In cases of anorexia, they may help decrease the obsessions and anxiety related to eating, but there is not enough evidence to determine if they are useful.

Most people with eating disorders have some success with treatment. However, the extent and speed of response vary with the individual, and relapses are common.

Like most health problems, early detection and treatment are best. This will help keep the damaging cycle from becoming habitual. Early intervention can help treat psychological problems as well.

If you think you may have an eating disorder, make an appointment to talk with your doctor or a mental health professional. If you suspect someone you know may have an eating disorder, encourage her or him to seek professional help.


National Eating Disorders Organization
Overeaters Anonymous


Canadian Mental Health Association
National Eating Disorder Information Centre


American Psychiatric Association. Desk Reference to the Diagnostic Criteria from DSM-5. Washington, DC: American Psychiatric Association; 2013.
Anorexia nervosa. EBSCO DynaMed Plus website. Available at: Updated November 19, 2015. Accessed April 10, 2017.
Eating disorder types and symptoms. National Association of Anorexia Nervosa and Associated Disorders website. Available at:
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Accessed April 10, 2017.
Bulemia nervosa. EBSCO DynaMed Plus website. Available at: Updated January 17, 2017. Accessed April 10, 2017.
Shapiro JR, Berkman ND, et al. Bulimia nervosa treatment: Asystematic review of randomized controlled trials. Int J Eat Disord. 2007;40:321-336.
Last reviewed April 2017 by Michael Woods, MD, FAAP
Last Updated: 4/14/2015

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