Celebrities like Camila Mendes, Kesha, Gabourey Sidibe, and many others have spoken out about their struggles with body image and eating way too much or way too little food which, in many cases, led to long periods of treatment and recovery. Truth is, eating disorders are serious mental health conditions and, although they can affect anyone, they are most common in girls and women. Psycom spoke with eating disorder specialist Jennifer Rollins, MSW, LCSW-C, founder of The Eating Disorder Center in Rockville, Maryland, about identifying, treating, and recovering from disordered eating.

Approximately 20 million American women will have developed at least one type of eating disorder at some point in their lives, and perhaps more than one. The four specific types of eating disorders are recognized by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM) that can affect young girls and older women include anorexia nervosa, bulimia nervosa,  binge-eating disorder, and avoidant restrictive food intake disorder (ARFID).

Although there are common signs and symptoms, any two girls or women with the same eating disorder can have somewhat different experiences. These conditions not only affect physical well-being, often leading to severe and even deadly medical issues, but also psycho-social functioning, or how you think, feel, and relate to other people. Eating disorders often co-occur with other mental health conditions like depression, anxiety, obsessive-compulsive disorder, and substance abuse.

Although anyone, rich or poor, young or old, and of any race, ability, culture, gender or sexual orientation can develop an eating disorder, they are most commonly associated with young, caucasian women between the ages of 12 and 35, many of whom are athletic. In fact, females are twice as likely as males to have an eating disorder. But be careful of any and all stereotypes.1,2 “Eating disorders don’t discriminate,” Jennifer warns. “The danger for those girls and women who don’t meet the “young, caucasian” stereotype is not having access to or not seeking treatment because the condition goes unrecognized.”

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While there are many factors associated with eating disorders, there is no specific known cause. Personal experiences such as sexual abuse and bullying are often associated with eating disorders. At the same time, experts have yet to figure out why some people develop eating disorders under these circumstances but others in similar situations do not.

“A perfect storm of several factors come together to cause an eating disorder,” Jennifer says. “That includes past trauma, personal history, temperament, and genetics.”

Recognizing Signs and Symptoms

Any two girls or women with the same eating disorder can have somewhat different symptoms and experiences. Overall, however, these are the common, most recognizable signs and symptoms that meet the diagnostic criteria for each of the four officially recognized eating disorders. 1,2,3

Anorexia Nervosa

  • Food intake is limited, leading to very low body weight for one’s age and height
  • Extreme fear of weight gain and being fat or extreme measures to prevent weight gain, even though the individual is underweight
  • Issues with body image or denial that underweight condition is a serious problem

Bulimia Nervosa

  • Eating often, eating large amounts of food, feeling out of control over eating behavior and amount of food eaten
  • Frequently purging to prevent weight gain using such methods as self-induced vomiting, laxatives or diuretics, routine fasting or overexercising.
  • Overly concerned with body weight and shape
  • Associated behaviors occur at least once a week for 3 months

Binge-Eating Disorder

  • Binge eating at least once a week for 3 months, plus:
  • Eating more food in a specific period of time than most people would eat in the same amount of time, and
  • Feeling out of control over eating behavior and amount of food eaten, plus, episodes of binge eating that involve at least three of these five behaviors:
  1. Eating much faster than normal
  2. Eating until uncomfortably full
  3. Eating huge amounts of food even when not feeling hungry
  4. Eating secretively or alone out of shame
  5. Experiencing feelings of disgust, depression or extreme guilt after bingeing

Avoidant Restrictive Food Intake Disorder (ARFID)

  • Lack of interest or other avoidance of food due to the sensory characteristics of food, such as colors and textures. Avoidance is associated with at least one of the following:
  1. Significant weight loss or, in children, failure to reach expected weight and height
  2. Significant nutrient deficiency
  3. Dependence on nutritional supplements or oral feeding tube
  4. Disruption of psycho-social functioning
  • The condition cannot be explained away by the unavailability of foods or culturally approved eating practices.
  • There are no issues with body weight or body image and avoidance is not associated with anorexia or bulimia.
  • There is no other eating disturbance or medical condition present that would explain the avoidance, or the avoidance is more extreme than would normally be associated with another condition.

Accepting Help and Handling the Stigma of Eating Disorders

As if it’s not enough to cope with both the psychological and physical symptoms, there is often a social stigma towards people with eating disorders that is greater than for other common mental health issues, like depression. If you have an eating disorder, you may sense that others see you as weaker, responsible for your disorder or as someone who is using your disorder to get attention. 

On the flip side, other women may express feelings of admiration or envy, particularly in the case of anorexia, seeing the condition as having some benefit in a society that values thin body types. All of this can interfere with your motivation to get help for a condition that should not be considered desirable and is not your fault. 4,5

Recognizing your own disordered eating patterns is a good first step toward getting and accepting help. Now it’s time to trust a friend, family member, therapist, or doctor who can provide a safe, supportive environment in which you can open up about your feelings and ask for help. 

“When your brain has been hijacked by an eating disorder, you need other people to help you move forward in your recovery,” Jennifer advises. “Remember that your supporters may not be familiar with all the ways an eating disorder has affected you, and may not know exactly what to do to help, so it’s important to share as much information as you can.”

Getting a Diagnosis 

If you think you or someone you know may have an eating disorder, it’s important to meet with a therapist who specializes in eating disorders as soon as possible to get an assessment. You may find out that it’s not a real issue for you, Jennifer points out, but it’s a good place to start to get help if you need it. A good therapist can also refer you to other specialists, if necessary. 

Try to be as specific as you can about your thinking and behavior regarding food and body image, and clear about what you need in the way of support. It may be difficult at first to acknowledge feelings like guilt and shame and talk about the effects of your food-related behaviors, but it is essential for getting to the next steps of evaluation, treatment, and recovery so that you can begin to have a healthier relationship with food. 

Ultimately, it can take a team of health professionals to bring someone with an eating disorder to a stage of full recovery. That may include medical doctors, registered dietitians or nutritionists, recovery coaches, and other types of counselors and therapists, depending on your particular needs.

“The goal of psychotherapy and other types of counseling is to create a healthy relationship with food, your body and, ultimately, yourself, Jennifer explains. “An eating disorder shrinks your life, makes it very small, so an important part of therapy is to expand your life beyond the confines of the disorder.”

What to Expect From Psychotherapy

Since different types of people may respond better to different types of therapy, there is no one type that is most effective for treating eating disorders. The following therapies are most commonly used:

  • Cognitive behavior therapy is a form of short-term therapy that focuses on distorted thinking patterns and emotions that drive disordered eating behavior.
  • Acceptance and Commitment therapy focuses more on changing behaviors than on changing thinking and feeling patterns.
  • Cognitive remediation therapy focuses on perfectionism and other rigid thinking patterns to improve treatment of adults with anorexia.
  • Dialectical behavior therapy focuses on changing behaviors by developing new habits through mindfulness, coping skills, and emotional regulation.

Additionally, family-based treatment (FBT) has been used effectively to promote healthy eating and restore normal weight in adolescents with anorexia or bulimia. FBT is a home-based program that involves all family members.

Interpersonal psychotherapy has been shown to help those with bulimia and binge eating disorder by focusing generally on improving interpersonal relationship issues and communication. Healthier interpersonal relationships and functioning within those relationships has been found to reduce symptoms of these eating disorders.

Psychodynamic Psychotherapy aims to get to the root of the problem, holding that you cannot permanently diminish the symptoms of an eating disorder without resolving the underlying causes and issues that drive the behavior.

“The goal of psychotherapy is to create a healthy relationship with food, your body and, ultimately, yourself,” Jennifer explains. “An eating disorder shrinks your life, makes it very small, so an important part of therapy is to expand your life beyond the disorder.”

IMPORTANT NOTE: If you need help, and you cannot get it from someone in your immediate support circle, call the National Eating Disorders Association helpline toll-free at 1-800-931-2237.


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Last Updated: May 28, 2021