Eating disorders are defined by the American Psychiatric Association as “a behavioral cognition characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.” The most important thing to note is that eating disorders are classified as a mental health condition and are treatable.
Kristin Francis, MD, a psychiatrist at Huntsman Mental Health Institute, lends her expertise to detecting and diagnosing eating disorders, suicide risk, and common triggers. “With early detection and intervention, we can reduce the severity and recurrence of eating disorders,” Francis says.
Types of Eating Disorders
The National Eating Disorder Association defines the most common disorders:
Anorexia Nervosa - A type of eating disorder characterized by weight loss and difficulties maintaining an appropriate body weight for your age, height, and stature. “We often compare how a person has historically grown and what body mass index (BMI) percentile they best functioned at prior to the onset of the eating disorder,” Francis says.
Francis makes an important distinction between BMI percentile and raw BMI. “Raw BMI is calculated by dividing a person’s weight by their height,” she says. “It is an outdated measurement tool and should not be the hallmark of what a ‘healthy’ weight is for someone."
There are two subtypes of anorexia nervosa: “binge-purge subtype” and “restrictive subtype.” In the former, people may have “subjective” binges where they eat a normative amount of food rather than a high-calorie amount typically associated with a “binge” but feel intense guilt and shame and then compensate through purging behaviors (self-induced vomiting or exercising).
Bulimia Nervosa – A cycle of binge eating and compensatory behaviors such as purging (self-induced vomiting, laxative use, exercise, restriction) to alleviate the effects of the binge.
Binge Eating Disorder (BED) – The most common eating disorder characterized by recurrent episodes of eating large quantities of food that are followed by feelings of shame and guilt. Unlike bulimia nervosa, people do not compensate for this binge eating by restriction or purging behaviors (including exercising).
Other Specified Feeding and Eating Disorder (OSFED) – Characterized for individuals who do not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still have/had significant disordered eating that impairs their functioning, mood, relationships, and health.
Rumination Disorder – Individuals regurgitate their food (re-chewed, re-swallowed, spit out) for more than a month. This is often involuntary, and food is not mixed with digestive juices so does not have an unpleasant taste.
Orthorexia – This term was coined in 1998 and describes an obsession with “proper” or overly “healthy” eating. Often this obsession results in an increasingly limited food variety and intake and requires an increasing amount of energy, time, and focus with unintended health consequences.
Compulsive Exercise – Characterized by excessive and extreme exercise that significantly interferes with areas of one’s life.
Q&A with Kristin Francis, MD
Q: Is there a distinct cause of eating disorders?
A: Dieting is the most well-studied cause of triggering an eating disorder. Most eating disorders have a genetic underpinning and require a situational stressor, which can be as simple as deciding to lose five pounds for a trip, an illness with subsequent weight loss, or being told by a health care professional that you should lose weight. Having a family history of eating disorders is another well-studied factor that can predispose someone to develop an eating disorder.
Q: What are the most common triggers and what are the best ways to detect them?
A: Dieting or “changing the way we eat in order to influence our size or shape” is the most common cause. Restrictions (physiologic and psychologic) are the biggest triggers that cause physiologic changes that increase our focus and desire for “forbidden” foods. Noticing if your food variety and amount has decreased, paying attention to food rules and how you feel physically and emotionally when you eat, and seeing that you are avoiding social situations due to food expectations can all be helpful clues that eating has become disordered. Additionally, the decline in your physical health (energy, mood, self-esteem, social responsiveness, and thoughts about life being arduous or burdensome) can be red flags that you are suffering from an eating disorder.
Q: What should you do first if you know someone who may be struggling with an eating disorder?
A: Talk to them! Express your concern about the changes you have observed in them (food variety, amount, energy, eating habits, mood, withdrawal from social settings).
Q: What are the best ways to get help?
A: The first step is to recognize that your attitudes about eating and your body may be interfering with your life. Then, seek support through a health care professional to assess the severity of your symptoms and review treatment options. There are doctors who specialize in providing medical and psychiatric support and therapists who can help coach you in health change so that you can have the abundant life you deserve. There are also specialized dieticians who can provide education about the demoralization of foods—“all foods are OK, there are no good or bad foods”—and work with you on increasing your variety and intake amounts. Or they can help you create scheduled meal times and snacks to nourish your body and reduce urges to binge and restrict.
Q: What can you do in your own time to help yourself if you feel like you are struggling with an eating disorder?
A: There are excellent online resources (AEDWEB.org, Nationaleatingdisorders.org, Ellyn Satter Institute, Intuitiveeating.org) to start with to learn more. Also, try not to be hard on yourself; realize that you are not alone and that our society’s unrealistic images and values surrounding thinness condition us for body dissatisfaction from an early age without our realization or permission. You did not cause this and have the power and support to change your eating and life.
Try not to be hard on yourself; realize that you are not alone and that our society’s unrealistic images and values surrounding thinness condition us for body dissatisfaction from an early age without our realization or permission. You did not cause this and have the power and support to change your eating and life.
Eating Disorders and the Link to Dying by Suicide
Starvation makes people more depressed, anxious, and suicidal, Francis says. Much of what we know about the effects of starvation on mood comes from the Minnesota Starvation Study and the concept of “set point theory,” that weight is genetically determined, and our bodies have an individualized weight range that we feel, function, and eat best at. Statistically, over 28 million Americans are currently or have struggled with an eating disorder, and 26% of those people attempt suicide—but less than 6% of those people are considered medically “underweight,” reported the National Association of Anorexia Nervosa (ANAN).
Eating Disorder Quick Facts:
- 9% of the U.S. population will have an eating disorder in their lifetime.
- 91% of women admitted to controlling their body weight in a college campus survey.
- Athletes are more likely to have an eating disorder than non-athletes.
- About 26% of people who have an eating disorder attempt suicide.
- One death every 52 minutes—eating disorders are among the deadliest mental illnesses.
Eating disorders are often secretive, and “people can be starving at any size,” Francis says. Of those that have eating disorders, 86% report onset before they turn 20 years old. Anorexia Nervosa has been suggested to have the highest mortality rate of any psychiatric condition, estimated to be 10%.
Eating disorders are serious medical illnesses, but help is out there. The first step is recognizing that you are not alone in this and that you did not cause this to happen to you.
If you or someone you know is struggling with an eating disorder, find a health care professional near you.