Eating disorders affect millions of people around the world. Although they’re most common in cultures that focus on weight and body image, they can affect people of all genders, races, ages, and ethnic backgrounds. People who have a negative body image and those who frequently diet are at risk of developing an eating disorder such as anorexia nervosa, bulimia nervosa, or binge eating disorder. Eating disorders have serious health consequences and require treatment. Recovery is possible with early intervention, the help of specially trained health care providers, and a strong support system.
What are eating disorders?
Eating disorders are complicated psychological conditions that affect a person’s physical and mental health. They involve intense emotions and behaviors about food. Eating disorders are very dangerous illnesses and can lead to permanent physical and psychological consequences if left untreated.
The five classifications of feeding and eating disorders are: anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED) and avoidant restrictive food intake disorder (ARFID).
- Anorexia Nervosa (pronounced: an-or -rex-ee-ah) involves food restriction (limiting or not having certain foods or food groups). People with anorexia drastically limit their food intake (both in quantity and variety) and have an intense fear of weight gain. Their weight is often affected by their lack of caloric intake.
- Bulimia Nervosa (pronounced: bull-ee-me-ah) involves cycles of binge eating followed by purging behavior(s). People with bulimia will eat an unusually large amount of food in a short period of time and then purge by self-induced vomiting, using laxatives, diuretics, or excessively exercising in an attempt to avoid gaining weight.
- Binge eating disorder involves eating an unusually large amount of food in a short period of time and feeling a loss of control during this episode. People with binge eating disorder do not purge afterwards, but often feel shame or guilt about their binge eating.
- Other specified feeding or eating disorder (OSFED) involves some combination of symptoms of other eating disorders such as an intense fear of weight gain and a preoccupation with food but does not meet the exact clinical criteria for another eating disorder. Atypical anorexia (where a person’s weight is not significantly low), purging disorder (similar to bulimia but without the binge eating element) and night eating syndrome are all examples of OSFED..
- Avoidant restrictive food intake disorder (ARFID). ARFID exists in three different subtypes; fear of consequence (such as choking on food or vomiting after eating), sensory sensitivities (such as being bothered by strong smells or certain textures of foods), or lack of interest in food/low appetite. A person with ARFID does not eat enough which is marked by lower than expected weight, nutritional deficiencies, and/or interference with social functioning. The main difference between anorexia and ARFID is that someone with ARFID does not have a fear of gaining weight or body image concerns.
Disordered eating is a term used to describe when someone doesn’t have a diagnosed eating disorder, but their eating patterns and behaviors put them at risk for developing an eating disorder. For example, anorexia nervosa can start when dieting becomes too extreme; binge eating disorder or bulimia nervosa can start because diets often restrict the amount and types of food eaten, which often leads to cravings and excessive hunger, thus causing loss of control around food. Sometimes extreme healthy eating is referred to as “orthorexia” which is not a diagnosable eating disorder but may still be a problem if interfering with health or day-to-day functioning.
Prevalence rates or how often eating disorders occur varies with each disorder, but overall, studies suggest that 1.2% of adolescent boys and 5.7% of adolescent girls have diagnosed eating disorders (López-Gil et al. 2023). The prevalence is likely higher because many eating disorders go undiagnosed.
Body Image and Self-Esteem: Teens are constantly exposed to unrealistic body ideals in the media such as airbrushed images, very skinny models, and constant celebrity images on social media which may cause pressure to lose weight or look a certain way. Because of these pressures, many teens develop negative body image and self-esteem. It’s important for teens to find ways to feel comfortable with the natural shape and size of their bodies.
Body distortion: Body distortion is when someone sees their body shape, size and appearance differently from how it really is. Body distortion causes a person to over-focus on flaws or imperfections that they are insecure about. Most people who struggle with an eating disorder have body distortion issues and often worry about how they look or what people will think of them. This is sometimes diagnosed as the mental health condition body dysmorphic disorder (BDD) if it gets in the way of normal life. These negative thoughts can be difficult to navigate, and it is helpful to work on positive self-talk strategies with a therapist.
How do I improve my body image?
- Write down things that your body can do when it’s healthy (running, dancing, hiking, biking, etc.).
- Write down 10 qualities you like about yourself that don’t involve your physical body (caring, responsible, funny, smart, creative etc.).
- Make a list of accomplishments you are proud of.
- Buy clothes that you feel comfortable in and give away any that make you feel self-conscious or uncomfortable.
- Relax using all your senses. Take a bath, listen to music, play a game, sing, or meditate.
- Spend time with positive people who make you feel comfortable and you can be yourself around.
- Remind yourself that everyone’s body is unique and not everyone is meant to be the same shape or size.
- Be critical of advertisements, social media “influencers” and other media outlets. You could send emails or messages to a company if you find their ads or articles upsetting or hurtful.
- Make yourself smile when you look in the mirror. It might feel weird at first, but after a while, you could start to notice a difference in the way you see yourself.
What do I do if I think my friend has an eating disorder?
Approaching a friend who you think has an eating disorder is very hard. People who have eating disorders might be in denial, and possibly very defensive about their behaviors. They also tend to be very secretive about their behaviors, and often refuse to talk about their problems. Despite the strong reactions, it’s very important to continue to try and help someone you care about. In most cases, they need a lot of support and encouragement from friends and family to help them seek treatment.
What are some suggestions for supporting someone you care about?
- Talk about the issue in a supportive and caring way
- Remind them how much you care about them and how important they are to you
- Read as much as you can about eating disorders to better understand what they’re going through
- Be direct
- Talk to them in private, not around other people or in public
- Instead of using the word “you” say “I” (ex. I’ve noticed that you have been eating less, or I’ve noticed that you always go to the bathroom after eating)
- Be patient and go slowly; it may take them a while to come to terms with their issue, and admit that they are struggling
- Always be there as a support and encourage them to seek treatment, if necessary
- If you feel uncomfortable talking to them directly or feel as if they won’t listen, write them a letter
- Talk to your parent(s) or a professional such as a teacher, school counselor, health care provider, nurse, or another trusted adult that will respect your friend’s privacy
- Be encouraging
Things to avoid:
- Sounding threatening or judgmental
- Talking about food or weight
- Offering them advice regarding food, exercise, etc.
- Controlling what they eat or how much
- Being the “food police” (watching or commenting on everything they eat), which could cause them to feel uncomfortable and not trust you