Eating disorders affect millions of teens and young adults around the world. They’re most common in cultures that focus on weight and body image and can affect people of all genders, races, and ethnic backgrounds. People who have a negative body image are at risk of developing an eating disorders such as anorexia nervosa, bulimia, binge eating disorder, or a category called other specified feeding or eating disorder (OSFED). Eating disorders have serious health consequences and require treatment. Recovery is likely with the help of specially trained health care providers and a supportive family. We hope this guide will help you understand eating disorders, the different kinds of treatment, and the recovery process.
What are eating disorders?
Eating disorders are complicated medical and psychological conditions that affect a person’s physical and emotional health and involve intense emotions and behaviors around food. Eating disorders are very dangerous illnesses and can lead to permanent consequences if left untreated.
The four main types of eating disorders are anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorder (OSFED).
- Anorexia (pronounced: an-or -rex-e-ah) involves food restriction (limiting or not having certain foods or food groups). People with anorexia drastically limit their food intake and have an intense fear of gaining weight, even though they are underweight.
- Bulimia (pronounced: bull-e-me-ah) involves cycles of binge eating followed by a purging behavior. People with bulimia will eat an unusually large amount of food in a short period of time and then exercise excessively or purge by vomiting, using laxatives, enemas, diuretics as a way 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. Binge eaters do not purge afterwards, but often feel a lot of shame or guilt about their binge eating.
- Other specified feeding or eating disorder (OSFED) involves some combination of symptoms of the other eating disorders such as an intense fear of weight gain and a preoccupation with food (thinking about food or having food related thoughts most of the day). People with OSFED have some of the symptoms of anorexia, bulimia, or binge eating disorder, but don’t meet all of the criteria for diagnosis.
Disordered eating is a term used when someone doesn’t have all the symptoms of an eating disorder, but their eating patterns and behaviors put them at risk for developing an eating disorder.
Prevalence rates, or how often eating disorders occur varies with each disorder. While anorexia nervosa and bulimia nervosa are fairly rare, binge eating disorder and OSFED are slightly more common. A study done in 2011 estimated that 0.3% of Americans between the ages of 13-18 suffer from anorexia, 0.9% from bulimia, and 1.6% from binge eating disorder (Swanson et al. 2011). Estimates of OSFED differ from study to study, but may be as high as 15%.
Causes and Risk Factors
There are many theories about what causes eating disorders and for each person the reason can be different. However, most eating disorders are caused by a combination of biological, psychological, and environmental factors and sometimes the cause may not be completely clear.
- A family history of anorexia, bulimia and/or binge eating disorder may make certain people more at risk to have an eating disorder because of their genes or family upbringing
- Chemicals in the brain that control hunger, digestion, and appetite
- Obsessive compulsive disorder (OCD)
- Past or current trauma such as physical, emotional or sexual abuse
- Desire to have control over some aspect of life
- Inability to control behaviors
- Personality traits such as perfectionism (wanting to be perfect), extreme desire to succeed, and/or impulsivity (doing things without planning or considering the consequences)
- Family values about body size, appearance and food
- Low self-esteem or self-worth
- Sense of loss
- Society’s intense focus on thinness and dieting
- Participation in sports that focus on body shape and size such as dancing, rowing, gymnastics, track, wrestling, etc.
- Abusive or troubled relationships that cause emotional stress and feelings of loss of control
- Stress at school, sports, with peer groups, etc.
- Specific cultural attitudes about how a person should look and behave
Body Image and Self-Esteem
Body Image and Self-Esteem: Teens are constantly exposed to unrealistic standards in the media such as airbrushed images and very fit-looking models and may feel pressure to lose weight or look a certain way. Because of these pressures, many teenagers develop bad body image and self-esteem. Although it’s normal for teenagers to not feel completely content with their bodies because they’re constantly changing, 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 her or his body shape, size and appearance differently from what everyone else sees. 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 that are very hard to get rid of, because they often worry about how they look and what people think of them.
How do I improve my body image?
- Start by writing down or journaling about 5 parts of your body that you like (ears, eyes, legs, teeth, hair, etc.).
- Write down things that your body can do when it’s healthy (running, dancing, hiking, biking, etc.).
- Write down 10 things you like about yourself (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. Take a shower, listen to music, play a game, 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 different and that not everyone is meant to be the same shape or size.
- Be critical of advertisements, magazines and the media. Many people will write letters to a company if they find their ads or articles upsetting or hurtful.
Helping a Friend
What do I do if I think my friend has an eating disorder?
Approaching a friend who you think has an eating disorder can be very hard. People who have eating disorders are often in denial, and therefore 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 take the first step to 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 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 meals)
- Be patient., 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 they won’t listen, write 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 and how much
- Being the “food police” (watching or commenting on everything they eat), which could cause them to feel uncomfortable and not trust you
Remember, you’re there to support and be a source of encouragement throughout the process, not to be a therapist or tell them what to do.Additional Resources