There is no one sign of an eating disorder; however, there are red flags. For anorexia nervosa, bulimia nervosa, and binge eating disorder, these can include excessive “fat, weight, or calorie talk,” a pattern of eating a limited choice of low-calorie foods, and/or a pattern of intermittent binge eating on calorie-dense foods. People with anorexia nervosa may excessively exercise or excessively stand, pace or fidget. Some individuals with eating disorders may avoid weight gain following meals by inducing vomiting or abusing laxatives, diuretics and diet pills. Feeling self-conscious about one’s eating behavior is common. People with eating disorders often avoid social eating settings and eat alone.

People with avoidant restrictive food intake disorder don’t have excessive concerns with weight and shape. They may avoid eating many foods due to a variety of reasons, including low appetite, disgust or sensitivity to many foods. They may fear negative consequences from eating certain foods, such as nausea, vomiting, or abdominal pain. See more on warning signs

There is no single cause of an eating disorder. Like other mental health conditions, eating disorders are complex diseases that result from the interplay between biological, psychological, and socioenvironmental factors. We now understand that genetics play a role in the risk of developing an eating disorder. Environment also plays a role, especially in triggering the onset of an eating disorder, often in adolescence or young adulthood. Pressure to diet, or weight loss related to a medical condition or life stressor, can be the gateway to anorexia nervosa or bulimia nervosa. Losing those first five to 10 pounds in someone who is genetically vulnerable seems to make further dieting increasingly compelling and rewarding.

The onset of puberty, particularly in girls, can often precipitate an eating disorder. Social media usage, particularly image-based platforms such as TikTok and Instagram, is associated with eating disorder development. Once an eating disorder is established, the consequences of restricting, bingeing, or purging play an increasing role in sustaining the disorder. This occurs through changes in the body’s controls of hunger and fullness sensations, changes in the gastrointestinal tract, and altered learning, habit, and decision-making about what and when to eat.

Treatment for an eating disorder is challenging. It involves interrupting thoughts and behaviors that have become automatic. Recovery takes a team, including family, friends, and other social supports, and medical and mental health professionals. Be empathic, but clear and firm. List specific signs or changes in behavior you have noticed and are concerned about, without overly focusing on physical appearance, for example, “I have noticed that you have been skipping family meals.” Help locate a treatment provider and offer to go with your friend or relative to an evaluation.

Be prepared that the individual may be uncertain or ambivalent about seeking treatment. Reassurance that this ambivalence is normal and that treatments are effective is important for instilling hope. Treatment assists those affected with an eating disorder to change what they do. It helps them establish healthy eating and weight control behaviors and challenge the irrational thoughts that sustain them. Full eating disorder recovery is possible and liberating, allowing individuals to be free from the psychological confines of an eating disorder, heal from the physical complications of starvation, and overall live a more joyous life.

Yes. It is true that young girls and women are more often affected. However, eating disorders can affect individuals of any gender, age, socio-economic status, racial/ethnic identity, and body size. An estimated 10 percent of people with anorexia nervosa and bulimia, and a third or more of people with binge eating disorder, are male. Avoidant restrictive eating disorder appears to be slightly more common in males than in females. Further, for men, eating disorder symptoms can present differently, with more focus on muscularity.

Other at-risk groups include sexual and gender minorities, racial/ethnic minorities, and athletes in sports that value leanness and aesthetics, such as dance, gymnastics, and distance running. Age of onset varies. Some people are only mildly affected until some life event triggers clinical worsening – a stressor, physical illness, or co-occurring psychiatric illness, such as depression or anxiety. Evidence strongly suggests that anxiety disorders, especially social anxiety disorder, and obsessive-compulsive personality traits increase an individual’s vulnerability to an eating disorder.

Occasional overeating, such as at Thanksgiving or other holidays and celebrations, is normal. By contrast, binge eating is the frequent consumption of a large amount of food associated with a sense of loss of control over eating. Binging is usually private and associated with feelings of embarrassment, shame, depression, and guilt over the behavior. It often includes eating rapidly, until uncomfortably full, or when not hungry.

Food addiction is a controversial term used by some researchers to describe parallels between the difficulties some people experience in limiting eating and substance addiction. Unlike in addiction, however, where an individual is addicted to one particular class of drug, it is difficult to identify one food that underlies “food addiction.” Similarly, the withdrawal syndrome caused by drug dependence is difficult to show in those who overeat. Despite the similarities between eating disorders and addiction, the neurobiology of binge eating and of drug addiction are not the same.

Research on eating disorders is progressing rapidly. It is now clear that eating disorders are biologically based illnesses, not simple lifestyle choices. Recent genetic work has focused on identifying genes that increase risk for an eating disorder and on gene-environment interactions that may contribute to the onset of an eating disorder. Emerging research suggests that there are significant genetic correlations between several eating disorders and psychiatric and metabolic traits. Brain imaging research is examining altered decision-making around food choice and reward learning in individuals with eating disorders. Other research focuses on understanding how starvation, exercise and binge-purge behaviors change brain reward circuits and gut-brain signaling. This work holds promise for developing novel treatments in the coming years.

The most effective current treatments are behavioral interventions that focus on helping individuals with eating disorders normalize their eating and weight control behaviors. For adolescents with anorexia nervosa, family-based treatment has the best evidence. The focus of effective family-based therapies is on helping parents to support and monitor their child’s meals. For severely ill patients at very low weight, and for many adult patients who are unable to gain weight in outpatient treatment, admission to a specialized residential or hospital-based treatment program can be lifesaving.

The most consistent indicator of relapse after intensive treatment is incomplete weight restoration, so reaching a healthy weight is necessary for recovery from anorexia nervosa. Evidence now suggests that weight gain of three to four pounds a week is safe even for very malnourished patients under close medical monitoring and 24-hour nursing care. Some programs utilize feeding tubes. However, many behavioral specialty programs can achieve four pounds a week weight gain with meal-based feeding alone in most cases. Close outpatient follow-up care following hospitalization is important, as relapse risk is elevated for six months following inpatient treatment.

Emerging treatments with promise, although still in their infancy, include the use of psychedelics, which may assist with reducing the cognitive rigidity associated with anorexia nervosa. Brain stimulation methods, such as repetitive transcranial magnetic stimulation (rTMS), targeting the dorsolateral prefrontal cortex are also of growing interest. Neuroimaging research has suggested abnormal connections in this area of the brain. To date, there are no pharmacological treatments approved for anorexia.

For bulimia nervosa, cognitive behavioral therapy is the most successful outpatient treatment approach. Fluoxetine is currently the only FDA-approved medication; however, other medications, including other antidepressants, show promise in clinical trials.

People with binge eating disorder also respond to cognitive behavioral interventions. Interpersonal therapy is also effective in both bulimia and binge eating disorder. The only FDA-approved pharmacological treatment for BED is lisdexamfetamine. However, research on other medications (such as serotonin reuptake inhibitors and topiramate) shows benefit. There is interest in the use of GLP-1 agonists in reducing binge eating, but more research is needed. Research for the treatment of avoidant restrictive food intake disorder (ARFID) is still relatively limited. However, existing research supports the use of cognitive behavioral therapy with family-based therapy also shows promise in younger children. There are no approved medications for the treatment of ARFID.

In general, one of the most important emerging predictors of treatment success for eating disorders across diagnoses is early behavior change. Even in individuals who are initially highly ambivalent about entering treatment and demoralized by their illness, motivation often increases as they start experiencing progress in controlling their disorder and recognize recovery is within reach.