Diagnosing and Treating Eating Disorders

Eating disorders are complex mental health conditions that impact physical and emotional well-being and daily functioning. They are frequently misunderstood and underdiagnosed, partly due to stigma and partly due to the often subtle nature of symptoms. Understanding what causes eating disorders, how to assess and diagnose them, and the available treatment approaches are essential for supporting long-term recovery.

What Causes Eating Disorders?

Eating disorders, characterized by an unhealthy relationship with food, are complex mental health conditions. Triggered by a combination of factors, disordered eating impacts men and women of all ages.

Research suggests there are several possible factors that lead to eating disorders, including:

Genetic Factors

While genes alone do not cause eating disorders, they can increase vulnerability, especially when combined with other factors. Individuals who have a first-degree relative diagnosed with eating disorders are at a higher risk ^[1]. 

Genetically influenced traits like perfectionism, anxiety, and impulsivity are also associated with a higher risk of developing eating disorders. Brain circuits related to reward, impulse control, and appetite regulation can contribute to disordered eating patterns, while metabolic factors and genetic variations can also increase risks. 

Psychological Factors

Internal influences like low self-esteem, perfectionism, or body dissatisfaction often shape how people view themselves, their bodies, and food, making people more vulnerable to disordered eating behaviors. Rigid thinking patterns, compulsive rituals, and a need for control are also common traits in people with eating disorders, particularly anorexia nervosa.

Environmental Factors

Cultural and social influences also contribute to eating disorders. The media’s portrayal of thinness as an ideal standard of beauty contributes to body dissatisfaction, especially in women. 

When people, especially young teens, are repeatedly exposed to these images, they sometimes internalize unrealistic body ideals and set unachievable standards. Low self-esteem and a desire for perceived perfection can cause unhealthy behaviors and negative self-perceptions ^[1].

Types of Eating Disorders

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5-TR) recognizes several types of eating disorders, each with distinct characteristics and health implications ^[2]. 

Anorexia Nervosa

Anorexia nervosa is marked by severe food restriction, an intense fear of gaining weight, and a distorted body image. Despite being underweight, those with anorexia often view themselves as overweight. The condition can lead to life-threatening complications, including heart failure, bone density loss, and infertility.

Bulimia Nervosa

Bulimia involves cycles of binge eating followed by purging through vomiting, laxative use, or excessive exercise. These episodes are often performed in secret and are driven by shame or guilt. Frequently, an obsessive desire to maintain body weight appears with time. Despite often maintaining a normal body weight, people with bulimia can experience serious consequences, including gastrointestinal damage and cardiac irregularities.

Binge Eating Disorder

Binge eating disorder is characterized by episodes of consuming large quantities of food without compensatory behaviors like purging. It often results in significant emotional distress and may lead to obesity and related health issues. This is the most common eating disorder in the United States and can occur across all demographic groups ^[3].

Avoidant/Restrictive Food Intake Disorder (ARFID)

Unlike other eating disorders, ARFID is not driven by body image concerns, but it can lead to nutritional deficiencies and impaired social functioning ^[2]. 

ARFID typically develops in childhood and involves a persistent failure to meet nutritional needs due to:

• A lack of interest in food
• Sensory sensitivity
• Fear of negative consequences, like choking

Signs of Eating Disorders

Some signs of eating disorders, such as eating less, might appear healthy initially. Certain signs gradually escalate, such as the person who occasionally skips breakfast and later moves to skipping two or three meals a day, making it difficult for a loved one to distinguish typical behaviors from unhealthy signs

Behavioral Signs of Eating Disorders ^[4]:

• Preoccupation with food, calories, or dieting
• Skipping meals or making excuses not to eat
• Sudden changes in eating habits, such as extreme food restriction or avoiding entire food groups
• Frequent trips to the bathroom after meals, possibly suggesting purging
• Increased irritability or withdrawal from social situations, especially those involving food
• Distorted body image, including frequent body-checking or negative self-talk about weight or shape

Physical Signs of Eating Disorders:

• Noticeable weight changes
• Frequent exhaustion 
• Dizziness or fainting
• Thinning hair
• Gastrointestinal issues
• Irregular or absent menstrual cycles

Assessing and Diagnosing Eating Disorders

When signs of eating disorders are present, a medical professional can help to diagnose the issue. The DSM-5-TR outlines symptoms for each type of eating disorder, though people don’t have to have every symptom to receive a diagnosis ^[2]. Screening tools like the Eating Disorder Examination Questionnaire (EDE-Q) or the SCOFF questionnaire help identify abnormal eating behaviors and attitudes ^[5].

In addition to psychological assessments, healthcare providers conduct physical evaluations to check for signs of malnutrition or electrolyte imbalances. This helps to rule out any organ dysfunction that can accompany eating disorders. Medical professionals also gather patient and family history to determine any underlying causes of changes in habits or eating disorders. 

The Link Between Mental Health and Eating Disorders 

There is a strong and complex connection between mental health and eating disorders, with many overlapping factors influencing both. Binge eating disorders negatively impact mental health conditions like anxiety and depression, with as many as half of the patients diagnosed with binge eating having a history of depression. 

Mood disorders, substance use disorders, and trauma-related disorders also frequently co-occur with eating disorders. These comorbid conditions complicate treatment and increase the risk of relapse ^[6].

Individuals with preexisting mental health disorders may turn to eating disorders as a coping mechanism for emotional pain or trauma. However, the resulting nutritional deficiencies can exacerbate existing health issues, diminishing overall quality of life and well-being. These co-occurring conditions often heighten emotional distress and hinder recovery, underscoring the need to simultaneously address the eating disorder and coexisting mental health issues ^[7].

In the most extreme cases, when suicide attempts or past trauma-related issues are present alongside eating disorders, immediate comprehensive psychiatric care and inpatient eating disorder treatment are especially important. 

Treatment for Eating Disorders

Whether eating disorders present on their own or alongside other mental health conditions, treatment typically involves a multidisciplinary approach. Effective teams can include:

• Psychologists
• Psychiatrists
• Primary care providers
• Registered dietitians

The healthcare team collaboratively addresses eating disorders by taking a holistic approach. The goal is to address disordered behaviors, correct nutritional imbalances, and improve emotional regulation. Several different techniques help to accomplish this ^[8]. 

Nutritional Rehabilitation

Restoring physical health begins with reestablishing regular eating patterns and addressing malnutrition. Dietitians work closely with patients to develop structured and achievable meal plans that gradually reintroduce balanced nutrition. In more severe cases, inpatient hospitalization is necessary to stabilize the patient’s nutritional deficits and prevent medical complications.

Psychotherapy

Psychotherapy also plays a foundational role in recovery. Cognitive behavioral therapy (CBT) is widely regarded as the gold standard for treating eating disorders. It identifies and challenges distorted beliefs around body image, food, and control. Dialectical behavior therapy (DBT) is particularly useful for people who struggle to manage emotional or physical responses to food. It also addresses self-harming behaviors that are often seen in binge eating or bulimia.

Because the family unit is an important source of support for anyone experiencing an eating disorder, family-based therapy (FBT) is often useful. This form of therapy is especially common with adolescents, as it empowers families to support recovery by taking an active role in managing eating behaviors and establishing a supportive home environment ^[8].

Medication and Psychiatric Care

Medications like selective serotonin reuptake inhibitors (SSRIs) are sometimes effective for reducing anxiety and depressive symptoms that co-occur with eating disorders. While pharmacological treatment alone is rarely sufficient, it can support therapy and improve overall functioning ^[8].

Levels of Care

Treatment for eating disorders is delivered at varying levels of intensity, depending on the severity of symptoms. In-person or virtual outpatient eating disorder treatment is often suitable for those with mild symptoms, while partial hospitalization programs (PHP) and intensive outpatient programs (IOP) offer more structured care. Inpatient and residential treatment facilities provide 24/7 support for those facing immediate medical risks or psychological crises.

Stepping down through levels of care over time allows for gradual reintegration into daily life while maintaining access to professional support ^[8].

Long-Term Recovery and Support

Recovery from an eating disorder takes time, and for some, therapy and medications continue for a lifetime. Consistent care, appropriate treatment, and a strong support network all play a role in the potential for recovery and ongoing health and wellness. Though relapse can occur, it does not mean failure. Rather, it emphasizes the need for flexibility and continued support from medical and mental health professionals ^[9].

Patients who remain active in their recovery and seek community support have the highest potential for success. Support groups, recovery coaching, and peer mentoring offer connection and encouragement throughout the healing journey. Additionally, patients with family and friends who are educated about eating disorders often recover in a more compassionate and understanding environment, reducing stigma and reinforcing long-term goals.

Eating Disorders Healing and Hope

Eating disorders are treatable, and recovery is achievable with early intervention, professional care, and ongoing support. Understanding what causes eating disorders lays the groundwork for diagnosis and long-term treatment, the path toward healing. By recognizing the signs, using evidence-based approaches, and treating the full spectrum of psychological and medical needs, people experiencing eating disorders can reclaim a healthier, more fulfilling life.

If you or someone you know is struggling, you are not alone. Help is available. Call or text the Suicide & Crisis Lifeline at 988 for free, confidential support 24/7. There is always hope, and support is just a call away.