February was National Eating Disorder Awareness Month. Spreading awareness about eating disorders is especially important at the high school level because this is the age when these issues often emerge.

Eating disorder quick facts

• About 9% of Americans will experience an eating disorder in their lifetime. 
• The most common eating disorder is Other Specified Feeding or Eating Disorder (OSFED), closely followed by Binge Eating Disorder (BED).
• Less than 6% of people with eating disorders are underweight
• Anorexia Nervosa (AN) is the deadliest mental illness after opioid addiction 
• Eating disorders are significantly more common in the LGBTQ+ community.
• Neurodivergent people (ADHD, Autism) are more likely to develop eating disorders than the general population. 
• There is a strong genetic component to eating disorders
• Eating disorders often co-occur with other mental health conditions such as depression, anxiety, OCD, and PTSD
• Eating disorders often develop during adolescence
• Approximately ⅓ of people struggling with eating disorders are male

What are eating disorders?

Eating disorders are a category of mental illness that involve a severe disturbance in eating behaviors and thoughts about food. They can affect people of all weights, genders, races, and socio-economic status, and there are several different types. 

Anorexia Nervosa (AN)

There are two subtypes of anorexia; Anorexia Nervosa Restricting subtype (ANR) and Anorexia Nervosa Binge-Purge Subtype (ANBP). Both are characterized by a restriction of food intake, causing extreme weight loss and often resulting in a disproportionate body weight for height and age, as well as an obsession with food and a distorted body image, also called “body dysmorphia.” However, with ANBP, episodes of binging and purging are also present, similar to bulimia. Approximately 30-50% of people with anorexia also engage in binge eating. 

Physical symptoms can include cold intolerance, chest pain, hair loss, osteopenia or osteoporosis (varying degrees of decreased bone density, leading to fragility), infertility, constipation/delayed gastric emptying (gastroparesis), small hairs all over body (lanugo), and loss of proper hunger/fullness cues. Other behavioral symptoms include an obsession with food (ex. cooking food for others but not eating it themselves, watching mukbangs, baking excessively), strict rules around eating, eating slowly and cutting up food into small pieces, and over-excerise.

Bulimia Nervosa (BN)

Characterized by a cycle of binge eating followed by compensatory behaviors, the most common of which is self-induced vomiting. Other purging behaviors can include laxative abuse, excessive exercise, and fasting. Signs someone is struggling include large amounts of food disappearing quickly or finding wrappers as evidence of a binge, long trips to the bathroom after meals, skipping meals, using diet foods and fad diets, and withdrawing socially. Bulimia causes strong feelings of guilt, isolation, and low self-esteem.   

Binge Eating Disorder (BED)

This highly misunderstood disorder is characterized by eating what most would consider a large amount of food in a short amount of time. This is not the same as simply overeating. Rather, these episodes (called a binge) include feeling “out of control” when eating, eating until uncomfortably or painfully full, eating despite not feeling hungry, and often occur alone due to embarrassment. These sessions are followed by extreme feelings of guilt. Unlike Bulimia Nervosa, binges are not followed by purging.

In my opinion, a binge episode should not be marked by the amount of food consumed, but rather the feeling of being out of control or “out of body.” Binge eating is not simply a failure of willpower, It is a serious mental disorder that can severely affect someone’s life. Shame about this disorder only makes those struggling feel more polarized so they will continue to suffer in silence. 

Other Specified Feeding or Eating Disorder (OSFED)

Despite being the most commonly diagnosed eating disorder, OSFED is virtually unheard of in the general public. This diagnosis is given when an eating disorder is present, but does not meet the full criteria for another eating disorder. 

Atypical anorexia is the same criteria for Anorexia Nervosa, except without being underweight.

Orthorexia is an unhealthy obsession with healthy or “clean” eating. Symptoms include cutting out a large number of food groups (ex. carbs, sugar, fat, meat) and an obsession with the “purity” of foods. What separates orthorexia from a normal healthy diet is the obsessive and perfectionistic nature of it. Ruminating about the healthfulness of food to the point where it comes at the expense of social life and hobbies is not healthy. Orthorexia often co-occurs with anorexia and can (ironically) cause malnutrition, as well as psychological distress. 

Night eating syndrome is similar to binge eating and occurs when someone eats large volumes of food (>25% of daily calories) late at night. This causes low appetite in the morning, often leading to skipping meals during the day, and then an extreme appetite at night. 

Purging disorder – when someone purges (vomits) their food, without the presence of binging. 

Avoidant Restrictive Food Intake Disorder (ARFID)

This diagnosis is often categorized separately from the other eating disorders as it does not involve body image. ARFID is characterized by a restriction in food not due to fear of calories, weight gain, or “unhealthiness,” but rather an aversion to textures or a fear of choking. Despite this difference, it can cause issues similar to anorexia, such as malnutrition and weight loss. It usually occurs with neurodivergence, such as Autism. 

Eating Disorders: A Deeper Understanding 

While the former half of this article is simply educational information about eating disorders, I want the latter half to bring a closer, more empathetic understanding of eating disorders. While I described eating disorders with very clinical, diagnostic language, it is important to remember that those symptoms and statistics represent real people, right now, who are struggling. Eating disorders are pretty well known in the public consciousness, but heavily misunderstood. Someone doesn’t need to be severely emaciated to have an eating disorder, even if that disorder is anorexia. You can be malnourished and psychologically distressed at any weight. The majority of people with eating disorders are at a “healthy weight”. Anorexia is not a weight diagnosis; it is a psychological problem. Not all eating disorders are simply starving yourself. They are a range and combination of behaviors (restriction, binging, purging, exercise, fasting, etc). Eating disorders don’t have a certain “look,” and anyone can be struggling. To observe Eating Disorder Awareness Month this year, take the opportunity to educate yourself. Refrain from making harmful or stereotypical jokes about people who struggle with them, as well as commenting on people’s bodies and diets. You never know who is struggling.

If you or anyone you know is struggling with an eating disorder, help is available. NEDA (National Eating Disorder Association) is a great resource for more information, screening tools, and treatment places.