Eating disorders: types, causes and treatment

Quick overview: Frequently asked questions and answers

What types of eating disorders are there? The main forms are anorexia, bulimia and binge eating disorder. In many cases they occur as a mixed form.

How do eating disorders arise? Eating disorders arise from an interplay of biological, familial, personal and socio-cultural factors. Psychological problems and traumatic experiences often also play a role.

What are typical symptoms of eating disorders? Symptoms may include being severely underweight or overweight, compulsive eating, excessive preoccupation with body image, and extreme dieting. Psychological symptoms such as anxiety and depression are also common.

Article contents at a glance:

What are eating disorders?

Eating disorders are serious mental illnesses. They are characterized by abnormal eating behavior and a distorted perception of one’s own body.

Such disorders cause considerable suffering and require professional treatment. Without professional help, eating disorders can have serious effects on mental and physical health.

The sooner those affected seek medical help, the greater the chances of a full recovery.

Who is affected?

Of the three types of eating disorders, binge eating disorder is the most common, followed by bulimia, while the most well-known form, anorexia, is the least common.

On average, out of 1,000 girls and women, about 28 will develop binge eating disorder, 19 will develop bulimia and 14 will develop anorexia.

Boys and men are less frequently affected, with about 10 cases of binge eating disorder, 6 of bulimia and 2 of anorexia per 1,000. However, the number of unreported cases is likely to be higher.

Types of eating disorders

The three most common types of eating disorders include:

• Anorexia nervosa: In anorexia, those affected drastically reduce their food intake. This results in severe weight loss, which has dangerous effects on the body. There is also what is known as atypical anorexia. People with the condition are of normal weight, but meet all the other criteria for anorexia.

• Bulimia (bulimia nervosa, binge eating disorder): Sufferers have repeated, uncontrollable eating binges. They then try to get rid of the calories by vomiting, excessive exercise or taking laxatives. Bulimia is not necessarily obvious to sufferers, as it often goes hand in hand with a normal weight.

• Binge eating disorder (food addiction): In the most common form, those affected repeatedly consume large amounts of food within a short period of time. These eating binges are often associated with a feeling of loss of control, guilt or shame. Binge eating is often accompanied by severe obesity.

There are also other forms of eating disorders, although their classification is not clearly defined. These include:

• Selective eating disorder: Those affected avoid certain foods or food groups. This results in nutrient deficiencies.

• Orthorexia (orthorexia nervosa): Sufferers are compulsively fixated on a healthy diet.

• Anorexia athletica (sports anorexia): Sports addiction is often accompanied by restrictive eating habits.

• Pica syndrome: Sufferers eat things that are not suitable for consumption, such as paper, hair or soil. Pica syndrome often occurs in children.

• Night Eating Syndrome (NES): People affected by NES often eat little during the day but consume large amounts of food in the evening and at night.

Mostly it is a mixed form

In most cases, mixed forms occur in which the characteristics of the individual disorders overlap. For example, anorexia can cause binge eating followed by vomiting, a behavior that is more typical of bulimia.

Likewise, some people with bulimia occasionally show symptoms of anorexia, attempting to control their weight and lose weight by strictly fasting after periods of binge eating.

Causes: How do eating disorders arise?

Eating disorders cannot be traced back to a single trigger. Rather, they arise from the interaction of various factors that are often linked to one another.

The main factors include:

• Biological causes: Genetic predispositions and biochemical imbalances in the brain can increase the risk of developing eating disorders.

• Psychological factors: Many affected people struggle with low self-esteem, perfectionism, or mental illnesses such as depression and anxiety disorders.

• Social influences: Social ideals of beauty, the media presentation of body images and social pressure can contribute to a disturbed relationship with one’s own body and with food.

• Family factors: Stress, conflict, abuse or family diet practices can also play a role. The risk of developing the disease is also increased if one parent is affected by an eating disorder.

• Personal experiences: Traumatic experiences or stressful life events such as bullying, the loss of a loved one or difficult relationships can promote the development of an eating disorder.

Eating disorders can be identified by these symptoms

The symptoms of eating disorders vary depending on the type of disorder, but there are some general signs that may indicate an eating disorder:

• Weight fluctuations: weight loss or weight gain, but people with eating disorders can also be of normal weight

• strict diets or fasting

• Binge eating or uncontrolled eating

• Eating secretly or hiding food

• Vomiting or abuse of laxatives after eating, countermeasures such as excessive exercise

• Feelings of guilt or shame after binge eating, sometimes even after normal meals

• Degradation of one’s own body, feelings such as self-loathing and disgust

• compulsive calorie counting

• Dysmorphophobia: distorted body image (seeing oneself as overweight even though one is underweight or of normal weight)

• extreme fear of gaining weight

• social withdrawal, avoidance of meals in company

Diagnosis of an eating disorder

The diagnosis of an eating disorder is often difficult because many people with eating disorders try to hide their illness from other people.

If those affected, parents or other relatives want to get professional help, the family doctor’s practice can be the first point of contact. Support is also available from the Federal Center for Health Education (BZgA). The website also contains addresses of advice centers throughout Germany.

Examinations in the medical practice

The diagnosis of an eating disorder can usually be made after a detailed conversation. However, a medical diagnosis should determine whether the symptoms may be caused by a physical illness.

Various examinations are carried out:

• Determination of body weight and height to calculate the body mass index (BMI)
• Measurement of blood pressure, pulse, body temperature
• Control of blood circulation
• Examination of cardiac function
• Blood test
• Urine test
• Examination of the liver and kidneys

Treatment of eating disorders is always necessary

Therapy depends on the type of eating disorder. The goal is to learn healthy eating habits again and also to treat the underlying or parallel psychological problems.

Various measures are available for this purpose. In principle, those affected must be willing to receive treatment.

Clinic and psychotherapy

In many cases, inpatient admission to a specialized clinic is advisable. Other options for intensive treatment include day clinics and residential groups that specialize in caring for people with eating disorders.

Psychotherapy is a crucial component of treatment. It helps those affected to discover and work through the reasons for their illness. Treatment can take place in individual and group therapy.

Behavioral therapy in combination with sport and other body-oriented therapies, art therapy or family therapy can help. Relaxation techniques and self-confidence training have also proven to be effective.

In some cases, the use of medication, often neuroleptics, is also useful. Another approach is social-educational support, which is particularly important in cases of long-standing eating disorders.

In an emergency and in cases of significant self-endangerment, compulsory admission to an inpatient facility can be considered. This is justified, for example, if the health condition of the person concerned is so threatening that there is a risk to life. The aim of treatment is initially to physically stabilize the sick person again.

Untreated eating disorders have serious consequences

All eating disorders are serious illnesses that can have serious consequences for the body and psyche. In up to ten percent of cases they are fatal.

The physical consequences include:

• Nutrient deficiency: Deficiency of essential vitamins and minerals, which can lead to anemia, bone loss (osteoporosis) and muscle weakness.

• Cardiovascular problems: irregular heartbeat, low blood pressure, heart failure and increased risk of heart attacks

• Gastrointestinal complaints: chronic constipation, irritable bowel syndrome, in severe cases life-threatening gastric perforation.

• hormonal disorders: irregular or absent menstruation in women (secondary amenorrhea) up to infertility, reduced testosterone production in men, growth disorders in adolescents.

• Tooth damage: Erosion of tooth enamel due to frequent vomiting, leading to sensitive and damaged teeth.

• Skin and hair problems: dry skin, brittle nails, hair loss or thinning hair. Severe underweight can lead to the development of lanugo hair, a downy hair on the face and back.

• Weakness and fatigue: Chronic fatigue and reduced physical performance.

The psychological effects include:

• Depression and anxiety: increased risk of depressive episodes and anxiety disorders.

• Social isolation: Withdrawal from social activities, avoidance of social situations involving eating.

• Obsessive compulsive disorder: Development of compulsive behavior, especially regarding food, weight, and exercise.

• Low self-esteem: excessive self-criticism, feeling of worthlessness and constant dissatisfaction with one’s own body.

• Emotional instability: frequent mood swings, irritability and emotional exhaustion.

Course and prognosis of eating disorders

The earlier therapy begins, the better the chances of finding a way out of the eating disorder. It is assumed that 70 to 80 percent of those affected succeed in doing so.

However, many people with eating disorders retain a difficult relationship with food even after they have recovered from the illness. They pay more attention than other people to what and how much they eat.

Just over 20 percent of people with anorexia experience repeated relapses or a chronic course.

It is crucial that those affected are willing to start therapy. A stable social environment is an important support in this regard.