Eating disorder symptoms: Anorexia, Bulimia, Binge eating, ARFID & more

Key Points

• Common eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, orthorexia, and pica.
• Eating disorders are serious mental health issues with severe health consequences.
• Learning the signs and symptoms of different eating disorders can help you or a loved one get help.
• Nutritional counseling by Registered Dietitian Nutritionists is a critical part of eating disorder treatment and recovery.

Eating disorders are mental health conditions that affect almost 30 million Americans during their lifetime. 

Unless they are treated early, eating disorders can cause serious health issues, including damage to the heart and other vital organs, and even lead to death.

Anorexia or Anorexia Nervosa (AN)

Anorexia nervosa develops during adolescence, around 15 years of age, and is more often found in females. It has the highest death rate compared to all mental health disorders, including death by suicide.

What is anorexia nervosa?

Anorexia nervosa is a life-threatening eating disorder that is characterized by an:

• Unhealthy low body weight.
• Intense fear of gaining weight.
• Unrealistic and distorted view of weight and body shape.
• Extreme effort to lose weight, which may include the misuse of laxatives, diuretics, and weight loss drugs.

Registered Dietitian Rita Faycurry, RD, elaborates, "People with anorexia may also cut out entire food groups in an attempt to lose weight and check their weight often, gaze at themselves in mirrors more frequently, and obsess over being thin. Getting help early can help improve the chances of recovery from anorexia. This includes nutritional counseling by experienced Registered Dietitian Nutritionists."

There is a subset of anorexia where individuals binge on large amounts of food and then purge. The difference between this and bulimia nervosa is a near-normal weight range. Studies show that binge purge anorexia occurs in 47% of people who were hospitalized with anorexia.

Binge purge anorexia may also involve food restriction followed by periods of binge eating and purging.

Health risks of anorexia nervosa

There are many health risks from anorexia nervosa, including:

• Extremely dry skin and brittle nails.
• Gastric issues like constipation, abdominal pain, stomach cramps, acid reflux, and much more.
• Problems with the heart include an irregular heart rate, slow heart rate, and low blood pressure (hypotension).
• Infertility, irregular menstrual cycles, and even missed periods.
• Growth of soft, fine hair called lanugo which helps keep the body warm when there is not enough body fat. Usually, lanugo covers a fetus or a prematurely born baby to keep them warm.
• Dental issues from purging, including gum disease, bleeding gums, cavities, and more.
• Long-term effects can also include slow growth and body development.
• Osteopenia because bones become brittle due to a lack of calcium, putting the individual at a greater risk for fractures.
• Thinning hair.

Bulimia or Bulimia Nervosa (BN)

Bulimia is more common than anorexia. It can affect people of any age and sex, but 90-95% of people with bulimia are female. Bulimia nervosa develops in early teens and early adulthood.

What is bulimia nervosa?

Bulimia is characterized by:

• Eating a lot of food in a short amount of time, for example, within a two-hour period (binge eating).
• A feeling of a loss of control during the binge (people feel unable to stop eating during the binge).
• Purging after the binge by forced vomiting, the use of laxatives or diuretics, food restrictions, or excessive exercise.
• An intense fear of gaining weight.

Health risks of bulimia nervosa

There are many health consequences of having bulimia nervosa, including:

• Tooth decay from forced vomiting.
• Sore throat.
• Acid reflux.
• Severe dehydration, which causes kidney stones or even kidney failure.
• Dizziness or fainting.
• Sleep-related issues.
• Dental problems caused by purging include enamel erosion, gum disease, bleeding gums, cavities, tooth decay, swallowing issues, and more.
• Inflammation and tears in the throat.
• An imbalance of electrolytes.

Regarding body weight, people with bulimia may be in any weight range, and many may maintain a near-normal range of weight.

Binge eating disorder (BED)

Binge eating disorder (BED) is the leading eating disorder in the United States. It usually begins during adolescence and affects mostly females, although one-third of people with BED are male.

The condition is a more recent addition to the Diagnostic and Statistical Manual of Mental Disorders (DSM); it was added in 2013.

What is binge eating disorder?

Binge eating disorder is characterized by:

• Eating a lot of food in a short amount of time (for example, a two-hour time period).
• A feeling of loss of control or dissociation during a binge (they may feel like they cannot stop binge eating).
• Eating faster and continue to eat even after feeling full or not hungry.
• Many who binge eat may eat alone out of embarrassment.
• Feelings of guilt, shame, and stress after a binge.
• No purging, laxative misuse, or excessive exercise after a binge.

If someone binges at least once a week for three months, it can be considered binge eating disorder.

Health risks of binge eating disorder

Health consequences of binge eating disorder include:

• A high risk of obesity
• Type 2 diabetes
• Metabolic conditions include high blood pressure, high cholesterol, high blood glucose, midsection obesity, and more.
• Heart disease
• Stroke
• Digestive issues like heartburn, acid reflux, bloating, diarrhea, and more.

Faycurry says, "Treatment for binge eating disorder is highly personalized. Psychotherapy, like cognitive behavioral therapy, can help people address underlying reasons why they binge. Additionally, nutritional counseling by an expert Registered Dietitian can help the individual develop a healthier relationship with food, balance their meals, and establish better eating habits."

Want help for an eating disorder but worried about the cost? Fay can help you get eating disorder treatment that fits your life, covered by your insurance. 

Avoidant restrictive food intake disorder (ARFID)

ARFID, or Avoidant Restrictive Food Intake Disorder, typically occurs during the first seven years of life and can continue into adulthood.

What is ARFID?

ARFID involves disrupted eating patterns, but not due to concerns about weight gain or body image. Individuals with ARFID may eat less than they need, often because they have little interest in food or a reduced appetite.

Sensory issues can also lead them to avoid certain foods that they find unpleasant in smell, taste, or texture. Additionally, some may restrict their diet due to a severe fear of choking or other negative effects of eating.

ARFID is closely related to autism spectrum disorder, anxiety disorder, and attention deficit hyperactivity disorder (ADHD). Other related conditions are learning disorders, obsessive-compulsive disorder (OCD),

What is the difference between ARFID and picky eating?

Rita Faycurry RD explains, “ARFID goes beyond what you might call extreme picky eating. It's a serious condition where kids might not hit their weight goals or might even lose weight quickly because they're just not eating enough. Unlike typical picky eaters who might not like but still eat certain foods, those with ARFID often experience intense anxiety about eating, especially in social settings or away from home. The anxiety from ARFID can be so overwhelming that it completely prevents them from eating certain foods.”

People with ARFID often simply forget to eat or don't think about food at all. In contrast, picky eaters feel hungry and will eat when they see foods they like.

Health risks of ARFID

ARFID is characterized by:

• Extreme weight loss and, depending on the severity, the individual may require hospitalization.
• Severe malnutrition.
• Heart conditions like irregular heartbeat and low blood pressure.
• Delayed puberty.
• Stunted growth.
• Severe nutritional deficiencies.
• Dependence on food supplements or even a feeding tube for nutrition.
• Low bone density.

Pica

The term "pica" is derived from 'pica-pica,' a Latin word for magpie, a bird notorious for collecting and consuming various objects out of curiosity. The condition seems to affect young children and females who are pregnant.

What is pica?

Pica is an eating disorder where an individual eats items that do not have any nutritional value over a time period of at least a month.

Examples of pica include eating:

• Chalk
• Paint
• Paper
• Cloth
• Dirt
• Rocks, and much more.

Faycurry, RD, elaborates, “Pica is not the same as biting your nails. Someone with pica compulsively eats objects that are not food, even if they get sick from this behavior. It is a psychological problem that may co-exist with autism spectrum disorder, schizophrenia, and other conditions.”

Health risks of pica

Health consequences of pica include:

• Stomach issues
• Abdominal pain
• Blood in the poop
• Intestinal tears
• Constipation, diarrhea, or a blocked gut.
• Dizziness
• Trouble sleeping
• Thinning or falling hair
• Brain fog and difficulty concentrating
• Low immunity.

"In some cases, an iron deficiency or malnutrition can cause pica. Along with psychiatric counseling, a Registered Dietitian may assess nutritional deficiencies and correct them."

Orthorexia

What is orthorexia?

Orthorexia is an obsession with eating "clean," "pure," or "healthy" foods.

Signs of orthorexia

People with orthorexia fixate on nutritional labels and the quality of food they're eating. They may have rigid rules around eating certain food groups and may avoid foods they consider "bad."

They may experience severe distress and anxiety if they are unable to follow their stringent rules surrounding food, and thoughts about food can impact their quality of life and daily activities.

Orthorexia versus anorexia nervosa

Faycurry, RD, says, "Orthorexia is different from anorexia because, with orthorexia, the focus is not on weight loss but on eating healthy. Orthorexia is not an official diagnosis yet, but it does have health risks associated with it. Like with any other eating disorder, early detection and treatment are important. Treatment involves a multi-disciplinary team that covers psychotherapy and nutritional counseling. "

How do you know if you or a loved one has an eating disorder?

According to the National Eating Disorder Association (NEDA), perfectionism is a leading risk factor for an eating disorder. In particular, self-oriented perfectionism involves having unrealistic standards towards their own body weight or achievements.

Warning signs of eating disorders often include:

• Poor body image: Watch out for excessive negative self-talk and being highly sensitive about weight or the amount of food intake.
• Having food rituals: People with restrictive eating-related eating disorders may have strict rituals surrounding food and may avoid or face severe distress when they have to eat in public or at social gatherings.
• Restrictive diets: Skipping or avoiding entire food groups is also a warning sign unless it is a cultural or religious preference or an allergy or sensitivity to certain foods. People with anorexia may even cook for other people, collect recipes, and watch videos online of people eating food but continue to restrict their food intake.
• Feeling cold: Eating disorders that result in severe weight loss may also lead to the individual feeling cold all the time.
• Secrecy surrounding food: Hiding or stashing food away from other people and binge eating in secret.

If you think you or a loved one may be battling an eating disorder, consider getting help. Fay can get you started with eating disorder treatment near you, covered by insurance.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.