Eating disorder

An eating disorder is a mental disorder defined by abnormal eating habits that negatively affect a person’s physical and/or mental health.[1] They include binge eating disorder, where people eat a large amount in a short period of time; anorexia nervosa, where people eat very little due to a fear of gaining weight and thus have a low body weight; bulimia nervosa, where people eat a lot and then try to rid themselves of the food; pica, where people eat non-food items; rumination syndrome, where people regurgitate food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons (see below); and a group of other specified feeding or eating disorders.[1] Anxiety disorders, depression and substance abuse are common among people with eating disorders.[2] These disorders do not include obesity.[1]

The causes of eating disorders are not clear, although both biological and environmental factors appear to play a role.[2][3] Eating disorders affect about 12 percent of dancers.[4] Cultural idealization of thinness is believed to contribute to some eating disorders.[3] Individuals who have experienced sexual abuse are also more likely to develop eating disorders.[6] Some disorders such as pica and rumination disorder occur more often in people with intellectual disabilities.[1] Only one eating disorder can be diagnosed at a given time.[1]

Treatment can be effective for many eating disorders.[2] Treatment varies by disorder and may involve counselling, dietary advice, reducing excessive exercise and the reduction of efforts to eliminate food.[2] Medications may be used to help with some of the associated symptoms.[2] Hospitalization may be needed in more serious cases.[2] About 70% of people with anorexia and 50% of people with bulimia recover within five years.[8] Recovery from binge eating disorder is less clear and estimated at 20% to 60%.[8] Both anorexia and bulimia increase the risk of death.[8]

In the developed world, anorexia affects about 0.4% and bulimia affects about 1.3% of young women in a given year.[1] Binge eating disorder affects about 1.6% of women and 0.8% of men in a given year.[1] Among women about 4% have anorexia, 2% have bulimia, and 2% have binge eating disorder at some time in their life.[8] Rates of eating disorders appear to be lower in less developed countries.[9] Anorexia and bulimia occur nearly ten times more often in females than males.[1] Eating disorders typically begin in late childhood or early adulthood.[2] Rates of other eating disorders are not clear.[1]

Classification

Bulimia nervosa is a disorder characterized by episodes of binge eating and purging, as well as excessive evaluation of one’s self-worth in terms of body weight or shape. Purging can include self-induced vomiting, over-exercising, and the use of diuretics, enemas, or laxatives.[1]

Anorexia nervosa is characterized by extreme food restriction, low body weight, and the fear of becoming fat.[1] Pubertal and post-pubertal females with anorexia often experience amenorrhea, or the loss of menstrual periods, due to the extreme weight loss these individuals face. Although amenorrhea was a required criterion for a diagnosis of anorexia in the DSM-IV, it was dropped in the DSM-5 due to its exclusive nature, as male, post-menopause women, or individuals who do not menstruate for other reasons would fail to meet this criterion.[10] Females with bulimia may also experience amenorrhea, although the cause is not clear.[11]

Two subtypes of anorexia nervosa are specified in the DSM-5—restricting type and binge-eating/purging type. Those who have the restricting type of anorexia nervosa restrict food intake and do not engage in binge eating, whereas those with the binge/purge type lose control over their eating at least occasionally and may compensate for these binge episodes. Although similar in presentation to bulimia, individuals with the binge-eating/purging subtype of anorexia are typically underweight, whereas those with bulimia tend to be normal weight or overweight.[11][12]

ICD and DSM

These eating disorders are specified as mental disorders in standard medical manuals, including the ICD-10 and the DSM-5.

  • Anorexia nervosa (AN) is characterized by lack of maintenance of a healthy body weight, an obsessive fear of gaining weight or refusal to do so, and an unrealistic perception, or non-recognition of the seriousness, of current low body weight.[13] Patients suffering from anorexia nervosa use laxatives, vomiting or diuretics to rid themselves of calories. [14]
  • Bulimia nervosa (BN) is characterized by recurrent binge eating followed by compensatory behaviors such as purging (self-induced vomiting, eating to the point of vomiting, excessive use of laxatives/diuretics, or excessive exercise). Fasting may also be used as a method of purging following a binge. However, unlike anorexia nervosa, body weight is maintained at or above a minimally normal level.
  • Binge eating disorder (BED) is characterized by recurring binge eating at least once a week for over a period of 3 months while experiencing lack of control and guilt after overeating.[1] There are no compensatory behaviors. However, unlike anorexia nervosa, body weight is maintained at or above a minimally normal level. The disorder can develop in individuals of a wide range of ages and socioeconomic classes.[15][16]
  • Other Specified Feeding or Eating Disorder (OSFED) is an eating or feeding disorder that does not meet full DSM-5 criteria for AN, BN, or BED. Examples of otherwise-specified eating disorders include individuals with atypical anorexia nervosa, who meet all criteria for AN except being underweight despite substantial weight loss; atypical bulimia nervosa, who meet all criteria for BN except that bulimic behaviors are less frequent or have not been ongoing for long enough; purging disorder; and night eating syndrome.[1]

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Other

  • Avoidant/restrictive food intake disorder (ARFID), which includes cases characterized by strict adherence to a limited repertoire of foods (“restriction”, former “selective eating disorder”), and cases with fears of eating secondary to fears of choking or vomiting (phobic, “avoidant”).[1][17]
  • Compulsive overeating, which may include habitual “grazing” of food or episodes of binge eating without feelings of guilt.[18]
  • Diabulimia, which is characterized by the deliberate manipulation of insulin levels by diabetics in an effort to control their weight.
  • Drunkorexia, which is commonly characterized by purposely restricting food intake in order to reserve food calories for alcoholic calories, exercising excessively in order to burn calories from drinking, and over-drinking alcohol in order to purge previously consumed food.[19]
  • Food maintenance, which is characterized by a set of aberrant eating behaviors of children in foster care.[20]
  • Night eating syndrome, which is characterized by nocturnal hyperphagia (consumption of 25% or more of the total daily calories after the evening meal) with nocturnal ingestions, insomnia, loss of morning appetite and depression.
  • Nocturnal sleep-related eating disorder, which is a parasomnia characterized by eating, habitually out-of-control, while in a state of NREM sleep, with no memory of this the next morning.
  • Gourmand syndrome, a rare condition occurring after damage to the frontal lobe. Individuals develop an obsessive focus on fine foods.[21]
  • Orthorexia nervosa, a term used by Steven Bratman to describie an obsession with a “pure” diet, in which a person develops an obsession with avoiding unhealthy foods to the point where it interferes with the person’s life.[22]
  • Klüver-Bucy syndrome, caused by bilateral lesions of the medial temporal lobe, includes compulsive eating, hypersexuality, hyperorality, visual agnosia, and docility.
  • Prader-Willi syndrome, a genetic disorder associated with insatiable appetite and morbid obesity.
  • Pregorexia, which is characterized by extreme dieting and over-exercising in order to control pregnancy weight gain. Prenatal undernutrition is associated with low birth weight, coronary heart disease, type 2 diabetes, stroke, hypertension, cardiovascular disease risk, and depression.[23]
  • Muscle dysmorphia is characterized by appearance preoccupation that one’s own body is too small, too skinny, insufficiently muscular, or insufficiently lean. Muscle dysmorphia affects mostly males.
  • Purging disorder. Recurrent purging behavior to influence weight or shape in the absence of binge eating. [1] It is more properly a disorder of elimination rather than eating disorder.

Symptoms and Long-term effects

Symptoms and complications vary according to the nature and severity of the eating disorder:[24]

Associated physical symptoms of eating disorders include weakness, fatigue, sensitivity to cold, reduced beard growth in men, reduction in waking erections, reduced libido, weight loss and growth failure.[28] Frequent vomiting, which may cause acid reflux or entry of acidic gastric material into the laryngoesophageal tract, can lead to unexplained hoarseness. As such, individuals who induce vomiting as part of their eating disorder, such as those with anorexia nervosa, binge eating-purging type or those with purging-type bulimia nervosa, are at risk for acid reflux.

Possible complications
acne xerosis amenorrhoea tooth loss, cavities
constipation diarrhea water retention and/or edema lanugo
telogen effluvium cardiac arrest hypokalemia death
osteoporosis[25] electrolyte imbalance hyponatremia brain atrophy[26][27]
pellagra[29] scurvy kidney failure suicide[30][31][32]

Associated physical symptoms of eating disorders include weakness, fatigue, sensitivity to cold, reduced beard growth in men, reduction in waking erections, reduced libido, weight loss and growth failure.[28]

Frequent vomiting, which may cause acid reflux or entry of acidic gastric material into the laryngoesophageal tract, can lead to unexplained hoarseness. As such, individuals who induce vomiting as part of their eating disorder, such as those with anorexia nervosa, binge eating-purging type or those with purging-type bulimia nervosa, are at risk for acid reflux.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women. Though often associated with obesity it can occur in normal weight individuals. PCOS has been associated with binge eating and bulimic behavior.[33][34][35][36][37][38]

Other possible manifestations are dry lips,[39] burning tongue,[39] parotid gland swelling,[39] and temporomandibular disorders.[39]

Environmental influences

Child maltreatment

Child abuse which encompasses physical, psychological and sexual abuse, as well as neglect has been shown to approximately triple the risk of an eating disorder.[99] Sexual abuse appears to about double the risk of bulimia; however, the association is less clear for anorexia.[99]

Social isolation

Social isolation has been shown to have a deleterious effect on an individual’s physical and emotional well-being. Those that are socially isolated have a higher mortality rate in general as compared to individuals that have established social relationships. This effect on mortality is markedly increased in those with pre-existing medical or psychiatric conditions, and has been especially noted in cases of coronary heart disease. “The magnitude of risk associated with social isolation is comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors.” (Brummett et al.)

Social isolation can be inherently stressful, depressing and anxiety-provoking. In an attempt to ameliorate these distressful feelings an individual may engage in emotional eating in which food serves as a source of comfort. The loneliness of social isolation and the inherent stressors thus associated have been implicated as triggering factors in binge eating as well.[100][101][102][103]

Waller, Kennerley and Ohanian (2007) argued that both bingeing–vomiting and restriction are emotion suppression strategies, but they are just utilized at different times. For example, restriction is used to pre-empt any emotion activation, while bingeing–vomiting is used after an emotion has been activated.[104]

Parental influence

Parental influence has been shown to be an intrinsic component in the development of eating behaviors of children. This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents’ own body shape and eating patterns, the degree of involvement and expectations of their children’s eating behavior as well as the interpersonal relationship of parent and child. This is in addition to the general psychosocial climate of the home and the presence or absence of a nurturing stable environment. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders. As to the more subtle aspects of parental influence, it has been shown that eating patterns are established in early childhood and that children should be allowed to decide when their appetite is satisfied as early as the age of two. A direct link has been shown between obesity and parental pressure to eat more.

Coercive tactics in regard to diet have not been proven to be efficacious in controlling a child’s eating behavior. Affection and attention have been shown to affect the degree of a child’s finickiness and their acceptance of a more varied diet.[105][106][107][108][109][110]

Adams and Crane (1980), have shown that parents are influenced by stereotypes that influence their perception of their child’s body. The conveyance of these negative stereotypes also affects the child’s own body image and satisfaction.[111] Hilde Bruch, a pioneer in the field of studying eating disorders, asserts that anorexia nervosa often occurs in girls who are high achievers, obedient, and always trying to please their parents. Their parents have a tendency to be over-controlling and fail to encourage the expression of emotions, inhibiting daughters from accepting their own feelings and desires. Adolescent females in these overbearing families lack the ability to be independent from their families, yet realize the need to, often resulting in rebellion. Controlling their food intake may make them feel better, as it provides them with a sense of control.[112]

Peer pressure

In various studies such as one conducted by The McKnight Investigators, peer pressure was shown to be a significant contributor to body image concerns and attitudes toward eating among subjects in their teens and early twenties.

Eleanor Mackey and co-author, Annette M. La Greca of the University of Miami, studied 236 teen girls from public high schools in southeast Florida. “Teen girls’ concerns about their own weight, about how they appear to others and their perceptions that their peers want them to be thin are significantly related to weight-control behavior”, says psychologist Eleanor Mackey of the Children’s National Medical Center in Washington and lead author of the study. “Those are really important.”

According to one study, 40% of 9- and 10-year-old girls are already trying to lose weight.[113] Such dieting is reported to be influenced by peer behavior, with many of those individuals on a diet reporting that their friends also were dieting. The number of friends dieting and the number of friends who pressured them to diet also played a significant role in their own choices.[114][115][116][117]

Elite athletes have a significantly higher rate in eating disorders. Female athletes in sports such as gymnastics, ballet, diving, etc. are found to be at the highest risk among all athletes. Women are more likely than men to acquire an eating disorder between the ages of 13–25. 0–15% of those with bulimia and anorexia are men.[118]

Other psychological problems that could possibly create an eating disorder such as Anorexia Nervosa are depression, and low self-esteem. Depression is a state of mind where emotions are unstable causing a person’s eating habits to change due to sadness and no interest of doing anything. According to PSYCOM “Studies show that a high percentage of people with an eating disorder will experience depression.”[119] Depression is a state of mind where people seem to refuge without being able to get out of it. A big factor of this can affect people with their eating and this can mostly affect teenagers. Teenagers are big candidates for Anorexia for the reason that during the teenage years, many things start changing and they start to think certain ways. According to Life Works an article about eating disorders “People of any age can be affected by pressure from their peers, the media and even their families but it is worse when you’re a teenager at school.” [120] Teenagers can develop eating disorder such as Anorexia due to peer pressure which can lead to Depression. Many teens start off this journey by feeling pressure for wanting to look a certain way of feeling pressure for being different. This brings them to finding the result in eating less and soon leading to Anorexia which can bring big harms to the physical state.

Cultural pressure

There is a cultural emphasis on thinness which is especially pervasive in western society. A child’s perception of external pressure to achieve the ideal body that is represented by the media predicts the child’s body image dissatisfaction, body dysmorphic disorder and an eating disorder.[121] “The cultural pressure on men and women to be ‘perfect’ is an important predisposing factor for the development of eating disorders”.[122][123] Further, when women of all races base their evaluation of their self upon what is considered the culturally ideal body, the incidence of eating disorders increases.[124]

Socioeconomic status (SES) has been viewed as a risk factor for eating disorders, presuming that possessing more resources allows for an individual to actively choose to diet and reduce body weight.[125] Some studies have also shown a relationship between increasing body dissatisfaction with increasing SES.[126] However, once high socioeconomic status has been achieved, this relationship weakens and, in some cases, no longer exists.[127]

The media plays a major role in the way in which people view themselves. Countless magazine ads and commercials depict thin celebrities like Lindsay Lohan, Nicole Richie, Victoria Beckham and Mary Kate Olsen, who appear to gain nothing but attention from their looks. Society has taught people that being accepted by others is necessary at all costs.[128] Unfortunately this has led to the belief that in order to fit in one must look a certain way. Televised beauty competitions such as the Miss America Competition contribute to the idea of what it means to be beautiful because competitors are evaluated on the basis of their opinion.[129]

In addition to socioeconomic status being considered a cultural risk factor so is the world of sports. Athletes and eating disorders tend to go hand in hand, especially the sports where weight is a competitive factor. Gymnastics, horse back riding, wrestling, body building, and dancing are just a few that fall into this category of weight dependent sports. Eating disorders among individuals that participate in competitive activities, especially women, often lead to having physical and biological changes related to their weight that often mimic prepubescent stages. Oftentimes as women’s bodies change they lose their competitive edge which leads them to taking extreme measures to maintain their younger body shape. Men often struggle with binge eating followed by excessive exercise while focusing on building muscle rather than losing fat, but this goal of gaining muscle is just as much an eating disorder as obsessing over thinness. The following statistics taken from Susan Nolen-Hoeksema’s book, (ab)normal psychology, show the estimated percentage of athletes that struggle with eating disorders based on the category of sport.

  • Aesthetic sports (dance, figure skating, gymnastics) – 35%
  • Weight dependent sports (judo, wrestling) – 29%
  • Endurance sports (cycling, swimming, running) – 20%
  • Technical sports (golf, high jumping) – 14%
  • Ball game sports (volleyball, soccer) – 12%

Although most of these athletes develop eating disorders to keep their competitive edge, others use exercise as a way to maintain their weight and figure. This is just as serious as regulating food intake for competition. Even though there is mixed evidence showing at what point athletes are challenged with eating disorders, studies show that regardless of competition level all athletes are at higher risk for developing eating disorders that non-athletes, especially those that participate in sports where thinness is a factor.[130]

Pressure from society is also seen within the homosexual community. Gay men are at greater risk of eating disorder symptoms than heterosexual men.[131] Within the gay culture, muscularity gives the advantages of both social and sexual desirability and also power.[132] These pressures and ideas that another homosexual male may desire a mate who is thinner or muscular can possibly lead to eating disorders. The higher eating disorder symptom score reported, the more concern about how others perceive them and the more frequent and excessive exercise sessions occur.[132] High levels of body dissatisfaction are also linked to external motivation to working out and old age; however, having a thin and muscular body occurs within younger homosexual males than older.[131][132]

Most of the cross-cultural studies use definitions from the DSM-IV-TR, which has been criticized as reflecting a Western cultural bias. Thus, assessments and questionnaires may not be constructed to detect some of the cultural differences associated with different disorders. Also, when looking at individuals in areas potentially influenced by Western culture, few studies have attempted to measure how much an individual has adopted the mainstream culture or retained the traditional cultural values of the area. Lastly, the majority of the cross-cultural studies on eating disorders and body image disturbances occurred in Western nations and not in the countries or regions being examined.[11]

While there are many influences to how an individual processes their body image, the media does play a major role. Along with the media, parental influence, peer influence, and self-efficacy beliefs also play a large role in an individual’s view of themselves. The way the media presents images can have a lasting effect on an individual’s perception of their body image. Eating disorders are a worldwide issue and while women are more likely to be affected by an eating disorder it still affects both genders (Schwitzer 2012). The media influences eating disorders whether shown in a positive or negative light, it then has a responsibility to use caution when promoting images that projects an ideal that many turn to eating disorders to attain.[133]

To try to address unhealthy body image in the fashion world, in 2015, France passed a law requiring models to be declared healthy by a doctor to participate in fashion shows. It also requires re-touched images to be marked as such in magazines.[134]

There is a relationship between “thin ideal” social media content and body dissatisfaction and eating disorders among young adult women, especially in the Western hemisphere.[135] New research points to an “internalization” of distorted images online, as well as negative comparisons among young adult women.[136] Most studies have been based in the U.S, the U.K, and Australia, these are places where the thin ideal is strong among women, as well as the strive for the “perfect” body.[136]

In addition to mere media exposure, there is an online “pro-eating disorder” community. Through personal blogs and Twitter, this community promotes eating disorders as a “lifestyle”, and continuously posts pictures of emaciated bodies, and tips on how to stay thin. The hashtag “#proana” (pro-anorexia), is a product of this community,[137] as well as images promoting weight loss, tagged with the term “thinspiration”. According to social comparison theory, young women have a tendency to compare their appearance to others, which can result in a negative view of their own bodies and altering of eating behaviors, that in turn can develop disordered eating behaviors.[138]

When body parts are isolated and displayed in the media as objects to be looked at, it is called objectification, and women are affected most by this phenomenon. Objectification increases self-objectification, where women judge their own body parts as a mean of praise and pleasure for others. There is a significant link between self-objectification, body dissatisfaction, and disordered eating, as the beauty ideal is altered through social media.[135]

While eating disorders are typically under diagnosed in people of color, they still experience eatings disorders in great numbers. It is thought that the stress that women of color face in the United States from being multiply marginalized may contribute to their rates of eating disorders. Eating disorders, for these women, may be a response to environmental stressors such as racism, abuse and poverty.[139]

African perspective

In the majority of many African communities, thinness is generally not seen as an ideal body type and most pressure to attain a slim figure may stem from influence or exposure to Western culture and ideology. Traditional African cultural ideals are reflected in the practice of some health professionals; in Ghana, pharmacists sell appetite stimulants to women who desire to, as Ghanaians stated, “grow fat”.[140] Girls are told that if they wish to find a partner and birth children they must gain weight. On the contrary, there are certain taboos surrounding a slim body image, specifically in West Africa. Lack of body fat is linked to poverty and HIV/AIDS.[141]

However, the emergence of Western and European influence, specifically with the introduction of such fashion and modelling shows and competitions, is changing certain views among body acceptance, and the prevalence of eating disorders has consequently increased.[141] This acculturation is also related to how South Africa is concurrently undergoing rapid, intense urbanization. Such modern development is leading to cultural changes, and professionals cite rates of eating disorders in this region will increase with urbanization, specifically with changes in identity, body image, and cultural issues.[142] Further, exposure to Western values through private Caucasian schools or caretakers is another possible factor related to acculturation which may be associated with the onset of eating disorders.[143]

Other factors which are cited to be related to the increasing prevalence of eating disorders in African communities can be related to sexual conflicts, such as psychosexual guilt, first sexual intercourse, and pregnancy. Traumatic events which are related to both family (i.e. parental separation) and eating related issues are also cited as possible effectors.[143] Religious fasting, particularly around times of stress, and feelings of self-control are also cited as determinants in the onset of eating disorders.[144]

Asian perspective

The West plays a role in Asia’s economic development via foreign investments, advanced technologies joining financial markets, and the arrival of American and European companies in Asia, especially through outsourcing manufacturing operations.[145] This exposure to Western culture, especially the media, imparts Western body ideals to Asian society, termed Westernization.[145] In part, Westernization fosters eating disorders among Asian populations.[145] However, there are also country-specific influences on the occurrence of eating disorders in Asia.[145]

Prevention

Prevention aims to promote a healthy development before the occurrence of eating disorders. It also intends early identification of an eating disorder before it is too late to treat. Children as young as ages 5–7 are aware of the cultural messages regarding body image and dieting.[239] Prevention comes in bringing these issues to the light. The following topics can be discussed with young children (as well as teens and young adults).

  • Emotional Bites: a simple way to discuss emotional eating is to ask children about why they might eat besides being hungry. Talk about more effective ways to cope with emotions, emphasizing the value of sharing feelings with a trusted adult.[240]
  • Say No to Teasing: another concept is to emphasize that it is wrong to say hurtful things about other people’s body sizes.[241]
  • Body Talk: emphasize the importance of listening to one’s body. That is, eating when you are hungry (not starving) and stopping when you are satisfied (not stuffed). Children intuitively grasp these concepts.[240]
  • Fitness Comes in All Sizes: educate children about the genetics of body size and the normal changes occurring in the body. Discuss their fears and hopes about growing bigger. Focus on fitness and a balanced diet.[242]

Internet and modern technologies provide new opportunities for prevention. On-line programs have the potential to increase the use of prevention programs.[243] The development and practice of prevention programs via on-line sources make it possible to reach a wide range of people at minimal cost.[244] Such an approach can also make prevention programs to be sustainable.

Treatment

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Treatment varies according to type and severity of eating disorder, and usually more than one treatment option is utilized.[245] Family doctors play an important role in early treatment of people with eating disorders by encouraging those who are also reluctant to see a psychiatrist.[246] Treatment can take place in a variety of different settings such as community programs, hospitals, day programs, and groups.[247] The American Psychiatric Association (APA) recommends a team approach to treatment of eating disorders. The members of the team are usually a psychiatrist, therapist, and registered dietitian, but other clinicians may be included.[248]

That said, some treatment methods are:

Two pharmaceuticals, Prozac[282] and Vyvanse,[283] have been approved by the FDA to treat bulimia nervosa and binge-eating disorder, respectively. Olanzapine has also been used off-label to treat anorexia nervosa.[284] Studies are also underway to explore psychedelic and psychedelic-adjacent medicines such as MDMA, psilocybin and ketamine for anorexia nervosa and binge-eating disorder.[285]

There are few studies on the cost-effectiveness of the various treatments.[286] Treatment can be expensive;[287][288] due to limitations in health care coverage, people hospitalized with anorexia nervosa may be discharged while still underweight, resulting in relapse and rehospitalization.[289]

For children with anorexia, the only well-established treatment is the family treatment-behavior.[290] For other eating disorders in children, however, there is no well-established treatments, though family treatment-behavior has been used in treating bulimia.[290]

A 2019 Cochrane review examined studies comparing the effectiveness of inpatient versus outpatient models of care for eating disorders. Four trials including 511 participants were studied but the review was unable to draw any definitive conclusions as to the superiority of one model over another.[291]

Outcomes

For anorexia nervosa, bulimia nervosa, and binge eating disorder, there is a general agreement that full recovery rates are in the 50% to 85% range, with larger proportions of people experiencing at least partial remission.[280][292][293][294] It can be a lifelong struggle or it can be overcome within months.

  • Miscarriages: Pregnant women with a binge eating disorder have shown to have a greater chance of having a miscarriage compared to pregnant women with any other eating disorders. According to a study done, out of a group of pregnant women being evaluated, 46.7% of the pregnancies ended with a miscarriage in women that were diagnosed with BED, with 23.0% in the control. In the same study, 21.4% of women diagnosed with Bulimia Nervosa had their pregnancies end with miscarriages and only 17.7% of the controls.[295]
  • Relapse: An individual who is in remission from BN and EDNOS (Eating Disorder Not Otherwise Specified) is at a high risk of falling back into the habit of self-harm. Factors such as high stress regarding their job, pressures from society, as well as other occurrences that inflict stress on a person, can push a person back to what they feel will ease the pain. A study tracked a group of selected people that were either diagnosed with BN or EDNOS for 60 months. After the 60 months were complete, the researchers recorded whether or not the person was having a relapse. The results found that the probability of a person previously diagnosed with EDNOS had a 41% chance of relapsing; a person with BN had a 47% chance.[296]
  • Attachment insecurity: People who are showing signs of attachment anxiety will most likely have trouble communicating their emotional status as well as having trouble seeking effective social support. Signs that a person has adopted this symptom include not showing recognition to their caregiver or when he/she is feeling pain. In a clinical sample, it is clear that at the pretreatment step of a patient’s recovery, more severe eating disorder symptoms directly corresponds to higher attachment anxiety. The more this symptom increases, the more difficult it is to achieve eating disorder reduction prior to treatment.[297]

Anorexia symptoms include the increasing chance of getting osteoporosis. Thinning of the hair as well as dry hair and skin are also very common. The muscles of the heart will also start to change if no treatment is inflicted on the patient. This causes the heart to have an abnormally slow heart rate along with low blood pressure. Heart failure becomes a major consideration when this begins to occur.[298] Muscles throughout the body begin to lose their strength. This will cause the individual to begin feeling faint, drowsy, and weak. Along with these symptoms, the body will begin to grow a layer of hair called lanugo. The human body does this in response to the lack of heat and insulation due to the low percentage of body fat.[299]

Bulimia symptoms include heart problems like an irregular heartbeat that can lead to heart failure and death may occur. This occurs because of the electrolyte imbalance that is a result of the constant binge and purge process. The probability of a gastric rupture increases. A gastric rupture is when there is a sudden rupture of the stomach lining that can be fatal.The acids that are contained in the vomit can cause a rupture in the esophagus as well as tooth decay. As a result, to laxative abuse, irregular bowel movements may occur along with constipation. Sores along the lining of the stomach called peptic ulcers begin to appear and the chance of developing pancreatitis increases.[299]

Binge eating symptoms include high blood pressure, which can cause heart disease if it is not treated. Many patients recognize an increase in the levels of cholesterol. The chance of being diagnosed with gallbladder disease increases, which affects an individual’s digestive tract.[299]

Risk of death

Eating disorders result in about 7,000 deaths a year as of 2010, making them the mental illnesses with the highest mortality rate.[300] Anorexia has a risk of death that is increased about 5 fold with 20% of these deaths as a result of suicide.[301] Rates of death in bulimia and other disorders are similar at about a 2 fold increase.[301]

The mortality rate for those with anorexia is 5.4 per 1000 individuals per year. Roughly 1.3 deaths were due to suicide. A person who is or had been in an inpatient setting had a rate of 4.6 deaths per 1000. Of individuals with bulimia about 2 persons per 1000 persons die per year and among those with EDNOS about 3.3 per 1000 people die per year.[301]