What Are Eating Disorders? Types, Mental Health Links, and When to Seek Help

Eating disorders are serious, brain-based mental illnesses characterized by severe and persistent disturbances in eating behaviors, thoughts about food and body weight, and a person’s sense of self-worth tied to shape or size. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies eating disorders as psychiatric conditions with defined diagnostic criteria, and every major medical organization recognizes them as life-threatening illnesses — not choices, phases, or vanity.

An estimated 9% of the U.S. population — approximately 28.8 million Americans — will develop an eating disorder in their lifetime, yet more than 70% will never access adequate treatment (Deloitte Access Economics, 2020; Alliance for Eating Disorders, 2024).

Eating disorders carry the second-highest mortality rate of any mental illness, resulting in approximately 10,200 deaths per year in the United States — one death every 52 minutes (ANAD, 2024). Identifying eating disorder symptoms, co-occurring mental health conditions, and evidence-based treatments facilitates early intervention and improves recovery outcomes.

Highlights

 ▸  28.8 million Americans will develop an eating disorder in their lifetime, and eating disorders cause roughly 10,200 deaths per year — one every 52 minutes (ANAD, 2024).

  ▸  More than 70% of people with an eating disorder will never receive adequate treatment, despite eating disorders being highly responsive to evidence-based care when caught early (Alliance for Eating Disorders, 2024).

  ▸  Up to 94% of individuals with binge eating disorder (BED) report lifetime mental health symptoms, including 70% mood disorders, 68% substance use disorders, and 59% anxiety disorders (Keski-Rahkonen, 2021).

  ▸  Up to 30% of eating disorder cases occur in males, but outdated screening tools cause men to wait an average of 18 months longer for a diagnosis than women (BCPH, 2025).

  ▸  ARFID — a fifth DSM-5 eating disorder type is especially prevalent in children and adolescents and is now treatable with cognitive-behavioral therapy for ARFID (CBT-AR), with 70–93% showing improvement (Thomas & Eddy, 2020).

  ▸  Adolescents with eating disorders are 5 times more likely to experience suicidal ideation than peers without one; 23% of people with BED have attempted suicide (Patel et al., 2021; Keski-Rahkonen, 2021).

  ▸  A 2024 clinical trial found a 50% reduction in binge days per week among BED patients receiving a GLP-1 receptor agonist, pointing to emerging pharmacological options alongside established psychotherapies (BCPH, 2025).

What Are Eating Disorders?

Eating disorders are clinically defined mental illnesses in which a person’s relationship with food, eating, and body image evokes psychological distress and functional impairment. 

The DSM-5 recognizes five primary diagnostic categories: anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified feeding or eating disorder (OSFED). Each involves distinct behavioral and psychological patterns, but all carry serious risks to physical and mental health.

A critical misconception is that eating disorders are volitional behaviors. Neuroimaging and genetic research confirm they involve structural and functional differences in brain circuits governing reward, impulse control, and interoception (the brain’s ability to sense and interpret internal body signals).

Twin studies estimate heritability for AN at 50-80% and for BN at 55-65%, establishing a substantial biological basis. A family history of an eating disorder raises an individual’s risk by 50-80% (Hoek, 2025).

What Are the Main Types of Eating Disorders?

The main types of eating disorders classified in the DSM-5 are anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, and other specified feeding or eating disorder. The table below compares their key clinical features:

Disorder	Key Feature	Gender Split	Mortality Risk	Top Co-Occurring Condition
Anorexia Nervosa (AN)	Severe restriction; distorted body image	~1:10 male: female	Highest of all mental illnesses	Anxiety, OCD
Bulimia Nervosa (BN)	Binge-purge cycles	1:9 male: female	~4%	Anxiety, mood disorders
Binge Eating Disorder (BED)	Recurrent binges; no purging	2:3.5 male: female	Elevated comorbidity risk	Mood disorders 70%; substance use 68%
ARFID	Avoidance NOT driven by weight/shape concerns	Slight male predominance	Limited data	Anxiety; autism spectrum
OSFED	Clinically significant ED symptoms; full criteria not met	39.5% M / 44.2% F of all ED cases	Varies by subtype	Depression, anxiety

Anorexia Nervosa (AN)

Anorexia nervosa is a severe eating disorder characterized by extreme restriction of food intake, an intense fear of weight gain, and a distorted perception of body size or shape. AN carries the highest mortality rate of any mental illness.

Women with AN face a mortality risk 12 times higher than women without the condition, and individuals with AN are 56 times more likely to attempt suicide (Eating Disorders Coalition, 2016). Onset occurs around puberty.

Weight restoration — supported by medical monitoring and nutritional rehabilitation — is a necessary precondition for psychological recovery, as malnutrition itself impairs the brain’s capacity to engage in therapy.

Bulimia Nervosa (BN)

Bulimia nervosa is characterized by recurrent cycles of binge eating — consuming large amounts of food in a discrete period with a subjective sense of loss of control — followed by compensatory behaviors such as self-induced vomiting, laxative misuse, fasting, or excessive exercise. 

BN is nine times more common in women than men, affecting up to 3% of women and 0.25% of men over their lifetime, with an overall mortality rate of approximately 4%.

Physiological consequences of purging include dental erosion, esophageal damage, electrolyte imbalances (dangerous shifts in sodium, potassium, and chloride that can trigger cardiac arrhythmias), and chronic gastrointestinal distress. Among DSM-5 eating disorders, BN shows the highest rates of co-occurring anxiety disorders.

Binge Eating Disorder (BED)

Binge eating disorder is the most prevalent eating disorder in the United States, affecting approximately 3.5% of women and 2% of men over their lifetime, three times more people than AN and BN combined.

BED involves recurrent episodes of consuming large quantities of food without compensatory purging, and must involve marked distress occurring at least once per week for three months to meet diagnostic criteria. 

A 2025 systematic review found that among adults in obesity treatment programs, the pooled clinical prevalence of BED was 14% — underscoring how frequently it goes undetected in weight-management settings (Calugi et al., 2025). Importantly, 94% of individuals with BED report lifetime mental health symptoms, and 23% have attempted suicide — rates that rival those seen in AN (Keski-Rahkonen, 2021).

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID is an eating disorder characterized by extreme avoidance or restriction of food intake that is not motivated by concerns about body weight or shape. Instead, ARFID is driven by sensory sensitivity to food textures, colors, or smells; fear of aversive consequences such as choking or vomiting; or a generalized lack of interest in eating. 

ARFID, added to the DSM-5 in 2013, is particularly prevalent among children, adolescents, and individuals with autism spectrum conditions or anxiety disorders. Because ARFID does not involve body image distortion, it is frequently misidentified as “picky eating” and goes untreated for years. 

Evidence-based treatment with cognitive-behavioral therapy for ARFID (CBT-AR) demonstrates strong outcomes — one study found 70% of adolescents no longer met diagnostic criteria after completing CBT-AR (Thomas & Eddy, 2020).

Other Specified Feeding or Eating Disorder (OSFED)

OSFED is a diagnostic category for clinically relevant eating disorder symptoms that do not fully meet criteria for AN, BN, or BED. Despite the “not otherwise specified” label, OSFED accounts for 39.5% of male and 44.2% of female eating disorder cases in the United States (Deloitte Access Economics, 2020). 

Common presentations entail atypical anorexia nervosa (full AN symptomatology in someone who is not underweight), purging disorder, and night eating syndrome. OSFED carries the same clinical urgency as any formal eating disorder and requires equivalent specialized assessment and treatment.

How Do Eating Disorders Affect Mental Health?

Eating disorders affect mental health through multiple intersecting pathways. They are both psychiatric conditions in their own right and powerful amplifiers of co-occurring mental health disorders — creating bidirectional relationships where each condition worsens the severity of the others.

Virtually all (97%) people hospitalized for an eating disorder have at least one co-occurring health condition, with mood and anxiety disorders being the most prevalent (Eating Disorders: The Journal of Treatment and Prevention, 2014).

The mechanisms through which eating disorders impair mental health include:

• Malnutrition and neurotransmitter depletion: Severe caloric restriction depletes the brain of essential nutrients, impairing serotonin (a neurotransmitter regulating mood, sleep, and appetite) and dopamine (a brain chemical driving motivation, reward, and pleasure) function — directly worsening depression and anxiety.
• Body image distortion: Persistent negative self-evaluation tied to body weight drives shame, social withdrawal, and deteriorating self-worth that sustain and intensify depressive and anxiety states.
• Behavioral consequences: Secrecy around binge-purge behaviors, avoidance of social eating, and chronically disrupted sleep compound psychological distress and functional impairment.
• HPA axis dysregulation: Chronic restriction or binge-purge cycles activate the hypothalamic-pituitary-adrenal (HPA) axis (the body’s central stress response system), producing elevated cortisol levels that sustain anxiety and depression.

What Is the Relationship Between Eating Disorders and Depression?

The relationship between eating disorders and depression is bidirectional and extensively documented: up to 75% of people with eating disorders also experience major depressive disorder. 

Depression is the most common co-occurring condition across all eating disorder types — present in 70% of BED cases alone (Keski-Rahkonen, 2021). The temporal relationship runs both ways: depression precedes and reinforces disordered eating as a form of emotional coping, while the physiological and psychological consequences of an eating disorder reliably produce or worsen depressive symptoms.

Treatment that addresses both conditions simultaneously is consistently associated with better outcomes and lower relapse rates than treating either condition in isolation.

What Is the Relationship Between Eating Disorders and Anxiety?

The relationship between eating disorders and anxiety is strong and frequently precedes the eating disorder itself: approximately 42% of individuals develop an anxiety disorder in childhood before eating disorder symptoms emerge, suggesting anxiety as a contributing risk factor (LAOP, 2021). 

Up to two-thirds of people with eating disorders experience at least one anxiety disorder over their lifetime. OCD is most strongly linked with AN; social anxiety disorder with BN; and generalized anxiety disorder with BED. Rigid food rituals, meal-related anxiety, and body-checking behaviors (repeatedly measuring or examining parts of the body) function as anxiety management strategies that inadvertently maintain the eating disorder.

What Is the Relationship Between Eating Disorders and Trauma?

Post-traumatic stress disorder (PTSD) and adverse childhood experiences are quite over-represented in eating disorder populations. Among individuals with BED, 32% have co-occurring PTSD (Keski-Rahkonen, 2021). 

Research on BN with PTSD found that women with both conditions showed heightened negative affect and body-shape preoccupations before meals, and the authors recommend integrating trauma-focused CBT early in treatment for this group (Tantillo et al., 2025). Trauma-informed care — an approach that explicitly recognizes how past trauma shapes current physiology and behavior — is considered a core component of best-practice eating disorder treatment.

What Is the Relationship Between Eating Disorders and Substance Use?

The relationship between eating disorders and substance use disorders is one of the most clinically relevant patterns in the field: up to half of people with an eating disorder misuse alcohol or illicit drugs at rates five times higher than the general population (NCASA, 2003). 

Among those with BED, 68% report lifetime substance use disorders (Keski-Rahkonen, 2021). When eating disorders and substance use co-occur, a dual-diagnosis treatment approach, addressing both conditions within the same care framework, is foundational. Treating one without the other is associated with substantially poorer outcomes and higher relapse risk.

What Neurobiological Factors Contribute to Eating Disorders?

The neurobiological factors that contribute to eating disorders are genetic predisposition, structural and functional differences in brain reward and inhibitory control circuits, and dysregulation of appetite-related hormones, including serotonin, dopamine, leptin, and ghrelin.

Twin studies consistently estimate heritability for AN at 50-80% and for BN at 55-65%. Neuroimaging studies show altered activity in the insula (a brain region processing interoception and disgust), the striatum (involved in reward processing and habit formation), and the prefrontal cortex (responsible for impulse control and decision-making) in individuals with active AN and BN. These findings explain why eating disorders are not volitional; the brain circuits governing appetite, reward, and self-regulation are demonstrably altered in affected individuals.

A major 2024 development is the emerging role of GLP-1 receptor agonists (medications originally developed for type 2 diabetes that reduce appetite by mimicking the gut hormone GLP-1) in treating BED. A 2024 clinical trial found a 50% reduction in weekly binge days among patients receiving a GLP-1 injection, opening a promising pharmacological pathway alongside established psychotherapies for this highly prevalent condition (BCPH, 2025).

What Are the Warning Signs of an Eating Disorder?

The warning signs of an eating disorder span behavioral, physical, and psychological domains. They emerge gradually, and a person does not meet full diagnostic criteria for months after early indicators first appear. Early recognition is critical because the duration of untreated illness is a consistent predictor of poorer long-term outcomes.

Behavioral Warning Signs

• Restricting food intake, skipping meals, or adhering to extremely rigid dietary rules.
• Disappearing to the bathroom consistently after meals.
• Excessive or compulsive exercise that continues despite injury, illness, or exhaustion.
• Avoiding meals with others, restaurants, or social situations involving food.
• Eating large amounts of food secretly, or consuming food unusually rapidly with apparent distress.
• Refusing entire food groups or textures without a medical reason, particularly in children.

Physical Warning Signs

• Considerable, rapid, or unexplained changes in weight.
• Consistently feeling cold, even in warm environments, a sign of slowed metabolism.
• Chronic fatigue, dizziness, or fainting.
• Hair thinning or loss; fine hair growth on the body in cases of severe AN (lanugo).
• Dental erosion, swollen jaw, or calluses on the knuckles — signs associated with purging behaviors.
• Chronic gastrointestinal symptoms: bloating, constipation, or acid reflux without a clear medical cause.

Psychological Warning Signs

• Intense, persistent preoccupation with food, weight, calories, or eating “perfectly.”
• Huge distress — anxiety, guilt, or shame — before, during, or after eating.
• Body image distortion: perceiving the body as much larger than it is, despite evidence to the contrary.
• Extreme fear of weight gain that persists even at or below a healthy weight.
• Depression, irritability, or social withdrawal that worsens around mealtimes.
• Rigid, rule-based thinking about food that causes distress when rules are violated.

What Evidence-Based Treatments Are Available for Eating Disorders?

Evidence-based treatments for eating disorders are specific, clinically validated therapeutic approaches shown in controlled research to reduce eating disorder symptoms, address underlying psychological factors, and support sustained recovery. 

A 2024 year-in-review published in Eating Disorders: The Journal of Treatment & Prevention confirmed that adapting established approaches, such as CBT and FBT, to account for specific symptom presentations and co-occurring conditions yields meaningful clinical improvements (Tantillo et al., 2025).

• Cognitive-Behavioral Therapy — Enhanced (CBT-E): CBT-E is the most extensively studied psychotherapy for eating disorders in adults and is recommended as a first-line treatment for BN and BED by international clinical guidelines. It targets cognitive distortions about body shape and weight that maintain disordered eating behaviors, addresses emotional triggers, and builds healthier coping strategies. It is effective across outpatient, intensive outpatient, and partial hospitalization settings.
• Family-Based Treatment (FBT): FBT is the preferred first-line approach for children and adolescents with AN and BN. Parents are actively involved in renourishing their child and restoring weight, a prerequisite for psychological recovery. A 2024 study found that the plate-by-plate method of meal planning within FBT supports parental self-efficacy and caregiver confidence throughout the recovery process (Hellner et al., 2024).
• Dialectical Behavior Therapy (DBT): DBT is widely used for BN and BED, where emotional dysregulation (difficulty managing intense emotions) drives binge and purge behaviors. DBT teaches distress tolerance, emotional regulation, interpersonal effectiveness, and mindfulness skills.
• Cognitive-Behavioral Therapy for ARFID (CBT-AR): CBT-AR is a 20–30-session structured treatment for ARFID, appropriate for individuals aged 10 and up. It uses staged food exposure and psychoeducation to expand dietary range and reduce anxiety around eating. Studies show 70–93% of patients demonstrate noteworthy improvement, with many no longer meeting diagnostic criteria at completion (Thomas & Eddy, 2020).
• Nutritional rehabilitation: Medical refeeding is a necessary component of AN treatment and is integrated into ARFID care when weight restoration is needed. Registered dietitians trained in eating disorder care develop individualized nutrition plans that support physical recovery while minimizing refeeding anxiety.
• Pharmacotherapy: Fluoxetine (an SSRI — a type of antidepressant that increases serotonin availability in the brain) is the only FDA-approved medication for BN. No medications are currently FDA-approved for AN; however, medications are frequently used to treat co-occurring depression, anxiety, and OCD. GLP-1 receptor agonists are showing promise for BED reduction in 2024 clinical research.

Who Else Is at Elevated Risk for Eating Disorders?

Eating disorders affect people of every gender, age, race, body size, and socioeconomic background. The clinical stereotype of a thin, white adolescent girl has obscured the prevalence of eating disorders in numerous other groups — delaying diagnosis and reducing access to care.

• Males: Up to 30% of eating disorder cases occur in males. Male-specific presentations, such as muscle dysmorphia (an obsessive drive to be more muscular) and desire for leanness rather than thinness, are poorly captured by screening tools designed for female presentations. Men wait an average of 18 months longer for diagnosis.
• LGBTQIA+ individuals: A 2021 Trevor Project survey found that 9% of LGBTQ+ youth had a formal eating disorder diagnosis, while 29% suspected they had one without a formal diagnosis. Transgender boys and nonbinary individuals assigned female at birth showed the highest rates.
• Athletes: Athletes in weight-category sports, aesthetic disciplines, or endurance events face elevated risk driven by performance pressure, normalized dietary restriction, and coaching cultures that conflate leanness with performance.
• Older adults: Globally, 13% of women over 50 experience disordered eating behaviors — a population frequently overlooked in clinical screening because practitioner attention is directed toward younger patients (International Journal of Eating Disorders, 2012).
• Individuals seeking weight loss treatment: Among adults in bariatric surgery programs, the clinical prevalence of BED is 14% by interview, making pre-surgical eating disorder screening a critical component of comprehensive weight management care (Calugi et al., 2025).

When Should You Seek Professional Help for an Eating Disorder?

You should seek professional help for an eating disorder when eating behaviors, thoughts about food or body image, or related emotional distress are precipitating terrible impairment in daily functioning, physical health, or relationships. There is no minimum severity threshold required before reaching out — early intervention consistently produces better outcomes, faster recovery, and fewer medical complications.

Seek urgent medical care when:

1. The person has fainted, is experiencing heart palpitations, or has signs of severe electrolyte imbalance — muscle cramps, weakness, or an irregular heartbeat.
2. Serious, rapid weight loss has occurred, particularly in a child or adolescent.
3. There are expressions of suicidal ideation or self-harm, given the elevated suicide risk across all eating disorder types.
4. The person is refusing all food or cannot maintain a minimally safe nutritional intake despite efforts by family or caregivers.

For non-urgent evaluation, a primary care physician, pediatrician, or licensed mental health professional with eating disorder experience performs an initial assessment, arranges medical monitoring, and provides referrals to specialists.

How Can You Support a Loved One With an Eating Disorder?

You can support a loved one with an eating disorder through patience, learning, and a deliberate focus on connection over control of their eating. The most effective approach is expressing concern without centering the conversation on food, weight, or body appearance; even positive comments about appearance inadvertently reinforce disordered thinking.

• Express concern calmly and from a place of care: focus on observable behavioral and emotional changes rather than what the person is or is not eating.
• Educate yourself on the specific disorder — understanding eating disorders as brain-based illnesses prevents unintentionally shaming or minimizing statements.
• Avoid advising about food, diets, or calories. Instead, gently encourage professional evaluation without ultimatums or threats.
• Maintain normal social connections. Social isolation worsens eating disorder symptoms; continuing to invite the person to activities that do not center on food supports their sense of belonging and normalcy.
• Seek your own support. Caregiver burnout is common and well-documented. Family-based therapy and caregiver-support groups, in addition to those offered by NEDA, are valuable resources for family members and partners.

What Should You Do Next?

If you are concerned about yourself or someone you care about, you should:

1. Contact a primary care provider or pediatrician for an initial evaluation and referral to a specialist.
2. Use the National Alliance for Eating Disorders helpline at 1-866-662-1235 for guidance, referrals, and crisis support. For immediate crisis support, text HOME to 741741 or call 988.
3. Request a referral to a licensed therapist or psychiatrist with eating disorder specialization and training in CBT-E, FBT, DBT, or CBT-AR, depending on the disorder type and age.
4. Contact a registered dietitian trained in eating disorder care to support the nutritional component of a multidisciplinary treatment plan.

Effective, evidence-based treatment for eating disorders exists for every disorder type — covering BED, ARFID, and OSFED — and across all levels of care severity. Recovery is achievable: when treatment addresses the eating disorder and co-occurring mental health conditions simultaneously, outcomes improve substantially. The key variable is early action. Talk to a healthcare provider who specializes in eating disorder treatment to determine whether outpatient, intensive outpatient, partial hospitalization, residential, or inpatient medical stabilization best matches the current level of clinical need.

References

Alliance for Eating Disorders Awareness. (2024). Eating disorder statistics: An updated view for 2024. https://www.allianceforeatingdisorders.com/eating-disorder-statistics-an-updated-view-for-2024/

ANAD. (2024). Eating disorder statistics. https://anad.org/eating-disorder-statistic/

Brown County Public Health (BCPH). (2025, February 26). Understanding eating disorders: Research and awareness in 2025. https://www.stayhealthybc.com/about/news/understanding-eating-disorders-research-and-awareness-in-2025-2025-02-26/

Calugi, S., Dalle Grave, R., & Fairburn, C. G. (2025). The prevalence of eating disorders and disordered eating in adults seeking obesity treatment: A systematic review with meta-analyses. Obesity Reviews. https://pmc.ncbi.nlm.nih.gov/articles/PMC12423590/

Deloitte Access Economics. (2020). The social and economic cost of eating disorders in the United States of America. STRIPED / Academy for Eating Disorders.

Hellner, M., Halstrom, S., Thomas, J. J., & Eddy, K. T. (2024). Dietary interventions in family-based treatment for eating disorders: Results of a randomized comparative effectiveness study. Eating Disorders: The Journal of Treatment and Prevention. https://doi.org/10.1080/10640266.2024.2302461

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Keski-Rahkonen, A. (2021). Epidemiology of binge eating disorder: Prevalence, course, comorbidity, and risk factors. Current Opinion in Psychiatry, 34(6), 525–531. https://doi.org/10.1097/YCO.0000000000000750

Miles, S., Phillipou, A., Neill, E., Newbigin, A., Kim, H. W., Eddy, K. T., & Thomas, J. J. (2025). An evaluation of CBT-AR in a youth outpatient eating disorders service. Contemporary Clinical Trials, 148, 107756. https://doi.org/10.1016/j.cct.2024.107756

National Center on Addiction and Substance Abuse (NCASA). (2003). Food for thought: Substance abuse and eating disorders. Columbia University.

National Eating Disorders Association (NEDA). (2025). Eating disorder statistics. https://www.nationaleatingdisorders.org/statistics/

Patel, P., Wheatcroft, R., Park, R. J., & Stein, A. (2021). The children of mothers with eating disorders. Clinical Child and Family Psychology Review. https://doi.org/10.1007/s10567-021-00362-4

Tantillo, M., Sanftner-Murray, J. L., MacDowell, P., & McGrath, M. (2025). Updates in the treatment of eating disorders in 2024: A year in review. Eating Disorders: The Journal of Treatment & Prevention. https://doi.org/10.1080/10640266.2025.2497750

Thomas, J. J., & Eddy, K. T. (2020). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder. Cambridge University Press.