Eating disorders are mental health conditions marked by severe disturbances in eating behaviors coupled with associated thoughts and emotions around food. Many people mistakenly believe that people with eating disorders are skinny and easy to diagnose. However, eating disorders can manifest in a number of different ways, and sufferers can be thin, obese, and anything in between.
Eating disorders are often misunderstood even by medical professionals, which makes it even harder for sufferers to get the help they need. This article will provide detailed insights into the harsh reality of eating disorders and provide evidence-based information that breaks down the damaging stereotypes that still prevail.
Eating disorders are recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a mental health condition characterized by severe, chronic disturbances in eating behaviors and distressing thoughts and emotions about food and the effect food has on the body.
Eating disorders manifest in a variety of ways. Often the indicators aren’t readily visible, especially to those with limited first-hand experience of the disorders. Anybody can suffer from an eating disorder, be they rich or poor, college-educated or high-school drop-out, and male or female.
While there is no singular or definitive cause of eating disorders, they share a strong comorbidity with other mental health conditions. Everything from past trauma, hormonal imbalances, and socio-cultural pressures can have a detrimental effect on eating habits.
The four most common eating disorders are:
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Other specified feeding or eating disorders (OSFED)
Around 1.66% of the US population has been diagnosed with an eating disorder. However, the true number is likely far higher — many people have not received an official diagnosis for their condition, though they are already suffering from a disorder.
Approximately 15-18% of eating disorder patients have also been diagnosed with OCD. Both conditions are often marked by obsessive thoughts, compulsive behaviors, and the use of rituals to alleviate anxiety around the obsessive thoughts.
Anorexia nervosa is characterized by a distorted body image and an irrational fear of gaining weight. People suffering from anorexia nervosa are prone to severe restriction of food intake and excessive exercise, and see themselves as overweight even if they are underweight, sometimes to the point of emaciation.
A distorted body image and a vehement denial of low body weight are common signs of anorexia. Other frequently noted symptoms include brittle hair and nails, low blood pressure, constantly feeling tired, and infertility.
While women are three times more likely to be diagnosed with anorexia than men, there is currently a 30% treatment rate for patients of both genders combined.
Bulimia nervosa is characterized by episodes of binge eating followed by self-induced purges such as vomiting, excessive laxative usage, or fasting in order to counteract caloric intake.
Bulimia nervosa is diagnosed three times more frequently in women (1.5%) than men (0.5%). Persistent acid reflux, sensitive or decaying teeth, and intestinal distress are three common signs of bulimia nervosa. While society tends to associate an eating disorder with being underweight, many people suffering from bulimia nervosa will maintain a normal weight or even be slightly overweight. This makes the condition less visible and harder to diagnose.
Binge eating disorder (BED) is characterized by recurring periods of extended eating. Many sufferers report feeling a loss of control during these binges, leading them to overwhelming feelings of shame, distress, and guilt. BED is more prevalent in women (approximately 1.5%) than in men (approximately 0.5%).
Eating quantities of food that go beyond excessive, within a narrow time frame, is a warning sign for BED. Another warning sign is eating alone through conscious embarrassment and constant dieting with minimal success.
Unlike many other eating disorders, ARFID patients are not obsessive about body shape, size, or weight. Rather, their disorder involves food avoidance due to sensory processing difficulties. While official numbers suggest ARFID affects approximately 0.3% of people, the real numbers could be much higher.
There is a strong link between ARFID and other conditions that are correlated with sensory processing difficulties, such as OCD and autism. This makes diagnosis more difficult, as professionals must ascertain which condition the symptoms relate to.
Sudden weight loss and a severe disinterest and aversion to food are the key signs of ARFID.
Pica is characterized by a compulsion to eat things that are either not considered food or contain no significant nutritional value. Pica is found in adults and children, however it is most commonly associated with pregnancy. Between 27.8% and 68% of pregnant women display symptoms that point toward a probable pica diagnosis. In most pregnancy cases, the condition corrects itself either pre- or post-natally.
There are two primary categories of pica consumables: geophagy (the consumption of earth-based substances such as soil, clay, or chalk) and amylophagy (the consumption of uncooked starches such as raw cassava, uncooked rice, cornstarch, or laundry starch).
Alongside the irregular eating habits, anemia, intestinal blockages, and irregular heart rhythms are some of the key symptoms of pica.
Rumination disorder is characterized by the repeated regurgitation of food after eating. Regurgitated food may be re-chewed and re-swallowed or spat out. There is no known cause of rumination disorder, however experts agree it is closely linked to anxiety.
Rumination disorder is found in children as young as three months, and while children frequently grow out of the condition, they have been shown to be more prone to anxiety issues later in life.
There is a global prevalence of rumination of around 3.1%. However, the condition is primarily found in individuals with learning disabilities. Bloating, gastrointestinal distress, and frequent nausea are the most common symptoms of rumination disorder.
Eating disorders are serious conditions that have a significant impact on patient health. The consequences of untreated eating disorders include short and long-term health problems and even death.
Over 50,000 hospital visits per year in the United States are directly attributed to eating disorders. The stigma that exists around eating disorders remains a key barrier to treatment, particularly for men.
The following collection of eating disorder statistics is meant to shed light on the mortality rates associated with eating disorders.
Anorexia nervosa has the highest mortality rate of all eating disorders, rising to as high as 20% for those battling the condition over a long period. The leading causes of anorexia-related deaths are heart problems, gastrointestinal issues, suicide, endocrine disorders, and refeeding syndrome.
Refeeding syndrome is a life-threatening condition that can occur when nutrition is reintroduced to anyone who is severely malnourished or who has been starved for a long time, which includes patients with anorexia nervosa. It’s caused by the sudden change in electrolytes (especially phosphate, potassium, and magnesium) in the body as a result of eating.
The seriousness of eating disorders cannot be overstated. Sufferers face a number of treatment barriers when looking for and receiving care, including financial barriers such as insurance costs, social stigmas, and cultural pressures, and the continued lack of knowledge and education surrounding eating disorders both within the medical field and the general populace.
Someone dies from an eating disorder every 52 minutes in the United States, which equates to the capacity of an average NCAA stadium per year.
For each of the primary eating disorders, women are approximately three times more at risk than men of developing the disorder. A driving factor behind this is the pressure for women to look a certain way or conform to fit certain stereotypes. This includes societal pressure and cultural and peer-based attitudes.
However, there are two important factors to consider. First, men face stigma regarding eating disorders that can prevent them from being diagnosed or seeking help. Second, the diagnosis criteria for eating disorders often have female-centric metrics, while disorders may manifest or impact men in different ways.
Weight discrimination is an under-discussed factor that increases the mortality risk of eating disorders by up to 60%. Many people find weight a sensitive subject and are critical of themselves as a result. When others discriminate against them based on weight, it serves as an additional stressor that has a detrimental effect on that person’s overall mental health.
In many instances, the damage done to mental health and self-image as a result of weight discrimination is enough to prevent people from seeking help or continuing treatments. Studies have shown that, relative to any other factor, weight discrimination has the highest impact on eating disorder mortality rates.
The seriousness of eating disorders is evident in the fact that, if left untreated, the risk of death increases to 20%. Yet when treatment is sought, the risk of death from an eating disorder drops to as low as 2% across the disorder spectrum.
However, many sufferers are still refusing or unable to seek treatment as a result of the stigma that surrounds eating disorders. People need to become more educated about eating disorders so that they can offer help to those in need.
Eating disorders can affect anyone, regardless of race, age, culture, or gender. Some eating disorders are more common in some demographics, but the simple truth is that anybody can develop an eating disorder.
The following statistics highlight the global effect eating disorders have and the importance of being able to recognize the signs and get help, or help others get the help they need.
Eating disorders are found all over the world, with statistics indicating that globally, as many as 17.9% of young women and up to 2.4% of young men have experienced an eating disorder that is diagnosable according to criteria laid out in the DSM-5.
Studies have shown that there is no direct link between socioeconomic status and eating disorder prevalence, which again serves to highlight the simple fact that everybody is at risk of developing one of these disorders.
While eating disorders have been a concern for hundreds of years, figures show an increase in prevalence across the globe. Between 1990 and 2017 eating disorder prevalence rose from 0.19% to 0.21% across all of the age demographics studied.
Looking at the data, the largest jump was in the 25-29 age bracket, where the prevalence rose from 0.41% to 0.48%. Currently, the three age groups between 15 and 34 have a prevalence rate of over 0.4%.
Worldwide, Australia suffers from the highest reported rate of eating disorders. Studies show that over a third of Australian adolescents demonstrate eating disorder tendencies in any given year. Australian culture emphasizes physical activity and fitness, which is often signaled through looks and lifestyle. This creates pressure on younger adolescents to meet the ideal body stereotypes, resulting in an increased number of eating disorder diagnoses.
While eating disorders are found everywhere, there is a generally increased rate within Westernized countries. However, there are no noteworthy differences across different socioeconomic backgrounds. The only exceptions to this are societies in which food itself is scarce and the pressure of body ideals is secondary to survival.
A UK study revealed that many eating disorders first materialize at an early age, with anorexia nervosa showing a peak onset between 15 and 17 years while bulimia nervosa peaks between 15 and 18 years. Many other eating disorders peak between 15 and 17, with binge eating disorder being the only one that shows three core peaks at 15, 25, and 40 years old.
While recovery from eating disorders is possible, their effects can last a lifetime. Young people are exposed to media and marketing that tells them to look and behave a certain way. Being at an impressionable age, they are influenced to create bad eating habits without realizing the risks they’re putting themselves at.
Avoidant/Restrictive Food Intake Disorder is one of the few eating disorders that is found more often in males than females. ARFID accounts for around 14% of eating disorders in adolescent patients, and the majority of these are male. A key reason for this could be the strong link between ARFID and autism, which boys are four times more likely to be diagnosed with.
However, these numbers are likely to be even higher. Because of the stigma males face regarding eating disorders, many fail to seek treatment or even diagnosis.
A recent study from the National Eating Disorders Association (NEDA) suggests that 2% of adolescent girls in the United States meet the DSM-5 criteria for one of the core eating disorders. The largest threats come from the constant pressure they feel to meet ‘thin culture’ and the presence of unrealistic ideals in the media.
Other studies, with similar outlooks to the NEDA study, also show that 60% of 15-year-old girls admitted to dieting at a moderate level, while a further 8% dieted at a severe level. This 8% were also 18 times more likely than their peers to develop an eating disorder within 6 months.
Eating disorders are present in every race and ethnicity. However, there is a clear disparity within the different types of eating disorders. Hispanic people suffer from anorexia nervosa and bulimia nervosa at approximately the same rate, while Asian Americans are more likely to suffer from bulimia nervosa. White Americans are more likely than others to struggle with a binge eating disorder.
Cultural beliefs and pressures may be responsible for racial differences, such as the heavy pressure for thinness in Asian communities leading to higher levels of bulimia and anorexia. The impact of cultural appropriation may also play a role, with the melding of two potentially opposing cultures and diets creating a platform for potential eating problems.
People in the LGBTQ community are at an increased risk for eating disorders. Studies show that those identifying as LGBTQ show increased numbers for both diagnosed and suspected eating disorders.
The reasons for this increased risk could be attributed to a wide range of factors, including increased bullying, stress, PTSD, and body dysmorphia due to differing shape-gender ideals.
While gay women are at an increased risk relative to straight women, many lesbians reported that being part of the LGBTQ community gave them a supportive framework for combating their issues. In contrast, gay males discussed a culture of fatphobia that made it harder to admit to problems and seek help.
Studies show a connection between religious beliefs and eating disorders. Religious men and women report feeling heavily pressured to change their eating habits for their faith. 12.30% of religious people surveyed in 2022 admit to changing their eating habits for purely religious reasons.
Some religious practices encourage or even require fasting, which can act as a trigger or provide dangerous cover for someone struggling with an eating disorder. Many people even use the cover of religious devotion to mask their eating issues and hide the signs of an eating disorder, delaying admission of a problem and getting help.
When looking at occupations, there is a clear increase in the rate of eating disorders surrounding professions that are directly influenced by weight and appearance such as modeling.
Polls reveal that 40% of models exhibit repeated disordered eating behaviors of some description. A further 62% have admitted to being told to lose weight in order to fit with industry requirements.
Models are heavily judged based on their appearance and weight. Boxers have to make weight for a fight, runners maintain an ideal weight for performance, and actors have to meet a certain figure for a role. Failing to meet these requirements has direct results on income and success, creating even creator pressures.
One of the more dangerous myths surrounding eating disorders is that patients are underweight to the point of emaciation. Studies show that only 15% of eating disorder patients are underweight. In fact, the lifetime prevalence of eating disorders is highest in those with class III obesity.
There are many treatment barriers that prevent eating disorder patients from getting help. Better societal awareness and understanding that extreme thinness is not a prerequisite for diagnosis is important to sufferers being diagnosed and treated.
40% of overweight adolescent females demonstrate disordered eating behavior, and 10% report using binge eating and extreme control behaviors, while a staggering 23.5% use extreme weight control measures in order to control their food intake. Overweight adolescent males are also at risk, with 20% showing signs of an eating disorder and 12.3% using extreme control measures.
Common extreme control measures include excessive calorie restriction, extreme exercise routines, induced vomiting, unnecessary use of diuretics and laxatives, and unhealthy food rituals.
Eating disorders can affect a person’s life to the point that they are effectively disabled — impaired in their ability to engage in key activities such as working, concentrating, sleeping, walking, or caring for oneself.
Moreover, eating disorders are often comorbid with other serious conditions, such as substance abuse disorders, cardiac problems, and decreased fertility.
Eating disorders are not just measured in prevalence rates or mortality percentages but in the impact they have on patients' daily lives. In 2019, eating disorders accounted for 6.6 million disability-adjusted life years (DALYs). DALYs are a measure of the impact a disease has on an individual’s life. They are calculated by adding together the impact on life expectancy and the average number of years individuals live with the specific condition.
The 2019 DALY rate equates to 85.9 DALYs per 100,000 people with the 20-24 year old demographic being the most heavily impacted.
Studies have shown that 30% of patients with an eating disorder develop osteoporosis at a younger age. Approximately 90% of anorexia patients also exhibit bone thinning, known as osteopenia, which is often seen as a precursor to osteoporosis.
Malnutrition is one of the driving causes of this condition, specifically the reduced intake of calcium and vitamin D, both of which are integral for maintaining bone health and strength. Eating disorders often result in increased cortisol levels which is linked to reduced bone density.
The severe level of dietary restrictions that anorexia nervosa patients suffer creates a range of complications. The stress placed on the body forces organs to work overtime. This extra stress results in 80% of anorexia patients experiencing cardiac problems.
And this is true for more than anorexia patients. While anorexia sufferers tend to develop issues with reduced heart rates, irregular rhythms, and even cardiac arrest, bulimia nervosa patients commonly develop palpitations and heart muscle weakness.
Women suffering from eating disorders also struggle with disrupted menstrual cycles and other challenges to fertility. In a survey of UK women with an eating disorder, between 68% and 98% reported not experiencing their menstrual cycle for at least three consecutive months.
The common cause of menstrual cycle disruption is hormone imbalances, including reduced estrogen levels, caused by severe dietary restrictions. One consequence of this is decreased reproductive health.
While it is possible for patients to recover and have their cycles return to normal, studies have shown that patients who maintain a low body fat percentage are less likely to see their cycles return to normal.
Another consideration is the impact eating disorders have on a patient who is pregnant. Pregnancy for someone with an eating disorder has many dangers, including increased chances of stillbirth and preterm labor. Postpartum complications for the mother include an increased risk of postpartum depression and breastfeeding complications. The baby faces developmental risks that arise from potential nutritional deficiencies during pregnancy.
Many patients suffering from an eating disorder also show signs of other serious mental health issues. Studies have shown that 58% of eating disorder comorbidities are psychiatric-based.
The most common comorbid condition is depression, with 70% of eating disorder patients being diagnosed and treated for the condition. Studies show that depression typically manifests in patients after the onset of their eating disorder, while anxiety disorders are typically present before the onset of an eating disorder.
Despite their strong correlations, eating disorders and their comorbid conditions remain entirely separate conditions, and treatment is recommended for each condition simultaneously.
Studies suggest a strong bidirectional link between eating disorders and substance abuse. 50% of eating disorder patients also abuse substances or alcohol, while 35% of people with a substance use disorder also exhibit eating disorder behaviors.
The combination of an eating disorder and substance abuse is more common than either occurring on their own. In fact, people with an eating disorder are five times more likely to abuse substances. A large reason for this relationship is the abundance of shared risk factors between the two sets of conditions.
Dieting is big business. 25% of American men and 45% of American women are dieting to lose weight at any point in time. However, dieting can quickly lead to deeper problems, with 25% of dieters later developing an eating disorder.
Battling weight problems can place a great mental toll on those who are dieting and increases the risk of eating disorder development.
A clear progression has been found, with 35% of dieters moving from the normal dieter classification to pathological dieters, with 25% then developing an eating disorder.
There is no single cause or trigger that is responsible for eating disorders. However, several factors have been shown as direct risks. One of the core risk factors is perfectionism, specifically self-oriented perfectionism, which sees people continually setting unrealistically high expectations for themselves.
A second risk factor is emotional dysregulation. This relates to a reduced or complete lack of emotional control, which typically leads to binge or purge types of eating disorders.
Social media, including Facebook, Instagram, and TikTok, help create pressure for people to maintain an unrealistic body size and shape. This applies to both men and women and has created an unstable foundation for people’s relationship with food and eating.
The following collection of statistics takes a closer look at the different contributing factors to eating disorders.
Eating disorders are linked to a combination of biological and psychological factors combined with a range of cultural and societal pressures. The result is a mass of pathways leading toward a host of different eating disorders.
Recent studies have shown that between 40 and 60% of an individual’s susceptibility to eating disorders may be due to genetic factors.
While there are few studies into the impact of genetics on eating disorders, there are links being discovered between personality and character traits and anorexia and bulimia nervosa. Some studies also suggest the presence of a potential genetic link, given that eating disorders tend to run in families.
The increasing use of social media continues to make people believe they need to conform to specific body stereotypes. The constant exposure to filtered and edited images and videos contributes to a great level of insecurity regarding body size and shape.
Studies have shown a direct link between social media usage times and disordered eating behaviors. Two of the most heavily linked platforms are Instagram and Snapchat, with the highest percentage of disordered eating behaviors being seen with over two hours of social media use per day.
When talking about eating disorders, focusing on female patients is an easy mistake to make. However, when it comes to the dangers of social media and its impact on increasing the risk of eating disorders, the danger to men is equally important.
A recent study showed that 62% of Instagram posts aimed at men depicted lean models, and 41% featured very muscular models. These posts create an unrealistic idea about what the male body should look like, as most people with the depicted body types are professional sportsmen and bodybuilders.
The result of so many social posts showing men trying to change their body weight and/or shape is an increase in negative body perception in males. One study showed that 27% of normal-weight men believe themselves to be underweight and in need of bulking aids. A second study from the National Eating Disorders Association showed that 22% of men engage in muscular-focused disordered eating behaviors to gain weight or muscle.
Eating disorders share a close bond with emotional control and regulation. Obsessive behaviors and a need to control some aspects of their life are key triggers for the emergence of disordered eating practices. Bullying is a driving factor behind people seeking such desperate control measures.
Studies have shown that 41.8% of bullying victims display clear signs of an eating disorder. This is compared to just 16.8% of people who are neither the bully nor the bullied. The rate of eating disorders among bullies themselves is almost twice the average of those not involved at all.
Sexual abuse in men is seldom discussed and chronically underreported, and its results can manifest in many ways over time, including with eating disorders. One study revealed that 30% of male sexual abuse victims later developed an eating disorder.
The reasons are twofold. First, internalized feelings of shame and pain can result in disordered eating as a means of finding a level of strict control. Second, growing bigger, either muscular or otherwise, makes victims feel less likely to be victimized again and better able to protect themselves.
Eating disorders are treatable. The key to beating eating disorders is education and removing the continuing stigma surrounding those who are struggling. People with eating disorders face a number of treatment barriers daily. Yet, finding the right treatment pathway gives people the highest chance of overcoming their disorder.
The following collection of statistics looks at the truth behind treatments for eating disorders.
Successful treatment of eating disorders requires an approach from three core disciplines: nutritional, medicinal, and psychological. This means incorporating treatments from all three areas simultaneously. Studies among high-performance athletes revealed that a multi-disciplinary approach resulted in a 50% treatment success rate.
The different professions and teams involved in each treatment need to be aware of one another and able to adapt to avoid problems with opposing styles and concepts.
Studies have shown that anorexia patients have the most increased chance of recovery over time, with 31.4% of treated patients classed as recovered nine years after treatment, increasing to 62.8% at a twenty-two-year review. The recovery percentage for bulimia patients is higher at 68.2%, but that figure remains consistent over time, unlike those with anorexia.
The same study also reported that within 10 years of beginning treatment, 10.5% of anorexia patients had relapsed, along with 20.5% of bulimia patients. The key takeaways are that recovery is possible, but it remains a battle that must be fought every day.
While recovery from eating disorders is possible, one of the largest challenges patients face is finding the strength and support to seek help. Studies suggest that fewer than 50% of adults with an eating disorder seek professional help in beating their condition. Within that, less than 30% sought the help of a counselor or psychologist, and fewer than 20% reported being given any sort of medication for their symptoms.
While there is no single tablet or elixir that can cure an eating disorder, there are medications that can be used to help treat some of the symptoms and ease people onto the road to recovery.
Eating disorders are serious mental health conditions that need to be brought further to light. People need to be better educated on eating disorders in terms of what they are, how they impact people, and, most importantly, how to recognize the true signs of a problem.
Stereotypes continue to prevail that negatively impact patients and those still unable to seek help. Early recognition of the signs of an eating disorder and the continued evolution of diagnostic models are key. Currently, 20% of serious eating disorders result in patient death if not treated. That number will only change if everybody is better informed and more understanding of the complexities and seriousness of disordered eating.
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