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Eating Disorder Types, Symptoms and Statistics

02 Mar 2016

Ask yourself, “What percentage of your day do you spend thinking about food, weight, and body image?” If your answer is that you spend so much time with these concerns that it interferes with your happiness or functioning, then we invite you to consider that you may have an eating disorder. Looking at eating disorders this way puts EDs on a continuum, rather than a yes or no question. You can have some degree of unhappiness, depression, anxiety, low self-esteem, and preoccupation because of body image and eating issues. And if you do, we invite you to participate in ANAD programs to get the support and help that you need to recover!

Here is the formal way that Eating Disorders are defined and determined in academic and medical settings:

According to the Diagnostic and Statistical Manual, Fifth Edition (May 2013) of The American Psychiatric Association, eating disorders are broken down into the categories of:

  • Anorexia Nervosa
  • Body Dysmorphic Disorder
  • Bulimia Nervosa
  • Binge Eating Disorder
  • Avoidant/Restrictive Food Intake Disorder
  • Other Specified Feeding or Eating Disorder
  • Unspecified Feeding or Eating Disorder
  • Pica
  • Rumination Disorder

What is Anorexia Nervosa (Anorexia)?

Anorexia is not getting enough calories in, which leads to significantly low body weight. The person with Anorexia will also show an intense fear of gaining weight or becoming fat. Or if the fear is not shown, there is still persistent behavior that interferes with weight gain, even though weight is significantly low. While suffering from Anorexia, a person also has a hard time recognizing the seriousness of their current weight or is unable to see how thin or underweight they are, or the person is very reliant on their body weight and shape for their self-evaluation.

What is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is characterized as an obsession with an imaginary defect in physical appearance or an extreme concern with a slight physical blemish, which other individuals may not even recognize. Individuals with BDD have misconceived beliefs regarding their body and the most common body parts for both men and women to have false misconceptions about are skin, hair, and nose. Others include eyes, teeth, chin, legs, lips, and height.

What is Bulimia Nervosa (Builimia)?

Bulimia is defined as recurrent episodes of binge eating along with compensatory behavior. An episode of binge eating includes eating an amount of food that is definitely larger than most people would eat within a two hour time period, with a sense of lack of control over eating during the episode (a feeling that one cannot stop eating or control what or how much one is eating). In Bulimia, a person also recurrently tries to make up for eating by compensating with fasting, self-induced vomiting, excessive exercise, or the use of laxatives, diuretics, or other medications. A person with Bulimia is very worried about their weight or shape.

What is Binge Eating Disorder?

Binge Eating Disorder is defined as recurrent episodes of binge eating. An episode of binge eating includes eating an amount of food that is definitely larger than most people would eat within a two hour time period, with a sense of lack of control over eating during the episode (a feeling that one cannot stop eating or control what or how much one is eating). A binge-eating episode may also include: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of embarrassment over how much one is eating and feeling disgusted with oneself, depressed or very guilty afterward.

What is Pica?

Pica is the eating of substances that have no nutritional value for a period of at least one month. For example, if someone eats cotton or clay, this would be considered Pica.

What is Rumination Disorder?

Rumination Disorder is repeated regurgitation of food for at least one month, which includes re-chewing, re-swallowing, or spitting out food.

What is Avoidant/Restrictive Food Intake Disorder?

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or feeding disturbance where a person is unable to meet their nutritional or energy needs. Some ways that you might notice this are significant weight loss or not keeping up with expected growth, nutritional deficiencies, dependence on nutritional supplements, or having one’s nutritional issues interfere with their psychosocial functioning.

What is Other Specified Feeding or Eating Disorder?

When you meet some of the criteria for an eating disorder, but not all, you may find yourself in the category of OSFED: There are 5 categories of OSFED:

Atypical Anorexia Nervosa: meeting all of the symptoms of Anorexia with weight at or above the normal range

Binge Eating Disorder that is less frequent or did not occur as long as needed for the full diagnosis

Bulimia Nervosathat is less frequent or did not occur as long as needed for the full diagnosis

Purging Disorder is when a person purges without bingeing

Night Eating Syndrome: this occurs when a person consumes at least 25% of their daily intake after the evening meal. Waking up after going to bed in order to eat may also occur.

Unspecified Feeding or Eating Disorder is for disorders that do not meet the criteria of any of the above disorders, but still cause great emotional upset or interferes with daily life.

Over the last 40 years of ANAD’s existence, we have heard time and time again that people have been told that they did not have an eating disorder because their weight was not low enough or because they were not a young, white female. ANAD wants you to listen to your own feelings and body. If you THINK you have an eating disorder, you most likely do.

ANAD is here to help you through any confusion you may have about what is going on with your body, your feelings, your eating, and your hunger. Please do not hesitate to contact us if you think that you have an eating disorder or you think that a loved one has an eating disorder, even if a medical professional, parent, teacher, trusted adult, friend, or otherwise has told you that you don’t. They don’t know you the way that you know yourself.

Eating Disorder Statistics

General statistics:

  • At least 30 million people of all ages and genders suffer from an eating disorder in the U.S.
  • Every 62 minutes at least one person dies as a direct result of an eating disorder.
  • Eating disorders have the highest mortality rate of any mental illness.
  • 13% of women over 50 engage in eating disorder behaviors.
  • In a large national study of college students, 3.5% of sexual minority women and 2.1% of sexual minority men reported having an eating disorder.6
  • 16% of transgender college students reported having an eating disorder.
  • In a study following active duty military personnel overtime, 5.5% of women and 4% of men had an eating disorder at the beginning of the study, and within just a few years of continued service, 3.3% more women and 2.6% more men developed an eating disorder.
  • Eating disorders affect all races and ethnic groups.
  • Genetics, environmental factors, and personality traits all combine to create risk for an eating disorder.

Anorexia Nervosa:

  • 0.9% of American women suffer from anorexia in their lifetime.
  • 1 in 5 anorexia deaths is by suicide.
  • Standardized Mortality Ratio (SMR) is a ratio between the observed number of deaths in a study population and the number of deaths than would be expected. SMR for Anorexia Nervosa is 5.86.
  • 50-80% of the risk for anorexia and bulimia is genetic.
  • 33-50% of anorexia patients have a comorbid mood disorder, such as depression. Mood disorders are more common in the binge/purge subtype than in the restrictive subtype.
  • About half of anorexia patients have comorbid anxiety disorders, including obsessive-compulsive disorder and social phobia.

Bulimia Nervosa:

  • 1.5% of American women suffer from bulimia nervosa in their lifetime.
  • SMR for Bulimia Nervosa is 1.93.
  • Nearly half of bulimia patients have a comorbid mood disorder.
  • More than half of bulimia patients have comorbid anxiety disorders.
  • Nearly 1 in 10 bulimia patients have a comorbid substance abuse disorder, usually alcohol use.

Binge Eating Disorder (BED):

  • 2.8% of American adults suffer from binge eating disorder in their lifetime.
  • Approximately half of the risk for BED is genetic.
  • Nearly half of BED patients have a comorbid mood disorder.
  • More than half of BED patients have comorbid anxiety disorders.
  • Nearly 1 in 10 BED patients have a comorbid substance abuse disorder, usually alcohol use.
  • Binge eating or loss-of-control eating may be as high as 25% in post-bariatric patients.

Other Specified Feeding or Eating Disorder (OSFED)[Previously called Eating Disorder Not Otherwise Specified or EDNOS]:

  • OSFED, as revised in the DSM-5, includes atypical anorexia nervosa (anorexia without the low weight), bulimia or BED with lower frequency of behaviors, purging disorder, and night eating syndrome.
  • SMR for EDNOS is 1.92.
  • Nearly half of EDNOS patients have a comorbid mood disorder.
  • Nearly 1 in 10 EDNOS patients have a comorbid substance abuse disorder, usually alcohol use.

Avoidant/Restrictive Food Intake Disorder (ARFID) 14:

  • ARFID is more than just “picky eating”. Children do not grow out of it and often become malnourished because of the limited variety of foods they will eat.
  • The prevalence of ARFID is still being studied but maybe 3-5% of children.
  • Boys might have a higher risk for this disorder than girls.

“Diabulimia:”

  • Diabulimia is deliberate insulin underuse in people with type 1 diabetes for the purpose of controlling weight.
  • About 38% of females and 16% of males with type 1 diabetes have disordered eating behaviors.
  • Insulin omission increases risks for retinopathy, neuropathy, and diabetic ketoacidosis.
  • In a longitudinal study, diabulimia increased mortality risk threefold.

Sources:

  1. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.
  2. Le Grange, D., Swanson, S. A., Crow, S. J., & Merikangas, K. R. (2012). Eating disorders not otherwise specified presentation in the US population. International Journal of Eating Disorders, 45(5), 711-718.
  3. Eating Disorders Coalition. (2016). Facts About Eating Disorders: What The Research Shows.http://eatingdisorderscoalition.org.s208556.gridserver.com/couch/uploads/file/fact-sheet_2016.pdf
  4. Smink, F. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports,14(4), 406-414.
  5. Gagne, D. A., Von Holle, A., Brownley, K. A., Runfola, C. D., Hofmeier, S., Branch, K. E., & Bulik, C. M. (2012). Eating disorder symptoms and weight and shape concerns in a large web‐based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. International Journal of Eating Disorders45(7), 832-844.
  6. Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144-149.
  7. Jacobson, I. G., Smith, T. C., Smith, B., Keel, P. K., Amoroso, P. J., Wells, T. S., Bathalon, G. P., Boyko, E. J., & Ryan, M. A. (2009). Disordered eating and weight changes after deployment: Longitudinal assessment of a large US military cohort. American Journal of Epidemiology, 169(4), 415-427.
  8. Marques, L., Alegria, M., Becker, A. E., Chen, C.-n., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412-4120.
  9. Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research Review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. Journal of Child Psychology and Psychiatry, 56(11), 1141-1164.
  10. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731.
  11. Trace, S. E., Baker, J. H., Peñas-Lledó, E., & Bulik, C. M. (2013). The genetics of eating disorders. Annual Review of Clinical Psychology, 9, 589-620.
  12. Ulfvebrand, S., Birgegard, A., Norring, C., Hogdahl, L., & von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from a large clinical database. Psychiatry Research, 230(2), 294-299.
  13. Berkman ND, Brownley KA, Peat CM, Lohr KN, Cullen KE, Morgan LC, Bann CM, Wallace IF, Bulik CM. Management and Outcomes of Binge-Eating Disorder. Comparative Effectiveness Review No. 160.
  14. Norris, M. L., Spettigue, W., & Katzman, D. K. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213-218.
  15. Hanlan, M. E., Griffith, J., Patel, N., & Jaser, S. S. (2013). Eating disorders and disordered eating in Type 1 diabetes: prevalence, screening, and treatment options. Current Diabetes Reports, 13(6), 909-916.
  16. Goebel-Fabbri, A. E., Fikkan, J., Franko, D. L., Pearson, K., Anderson, B. J., & Weinger, K. (2008). Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care, 31(3), 415-419.

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