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Eating Disorders: The “Silent Killers”

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19 min

Eating Disorders: The “Silent Killers”

Eating disorders can creep up on any of us. Several years ago, my former classmate asked me out for a cup of coffee. We were very close in high school, but we started drifting apart once we went to college. You know how it goes. We only met about once every six months to catch up.

As we were ordering coffee, I noticed two odd things. One, her eyes had become bigger—larger than I remembered. And two, she asked for a non-fat latte, though I didn’t remember her monitoring her calorie intake. I mean, she was a fitness trainer, so I expected lean protein, not “fat is bad.”

When I told her to get a seat at the table, she said she’d join me after seeing with her own eyes that the milk the barista used was, in fact, non-fat. I thought that was strange. Was she watching her weight so much she had to personally monitor the coffee-making process?

That day, she told me she had an eating disorder—anorexia. And then I realized why her eyes seemed so big—they were prominent on her skinny face. 

She seemed pretty comfortable telling me about her irrational fear of gaining weight. She even shared how she made it look like she was eating in front of her husband and son. But she told me not to worry because, in a few days, she was going to get treatment in a specialized center. 

We lost her the same week.

It was a shock to everybody. Just like many people with an eating disorder, she hid it very well. Back then, I didn’t know that eating disorders have one of the highest mortality rates among mental illnesses. 

What we see in the media are upper-class white privileged girls who normalize throwing up after a meal. But the real face of eating disorders is far different—and much closer. That’s what I want to discuss today. 

So, what is an eating disorder? What causes an eating disorder like anorexia, bulimia, or binge eating? What are the symptoms of eating disorders and some early warning signs of an eating disorder? I will answer this and more questions here and leave you with some things to consider.

What is an eating disorder?

Eating disorders are more than just a set of unhealthy habits; they are complex psychological conditions characterized by an unnatural obsession with food and body image. Let’s be real: western culture is manic about weight, and this is one reason why 9% of the US population will develop an eating disorder in their lifetime. 

Disorders such as anorexia, bulimia, and binge eating (an overeating disorder) often arise from profound disturbances in our relationship with what we eat. And the bad news is that the global prevalence of eating disorders rose from 3.5% to 7.8% between 2000 and 2018.

Behaviors and attitudes associated with eating disorders include preoccupation with weight, food, calories, and dieting, as well as avoidance of certain foods, forgetting to eat, discomfort eating around others, and engaging in food rituals. Constant worry about body size and appearance and frequent mirror checks are also common indicators.

And don’t think that only morbidly thin people with a fear of gaining weight suffer from eating disorders. Statistics say that less than 6% of people with an eating disorder are medically underweight. 

This means that people with a healthy weight might still have a food obsession. Some high-functioning individuals with eating disorders may not realize the seriousness of their situation because their bodies maintain a healthy weight. This misconception often delays diagnosis and treatment.

Who can affected by eating disorders?

Remember, eating disorders can affect anyone, regardless of gender identity, ethnicity, socioeconomic status, or sexual orientation. However, LGBTQ+ adults and teens are more susceptible to eating disorders than their heterosexual and cisgender counterparts as a result of perpetual stress. Sadly, though, people of color with eating disorders are half as likely to be diagnosed or receive treatment as their white peers. 

Eating disorders go beyond physical health, impacting our identity and self-esteem. But despite their seriousness, there’s a tendency to underestimate eating disorders. Which is a crime since they are extremely deadly: studies have found that suicide was attempted by:

  • 25% of people with anorexia nervosa
  • 31% of people with bulimia nervosa
  • 23% of people with binge eating disorder

Before we get deeper into the topic, I want you to understand that an eating disorder is not a choice. Rather, it’s a complicated coping mechanism that people develop to numb themselves from some deeper pain.

Eating disorder symptoms

The number one symptom of an eating disorder is the obsession with food. Whether people think about eating too much, too little, purging, binging in secret, feeling disgusted over particular textures, or having strict food-related rituals, all these thoughts hint at a real problem.

But there are, of course, other symptoms of an eating disorder. Some of these mental and physical signs a person struggles with are obvious, while others are less apparent. 

Physical warning signs of eating disorders

  • Odor-related issues: smelling of sick, bad breath
  • Dental problems: yellowing or rotting teeth
  • Skin and hair conditions: dry, grayish skin, hair loss
  • Throat and gland discomfort: very sore throat, swollen glands and cheeks
  • General fatigue and weakness: tiredness, exhaustion
  • Respiratory symptoms: coughing blood
  • Headaches
  • Digestive issues: hunger pains, constipation or diarrhea, strained stomach muscles, terrible bloating after binge eating or not eating for a long time, constant dull ache in the stomach, heartburn after making yourself sick
  • Cardiovascular symptoms: heart palpitations (linked to panic about vomiting or inability to reach the toilet), easy or frequent bruising
  • Electrolyte imbalance
  • Sudden weight gain/loss
  • Blood-related issues: high/low blood sugar, anemia
  • Fragile bones
  • Struggling with sleep
  • Panic
  • Menstrual irregularities or not having periods (when there isn’t enough nutrition, the body turns off some hormones, including estrogen, to save energy)
  • Freezing or hot flashes

Some of the physical symptoms of eating disorders are linked to starvation and obesity, while others are a result of frequent vomiting.

Mental signs of an eating disorder

  • Anxiety
  • Guilt after eating food
  • Shame
  • Embarrassment
  • Anger
  • Disappointment
  • Feeling like a failure
  • Self-harming behaviors
  • Seeking temporary relief in purging
  • A distorted sense of achievement after purging
  • No trust in scales or reflection 
  • Lying
  • Isolation
  • Not being able to think about anything but food (what to eat, if you can eat, observing food in supermarkets)
  • Dissociation
  • Changes in mood and behavior: getting snappy, being irritable
  • Loss of enjoyment in activities
  • Delusional thoughts

Eating disorders take a toll on your whole life and the lives of those around you. People who suffer from them go through physical and mental anguish every day. But why do we develop eating disorders in the first place? Shouldn’t we put a healthy relationship with food—the primary source of energy our lives depend on—above all else?

What are the symptoms of eating disorders?

What causes eating disorders?

Like with many mental illnesses, we can’t pinpoint specific causes of eating disorders. They are complex conditions influenced by a delicate interplay of genetic, biological, behavioral, psychological, and social factors. This combination often occurs at specific points in a person’s life (most often in adolescence), shaping their relationship with food and body image.

While we can’t tell for sure what causes bulimia and anorexia, here are some factors that may contribute:

1. Neurological causes

Eating disorders have a biological basis in the brain, affecting emotional processing, decision-making, and reward circuits. For people with eating disorders, eating food can trigger anxiety and disturbing thoughts, not pleasure and satisfaction, causing some to avoid food altogether.

Neurobiological research, which is still at an early stage, shows the short-term effects of eating disorders on brain structure, particularly on reward pathways. Other researchers have studied the brain regions involved in emotions, decisions, and rewards in people with eating disorders. They discovered that changes in these areas are related to taste preferences and reward sensitivity in people with anorexia nervosa.

Neurotransmitters like serotonin and dopamine also play a role. In binge eating, the regulation of dopamine production gets tangled, creating a neurological pattern resembling addiction, while serotonin dysfunctions are linked to self-starvation.

2. Psychological causes

People with eating disorders may seek a sense of belonging, connection, love, esteem, and security by striving for a specific body image. And for them, controlling their body weight and image is the way to achieve this.

3. Environmental causes

Environmental stressors contribute to the development of eating disorders. Societal pressures, especially in a competitive environment, can lead people to see eating disorders as a solution to various stressors they’re exposed to. After all, 69-84% of women in the US are dissatisfied with their bodies and want to be thinner.

4. Genetic causes

There is a genetic component and a biological susceptibility to eating disorders, suggesting that people may be born with a predisposition. An increased risk is observed in people whose genetic relatives are affected by eating disorders.

5. Temperament and personality

Unsurprisingly, temperament and personality traits also play a role. In a study of eating disorders, researchers found that 61.8% of individuals had at least one personality disorder. Anorexia-restricting types often had avoidant personality disorder, and bulimia was linked to borderline personality disorder.

Overall, people with eating disorders showed high neuroticism and low self-control. Bulimia was associated with higher harm avoidance, while people with anorexia had higher persistence.

6. Underlying conditions

Over 70% of people with eating disorders experience additional mental health conditions:

Unfortunately, the co-occurrence of mental health problems can complicate the treatment and recovery of people with eating disorders.

7. Social factors

Perfectionism and dissatisfaction with body image contribute to the risk of developing eating disorders. Societal influences, such as internalized weight stigma, bullying, racial and ethnic assimilation, and limited social networks, can affect a person’s perception and behavior.

As you can see, there are numerous causes of eating disorders, most of which aren’t biological. So, it’s important to approach eating disorders with empathy and understanding, recognizing all the diverse factors at play.

Types of eating disorders

Medical manuals like the ICD-11 and the DSM-5 cover many different types of eating disorders:

  • Anorexia nervosa, is characterized by an obsession with losing weight
  • Bulimia nervosa, characterized by binge eating and purging
  • Binge eating disorder (BED), is characterized by recurrent binge eating without purging
  • Avoidant/restrictive food intake disorder (ARFID), is characterized by a lack of interest in food or extreme avoidance of foods with the wrong color, texture, etc.
  • Other Specified Feeding or Eating Disorder (OSFED) includes disorders that don’t fully meet DSM-5 criteria for the above illnesses, like atypical anorexia nervosa, atypical bulimia nervosa, etc.
  • Pica is characterized by eating non-food items (paper, hair, paint, etc.)
  • Rumination disorder, characterized by effortless vomiting of food, possibly rechewed and re-swallowed

However, there are many also disordered eating (EDNOS)  but not classified eating disorders yet:

  • Diabulimia—decreasing or stopping the use of insulin to control weight
  • Drunkorexia (anorexia plus alcohol use disorder)—not eating food to allow yourself the calories in alcohol
  • Night eating syndrome—when 25% or more of the daily calorie intake happens at night
  • Orthorexia nervosa—obsession with a healthy diet and avoiding anything remotely unhealthy
  • Pregorexia—extreme dieting to limit pregnancy weight gain

These and other eating disorders prove that the issue is frightening, and we should all pay more attention to understanding and fighting it. I’ll start with the ones you’re probably most familiar with.

It’s important to know the first signs of an eating disorder because if you recognize them early, you can recover more quickly and completely.

1. Anorexia nervosa

Anorexia nervosa, often simply called anorexia, is more than just a physical condition; it’s a psychiatric disorder that requires understanding and compassion. People suffering from anorexia nervosa severely restrict their food intake, exercise excessively, and may resort to purging or using laxatives. In severe cases of anorexia, death is unfortunately common: anorexia has the highest case mortality rate of any mental illness.

The core of the illness is the fear of gaining weight and a distorted body image, which is often accompanied by denial of the seriousness of the situation (both by the person themselves and those around them).

Scientists distinguish two main types of anorexia: 

  • Restriction, characterized by an extremely low-calorie diet, excessive exercise, and purging
  • Binge/purge, meaning binge eating in combination with restrictive behaviors

Sometimes, a person with anorexia shifts from one type to the other and back as the illness progresses.

Anorexia symptoms typically occur during puberty (between the ages of 10 and 20)—a critical time when identity and autonomy are just developing—and primarily affects young women. The pursuit of thinness becomes a means of control for people with rigid thinking, perfectionist tendencies, and a strong aversion to risk and harm. For them, controlling weight offers a semblance of control in a world where autonomy feels elusive.

The struggle involves maintaining a starvation diet despite being considerably underweight (often 15% or more below normal weight). It may start innocently as a diet you read about in a magazine (remember those?) or saw in a video, but then develops into an obsession with continuous weight loss and a persistent feeling of still being overweight and not meeting standards.

As the body is deprived of essential nutrients, it slows down to conserve energy, leading to the following symptoms of anorexia:

  • An abnormally slow heart rate
  • Loss of bone density
  • Fatigue, muscle weakness
  • Hair loss
  • Severe dehydration
  • An extremely low BMI

Anorexia isn’t something you just grow out of; beating it requires understanding, empathy, and professional support.

2. Bulimia nervosa

Bulimia nervosa, also known as bulimia, is often mentioned along with anorexia, but the two eating disorders have distinct differences. People with bulimia experience recurring episodes of binge eating followed by forced vomiting, fasting, using laxatives, or excessive exercise. In this way, they try to numb their inner pain and regain control over at least this part of their lives.

Although they maintain at least a reasonably healthy body weight, people with bulimia often fall into a cycle of binge eating, usually of high-calorie foods, and purging or fasting. Unlike anorexia, people with bulimia may not be obviously underweight, making it a nuanced disorder that requires careful attention.

The addictive pattern of binging and purging can take a toll on the entire digestive system, leading to:

  • Inflammation of the mouth and esophagus
  • Tooth decay and staining
  • Irregular heartbeat
  • Irregular bowel movements
  • Pancreatitis
  • Peptic ulcers

And these are just the physical consequences. Their minds also struggle with feelings of inadequacy, disgust, anger, and shame. Even though they know what they’re doing is wrong, people who have bulimia often can’t stop and may keep this behavior a secret for decades, even from the people closest to them. When it comes to bulimia, recovery is possible and effective. I’ll talk about this in detail later.

3. Binge eating disorder

People with binge eating disorder (BED) experience binge eating episodes without purging or fasting. You can think of BED as a severe stress-eating disorder. 

The overwhelming urge to eat, coupled with the feeling of powerlessness to stop, can lead to significant weight gain, associated health problems, and self-harm. Though it may look like it, BED is not the opposite of anorexia, both conditions similarly affect the mind. For instance, this disorder also causes serious emotional distress, depression, anxiety, feelings of lack of control, disgust, and guilt.

People diagnosed with BED experience at least three of the following: 

  • Eating faster than normal
  • Feeling uncomfortably full
  • Eating large amounts even when not hungry
  • Eating alone out of shame
  • Feelings of disgust, depression, or guilt after eating

Risk factors that contribute to BED include yo-yo dieting, diabetes, and experiences of bullying or weight shaming. Overall, binge eating disorder is often a sign of low self-esteem, a need for perfection, a fear of not living up to expectations, and concern about how others perceive the person eating so much.

4. Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder, commonly known as ARFID, goes beyond mere picky eating. While a picky eater may have preferences, they won’t be overwhelmed by the thought of trying new foods, and this selectiveness doesn’t interfere with their lives. ARFID, on the other hand, is marked by an underlying anxiety and powerlessness when it comes to food choices.

Previously called selective eating disorder, ARFID often occurs in infancy or childhood and can persist into adulthood, causing people to be extremely selective about the foods they eat. Although little research has been done into the disorder, figures suggest that 0.5-5% of children and adults suffer from ARFID. And perhaps unsurprisingly, 13% to 58% of ARFID patients also have an autism spectrum disorder.

The condition involves a lack of appetite, complete disinterest in food, or avoidance of certain textures, colors, smells, or tastes so that the diet is sometimes limited to a handful of items. As a result, people with ARFID may consume fewer calories than necessary and lack essential nutrients, which can lead to weight loss, anemia, kidney and liver problems, and heart problems.

Finally, you should know that, unlike the other eating disorders I mentioned, ARFID isn’t driven by a disturbed body image, dysmorphia, or a desire to be thin. It’s more about sensations while eating.

What are the signs of an eating disorder?

It’s important to know the first signs of an eating disorder because if you recognize them early, you can recover more quickly and completely.

1. Fear of gaining weight

People who struggle with eating disorders often have an irrational fear of gaining weight. They start obsessively counting calories, dieting, fasting, and exercising excessively.

This fear is often a result of social stigmatization around weight, unrealistic body standards, striving for perfection, anxiety disorders, and negative past experiences. In stressful situations, some people try to control their food intake to cope since they don’t know any other coping mechanisms.

2. Low self-esteem

The impact of food and body image on self-esteem is hard to deny, especially when the health and beauty industry screams that we don’t look “normal” if we’re not thin. People with low self-esteem consider themselves unattractive or unworthy and believe that being thin makes them confident, successful, and desirable. So, they resort to the simplest means of taking matters into their own hands—manipulating their food intake.

Also, low self-esteem distorts your perception of body image and self-worth and makes you more susceptible to what others think or say. So, when you see all these size-zero people in the media with their unrealistic body standards and unattainable perfection, it triggers eating disorders.

3. Food obsession

People with an eating disorder, be it anorexia, bulimia, or binge eating, can’t stop thinking about food: what they’ll eat, when they’ll eat it, how many calories they’ve consumed, how guilty they feel after eating, and much more. Even worse, they can’t think about anything but food, so they’re often distracted and confused and can’t remember things.

4. Using food as a reward/punishment

Eating is our natural way of getting energy. We should not tell ourselves when we can and cannot eat but rather simply eat whenever we feel hungry without feeling guilty.

However, people who suffer from an eating disorder often use food as a punishment or reward. Sometimes, they only allow themselves to eat according to certain rituals. Exercising until you drop to punish your body for that piece of cake or fasting to earn a drink in the evening are all worrying signs of a disorder.

5. Deteriorating social relations

When people are obsessed with food, it begins to dominate their lives, leading to isolation. If they put food above everything else, start getting late for work, miss school, or stop hanging out with friends because of it, the people around them will notice. They will ask questions that people with eating disorders don’t want to answer, which puts even more strain on relationships.

People with an eating disorder are usually very secretive. They know that what they do will not be accepted. So, they often eat alone, develop specific rituals around eating, feel ashamed of the things they do after eating, and can even become aggressive and defensive if someone gets in the way of their disorder.

Eating disorders are hard to diagnose, so before you visit a specialist (primary care physician, psychiatrist, therapist, or nutritionist), it’s a good idea to go over the questions they may ask you.

Eating disorder test

As we know, eating disorders are serious illnesses that require an official diagnosis and appropriate treatment. So you shouldn’t diagnose yourself based on tests on the internet. But perhaps this eating disorder quiz can give you the opportunity to reflect on whether you may have some symptoms of the eating disorder.

  1. Do you ever eat in secret?
  2. Do you find yourself hiding food?
  3. Do you lie to hide your eating habits?
  4. Does your weight fluctuate frequently?
  5. Do you eat even when you’re not hungry?
  6. Do you avoid some foods out of fear or disgust?
  7. Do you sometimes feel out of control when eating?
  8. Do you skip meals or go a whole day without eating?
  9. Do you get angry when you’re interrupted while eating?
  10. Do you feel insecure when you eat in front of other people?
  11. Does your perception of body size differ from the opinions of others?
  12. Do you rush through meals, often unaware of how much you’ve eaten?
  13. Do you choose clothes that hide your weight loss or, conversely, show it off?
  14. Do thoughts about food interfere with your ability to concentrate on daily tasks?
  15. Have you experienced strong feelings of disgust or anxiety about your body image?
  16. Do you skip group activities and avoid social gatherings because they involve eating together?
  17. Have you engaged in harmful behaviors such as vomiting or excessive exercise to prevent weight gain?
Katherine Pocock, Clinical Neuropsychiatrist, MBPsS, adds Eating disorders are complex and culturally sensitive issues. They don’t look the same for everyone, and they might not look the same way they’re portrayed in the media. If you feel concerned about your eating behaviors or weight, please speak to a medical professional.

Eating disorder treatments

Recovery from eating disorders is real and achievable, although it’s a gradual process that requires comprehensive support for both body and mind. 

It’s important to consult with a specialized team of health professionals that includes gastrointestinal specialists and nutritionists for physical healing and mental health experts such as psychologists, psychiatrists, or therapists.

But be very attentive when seeking help: two-thirds of people experiencing weight stigma were further stigmatized by doctors. So, look for a doctor who specializes in eating disorders and offers compassionate and effective treatment. 

Unfortunately, not everyone receives a timely diagnosis or has equal access to treatment. Anyone who doesn’t fit the mold of a skinny, white cis-gender woman can fly under the radar when it comes to eating disorders. Factors such as race, socioeconomic status, insurance coverage, and location affect access to diagnostics and treatment. Case in point, youth of color are less than two-thirds as likely to receive recommended treatment. This makes awareness much more important, so share this information with anyone seeking help.

1. Psychological treatment

Psychological treatments play a central role in recovery, with licensed therapists helping people who suffer from eating disorders understand and address their underlying triggers or trauma. Techniques like Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT) help to change the thought and behavior patterns associated with eating disorders.

2. Nutritional counseling

Nutritional counseling, provided by licensed dietitians, focuses on learning proper nutrition, cultivating healthy eating habits, and managing weight changes. Plus, they offer tailored meal plans and monitor the recovery progress to alter dietary recommendations as necessary.

3. Eating disorder medications

Sometimes, doctors suggest medications such as antidepressants, antipsychotics, or mood stabilizers to treat eating disorders. If your doctor recommends medication, they should explain how it can help and answer any questions you may have. These medications not only address the eating disorder but also tackle issues like depression or anxiety that may accompany it.

4. Support groups and treatment centers

Support groups, crisis lines, treatment centers, and mentorship programs create nurturing environments for healing, fostering emotional, psychological, and physical well-being for people with eating disorders and their families. Residential treatment programs, where people learn from those who have successfully recovered, have also proven very effective in the United States.

Recovering from an eating disorder means finding new, healthier ways to cope with your feelings instead of using food. It’s a journey, but with the right support, you can get there.

How to help someone with an eating disorder

Helping someone with an eating disorder requires compassion, kindness, and understanding. People with eating disorders often feel alone and misunderstood, experiencing emotions like embarrassment, shame, and guilt. Be patient and expect resistance as they navigate their journey to healing. Support and personal connection are crucial, and it takes time and repeated efforts to aid their recovery.

Avoid talking about the body because people with eating disorders can be triggered by both criticism and compliments. Also, avoid discussing diets around them (it makes them feel even guiltier when they eat), and don’t minimize their struggles. No, you don’t know what it’s like unless you’ve struggled with an eating disorder yourself.

Forget phrases like “You don’t look like you have an eating disorder,” “I wish I had a body like yours,” and “It’s all in your head.”

Instead, offer genuine support and refrain from making comparisons. Remember, they need love and support, both mentally and physically.


Food is our basic energy source and a central part of our celebrations and socialization. Yet every 52 minutes, one person in the US dies as a result of an eating disorder, highlighting the urgent need for awareness and help.

If you’re struggling with an eating disorder, remember that you are not alone and can make a full recovery with the proper treatment. This often includes nutritional counseling, talk therapies such as CBT and family-based therapy, and sometimes medication.

Through understanding, support, and early help, you can work toward a healthier relationship with food and break the cycle of suffering. I believe in you. We all do.

Katherine Pocock, MBPsS photo

Reviewed by Katherine Pocock, MBPsS

Katherine Pocock MBPsS holds an MSc in Clinical Neuropsychiatry from King's College London and a BSc in Psychology with Neuroscien...