Eating disorders are a group of mental health conditions defined by persistent disruptions in eating behavior that affect physical health, emotional wellbeing, and daily functioning. They carry the second highest mortality rate of any psychiatric illness, behind only opiate addiction. The major recognized eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder.
Anorexia Nervosa
Anorexia nervosa involves restricting food intake to the point of maintaining a significantly low body weight, combined with an intense fear of gaining weight and a distorted perception of one’s own body size or shape. Someone with anorexia may look in the mirror and perceive themselves as overweight even when they are dangerously underweight. Severity in adults is categorized by BMI: mild is a BMI of 17 or above, moderate falls between 16 and 16.99, severe between 15 and 15.99, and extreme is below 15.
There are two subtypes. The restricting type involves limiting calories through dieting, fasting, or excessive exercise. The binge-eating/purging type involves episodes of eating large amounts of food followed by self-induced vomiting, laxative misuse, or other methods to prevent weight gain. This second subtype is sometimes confused with bulimia, but the key distinction is the persistently low body weight.
Anorexia is the most physically dangerous eating disorder. Prolonged starvation damages the heart, bones, kidneys, and brain. It can cause dangerously slow heart rate, loss of bone density, organ failure, and death.
Bulimia Nervosa
Bulimia nervosa is characterized by repeated cycles of binge eating followed by compensatory behaviors aimed at preventing weight gain. Unlike anorexia, people with bulimia often maintain a weight that appears normal, which can make the condition harder to spot from the outside.
A diagnosis requires that both the binge eating and the compensatory behaviors happen at least once a week for three months. Compensatory behaviors go well beyond vomiting. They include laxative abuse, excessive joyless exercise, periods of strict fasting, diuretic use, appetite suppressants, and in people with type 1 diabetes, deliberately skipping insulin doses. The repeated purging cycle takes a serious toll on the body, eroding tooth enamel, damaging the esophagus, disrupting electrolyte balance, and straining the heart.
Binge Eating Disorder
Binge eating disorder (BED) is the most common eating disorder. It involves regularly eating unusually large amounts of food in a short period while feeling a complete loss of control, but without the purging or compensatory behaviors seen in bulimia. Nearly everyone overeats occasionally, like going back for thirds at a holiday dinner. What separates BED is the pattern: binges happen repeatedly, feel uncontrollable, and cause significant distress afterward.
Triggers vary widely. Stress, poor body image, boredom, social situations like parties, and even driving in the car can set off an episode. One of the more counterintuitive triggers is dieting itself. Restricting calories during the day often creates an urge to binge later. The severity of BED is measured not just by how often binges occur, but by how much the episodes affect your mood and ability to function day to day.
Avoidant Restrictive Food Intake Disorder
ARFID involves severely limiting the amount or variety of food you eat, but for reasons that have nothing to do with body image or fear of gaining weight. That distinction is important. Someone with ARFID might avoid foods because of their texture, smell, color, or temperature, or because of a fear of choking or vomiting. Others simply have very little interest in eating.
ARFID is sometimes dismissed as “just picky eating,” but there’s a clear line between the two. Ordinary picky eating in children tends to improve over time and doesn’t cause nutritional problems. With ARFID, the range of accepted foods gets narrower over time, not wider. The restriction becomes severe enough to cause nutritional deficiencies, weight loss, dependence on nutritional supplements, or significant interference with social life. Children who don’t outgrow normal picky eating, or whose picky eating is unusually severe, appear more likely to develop ARFID.
Pica
Pica involves regularly eating substances that are not food and have no nutritional value. The list of ingested materials is surprisingly broad: clay, soil, chalk, plaster, plastic, metal, paper, charcoal, ash, cloth, baby powder, coffee grounds, eggshells, and ice. Some forms have specific names. Geophagy is eating earth, pagophagia is eating ice, and amylophagy is eating raw starches like corn flour in large quantities.
For a diagnosis, the behavior has to persist for at least a month and be inappropriate for the person’s developmental stage. A toddler putting things in their mouth is normal. An older child or adult regularly consuming non-food items is not. Pica is more common in people with intellectual disabilities, during pregnancy, and in individuals with iron deficiency, though it can occur in anyone.
Rumination Disorder
Rumination disorder involves repeatedly and intentionally bringing already-swallowed food back up into the mouth, where it may be re-chewed and swallowed again or spit out. This is not vomiting. The regurgitation happens without nausea and without any apparent effort. It typically occurs within minutes of eating and can happen at every meal.
The condition occurs in infants, children, and adults. In adults, it often goes undiagnosed for years because it’s mistaken for acid reflux or other gastrointestinal problems. Over time, it can lead to malnutrition, weight loss, tooth erosion, and social withdrawal, since many people with the disorder avoid eating around others.
Orthorexia: Not Yet Official
Orthorexia nervosa is a proposed condition, not currently recognized in the DSM-5-TR, but increasingly discussed by clinicians. It describes an extreme fixation on eating “healthy” or “clean” foods that becomes rigid and compulsive enough to impair daily life. It often starts innocently, with someone trying to follow nutritional guidelines, manage an illness, or avoid processed foods. Over time, the rules around food become so strict that they cause conflict with family, limit social opportunities, and paradoxically lead to nutritional deficiencies.
Unlike anorexia or bulimia, orthorexia is not driven by fear of weight gain or distorted body image. The preoccupation is with food quality rather than quantity. Because it lacks formal diagnostic criteria, people with orthorexic patterns may be diagnosed under the broader category of “other specified feeding and eating disorder.”
Who Is Affected
Eating disorders affect people of every age, gender, race, and socioeconomic background, though they are most commonly identified in adolescents and young adults. Among people aged 10 to 24, the global prevalence rate rose from about 301 per 100,000 in 1990 to roughly 355 per 100,000 in 2021. Those numbers likely undercount the real burden, since binge eating disorder and several other types were excluded from that analysis, and underreporting is common in lower-income regions.
Eating disorders are not a choice or a phase. They have biological, psychological, and social roots. Genetics play a role, as do personality traits like perfectionism, experiences of trauma, and cultural pressures around body size.
How Eating Disorders Are Treated
Treatment depends on the type and severity of the disorder, but talk therapy is the backbone for most. Enhanced cognitive behavioral therapy (CBT-E) is one of the most studied approaches for bulimia and binge eating disorder. It works by first restoring healthy eating patterns, then helping you identify and change the distorted thoughts and feelings that drive disordered behavior. Family-based treatment is commonly used for adolescents with anorexia, placing parents in an active role in restoring their child’s nutrition and weight.
More severe cases, particularly anorexia at very low body weights, may require structured treatment programs where meals are supervised and medical complications are monitored. Recovery timelines vary widely. Some people improve within months of starting treatment, while others cycle through periods of progress and relapse over years. Early intervention consistently leads to better outcomes, regardless of the specific disorder.