As many as 30 million people in the United States have an eating disorder. While people of all genders, races, and ethnicities have these disorders, for 95% of people they onset or start between the ages of 12 and 25 years old—and many of them unfortunately continue to struggle into adulthood. What's more, these deadly illnesses have a ripple effect, tending to upend the lives of friends and family as well as harming the mental and physical health of the person struggling.

To better understand eating disorders, the Newsroom staff sat down with Dr. Erin Parks, a clinical psychologist and researcher and the cofounder, chief operating officer, and clinical officer at Equip, a company that provides virtual and evidence-based care for people suffering with an eating disorder.

What are the different types of eating disorders?

“Eating disorder” is an umbrella term for seven different disorders. What is common in all eating disorders is that the people suffering are robbed of health and joy by having their brain be preoccupied by thoughts, worries, and/or obsessions about food and/or their body. Most people struggling with eating disorders also struggle with depression and/or anxiety. Importantly, no one with an eating disorder chooses to be ill, just as no one chooses depression or anxiety.

• Anorexia nervosa is characterized by restriction of food, which can include restricting quantity (such as eating fewer calories than their body needs) and/or a restriction in variety (such as eliminating food groups like sugar, gluten, or “sweets”).
• Binge eating disorder is the most common eating disorder in the U.S. It involves restriction, similar to anorexia, followed by bingeing: eating large amounts of food, often while feeling out of control and/or shame.
• Bulimia nervosa involves restricting followed by bingeing, and adds purging: a shame-driven compensatory behavior after eating that can include vomiting, laxatives, or excessive exercise.

Other, less commonly known eating disorders include:

• Avoidant/restrictive food intake disorder (ARFID): An eating disorder where a person has a limited palette (i.e., extreme picky eating), and/or exceedingly low hunger cues, and/or excessive fear or phobias around different aspects of eating such as a fear of being poisoned or a fear of choking.
• Pica: An eating disorder in which a person eats items with no nutritional value, such as ice, paper, or soil.
• Rumination disorder: An eating disorder in which a person spits up food from the stomach, rechews it, and swallows it again or spits it out.
• Other specified feeding or eating disorder (OSFED): A general name given to eating disorders that don't meet the specific criteria of other disorders but cause harm and require treatment.

How common are eating disorders?

Eating disorders are more common than you might think: 10% of Americans will develop an eating disorder in their lifetime, most commonly presenting in teenagers and young adults.

What’s more, eating disorder rates have spiked since the start of the pandemic: hospital rates have doubled, and the National Eating Disorders Association (NEDA) has seen a 70% spike in calls and online chat inquiries.

Are certain traits more common in individuals with eating disorders?

Eating disorders are complex brain disorders with strong genetic, neurobiological, and psychological underpinnings. No single person, experience, or issue causes an eating disorder. They often co-occur with and can be hidden by anxiety disorders, depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and substance use disorder.

Research shows that some personality traits are associated with certain eating disorders. Anorexia is associated with excessive worrying, anxiety, shyness, persistence, and low levels of novelty-seeking, among other characteristics. Bulimia is associated with high levels of novelty-seeking, impulsivity, and anxiety, among other characteristics. Both disorders are associated with perfectionism and inflexibility. Personality traits associated with other eating disorders aren’t well understood at this point.

It’s important to understand that not everyone with these personality traits will develop an eating disorder, and not everyone with an eating disorder will exhibit these personality traits.

Are behavioral and medical conditions common in individuals with an eating disorder?

Yes. Though the rates of comorbidities vary among eating disorders, they are considerable for all. According to the National Institutes of Health (NIH), 56.2% of those with anorexia, 94.5% of those with bulimia, and 78.9% of those with binge eating disorder meet criteria for at least one other mental health diagnosis. For all three eating disorders, the highest rates of comorbidities were with any anxiety disorder.

What are some of the signs/symptoms of eating disorders?

Eating disorders are sneaky and often secretive. If you’re concerned about a loved one but can’t pinpoint specific behaviors, continue to pay attention and consider voicing your concerns to them in a curious, compassionate way. We’ve developed an eating disorder assessment to help loved ones understand key signs of eating disorders, knowing that signs can range from eating and exercise habits, to mood, to social behaviors, and more.

If you’ve seen (or are experiencing) several of the behaviors listed in the assessment, we recommend getting a professional consultation. You can reach out to your pediatrician or primary care physician as a first step.

What causes eating disorders?

Eating disorders are brain disorders that occur as a complex confluence of neurological, biological, and environmental influences.

Researchers are still learning what triggers or "turns on" eating disorders in the brain. For many, it seems to come from a negative energy balance caused from more calories out than in, which can be triggered by a diet, excessive exercise, a stomach bug, or surgery. Once that imbalance occurs, a switch flips in the brain, turning on the eating disorder and tyrannizing the brain.

Societal and cultural factors such as the pandemic, diet culture, and social media can contribute to the development of an eating disorder for those with a genetic predisposition. In addition, these factors can trigger big emotions that people try to combat with disordered behaviors.

How do you get diagnosed?

If you’re worried that you or a loved one might have an eating disorder, it’s important to get a prompt diagnosis from an eating disorder professional. You could do this by getting a referral from your pediatrician or primary care physician or by reaching out to an eating disorder organization or treatment provider. For instance, you can use the free screening tool from NEDA, and both Equip and Project HEAL offer free consultations.

Where do you go for help?

Several treatment options are available for people struggling with an eating disorder. First, it’s important to consider medical stability: If a doctor deems that you or your loved one are medically unstable, hospitalization is the first step. The doctor will make this determination based on your vital signs and the results of lab tests.

For those who don’t need hospitalization (or after discharge for those who do), several potential treatment options are available. You can choose a residential (live-in) treatment facility, an outpatient treatment program, or virtual treatment. Virtual eating disorder treatment has been proven to be as effective as in-person treatment, and it’s more affordable and more convenient than live-in options, making it a good choice for many families.

Many nonprofits exist with an abundance of resources to help you make a choice about treatment. Project HEAL, NEDA, and ANAD are great places to start.

It’s important to understand that eating disorders are serious, deadly diseases, and that recovering from one requires professional help. These illnesses are not simply a choice someone makes, and recovery can’t be done alone.

What does Equip treatment look like?

There are many different types of eating disorder treatment as well as treatment settings.

Family-Based-Treatment (FBT) is considered the gold standard for young people with eating disorders, as evidence consistently shows it’s the most effective approach for lasting recovery. Equip’s treatment takes the FBT approach and builds on it.

In our model, each family has a dedicated provider team: a medical provider and/or psychiatrist, a therapist, a dietitian, a peer mentor, and a family mentor. Families are matched with their dedicated provider team based on shared background and experiences, helping to make treatment a safe space for everyone we serve.

Equip is considered a replacement for all levels of care, with the exception of situations in which a patient requires to be hospitalized for medical stabilization. Throughout treatment, families meet regularly with each member of their Equip provider team as they work toward their individual treatment goals.

A great deal of work is also done between sessions, as family members work on nourishing their child and preventing eating disorder behaviors at home. Equip is designed to support that work with self-help resources as well as our messaging feature, which allows families to communicate with their provider team between sessions. Additionally, medical markers such as weight and vitals are monitored by families throughout treatment, just as they would be in residential settings.

If a patient should need medical stabilization prior to or during treatment, we transfer them to an inpatient level of care. We can resume Equip treatment once they are stabilized.