As many as 30 million people in the United States have an eating disorder. People of all genders, races, and ethnicities have these disorders. 95% of eating disorders begin between the ages of 12 and 25 years old – and many individuals unfortunately continue to struggle into adulthood.

Eating disorders also 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. Importantly, eating disorders are not a matter of willpower, and no one with an eating disorder chooses to be ill.

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

What are the different types of eating disorders?

“Eating disorder” is an umbrella term for several different disorders. Across all types of eating disorders, there are common characteristics that include excessive thoughts, worries, and/or obsessions about food and/or their body. Many people struggling with eating disorders also struggle with depression and/or anxiety. Symptoms vary depending on the type of eating disorder; here are some of the most well-known:

• 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 or gluten).

• 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 restriction followed by bingeing, and adds purging: a shame-driven compensatory behavior after eating that can include vomiting, laxative misuse, or excessive exercise.

Other, less commonly known eating disorders include:

• Avoidant/restrictive food intake disorder (ARFID): An eating disorder where a person has extreme food sensitivities, 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.

• 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 still 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. An estimated 10,200 deaths occur annually in the U.S. due to eating disorders. 

What’s more, eating disorder rates have spiked since the start of the pandemic: 57% of patients with an eating disorder have seen their symptoms worsen, and hospital rates have doubled among adolescents with eating disorders.

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 disorders.

Research shows that some personality traits are associated with certain eating disorders. For example, anorexia is associated with:

• Excessive worrying
• Anxiety
• Shyness
• Persistence
• Low levels of novelty-seeking

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?

The short answer is, 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 adults 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 disordered eating and exercise habits, to mood swings, to social withdrawal, 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 primary care physician or pediatrician 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, some people may use disordered eating or excessive exercise coping mechanisms for stressors, which can become an eating disorder over time.

How do you get diagnosed?

If you’re worried that you or a loved one might have an eating disorder, it’s important to seek a diagnosis from an eating disorder professional. You could do this by getting a referral from your primary care physician or pediatrician or by reaching out to an eating disorder organization or treatment provider. For instance, Equip offers 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. Plus, it allows patients to stay connected to their everyday lives and put new skills directly into action.

It’s important to understand that eating disorders are serious, life-threatening diseases, and that recovering from one requires professional help. These illnesses are not simply a choice someone makes, and you can’t white-knuckle through recovery alone.

What does Equip treatment look like?

We tailor treatment for each patient by using a variety of evidence-based modalities to meet each patient’s needs. This often means leaning into certain clinical techniques at different points in treatment, shifting as needed based on what’s working, or using multiple different approaches at once.

Some of the most commonly used treatment modalities at Equip include family-based treatment (FBT), the gold standard for young people with eating disorders, and enhanced cognitive behavioral therapy (CBT-E), one of the most effective eating disorder treatments for adults.

No matter what treatment modality is used, each patient at Equip has a dedicated provider team, including a medical provider, psychiatrist, therapist, dietitian, and a peer and family mentor who have lived experience with eating disorder recovery. Patients and their 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.

Patients and their loved ones can attend appointments from home so they can stay connected to what matters most to them, like hobbies, friends, family, school, or jobs. This approach also allows patients to apply new skills directly into their everyday lives as they learn them. 

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 or psychiatric stabilization. Throughout treatment, patients meet regularly with each member of their Equip provider team as they work toward their individual treatment goals.

Equip also provides self-help resources, interactive support groups, and a messaging feature that allows patients and their families to communicate with their provider team between sessions. Additionally, medical markers such as weight and vitals are monitored throughout treatment, just as they would be in residential settings.

Equip is dedicated to providing accessible care for anyone who needs it. We treat patients of all ages in all 50 states, and Equip is in-network with Cigna/Evernorth as well as many other insurers. To learn more about our treatment and get a free phone consultation, visit here or call (855) 387-4378.