Condition

Eating Disorders: Types, Medical Risks, and Treatment

Summary

Eating disorders — anorexia nervosa, bulimia nervosa, binge-eating disorder, and ARFID — are serious medical and psychiatric illnesses, not lifestyle choices. Binge-eating disorder is the most common, affecting an estimated 2.8% of U.S. adults over a lifetime. Anorexia nervosa carries one of the highest mortality rates of any psychiatric illness, roughly six times the rate expected for a person's age and sex. Evidence-based treatments — family-based treatment for younger patients, enhanced CBT for adults — lead to recovery.

Written by Gale Editorial · grounded in the cited clinical sources below · Updated 2026-07-07. How we write.

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What eating disorders are

Eating disorders are serious mental illnesses defined by a persistent disturbance in eating or eating-related behavior that harms physical health, emotional wellbeing, or the ability to function. They are not a lifestyle choice, a phase, or a matter of willpower. A 2020 Lancet review characterizes them as "disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning" 4.

They occur across every age, sex, gender, body size, and background, including in adults whose illness began in adolescence and in people whose weight looks unremarkable. Some of the most dangerous consequences are internal — affecting the heart, fluids, and electrolytes — so the severity of an eating disorder cannot be read from body size alone 4.

The four main eating disorders

Anorexia nervosa (AN) involves restriction of food intake leading to significantly low body weight, an intense fear of weight gain, and a distorted experience of body weight or shape. Some people primarily restrict; others also binge and purge 4.

Bulimia nervosa (BN) is defined by recurrent episodes of binge eating followed by compensatory behavior meant to prevent weight gain — self-induced vomiting, laxatives, fasting, or excessive exercise — with self-evaluation unduly tied to shape and weight. Body weight is often in the normal range, which can delay recognition 4.

Binge-eating disorder (BED) involves recurrent binge eating — eating an unusually large amount with a sense of loss of control — without the regular compensatory behavior seen in bulimia. It is the most common eating disorder in adults and is frequently accompanied by distress and shame 12.

Avoidant/restrictive food intake disorder (ARFID) is food avoidance or restriction that is not driven by concerns about weight or shape. It stems from the sensory characteristics of food, a fear of aversive consequences such as choking or vomiting, or an apparent lack of interest in eating, and it can cause weight loss, nutritional deficiency, or dependence on supplements. ARFID is one of the recognized eating disorders in current diagnostic criteria 4.

How common eating disorders are

Eating disorders are more common than they are often assumed to be, and survey data likely undercount them because many people never disclose symptoms.

In the National Comorbidity Survey Replication — the main U.S. epidemiological source — estimated lifetime prevalence among adults was:

  • Binge-eating disorder: about 2.8% overall 1 (3.5% of women, 2.0% of men) 2 — the most common eating disorder 12.
  • Bulimia nervosa: about 1.0% overall 1 (1.5% of women, 0.5% of men) 2.
  • Anorexia nervosa: about 0.6% overall (0.9% of women, 0.3% of men) 12.

The impairment attached to these conditions is substantial. Among U.S. adults with bulimia nervosa, 78.0% reported role impairment and 43.9% reported severe impairment; among those with binge-eating disorder, 62.6% reported some impairment and 18.5% severe 1. Among adolescents aged 13 to 18, the lifetime prevalence of eating disorders is an estimated 2.7% (3.8% of girls, 1.5% of boys) 1, and adolescent-onset illness frequently continues into adulthood 4.

Why eating disorders are medically serious

Eating disorders have among the highest mortality of any psychiatric illness. A meta-analysis of 36 studies found a weighted annual mortality of 5.10 deaths per 1,000 person-years for anorexia nervosa, corresponding to a standardized mortality ratio of 5.86 — meaning people with anorexia die at roughly six times the rate expected for their age and sex. Bulimia nervosa (standardized mortality ratio 1.93) and other specified eating disorders (1.92) also carry elevated mortality 3.

Deaths come from two directions: the medical consequences of starvation, purging, and electrolyte disturbance, and suicide. In the same analysis, one in five people with anorexia nervosa who died had taken their own life 3. This is why an eating disorder is treated as a medical as well as a psychological condition, and why acute medical instability — not weight alone — determines when hospital-level care is needed.

Treatments with the strongest evidence

Eating disorders are treatable, and most people improve with evidence-based care. Treatment choice depends on the disorder, the person's age, and their medical status 5.

Family-based treatment (FBT). For adolescents and emerging adults with anorexia nervosa who have an involved caregiver, family-based treatment is the recommended first-line approach; it enlists parents to help restore nutrition and interrupt eating-disorder behaviors before gradually returning control to the young person 5. In a randomized trial comparing FBT with adolescent-focused individual therapy, FBT produced significantly higher rates of full remission at both 6- and 12-month follow-up 6.

Enhanced cognitive behavioral therapy (CBT-E). For adults, eating-disorder-focused CBT is the leading psychological treatment for bulimia nervosa and is used transdiagnostically across eating disorders. In a two-site trial of transdiagnostic CBT, 51.3% of patients had eating-disorder features less than one standard deviation above the community mean at 60-week follow-up, with gains largely maintained over time 7. Interpersonal psychotherapy (IPT) is also effective for binge-eating disorder 5.

Medications. For bulimia nervosa, guidelines recommend combining eating-disorder-focused CBT with an SSRI, with fluoxetine at 60 mg daily having the strongest evidence 5. For binge-eating disorder, lisdexamfetamine became the first and only medication approved by the U.S. Food and Drug Administration for moderate-to-severe disease in 2015 9; in its pivotal trial, 42.2% (50 mg) and 50.0% (70 mg) of participants achieved four weeks of abstinence from binge eating, versus 21.3% on placebo 8. No medication is approved specifically to treat anorexia nervosa, where care centers on nutritional restoration and psychotherapy 5.

What to expect from care

Most people are treated as outpatients. A first assessment covers eating patterns and behaviors, weight history, medical status, and co-occurring conditions such as depression, anxiety, and substance use, which are common 4. Treatment is usually a team effort — a therapist, a medical provider, and often a dietitian.

Higher levels of care (day programs, residential, or inpatient) are used when someone is medically unstable or not improving as an outpatient; that decision turns on medical measures such as vital signs and electrolytes rather than weight alone 5. Early in refeeding, clinicians monitor closely for refeeding syndrome — a dangerous shift in fluids and electrolytes that can occur when nutrition is restored too quickly.

Recovery is realistic, and most people improve with evidence-based treatment 5. Progress is often non-linear, and relapse is treated as part of the illness course rather than a failure.

Eating disorders, weight, and who is affected

An eating disorder cannot be diagnosed — or ruled out — by looking at someone. People with bulimia nervosa and binge-eating disorder are frequently at or above average weight, and some people have every feature of anorexia nervosa except low weight while facing similar medical risks 4.

Because the illness is stereotyped as affecting thin young women, it is under-recognized in men and in people in larger bodies. More than a third of adults with binge-eating disorder are men, yet men are less likely to be screened or referred 12. Anyone can develop an eating disorder, and physical appearance is a poor guide to how ill a person is.

Example practice profiles

2 example practice profiles focus on eating disorders →

Common questions

Yes. Eating disorders are among the most lethal psychiatric illnesses. A meta-analysis of 36 studies found that people with anorexia nervosa die at roughly six times the rate expected for their age and sex, and that one in five of those deaths was by suicide. Bulimia nervosa and other eating disorders also carry elevated mortality. Deaths result from both the medical effects of starvation and purging and from suicide, which is why an eating disorder is treated as a medical as well as a psychological condition.

Anorexia nervosa involves restricting food to the point of significantly low body weight, with an intense fear of weight gain. Bulimia nervosa involves recurrent binge eating followed by compensatory behavior such as vomiting or laxative use, usually at a normal body weight. Binge-eating disorder involves recurrent binge eating with a sense of loss of control but without the regular compensatory behavior seen in bulimia, and it is the most common of the three.

Avoidant/restrictive food intake disorder (ARFID) is food avoidance or restriction that is not driven by concerns about weight or shape. It usually stems from the sensory qualities of food, a fear of consequences such as choking or vomiting, or a lack of interest in eating. It can cause weight loss, nutritional deficiency, or reliance on nutritional supplements, and it is one of the eating disorders recognized in current diagnostic criteria.

Family-based treatment is the recommended first-line approach for adolescents and emerging adults with anorexia nervosa. For adults, eating-disorder-focused cognitive behavioral therapy (CBT-E) is the leading psychological treatment for bulimia nervosa and is used across eating disorders, and interpersonal psychotherapy is also effective for binge-eating disorder. Medications play a supporting role: fluoxetine for bulimia nervosa, and lisdexamfetamine for moderate-to-severe binge-eating disorder. There is no medication approved specifically for anorexia nervosa.

Yes. Eating disorders occur across every sex, gender, age, and body size. More than a third of adults with binge-eating disorder are men, and people with bulimia nervosa and binge-eating disorder are frequently at or above average weight. Some people meet every criterion for anorexia nervosa except low weight while facing similar medical risks. Because eating disorders are stereotyped as affecting thin young women, they are often underdiagnosed in everyone else.

Urgent care is warranted for fainting, chest pain, a very slow or irregular heartbeat, seizures, vomiting blood, or signs of severe dehydration or electrolyte disturbance such as confusion or muscle weakness. Thoughts of suicide or self-harm are also an emergency. If you are having thoughts of suicide or self-harm, call or text 988. For fainting, chest pain, an irregular heartbeat, or seizures, call 911.

Related conditions

Depression: Signs, Causes, and Treatment · Anxiety: Symptoms, Types, and Treatment · OCD (Obsessive-Compulsive Disorder): Symptoms, Subtypes, and Treatment · Substance Use Disorder: Spectrum, Diagnosis, and Treatment

Specialties

Behavioral Health: What Therapists and Psychiatrists Treat

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When to seek care

  • —Thoughts of suicide or self-harm — call or text 988 immediately
  • —Fainting, chest pain, a very slow or irregular heartbeat, or seizures — call 911
  • —Vomiting blood, or blood in the stool
  • —Confusion, severe weakness, or muscle cramps — possible signs of dangerous electrolyte disturbance
  • —Rapid or extreme weight loss, or an inability to keep any food or fluids down
  • —Purging (vomiting, laxatives, or diuretics) or fasting that has become frequent or daily
  • —An eating disorder in someone who is pregnant, has diabetes, or is otherwise medically ill

If you are having thoughts of suicide or self-harm, call or text 988 (Suicide and Crisis Lifeline, available 24/7). For fainting, chest pain, an irregular heartbeat, seizures, or vomiting blood, call 911.

General health information, not medical advice. Synthetic demonstration content.

References

  1. 1.National Institute of Mental Health (NIMH) (2024). Eating Disorders: Statistics. NIMH. link ✓U.S. adult lifetime prevalence (binge-eating disorder 2.8%, bulimia nervosa 1.0%, anorexia nervosa 0.6%); lifetime sex split shown for anorexia nervosa only (0.9% women / 0.3% men); 12-month (not lifetime) sex splits for bulimia nervosa (0.5% women / 0.1% men) and binge-eating disorder (1.6% women / 0.8% men); role impairment (bulimia 78.0% any / 43.9% severe; binge-eating 62.6% any / 18.5% severe); adolescent lifetime prevalence 2.7% (girls 3.8%, boys 1.5%)
  2. 2.Hudson JI, Hiripi E, Pope HG Jr, Kessler RC (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry. doi:10.1016/j.biopsych.2006.03.040 ✓Lifetime prevalence by sex from the NCS-R: anorexia nervosa 0.9% women / 0.3% men, bulimia nervosa 1.5% / 0.5%, binge-eating disorder 3.5% / 2.0%; binge-eating disorder is the most common eating disorder
  3. 3.Arcelus J, Mitchell AJ, 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. doi:10.1001/archgenpsychiatry.2011.74 ✓Weighted annual mortality for anorexia nervosa 5.10 per 1,000 person-years; standardized mortality ratios AN 5.86, bulimia nervosa 1.93, EDNOS 1.92; one in five deaths in anorexia nervosa was by suicide
  4. 4.Treasure J, Duarte TA, Schmidt U (2020). Eating disorders. The Lancet. doi:10.1016/S0140-6736(20)30059-3 ✓Recognized eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID); eating disorders are "disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning"; frequent psychiatric comorbidity
  5. 5.American Academy of Family Physicians (summary of the APA 2023 Practice Guideline) (2024). Treating Patients With Eating Disorders: Guidelines From the American Psychiatric Association. American Family Physician. link ✓First-line recommendations: family-based treatment for adolescents/emerging adults with anorexia nervosa; eating-disorder-focused CBT plus an SSRI (fluoxetine 60 mg has the most evidence) for bulimia nervosa; CBT and interpersonal psychotherapy for binge-eating disorder; lisdexamfetamine for binge-eating disorder; higher-level care determined by medical status
  6. 6.Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B (2010). Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa. Archives of General Psychiatry. doi:10.1001/archgenpsychiatry.2010.128 ✓Family-based treatment (FBT) was significantly superior to adolescent-focused individual therapy on full remission at both 6- and 12-month follow-up in adolescent anorexia nervosa
  7. 7.Fairburn CG, Cooper Z, Doll HA, O'Connor ME, Bohn K, Hawker DM, Wales JA, Palmer RL (2009). Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up. American Journal of Psychiatry. doi:10.1176/appi.ajp.2008.08040608 ✓Transdiagnostic CBT (CBT-E): at 60-week follow-up 51.3% of patients had eating-disorder features less than one standard deviation above the community mean, with gains maintained over time
  8. 8.McElroy SL, Hudson JI, Mitchell JE, Wilfley D, Ferreira-Cornwell MC, Gao J, Wang J, Whitaker T, Jonas J, Gasior M (2015). Efficacy and Safety of Lisdexamfetamine for Treatment of Adults With Moderate to Severe Binge-Eating Disorder: A Randomized Clinical Trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2014.2162 ✓In moderate-to-severe binge-eating disorder, four-week binge-eating abstinence was achieved by 42.2% (50 mg) and 50.0% (70 mg) of participants vs 21.3% on placebo; the 30 mg dose was not significantly better than placebo
  9. 9.Shire (Takeda) (2015). Vyvanse (Lisdexamfetamine Dimesylate) Becomes First and Only Treatment Approved by the FDA for Adults With Moderate to Severe Binge Eating Disorder. Shire/Takeda news release. link ✓On January 30, 2015 the FDA approved lisdexamfetamine (Vyvanse) as the first and only medication for the treatment of moderate to severe binge-eating disorder in adults

https://www.gale.care/conditions/eating-disorders · 9 sources. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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