Understanding Eating Disorders: Signs, Stigma, and Support
Published March 18, 2026
By Shalina Covington, MSW Candidate and co-authored by Zoe Skowronski, LCSW.
Eating disorders are serious mental health conditions that affect millions of individuals worldwide. Despite increasing awareness, many people still misunderstand these disorders or assume they are simply unhealthy eating habits. In reality, eating disorders involve complex emotional, psychological, and physiological processes that require compassion, education, and professional intervention. Understanding the different types of eating disorders, their presentations, and treatment approaches can help reduce stigma and support earlier intervention.
What Are Eating Disorders?
Eating disorders are psychiatric conditions characterized by persistent disturbances in eating behaviors and a maladaptive preoccupation with body weight, shape, or food. These disorders are associated with significant impairment in physical health, emotional regulation, and psychosocial functioning. They are recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and often co-occur with conditions such as anxiety, depression, trauma-related disorders, and obsessive-compulsive features (American Psychiatric Association, 2022).
Eating disorders affect individuals across all genders, ages, racial identities, and body sizes, though they are often underdiagnosed in marginalized populations due to bias and stigma (NEDA, 2023; Sonneville et al., 2018).
Types of Eating Disorders
Anorexia Nervosa
Anorexia nervosa is characterized by persistent restriction of energy intake, intense fear of gaining weight, and a distorted perception of body shape or size. Individuals may engage in severe caloric restriction, excessive exercise, or other compensatory behaviors. Medical complications can include bradycardia, osteoporosis, electrolyte imbalances, and organ dysfunction, making it one of the most life-threatening psychiatric conditions (Arcelus et al., 2011).
There are subtypes:
Restricting type (primarily food restriction)
Binge-eating/purging type (episodes of bingeing or purging behaviors)
Bulimia Nervosa
Bulimia nervosa involves recurrent episodes of binge eating followed by compensatory behaviors such as vomiting, laxative misuse, fasting, or excessive exercise. Unlike anorexia, individuals are often within a “normal” weight range, which can delay recognition and diagnosis.
Psychologically, bulimia is often associated with cycles of shame, loss of control, and attempts to regain control through purging behaviors (Fairburn et al., 2003).
Binge-Eating Disorder (BED)
Binge-eating disorder is the most prevalent eating disorder in the United States. It involves recurrent episodes of consuming large quantities of food accompanied by a sense of loss of control, without compensatory behaviors. Individuals often experience significant distress, shame, and emotional dysregulation related to eating (Hudson et al., 2007).
BED is associated with higher rates of comorbid mood disorders, trauma histories, and weight stigma-related distress.
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is characterized by restrictive eating that is not driven by body image concerns but rather by sensory sensitivities, fear of adverse consequences (e.g., choking, vomiting), or lack of interest in eating. This can lead to nutritional deficiencies, weight loss, or dependence on supplements (Thomas et al., 2017).
ARFID is more commonly identified in children but also occurs in adults, particularly those with neurodivergence or anxiety disorders.
Other Specified Feeding or Eating Disorder (OSFED)
OSFED includes clinically significant eating disturbances that do not meet full criteria for other diagnoses but still cause impairment. Examples include:
Atypical anorexia nervosa (weight not below normal range)
Purging disorder
Night eating syndrome
OSFED is often overlooked but represents a large proportion of eating disorder presentations (Keel et al., 2017).
Orthorexia (Emerging Concept)
Although not formally recognized in the DSM-5-TR, orthorexia refers to an obsessive focus on “healthy” or “clean” eating that becomes rigid, distressing, and impairing. Individuals may eliminate entire food groups and experience anxiety or guilt when deviating from strict dietary rules (Dunn & Bratman, 2016).
Research suggests that approximately 9% of individuals will experience an eating disorder in their lifetime, though rates are likely underestimated due to underreporting and diagnostic limitations (Deloitte Access Economics, 2020).
Warning Signs Individuals May Notice
Eating disorders often develop gradually, and early symptoms may be subtle or normalized.
Physical warning signs
● Sudden weight loss or fluctuations
● Fatigue, dizziness, or fainting
● Hair thinning or hair loss
● Gastrointestinal issues
● Hormonal disruption (e.g., menstrual irregularities)
Behavioral warning signs
● Restricting or avoiding food groups
● Binge eating episodes
● Compensatory behaviors (purging, overexercise)
● Ritualistic eating patterns
● Avoidance of eating in social settings
Emotional warning signs
● Intense fear of weight gain
● Body dissatisfaction or distortion
● Shame, guilt, or secrecy around eating
● Increased anxiety, irritability, or depression
Early identification is critical, as earlier intervention is associated with improved treatment outcomes (Treasure et al., 2020).
Risk Factors and Social Influences
Eating disorders are multifactorial conditions involving an interplay of biological, psychological, and environmental factors.
Biological risk factors include genetic predisposition, neurobiological differences in reward processing, and family history (Academy for Eating Disorders, 2022; Culbert et al., 2015).
Psychological risk factors may include:
Perfectionism
Low self-esteem
Emotion dysregulation
Trauma exposure
Need for control
Environmental and sociocultural influences include:
Diet culture and weight stigma
Social media exposure
Athletic or aesthetic performance pressures
Family dynamics around food and body image
These factors can interact to reinforce disordered eating behaviors as maladaptive coping strategies.
Stigma and Misconceptions
A major barrier to treatment is the persistent stigma surrounding eating disorders. Common misconceptions include:
“You have to look underweight to have an eating disorder”
“It’s just about food or vanity”
“People can just stop if they try hard enough”
In reality, eating disorders are serious psychiatric conditions with one of the highest mortality rates among mental illnesses (Arcelus et al., 2011).
Weight stigma and diagnostic bias also contribute to delayed or missed diagnoses, particularly in individuals in larger bodies or from marginalized communities (Puhl & Heuer, 2010).
A Trauma-Informed Perspective
A trauma-informed lens recognizes that disordered eating behaviors often function as adaptive coping strategies in response to overwhelming emotional experiences.
Trauma may include:
Abuse or neglect
Bullying or body-based criticism
Chronic stress
Medical trauma
From this perspective, behaviors such as restriction, bingeing, or purging are understood as attempts to regulate affect, manage distress, or regain control (Brewerton, 2007).
Treatment therefore focuses not only on symptom reduction but also on:
Nervous system regulation
Emotional processing
Identity reconstruction
Development of adaptive coping strategies
Treatment, Recovery, and Support
Recovery is possible with comprehensive, evidence-based care.
Evidence-based treatments include:
Cognitive Behavioral Therapy (CBT-E)
Targets maladaptive beliefs about food, weight, and self-worth while restructuring eating behaviors (Fairburn, 2008).
Family-Based Therapy (FBT)
Empowers caregivers to support nutritional rehabilitation, particularly in adolescents (Lock & Le Grange, 2013).
Dialectical Behavior Therapy (DBT)
Addresses emotion dysregulation, distress tolerance, and impulsivity, particularly in binge/purge presentations.
Trauma-focused therapies (e.g., EMDR, TF-CBT)
Address underlying trauma contributing to disordered eating patterns.
Treatment often also includes:
Medical monitoring
Nutritional counseling
Psychiatric support for co-occurring conditions
National Eating Disorder Resources
If you or someone you know may be struggling with an eating disorder, there are several trusted, nationwide resources that provide education, support, and treatment referrals. These organizations offer confidential support and can help individuals take the next step toward recovery.
The National Eating Disorders Association (NEDA) offers one of the most widely used free screening tools, along with treatment referrals and educational resources. Individuals can also access support through their helpline at (800) 931-2237, as well as online chat options (NEDA, 2023).
The National Alliance for Eating Disorders provides therapist-supported groups, referrals to specialized providers, and a national helpline (866-662-1235) to help individuals find appropriate levels of care. Their services are often helpful for those looking for structured support beyond initial screening (National Alliance for Eating Disorders, 2026).
The National Association of Anorexia Nervosa and Associated Disorders (ANAD) offers free peer-led support groups, mentorship programs, and a helpline (888-375-7767). These services can be especially valuable for reducing isolation and connecting with others who are in recovery (ANAD, 2026).
For individuals experiencing immediate emotional distress, the Crisis Text Line provides 24/7 support by texting 741741, connecting individuals with a trained crisis counselor in real time. Similarly, the 988 Suicide & Crisis Lifeline is available by call or text at 988 for urgent mental health support across the United States.
Additionally, Project HEAL helps individuals navigate financial and systemic barriers to care, including assistance with insurance, treatment placement, and funding options for those who may not otherwise have access to services (Project HEAL, 2024).
Reaching out for support does not require having a formal diagnosis or being in crisis. Many individuals begin by using a screening tool, attending a support group, or speaking with a helpline specialist. Taking that first step—however small—can be an important part of moving toward recovery.
Important Note:
Seeking help early can significantly improve recovery outcomes. Many of these resources offer free screenings, consultations, and support options, making them a valuable first step even if someone is unsure whether they meet criteria for an eating disorder.
Conclusion
Eating disorders are complex, multifaceted conditions that extend far beyond food. They are rooted in emotional, psychological, and social experiences and require compassionate, evidence-based care. Increasing awareness, reducing stigma, and promoting early intervention are essential steps toward supporting individuals in recovery.
References
Academy for Eating Disorders. (2022). Eating disorders: Critical points for early recognition and medical risk management.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR).
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724–731.
Brewerton, T. D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders, 15(4), 285–304.
Crisis Text Line. (2026). Eating disorder support and crisis services.
Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research review: What we have learned about the causes of eating disorders. Journal of Child Psychology and Psychiatry, 56(11), 1141–1164.
Deloitte Access Economics. (2020). The social and economic cost of eating disorders in the United States.
Dunn, T. M., & Bratman, S. (2016). On orthorexia nervosa: A review of the literature. Eating Behaviors, 21, 11–17.
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528.
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358.
Keel, P. K., Brown, T. A., Holland, L. A., & Bodell, L. P. (2017). Empirical classification of eating disorders. Annual Review of Clinical Psychology, 13, 381–404.
Lock, J., & Le Grange, D. (2013). Treatment manual for anorexia nervosa: A family-based approach (2nd ed.). Guilford Press.
National Alliance for Eating Disorders. (2026). Referral services and support programs.
National Association of Anorexia Nervosa and Associated Disorders (ANAD). (2026). Support services and recovery resources.
National Eating Disorders Association. (2023). Eating disorder statistics and research.https://www.nationaleatingdisorders.org
Project HEAL. (2024). Access to eating disorder treatment and support programs.
Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: Important considerations for public health. American Journal of Public Health, 100(6), 1019–1028.
Sonneville, K. R., Lipson, S. K., & Eisenberg, D. (2018). Disparities in eating disorder diagnosis and treatment. International Journal of Eating Disorders, 51(10), 1104–1113.
Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/restrictive food intake disorder. Current Psychiatry Reports, 19(8), 54.
Treasure, J., Duarte, T. A., & Schmidt, U. (2020). Eating disorders. The Lancet, 395(10227), 899–911.
988 Suicide & Crisis Lifeline. (2026). National crisis support services.
