Eating disorders: anorexia, bulimia and binge eating explained

What are eating disorders, and are they a mental illness?

Eating disorders are mental illnesses marked by severe disturbances in eating behavior, such as restricting food, overeating or getting rid of it. Often the person uses control over food as a way of coping with feelings and stress, and some types, such as anorexia and bulimia, come with an intense preoccupation with weight and body shape, though not every type does. The direct answer is yes: they are real mental illnesses, and the US National Institute of Mental Health (NIMH) stresses that they are "not a choice". They can harm the body and mind, and sometimes threaten life. The reassuring news, according to the UK's National Health Service (NHS), is that with treatment most people recover.

They are not rare. The World Health Organization (WHO) fact sheet on mental disorders (2026) states that 18 million people worldwide experienced eating disorders in 2023, including 4.7 million children and adolescents. And you cannot tell from someone's appearance: the UK's Royal College of Psychiatrists notes that most people living with an eating disorder are not underweight.

Types of eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder

Anorexia nervosa

The person cuts down on food severely, driven by an intense fear of gaining weight or a distorted image of their own body: they see themselves as fat while they are thin. They may exercise excessively and deny how serious their low weight is, so typical anorexia nervosa symptoms show up in eating, exercise and the way the person sees their body. WHO notes that anorexia often begins in adolescence or early adulthood.

Bulimia nervosa

Repeated episodes of eating large amounts of food with a sense of losing control, followed by attempts to get rid of the food or make up for it, such as deliberately making yourself sick (vomiting after eating), laxatives, fasting or excessive exercise. As NIMH points out, the person's weight may stay average or above average, so their appearance does not catch the family's attention, and the signs of bulimia are easy to miss.

Binge eating disorder (compulsive overeating)

The person regularly loses control and eats a very large amount of food in a short time, often quickly, in secret and even after feeling full, then feels ashamed or guilty. Unlike bulimia, though, the person does not regularly try to get rid of the food or make up for it afterward by vomiting, laxatives, fasting or excessive exercise.

There are other types too, including avoidant/restrictive food intake disorder (ARFID), which is not linked to worries about weight, and cases whose symptoms do not exactly fit any one type, which according to the NHS are the most common.

Signs of eating disorders that families notice

Eating disorders are hard to spot because they can look like a "diet" or an interest in healthy living, and because the person often hides them. Signs described by the NHS, the Royal College of Psychiatrists and Cleveland Clinic include:

• In eating: skipping meals or eating very little, avoiding meals with the family or at gatherings and invitations, cutting food into tiny pieces, lying about what they have eaten, or hiding food.
• After eating: going to the bathroom a lot straight after meals, or using laxatives or appetite suppressants.
• In body image: excessive worry about weight and shape, believing they are fat when they are not, and wearing loose clothes to hide weight loss.
• In exercise: excessive exercise, or being far more active than usual in order to lose weight.
• In mood and behavior: withdrawing from people, anxiety, sadness or irritability, and very strict habits around food.
• In the body: rapid weight loss, feeling cold, tiredness and dizziness, and irregular or stopped periods in girls.

Not every sign has to appear, and having some of them does not mean a diagnosis; only a professional can make one. But when several signs come together, it is worth acting rather than waiting.

Why are eating disorders dangerous for the body and mind?

Eating disorders are mental illnesses, but their effects reach every organ in the body. The complications listed by NIMH include:

• With anorexia nervosa: thinning bones, anemia, muscle weakness, low blood pressure, slow pulse and breathing, heart damage and infertility, and it can lead to multiple organ failure.
• With bulimia nervosa: a chronically inflamed throat, worn tooth enamel, acid reflux, severe dehydration and an imbalance of the body's salts (electrolytes).
• With binge eating disorder: obesity, type 2 diabetes, and problems with the heart, sleep and digestion.

NIMH adds that anorexia nervosa has an extremely high death rate compared with other mental disorders, because of the complications of starvation or suicide. Eating disorders also often come with other mental health conditions. According to NIMH the most common are depression, anxiety and drug or alcohol use, Cleveland Clinic also mentions obsessive-compulsive disorder, and NIMH stresses that these must be treated as part of the same plan. That is why talking therapy alone is not enough: the person needs a medical assessment and whatever tests the doctor decides on.

Do men and boys get eating disorders too?

Yes. The common picture is that eating disorders are "a girls' illness", and that picture itself delays treatment for young men. Guidance from the UK's National Institute for Health and Care Excellence (NICE) points out that eating disorders can develop at any age, but the risk is highest for young men and women between 13 and 17. A scientific review published in 2012 reports that males made up roughly 10% of people with anorexia and bulimia in one study and 25% in another, and that men with eating disorders are underdiagnosed and undertreated.

The same review explains that the picture can look different in men: the focus is often on building muscle rather than being thin, and excessive exercise is more common than vomiting, so from the outside it looks like an interest in health. Shame keeps many men from asking for help, because society expects a man to hide his vulnerabilities.

At Oxygen Center, doctor appointments and therapy sessions are open to men and women aged 15 and over (under 18 with a guardian's consent); the center does not offer services for children under 15.

Diet culture, social media and comments about the body

Eating disorders have no single known cause; NIMH explains that a combination of genetic, biological, psychological and social factors is thought to be involved. Risk factors listed by the NHS include you or someone in your family having had an eating disorder, depression, or alcohol or drug misuse; being criticized for your eating or body shape; pressure to be slim in certain jobs and sports; and perfectionism and low self-esteem.

The Royal College of Psychiatrists notes that our ideas of what looks good are strongly shaped by social media and fashion, and that comparing ourselves with edited pictures and influencers who don't represent real bodies creates negative feelings about our own. It also warns that strict diets don't help people lose weight in the medium or long term, and can lead to disordered eating and depression.

At home, a passing remark at a family gathering, such as "you've put on weight" or "you need to lose some before the wedding", can leave a deeper mark than we imagine on a teenager who already worries about their looks. Cleveland Clinic advises parents, especially when eating disorders run in the family, to be a positive role model for healthy eating, not to describe foods as "good" or "bad", and to avoid diet talk and negative comments about bodies.

How do you talk to someone you're worried about without blame or comments about their weight?

The person often denies the problem, hides it or gets angry when you bring it up, as the NHS notes, so don't expect the first conversation to work. Its advice for parents includes:

• Stay calm and prepare what you want to say beforehand.
• Use "I" sentences: "I'm worried about you because you don't seem happy lately", instead of "You're not eating" or "You're fooling us".
• Focus on their feelings, not on food: ask how they are and what is bothering them, and listen patiently without judging.
• Don't comment on their weight or appearance, and avoid talking about diets or other people's weight in front of them.
• Don't blame or judge them, and don't take their secrecy personally; the secrecy is part of the illness, not of your relationship.
• Let them know that professional help exists, and keep telling them that you love them and will be there for them.

If you feel guilty or that you are to blame, know that NICE guidance reminds clinicians that families may feel this way, and that the family therapy it recommends for teenagers is built on the family supporting their son or daughter through recovery. The family can also come alone first if the person refuses to attend.

Eating disorder treatment: what actually works?

WHO confirms that effective treatments exist, including family-based treatment and cognitive-based therapy. Treatment usually relies on a team from different specialties and includes:

• Eating-disorder-focused cognitive behavioral therapy (CBT-ED): helps the person eat regularly, change their thoughts about weight and shape, and prevent relapse; NICE lists it among the treatment options for adults.
• Family therapy for teenagers and young people: NICE recommends it for anorexia nervosa and bulimia nervosa, and NIMH notes that it can improve treatment outcomes, particularly for adolescents.
• Guided self-help: may be a suitable first step for adults with bulimia or binge eating disorder, under a professional's supervision.
• Medical monitoring and nutrition support: tests decided by the doctor, and a regular eating plan to reach and keep a healthy weight.

A doctor may decide on medication in some cases, such as bulimia, binge eating disorder, or depression and anxiety that come with them. But NICE states that medication should not be the only treatment for anorexia, bulimia or binge eating disorder, and NIMH notes that there is still no medication approved in the United States to treat anorexia nervosa itself. Never start, stop or change any medicine except on your doctor's decision.

At Oxygen Center, the first step is a doctor's appointment with a psychiatrist to assess the situation and order the necessary tests, followed by therapy sessions with the family involved when needed; both are available to men and women. If the person's physical condition needs hospital treatment, or a specialized eating disorder program is needed, the doctor will tell you so clearly and point you to it.

When should you seek help, and when is it urgent?

Don't wait until a lot of weight has been lost. NICE guidance states that the need for treatment should not be decided by a single measure such as body mass index (BMI), and Cleveland Clinic notes that early detection and treatment give the best chance of recovery. Book a doctor's appointment if eating or thoughts about weight are causing you distress or disrupting your life.

If there is an acute mental health risk, such as serious thoughts of suicide, NICE recommends considering psychiatric crisis care or inpatient psychiatric care. Inpatient psychiatric treatment at Oxygen Center is for males only, aged 15 and over, and the doctor decides after an assessment whether it suits the situation. But immediate danger, for a man or a woman, does not wait for an appointment: get help now as described in the box below.

Recovery from an eating disorder is possible, even if it takes time and looks different for each person. Every early step, even a calm conversation tonight, brings the person you love closer to a life that food does not control.