FAQ's on eating disorders

NICE Treatment guidelines

You can find out more about the UK NHS NICE Treatment guidelines

These treatment guidelines set out evidence based recommendations on the treatment of eating disorders and were published in 2004.

beat was involved, representing patients and carers in the compilation of these guidelines and we thoroughly support their implementation.

Frequently Asked Questions

1.  What are eating disorders?

• Eating disorders are serious mental illnesses.  They are treatable, and the sooner someone gets the treatment they need, the more likely they are to make a good recovery.
• Eating disorders are NOT choices, passing fads or phases.  Eating disorders are severe and can be fatal.
• Eating disorders can be recognised by a persistent pattern of unhealthy eating or dieting behaviour that can cause health problems and/or emotional and social distress.
• The three official categories of eating disorders are anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified (EDNOS).  People with EDNOS do not have the full set of symptoms for either anorexia or bulimia, but may have aspects of both.  EDNOS is as serious as other eating disorders and as potentially damaging to health.
• Although there are formal, internationally recognised guidelines that healthcare professionals use to diagnose eating disorders, unhealthy eating behaviours exist on a continuum.  Even if a person does not meet the formal criteria for an eating disorder, they may be experiencing unhealthy eating behaviours that cause substantial distress and may be damaging to both physical and psychological health.

2.  What is Anorexia Nervosa?

• The rarest - 10% of eating disorders - typically affects between age of 12-20
• Individuals with anorexia nervosa do not maintain or have a body weight that is normal or expected for their age and height.  Typically, this means that a person is less than 86% of their expected weight.
• Even when underweight, individuals with anorexia continue to be fearful of weight gain.  Their thoughts and feelings about their size and shape have a profound impact on their sense of self-esteem as well as their relationships.
• They often do not recognise or admit the seriousness of their weight loss and deny that it may have permanent adverse health consequences.  Women with anorexia nervosa often stop having their periods.
• There are two subtypes of anorexia nervosa: in the restricting subtype, people maintain their low body weight purely by restricting food intake and sometimes, by exercise.  Individuals with the binge-eating/purging type also restrict their food intake, but regularly engage in binge eating and/or purging behaviours such as self-induced vomiting or the misuse of laxatives, diuretics or enemas.  Many people move back and forth between subtypes during the course of their illness.

3.  What is Bulimia Nervosa?

• 40% of cases mainly with adolescent onset - affects between the age of 18-25
• Individuals with bulimia nervosa experience binge-eating episodes which are marked by eating an unusually large amount of food, usually within a couple of hours, and feeling out of control while doing so.  The sense of being out of control is what distinguishes binge-eating from regular overeating.  For example, during a binge, an individual may feel compelled to eat, and find it extremely difficult, if not 'impossible' to stop eating.
• Binge eating is followed by attempts to "undo" the consequences of the binge by using unhealthy behaviours such as self-induced vomiting, misuse of laxatives, enemas, diuretics, severe caloric restriction, or excessive exercising.
• Individuals with bulimia nervosa are obsessed and preoccupied with their shape and weight and often feel as if their self-worth is dependent on their weight or shape.
• Formal diagnostic criteria for bulimia nervosa describe binge eating and engagement in appropriate, unhealthy behaviours to counteract the binges at least twice weekly for three months.  However, regardless of frequency, these behaviours are concerning and can have adverse physical and psychological health consequences.
• There are two subtypes of bulimia nervosa:  The purging type includes those individuals who self-induce vomiting or use laxatives, diuretics, or enemas.  The non-purging type refers to those who compensate thorugh excessive exercising or dietary fasting.

4.  What is Binge Eating Disorder?

• Individuals with binge eating disorder (BED) engage in binge eating, but do not regularly use inappropriate or unhealthy weight control behaviours such as fasting or purging to counteract the binges.
• Binge Eating Disorder is more common among individuals who are overweight or obese.  Previous terms used to describe these problems included compulsive overeating, emotional eating, or food addiction.
• Binge eating disorder is not an officially recognised disorder, but is included in the EDNOS category.

5.  Who may be affected by eating disorders?

• Anyone can be affected.  Eating disorders do not discriminate on the basis of sex, age or race.  They can be found in both sexes, all age groups, and across a wide variety of races and ethnic backgrounds.  However, there are groups who display an increased risk for eating disorders (see below).

6.  Who is at increased risk for eating disorders?

• Eating disorders are more common in women, but they do occur in men.  Rates of binge eating disorder are similar in females and males.
• Athletes in certain sports are at particularly high risk for eating disorders.  Female gymnasts, ice skaters, dancers and swimmers, to name a few, have been found to have higher rates of eating disorders.  In a study of elite athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa.
• Male athletes are also at increased risk - especially those in sports such as wrestling, bodybuilding, rowing, running, cycling, climbing and football.
• Although white females may be more likely to suffer from anorexia nervosa, body dissatisfaction in young girls has been shown in all ethnic groups.

7.  How common are eating disorders?

• Anorexia nervosa:  Between 0.3-1% of young women have anorexia nervosa (which makes anorexia as common as autism)
• Bulimia nervosa:  Around 1-3% of young women have bulimia nervosa.
• Binge eating disorder: Around 3% of the population has binge eating disorder.
• Between 4% and 20% of young women practise unhealthy patterns of dieting, purging, and binge-eating.
• Currently, about one in 20 young women in the community have an eating disorder.

8.  Has the prevalence of eating disorders increased over the years?

• Anorexia nervosa:  Cases of anorexia nervosa have been described throughout history in many different cultural contexts, with the first medical descriptions dating back to the 17th Century.  The number of new cases presenting increased up to the 1970s and since then has been stable.
• Bulimia nervosa:  Bulimia nervosa is a newer disorder and between the 1980s and 1990s there was a dramatic rise in the number of cases presenting with this disorder.  The number of new cases presenting is now stabilizing, with the largest proportion of people presenting for treatment being adolescents.
• Currently about one in 20 young women in the community have an eating disorder.

9.  What causes eating disorders?

• Eating disorders are complex and influenced by both genetic and environmental (i.e. pressure to be thin, trauma, etc) factors.  Eating disorders are not simply caused by Western cultural values of thinness although these are an influence.
• While the current Western obsession with slimness and the glamorous portrayal of emaciated women in the media may have some role to play in the recent increase of eating disorders, genetic vulnerability, personality, psychological and environmental factors all contribute to the causes of eating disorders. 

10.  How devastating are eating disorders?

• For women aged 15-24, eating disorders are among the top four leading causes of burden of disease in terms of years of life lost through death or disability.
• Anorexia nervosa has one of the highest overall mortality rates and the highest suicide rate of any psychiatric disorder.  The risk of death is three times higher than in depression, schizophrenia or alcoholism and 12 times higher than in the general population.
• Up to 10% of women with anorexia nervosa may die due to anorexia-related causes.  Early recognition of symptoms and proper treatment can reduce the risk of death.  Deaths in anorexia nervosa mainly result from complications of starvation or from suicide.
• Health consequences such as osteoporosis (brittle bones), gastrointestinal complications, and dental problems are significant health and financial burdens throughout life.
• Quality of life is severely impaired in all eating disorders.

12.  Can one recover from an eating disorder?

• In general, early detection and treatment are associated with a better chance of recovery.  One reason for this may be that brain development is not complete until about age 20 and the effects of starvation on the developing brain are particularly dangerous.
• Anorexia nervosa:  Over a 10-year period, about half of people with anorexia nervosa recover fully, a small percentage continues to suffer from anorexia nervosa, and the rest develop other eating disorders.  Even among those individuals who recover from an eating disorder, it is common for them to continue to maintain a low body weight and experience depression.
• Bulimia nervosa:  Over half the people affected by bulimia nervosa can make a successful recovery, with treatment.