Eating disorders (EDs) are complex illnesses that negatively affect a person’s overall health, mentally and physically. They are included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, demonstrating the aspect of mental illness within EDs. In the beginning of EDs, there is primarily a psychological and behavioral component encompassing the hyper fixation and stress on food and body image, which then leads to the physical component of disordered eating behaviors that wreaks havoc on the body. 

Eating Disorder Symptoms

Eating disorder symptoms are varied and complex, requiring a deep understanding of their impact. They can vary, and their conceptualization is being tinkered with to improve identification and treatments. Some of the more commonly known ones are anorexia nervosa, bulimia nervosa, and binge eating disorder. Anorexia is characterized by severe restriction of food and can thus lead to severe weight loss. Bulimia and binge eating disorder both include a large consumption of calories in one sitting known as binging. Still, additionally, people with bulimia will attempt to counteract binging by purging and excreting calories by making themselves throw up or taking laxatives.

Clearly, due to altered eating behaviors, eating disorders have detrimental effects on normal physiology. But because of the gut-brain connection and the gut’s involvement in satiety signals, it is hypothesized that the gut also has a central role in the detriment of EDs. Some studies have shown that anorexic patients have decreased diversity of the gut microbiome which is associated with worse health. Specific changes in bacterial species have been reported in anorexic patients, one of which being increased abundance of Methanobrevibacter smithii. This bacterial species is important for fermenting carbohydrates, and an increased abundance of it is a sign of optimizing calorie and nutrient extraction. Thus, the nutrient deficiencies and insufficient caloric intake of anorexia damage the gut by causing a dysregulated microbiome, in addition to intestinal permeability and chronic, low-grade inflammation.

An altered gut microbiome has been seen in other EDs as well. In a study by Leyrolle et al., the authors researched obese patients with and without binge-eating disorder (BED) and found that after adjusting for BMI and other confounding variables, those with BED showed gut microbiome changes, such as a decreased population of Akkermansia. Because Akkermansia muniphila produces short-chain fatty acids (SCFAs) involved in immunity and more, the decreasedincidence of Akkermansia has been linked to increased inflammation and insulin resistance. Anxiety also frequently occurs with EDs (termed “comorbid”), and there have been more studies attempting to unravel the gut microbiome’s role in anxiety. There seem to be alterations in the gut microbiome with anxiety. Further studies are needed to fully understand the role of the gut in eating disorders.

Types of Eating Disorders Explained

Eating disorders include a variety of conditions that affect people of all ages, genders, and backgrounds. While anorexia, bulimia, and binge eating disorder are the most well-known, other types are equally important to recognize for proper diagnosis and treatment. Below are some of the main types of eating disorders:

1. Anorexia Nervosa: Anorexia nervosa is marked by severe food restriction due to an intense fear of gaining weight, coupled with a distorted body image. People with anorexia often perceive themselves as overweight even when they are dangerously underweight. Symptoms include extreme calorie restriction, avoidance of food, and compulsive behaviors like excessive exercise. Over time, anorexia can cause malnutrition, brittle bones, heart damage, and organ failure, and it has one of the highest mortality rates among mental illnesses.
2. Bulimia Nervosa: Bulimia involves recurring episodes of binge eating, where individuals consume excessive amounts of food in a short period. This is followed by compensatory behaviors, such as self-induced vomiting, misuse of laxatives, diuretics, or excessive exercise, to avoid weight gain. Unlike anorexia, individuals with bulimia may maintain a normal weight, but the disorder still takes a toll on their health. Frequent purging can cause dehydration, severe electrolyte imbalances, tooth erosion, and gastrointestinal issues.
3. Binge Eating Disorder (BED): Binge eating disorder is the most common eating disorder in the United States. It is characterized by recurrent binge eating episodes without compensatory behaviors like purging. People with BED often feel out of control during binges and experience intense feelings of guilt, shame, and distress afterward. Over time, BED can lead to obesity, cardiovascular disease, diabetes, and other serious health conditions. It is often linked to emotional eating, where food becomes a coping mechanism for stress or trauma.
4. Avoidant/Restrictive Food Intake Disorder (ARFID): ARFID involves avoiding or restricting food intake but without concerns about body weight or shape, which distinguishes it from anorexia. Individuals with ARFID may avoid certain foods due to sensory sensitivities, fear of choking, or lack of interest in eating. This disorder can lead to malnutrition, significant weight loss, and developmental delays in children.
5. Other Specified Feeding or Eating Disorders (OSFED): OSFED refers to eating disorders that do not meet the full criteria for anorexia, bulimia, or BED but still cause significant distress and impairment. Examples include atypical anorexia nervosa, where individuals exhibit all anorexia symptoms but are not underweight, and purging disorder, where purging occurs without binge eating episodes.
6. Orthorexia Nervosa: While not officially recognized in the DSM-5, orthorexia describes an unhealthy obsession with “healthy” eating. People with orthorexia focus excessively on the quality and purity of food, often eliminating entire food groups. This behavior can lead to severe nutritional deficiencies and social isolation due to restrictive eating patterns.

Do I Have an Eating Disorder? 

Eating disorder symptoms to watch out for include:

• A hyper fixation on food, calories, weight, or body image.
• Skipping meals or extreme dieting.
• Episodes of binge eating.
• Use of laxatives, vomiting, or overexercising to compensate for eating.
• Feeling stress, guilt, or anxiety about eating.

These behaviors can indicate underlying types of eating disorders such as anorexia, bulimia, or binge eating disorder. If you are questioning, "Do I have an eating disorder?" seeking professional advice is essential for diagnosis and treatment.

People may be more familiar with the fact that psychotherapy is part of the treatment for eating disorders, but another essential treatment used alongside is nutritional therapy. Nutritional therapy, sometimes referred to as nutritional rehabilitation, helps to introduce proper nutrition and encourages patients to maintain healthy eating behaviors. Patients work with a registered dietitian who helps them restore normal eating patterns, monitor physical health signs like electrolytes, and create a personalized nutrition plan. The goals of nutritional therapy are to restore the perception of hunger and satiety cues and empower ED patients to eat nutritionally, eventually on their own.

Nutritional Therapy and Recovery

As mentioned, nutritional therapy plays an essential role in recovery, as food is the foundation for health and healing. It focuses not only on correcting physical health imbalances caused by EDs but also on fostering a healthier emotional relationship with eating.

With guidance from a registered dietitian, patients learn about balanced eating, hunger cues, and the importance of nutrients. This is particularly helpful for stress eating disorder, where individuals often eat in response to emotional triggers rather than hunger. Nutritional therapy works in tandem with psychotherapy to address both the physical and emotional components of eating disorders.

The recovery process is not just about weight restoration or stopping disordered behaviors but also about achieving mental and emotional wellness. Food becomes nourishment rather than stress, and this shift is crucial in preventing relapse.

Gut Health and Eating Disorders: An Ongoing Study

Further studies continue to investigate the gut-brain relationship in eating disorders. Understanding the gut microbiome's role may open new treatment pathways to complement current therapies. Dysbiosis—an imbalance in gut bacteria—has been observed in anorexia, bulimia, and binge eating disorder. Interventions aimed at restoring gut health may eventually support recovery.

Final Thoughts

Eating disorders are multifaceted as they damage the body, mentally and physically. Therefore, nutrition is especially important for those with EDs as it leads their recovery to overall mental and physical wellness. As food is nourishment for the body, we must do so and understand fully how to do so.

If you or someone you know is struggling, early intervention is critical. Recognizing eating disorder symptoms and understanding eating disorder can be the first step toward recovery. Seeking professional help, combining psychotherapy with nutritional therapy, and addressing gut health are key components of a comprehensive treatment plan. Recovery is possible with education, support, and personalized care.