Types of eating disorders and understanding the signs

Updated December 2022 | 7 min read
Expert contributor Christine Morgan, CEO of The Butterfly Foundation
Words by Jo Stratmoen

Eating disorder signs often go unrecognised and untreated, but increased awareness and understanding can drive positive change.

Eating disorders can be perceived as an adolescent girls’ obsession with their weight or a lifestyle choice in the age of social media. The reality is that they’re serious mental illnesses, with serious consequences.

More people die from health complications resulting from an eating disorder than any other mental illness, and young people with eating disorders are 10 times more likely to die prematurely than their peers. And yet many sufferers aren’t getting the help they need. It’s been suggested that out of the one million people with an eating disorder, less than a quarter seek help.

According to Christine Morgan, CEO of The Butterfly Foundation and National Director of the National Eating Disorders Collaboration (NEDC), people with eating disorders often feel high levels of shame, embarrassment and denial, which may prevent them from seeking what could be life-saving treatment.

“This is a concern because the sooner treatment is started the more successful it’s likely to be,” says Christine. She says that reducing the stigma around eating disorders through education is a key factor in promoting early identification and treatment.

The COVID-19 pandemic saw an increase in presentations of eating disorders, with one study showing a 62% increase in the number of annual eating disorder presentations among children and adolescents in 2020 compared to the two years prior.

And The Butterfly Foundation’s Helpline saw a 63% increase in calls compared to the previous year.

A study conducted in January 2022 by InsideOut Institute for Eating Disorders at the University of Sydney revealed a widespread escalation of eating disorder symptoms during the COVID-19 lockdowns in Australia, with 40% of people going undiagnosed.

The study also showed alarmingly low diagnosis and treatment rates. While nearly all participants (96%) reported experiencing eating disorder signs at the time of the survey, only half were getting treatment.

The same study reported that increased body image concerns, food restrictions and binge eating contributed to a significant experience of depression, anxiety, stress and loneliness.

Types of eating disorders

By encouraging better understanding of eating disorders, we can help people feel safe to tell someone about what they're experiencing and make sure people around those with a potential disorder can see there's something wrong earlier. Part of understanding is being familiar with different types of eating disorders. According to The Butterfly Foundation, there are eight types of eating disorders.

• Binge eating disorder: this is most common type, at 47%. It’s characterised by repeatedly eating an excessive amount of food within a short period of time – as little as two hours – at least once a week. Although people with this disorder can be a normal weight, they’re more likely to be overweight or obese and experience many of the same problems, including high blood pressure and cholesterol levels, heart disease and type 2 diabetes.
  
• Bulimia nervosa: bulimia accounts for 12% of eating disorders. People with bulimia also experience repeated episodes of binge eating, but they may also force themselves to vomit, misuse laxatives or other medications, or exercise excessively to avoid gaining weight. Their weight may fluctuate but they’re usually within the normal weight range or are overweight. Health issues can include irregular heartbeat, and even heart failure, inflammation and rupture of the oesophagus.
  
• Anorexia nervosa: less common (3%) is anorexia. The hallmarks are an intense fear of gaining weight and severely restricting calorie intake. As a result, their weight is way lower than it should be. Some people also indulge in binge eating and purging and, as with bulimia, their self-worth is built to a large extent on their perception of how they look. Complications can include an abnormally slow heart rate and low blood pressure, potentially leading to heart failure, dry, brittle bones, and muscle loss and weakness.
  
• Avoidant restrictive food intake disorder (ARFID): previously known as “Selective Eating Disorder”, a person with ARFID doesn’t eat enough food to grow or develop properly. Adults with ARFID don’t consume enough food to maintain basic body function.
  
• Other specified feeding or eating disorder (OSFED): previously known as “Eating Disorder Not Otherwise Specified (EDNOS)”, OSFED is a diagnostic category to include individuals who don’t meet the strict criteria for anorexia nervosa or bulimia nervosa but have an eating disorder.
  
• Unspecified Feeding and Eating Disorders (UFED): this category applies to behaviours that cause significant distress or impairment of functioning but don’t meet feeding or eating disorder criteria for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders.
  
• Rumination disorder: similar to bulimia, rumination disorder is when a person involuntarily regurgitates their food rather than inducing vomiting or regurgitation.
  
• Pica: when a person regularly eats non-food substances like chalk, soap or paper or eats low-nutritional substances like ice.

Other types of disorders not yet classified include:

• Orthorexia: when a person is obsessed with eating healthy food and the quality of their food, not the quantity of their food.
  
• Compulsive exercise: when a person exercises to relieve the guilt associated with eating.
  
• Disordered eating: when a person has eating patterns that include restrictive dieting, compulsive eating or skipping meals.
  

Who gets eating disorders?

“At any one time nearly one million Australians have an eating disorder,” says Christine. They’re most common in girls and women, but boys and men aren’t immune. As many as 63% of Australian females and 37% of males will experience an eating disorder in their lifetime.

We know eating disorders are more common in developed countries where the “thin ideal” prevails. Girls involved in activities like athletics and modelling, where body image is all-important, tend to be at higher risk.

Low levels of self-esteem are found across the eating disorder spectrum. People with anorexia tend to be perfectionists and those with binge eating disorder and bulimia tend to be impulsive in nature.

Research suggests that discrimination, trauma, violence and abuse can increase someone’s risk of developing an eating disorder.

It has been suggested that childhood unhappiness can play a part, with parental separation or divorce increasing the risk. Sexual abuse during childhood and fear of social rejection have also been associated with eating disorders.

There’s also strong evidence that eating disorders have a genetic basis. This may be due to the passing down of biological systems that relate to appetite, food intake, metabolism and reward-pleasure responses.

Physical symptoms of eating disorders

Eating disorder signs can be hard to spot. In many cases people with eating disorders aren’t extremely overweight or thin. They may also hide their behaviour or be in denial.

“A reluctance to eat with other people, change in clothing size, mood swings, negative comments about body shape, compulsive exercise, frequent trips to the bathroom and social withdrawal are all red flags that something is going on,” Christine says.

Eating disorder signs include rapid weight loss or frequent weight changes, menstrual disturbances, decreased libido, lethargy and disturbed sleep, and damage to teeth and bad breath from induced vomiting.

How to support someone with an eating disorder

“One approach is to gently observe that the person doesn’t seem overly happy and to ask if anything is troubling them,” says Christine.

The most important thing is to let them know you care about them and want to help. “Listen respectfully and let them know that you won’t judge or criticise them,” she adds.

Treatment and recovery for people with eating disorders

Seeing a GP is the first step to building a treatment team, which will include an eating disorder specialist and possibly a psychologist, social worker and dietitian. Successful treatment means overcoming physical, mental and emotional barriers to get back to normal eating habits, thoughts and behaviours.

While the road to recovery isn’t easy, with a good support network and a high level of personal commitment, it’s possible to recover.

Getting help for eating disorders

If you think you or a family member may have an eating disorder, there are a number of places you can turn to.

• The Butterfly Foundation is an advocacy group for people with eating disorders. It operates a national helpline staffed by experienced counsellors. You can call 1800 334 673.
  
• The Foundation also coordinates The National Eating Disorders Collaboration, which brings together health professionals to create recommendations and guidelines.
  
• The Headspace National Youth Mental Health Foundation provides early intervention mental health services to 12 to 25-year-olds. Use their confidential online chat tool or call 1800 650 890.

A helping hand when you need it

If you’re worried about your physical and mental wellbeing, or that of a loved one, seeing a GP is a great place to start. Through our partnership with GP2U, all HCF members with health cover can access a standard online video GP consultation (up to 10 minutes) for a fee of $50. See hcf.com.au/gp2u for more information. You can call our partner GP2U on 1300 472 866 or register to book an appointment here.

Eligible HCF members^{^} can also access a free HealthyMinds Check-in with a PSYCH2U psychologist and book an appointment online with PSYCH2U. This gives you, or a loved one, easier access to qualified mental health professionals and digital support services.