More Than Food: Understanding Eating Disorders

Eating disorders are among the most misunderstood mental health conditions. From the outside, they may

appear to be about vanity, willpower, or simply “taking a diet too far.” But eating disorders are serious,

potentially life-threatening mental illnesses—not choices, phases, or lifestyle preferences.¹ ²

Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances

in people’s eating behaviors and related thoughts and emotions.¹ They have the highest mortality rate of

any mental health condition.² Approximately 30 million Americans will experience an eating disorder at

some point in their lives.³

These conditions don’t discriminate—they affect people of all genders, ages, races, body sizes, and

socioeconomic backgrounds.² ³ While eating disorders often emerge during adolescence, they can develop

at any age, and many adults struggle silently for decades without seeking help.

At The Horizon Behavioral Health in Worcester, we understand that eating disorders involve far more

than food. They’re deeply intertwined with anxiety, depression, trauma, perfectionism, and complex

emotional patterns. We provide therapeutic support for the mental health dimensions of disordered eating

and connect individuals with the specialized treatment resources their recovery requires.

Types of Eating Disorders

Eating disorders take several forms, each with distinct features but overlapping underlying dynamics.¹ ² ³

Anorexia Nervosa

Anorexia nervosa is characterized by weight loss (or lack of appropriate weight gain in growing children),

difficulties maintaining appropriate body weight, and in many individuals, distorted body image.¹ ² People

with anorexia generally restrict calories and types of food, and some also exercise compulsively, purge, or

binge eat.²

Anorexia has the highest mortality rate of any psychiatric disorder.² Death can result from complications

of starvation or from suicide. It’s crucial to understand that anorexia can occur at any body size—a person

doesn’t need to appear emaciated to be seriously ill.³

Bulimia Nervosa

Bulimia nervosa is characterized by recurrent episodes of eating large quantities of food (binge eating),followed by behaviors to compensate for the overeating, such as self-induced vomiting, misuse of

laxatives or diuretics, fasting, or excessive exercise (purging).¹ ²

People with bulimia often maintain a relatively normal weight, making the disorder less visible—but no

less dangerous.² Purging behaviors cause serious medical complications including electrolyte imbalances

that can cause cardiac arrest.

Binge Eating Disorder

Binge Eating Disorder (BED) is the most common eating disorder in the United States.¹ ³ It is

characterized by recurrent episodes of eating large quantities of food, often rapidly and to the point of

discomfort, accompanied by a feeling of loss of control and experiencing shame, distress, or guilt

afterward.¹ ² Unlike bulimia, BED does not involve regular compensatory behaviors.

BED occurs across all body sizes. Assuming someone has BED based on their weight is both inaccurate

and harmful.³

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID is characterized by eating or feeding disturbance that results in persistent failure to meet

nutritional and/or energy needs.¹ Unlike anorexia, ARFID does not involve distress about body shape or

size. People with ARFID may avoid food based on sensory characteristics, fear of negative consequences

like choking, or lack of interest in eating.²

Other Specified Feeding or Eating Disorder (OSFED)

OSFED encompasses eating disorders that cause significant distress but don’t meet the full criteria for

another eating disorder.¹ These presentations are no less serious and deserve quality care.

Warning Signs of Eating Disorders

Recognizing warning signs enables earlier intervention.² ³ Warning signs include:

Behavioral signs:

Preoccupation with weight, food, calories, or dieting

Skipping meals or making excuses to avoid eating

Excessive exercise despite illness, injury, or fatigue

Withdrawal from social activities, especially those involving food

Evidence of binge eating or purging behaviors

Elaborate food rituals

Physical signs:

Unexplained weight changes

Dizziness, fainting, or difficulty concentrating

Gastrointestinal complaints

Feeling cold all the time

Dental problems (from purging)Hair loss or growth of fine body hair

Emotional signs:

Intense fear of weight gain

Distorted body image

Rigid thinking about food

Mood swings, irritability, or depression

Withdrawal from relationships

The Mental Health Connection

Eating disorders rarely exist in isolation. They’re deeply intertwined with other mental health conditions:²

³ ⁴

Anxiety and Eating Disorders

Anxiety disorders co-occur with eating disorders at high rates.⁴ For many, disordered eating begins as an

attempt to manage overwhelming anxiety—controlling food provides a sense of predictability.

Depression and Eating Disorders

Depression commonly accompanies eating disorders, sometimes preceding them and sometimes

developing as a consequence.⁴ Malnutrition itself causes depressive symptoms.

Trauma and Eating Disorders

Histories of trauma are significantly more common among people with eating disorders.⁴ Disordered

eating can serve as an attempt to cope with unprocessed trauma.

OCD and Eating Disorders

Obsessive-compulsive patterns frequently appear in eating disorders—ritualistic behaviors, intrusive

thoughts about food, compulsive exercise.⁴

Why Specialized Treatment Matters

Eating disorders require specialized care. Medical monitoring is essential—eating disorders cause

dangerous physical complications.² Nutritional rehabilitation follows specific protocols. The

psychological treatment that works for eating disorders differs from standard therapy approaches.²

Levels of Care

Eating disorder treatment exists on a continuum:² ³

Inpatient hospitalization — 24-hour medical and psychiatric care for those who are medically unstable

Residential treatment — 24-hour care in a structured setting with therapeutic meals and intensive

programming

Partial hospitalization (PHP) — Full-day treatment while returning home at nightIntensive outpatient (IOP) — Several hours of treatment several days per week

Outpatient treatment — Regular therapy with a treatment team including therapist, dietitian, and

medical provider

Our Approach: Therapeutic Support and Specialized Referrals

At The Horizon Behavioral Health, we recognize that eating disorder recovery requires both specialized

treatment resources and ongoing mental health support. We provide comprehensive care for the

psychological dimensions of disordered eating while connecting individuals with the specialized

treatment their recovery requires.

What We Offer

Therapeutic support for underlying issues. We provide therapy that addresses the anxiety, depression,

trauma, perfectionism, and emotional patterns intertwined with disordered eating.

Treatment for co-occurring conditions. Many people with eating disorders need treatment for anxiety

disorders, depression, PTSD, OCD, or other conditions. Our clinicians provide evidence-based treatment

for these co-occurring issues.

Assessment and referral coordination. We help individuals understand their symptoms, assess the

appropriate level of care, and connect with specialized eating disorder treatment programs.

Support during and after specialized treatment. We provide continuity of care during transitions

between treatment levels and ongoing therapeutic support after completing intensive programs.

Family support and education. Eating disorders affect entire families. We help loved ones understand

the illness and develop supportive responses.

Frequently Asked Questions About Eating Disorders

Do you have to be underweight to have an eating disorder?

Absolutely not. Eating disorders occur across all body sizes.² ³ Someone in a larger body can be severely

malnourished. Binge eating disorder affects people of all sizes. Less than 6% of people with eating

disorders are medically diagnosed as “underweight.”³

Are eating disorders a choice or a cry for attention?

No. Eating disorders are serious mental illnesses with biological, psychological, and social contributing

factors.¹ ² No one chooses to develop an eating disorder.

Can men have eating disorders?

Yes. An estimated 10 million American men will experience an eating disorder in their lifetime.³ Men

face unique barriers to seeking help, including stigma and the misconception that eating disorders are

“women’s diseases.”

What should I say to someone I think has an eating disorder?

Express concern from a place of love without focusing on weight, food, or appearance.³ Avoid comments

like “You’ve lost so much weight” or “Just eat something.” Offer to help find resources without issuingultimatums.

Can someone fully recover from an eating disorder?

Yes. Full recovery—not just symptom management but genuine freedom—is possible.² ³ With appropriate

treatment, the majority of people experience significant improvement.

Eating Disorders

Eating disorders are serious mental health conditions affecting over 30 million Americans—they involve

far more than food and are intertwined with anxiety, depression, trauma, and complex emotional patterns.

If you’re struggling with disordered eating, we offer therapeutic support for underlying mental health

issues and help connect you with specialized treatment resources tailored to your unique situation.

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References

1. 2. 3. 4. 5. National Institute of Mental Health. (2024). Eating Disorders. NIMH.

https://www.nimh.nih.gov/health/topics/eating-disorders

American Psychiatric Association. (2022). What Are Eating Disorders? APA.

https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders

National Eating Disorders Association. (2024). What Are Eating Disorders? NEDA.

https://www.nationaleatingdisorders.org/what-are-eating-disorders

National Alliance on Mental Illness. (2024). Eating Disorders. NAMI.

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders

Mayo Clinic. (2024). Eating Disorders. Mayo Clinic. https://www.mayoclinic.org/diseases-

conditions/eating-disorders/symptoms-causes/syc-20353603Word Count: ~1,700 words Last Updated: January 2025 Medical Review: Content based on current

clinical guidelines and peer-reviewed sources