Eating disorders: signs, how they differ from dieting and what helps

Eating disorders are mental health conditions in which eating behaviour and thoughts about food become seriously disturbed, usually together with worries about body weight or shape, causing real harm to physical health and daily life (WHO, 2024). They can also show up as using control over food to cope with feelings and situations (NHS, 2024a). Eating disorders are not a choice, and they can affect people of any age, sex or body size. Someone can look healthy and still be very ill, so you cannot tell by looking (NIMH, 2024).

There are four main eating disorders. Anorexia nervosa involves severely restricting food, usually out of an intense fear of gaining weight, so that weight falls low enough to harm health for the person’s age, height and stage of development. Bulimia nervosa involves repeated binge eating that feels impossible to stop, followed by harmful behaviours meant to prevent weight gain. Binge eating disorder involves frequent, uncontrollable binge eating over several months without those compensatory behaviours. Avoidant-restrictive food intake disorder (ARFID) involves eating much less, or far fewer kinds of food, not out of fear of gaining weight but because of sensory reasons such as smell or texture or a fear of choking, to the point that health or daily life suffers (WHO, 2024). “Other specified” eating disorders, which do not fit any of these exactly, are actually the most common (NHS, 2024a).

Eating disorders can be life-threatening, but they can be treated, and spotting them and starting treatment early helps recovery (NIMH, 2024). mind.io does not offer an eating disorder test. Children and teenagers should see a professional together with a parent or carer. If you have thoughts of ending your life, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

Signs can include spending a lot of time worrying about weight and body shape, avoiding social occasions where there might be food, developing very strict rules or habits around eating, and changes in mood such as becoming withdrawn, anxious or low. Physically, people may feel cold, tired or dizzy, or notice their heart racing or feel faint (NHS, 2024a). Feeling that your weight or shape decides your worth as a person is another important sign (WHO, 2024).

The core of a binge is not the amount eaten but a loss of control, a feeling that you cannot stop, and binges are usually followed by painful feelings such as guilt, disgust or shame. Early on, symptoms are often hidden and daily life kept going only with great effort (WHO, 2024). If you are doing things to stop yourself gaining weight after eating, please do not keep it to yourself; tell a doctor.

Common dissatisfaction with weight or shape, ordinary dieting and eating a lot at a festive meal are not eating disorders (WHO, 2024). Appetite changing for a while under stress, or sometimes eating a lot, is also common and usually settles. An eating disorder is when eating or not eating has become a way of managing painful thoughts and feelings, so it is not something to wait out or push through with willpower (National Mental Health Information Portal, 2020). Stress eating is covered in stress relief: what helps.

Eating without paying attention but being able to stop at any time, or eating more than planned without a sense of losing control, is not binge eating disorder. Very picky eating is not ARFID if it does not cause weight loss, nutritional deficiencies or problems in daily life. Overeating that is better explained by depression is also considered separately from binge eating disorder (WHO, 2024); appetite changes in depression are covered in depression symptoms. Being preoccupied with a flaw in appearance that others barely notice, rather than with weight or shape, may point to body dysmorphic disorder (WHO, 2024), which is covered in OCD: what helps.

Dieting can, however, be a path into an eating disorder. In a study that followed about 1,700 Australian secondary-school students for 3 years, girls who dieted severely were 18 times more likely to develop an eating disorder than girls who did not diet. Being an observational study, it cannot prove that dieting is the cause, and having marked depression or anxiety also raised the risk on its own (Patton et al., 1999). Severe restriction can also be dangerous without a low weight; a review found such cases in community studies as common as, or more common than, typical anorexia, but less often referred to specialist care (Harrop et al., 2021).

People with anorexia often do not recognise that they are ill, and those around them may see it simply as watching their figure, which makes it hard to get to a doctor (National Mental Health Information Portal, 2021). A questionnaire alone should not be used to decide whether someone has an eating disorder; if you suspect one, a professional assessment is needed (NICE, 2017).

How common eating disorders are depends a lot on how they are measured. A review of studies from 2000-2018 found that, on average, 8.4% of women and 2.2% of men had had an eating disorder at some point in their lives (Galmiche et al., 2019), while another analysis of general-population studies found 0.91% (Qian et al., 2022). In the WHO World Mental Health Surveys (24,124 adults in 14 countries), lifetime binge eating disorder averaged 1.9% and bulimia nervosa 1.0%, so binge eating disorder was more common, and fewer than half had ever been treated for an eating disorder: 38.3% for binge eating disorder and 47.4% for bulimia (Kessler et al., 2013).

The WHO estimates that 18 million people worldwide had an eating disorder in 2023, including 4.7 million children and adolescents (WHO, 2026). However, the Global Burden of Disease study behind this figure has mainly counted anorexia and bulimia, and one analysis estimated that adding binge eating disorder and other eating disorders would add about 41.9 million people in 2019 (Santomauro et al., 2021).

In Korean health insurance records, the number of people treated with bulimia nervosa as the main diagnosis rose from 1,399 in 2010 to 3,750 in 2025; 92.3% were women and people in their 20s were the largest group. In 2025, 2,226 people were treated for anorexia nervosa, with teenagers the largest age group, although many were 70 or over (Health Insurance Review and Assessment Service, 2026); this may reflect appetite problems in later life recorded under the same code. These counts only include people who sought care, so far more people may be affected; a review of European studies found that only about 1 in 3 people with an eating disorder are detected by health services (Keski-Rahkonen & Mustelin, 2016). A Korean study of new diagnoses in health insurance data found the highest rates at ages 20 to 24 (Kim et al., 2026).

In Korea’s 2025 Youth Risk Behavior Survey, 28.2% of girls and 17.6% of boys in secondary school who were not overweight thought of themselves as fat (Korea Disease Control and Prevention Agency, 2025). Such thoughts are not an illness in themselves, but if worries about shape are taking over daily life, it is worth talking about. Eating disorders are more common in women but also affect men, sometimes as a worry about not being muscular enough (WHO, 2024). Because diagnostic criteria and assessment tools were built around women, eating disorders in men are easily missed (Mitchison & Mond, 2015). In a US adult survey, 2.0% of men had had binge eating disorder (Hudson et al., 2007).

The exact causes of eating disorders are not fully understood; genetic, biological, behavioural, psychological and social factors appear to raise the risk together (NIMH, 2024). Cognitive behavioural therapy describes a cycle that keeps eating disorders going: when weight and shape become the yardstick of self-worth, people set strict eating rules; when the body and mind cannot keep to those rules, a binge follows, and further restriction or compensation keeps the cycle turning. For some people, perfectionism, low self-esteem, difficulty tolerating painful emotions and problems with relationships make the cycle harder to break (Fairburn et al., 2003). This is why CBT for eating disorders starts with re-establishing regular eating (NICE, 2017).

Eating disorders can be life-threatening. In an analysis of 36 studies, people treated for anorexia died at about 6 times (5.86 times) the rate of people of the same age and sex, and 1 in 5 of those who died had taken their own life; for bulimia and other eating disorders the rate was about twice as high (Arcelus et al., 2011). A review comparing mental disorders placed anorexia, together with substance use disorders, among those with the highest risk of death (Chesney et al., 2014). Suicide attempts were not rare in bulimia and binge eating disorder either, not only in anorexia (Mandelli et al., 2019). Even so, eating disorders can be treated and people do recover. If you have thoughts of ending your life, reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere.

Long-term malnutrition can cause problems throughout the body, including bones and muscles, the heart and blood vessels, and the brain and nerves, but these usually begin to improve once eating improves (NHS, 2024b). That is why starting treatment early matters so much.

UK guidelines say people with a suspected eating disorder should be assessed and treated as early as possible, and that a single measure such as body mass index or how long someone has been ill should not decide whether treatment is offered. For adults with anorexia, they suggest choosing, after an explanation, between eating-disorder-focused cognitive behavioural therapy (CBT-ED), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) and specialist supportive clinical management (SSCM); for children and young people with anorexia, family therapy. Binge eating disorder starts with a guided self-help programme, moving to group or individual CBT-ED if it has not helped after 4 weeks. Bulimia nervosa is also treated with guided self-help or CBT-ED, and with family therapy for children and young people (NICE, 2017).

The aim of treating binge eating disorder is to stop binge eating, not to lose weight (NICE, 2017). The NHS advises not trying to diet during treatment, because dieting can make it harder to stop binge eating (NHS, 2023a). France’s health authority likewise states that bulimia and binge eating disorder are not caused by a lack of willpower but are illnesses that need care, and that diets or efforts to reach a “perfect body” do not solve them (HAS, 2019).

A meta-analysis of 81 randomised trials (7,515 people) found that psychological therapy, mostly CBT, reduced binge eating far more than a waiting list, and structured self-help had medium to large effects, although study quality was uneven and the certainty of the evidence was generally very low (Hilbert et al., 2019). Another analysis of 79 trials found that therapist-led CBT worked better than a waiting list or other psychological therapies for bulimia and binge eating disorder, but there was no evidence that it beat other behavioural or supportive therapies (Linardon et al., 2017). Self-help worked better with guidance from a professional (Traviss-Turner et al., 2017). This evidence comes from adults with bulimia or binge eating disorder; there is no evidence that self-help alone is enough for anorexia or for children and young people.

Family therapy is the most widely recommended treatment for teenagers with anorexia. In a trial of 121 young people aged 12 to 18, there was no difference from individual adolescent-focused therapy at the end of treatment, but 6 and 12 months later those who had received family-based treatment were more likely to be in full remission (Lock et al., 2010). With few studies, though, the certainty of the evidence is still low (Fisher et al., 2019). The psychological therapies recommended for adults with anorexia showed no clear winner when compared with one another (Solmi et al., 2021). A review bringing together treatment studies judged the overall effects to be modest, while finding family-based therapy effective for young people and CBT-ED the most broadly effective treatment for adults with bulimia (Monteleone et al., 2022).

Medicine is not at the centre of treatment. UK guidelines say anorexia, bulimia and binge eating disorder should not be treated with medicine alone (NICE, 2017). French guidelines say an antidepressant (an SSRI) can be a second choice for adults with bulimia or binge eating disorder when structured psychological therapy is not available, always alongside psychological care (HAS, 2019). In the US, no medicine is approved to treat the symptoms of anorexia or ARFID (NIMH, 2024). Talk to your doctor before starting or stopping any medicine; what to know about antidepressants is covered in antidepressants and psychiatric medication and depression: what helps.

Among the main barriers to seeking help for an eating disorder were stigma and shame, not realising how serious the illness is, and a lack of encouragement from others (Ali et al., 2017), so a word from someone close can be the first step. Raise it when you feel calm, do not blame or judge, and focus on how they are feeling. Avoid commenting on their appearance, even kindly, and use sentences that start with “I”, such as “I’m worried because you do not seem happy” (NHS, 2024c).

Try not to feel hurt if they do not open up straight away or are secretive; that is part of the illness, not about your relationship (NHS, 2024c). Keep inviting them, and offer to go with them to appointments (NHS, 2023b). As a family, agree not to talk about portion sizes or the food at mealtimes, and if they are in treatment, ask the treatment team how to help with meals (NHS, 2024c). Leave direct talk about food and weight to the clinicians, and praise their efforts and achievements (National Center of Neurology and Psychiatry, n.d.).

There is no clear evidence that families cause eating disorders; what matters is not who is to blame but how to help from now on (National Center of Neurology and Psychiatry, n.d.; Assurance Maladie, 2026). Family members get worn out too: in an analysis of 13 studies of education and support programmes for carers, carers’ distress and burden fell, and the benefits lasted (Hibbs et al., 2015).

Recovery is possible. In a US study that followed 246 women with anorexia or bulimia for over 20 years, about 2 in 3 recovered (62.8% with anorexia and 68.2% with bulimia), and about half of those with anorexia who had not recovered by year 9 had recovered by year 22 (Eddy et al., 2017). Recovery takes time and there may be setbacks along the way, but these are seen as part of the recovery process; even after many years of illness, it is never too late to start treatment (HAS, 2019).

A racing heart or feeling faint can be a sign that an eating disorder is straining the body (NHS, 2024a). If someone has fainted, has chest pain, or is limp and slow to respond, call your local emergency number or go to an emergency department straight away, whatever their weight. If someone looks seriously unwell, they need to go to hospital even if they do not want to (National Center of Neurology and Psychiatry, n.d.).

On average, it took about 2 and a half years from the start of anorexia to first treatment, about 4 and a half years for bulimia and about 5 and a half years for binge eating disorder, and there is early evidence that a shorter delay may mean a better chance of recovery (Austin et al., 2021). Community surveys found that only about 1 in 4 people with an eating disorder (23.2%) had sought treatment for it, and more had sought weight-loss treatment instead (Hart et al., 2011). If binge eating is the problem, mental health care comes before diet advice.

In the UK, Beat’s helpline is free and, as of October 2026, open on weekdays from 3pm to 8pm (England 0808 801 0677), and you don’t need a diagnosis to call (Beat, n.d.). Elsewhere, start with a family doctor, who can also check your physical health. In Korea, you can see a psychiatrist (a child and adolescent psychiatrist for young people), and the mental health crisis line 1577-0199 (24 hours) connects you to a nearby mental health welfare centre (Ministry of Health and Welfare, 2025). If you do not want to know your weight when you are weighed, you can say so (NHS, 2024d). The conditions for the 2026 counselling voucher are in depression: what helps. mind.io does not offer a test that detects eating disorders; the depression check-in (PHQ-9) and anxiety check-in (GAD-7) only look at the depression and anxiety that often come with them.

People with eating disorders often also have depression, anxiety or substance use problems, and their risk of suicide is higher (NIMH, 2024). If you have thoughts of ending your life or feel you might harm yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

Q. How is a binge different from just eating a lot? A. The key is control. If you repeatedly eat far more than usual with a sense that you cannot stop, followed by distress, that is closer to a binge. Eating a lot while distracted, when you could have stopped at any time, is not counted as a binge (WHO, 2024).

Q. Can I have an eating disorder if I have not lost weight? A. Yes. Bulimia and binge eating disorder are diagnosed regardless of weight (WHO, 2024), and severe restriction can be dangerous even without a low weight (Harrop et al., 2021).

Q. Can I check myself for an eating disorder? A. mind.io does not offer an eating disorder test, and UK guidelines say screening questionnaires should not be the only way to decide whether someone has an eating disorder (NICE, 2017). If you notice the signs above, talk to a professional.

Q. Can men get eating disorders? A. Yes. They are more common in women but also affect men, who are less likely to seek treatment (WHO, 2024). In a US survey, 2.0% of men had had binge eating disorder at some point (Hudson et al., 2007).

Q. Won’t dieting reduce binge eating? A. During treatment for binge eating disorder, dieting can make it harder to stop binge eating (NHS, 2023a). The aim of treatment is to stop binge eating, not to change weight (NICE, 2017).

Q. Can people fully recover? A. Many do. In a study that followed women with anorexia or bulimia for over 20 years, about 2 in 3 recovered (Eddy et al., 2017), and with treatment most people can recover (NHS, 2024a).

Q. It’s so hard I’m having thoughts of harming myself. A. Please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

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