Eating disorders, which are among the deadliest mental illnesses, are on the rise worldwide, increasingly prevalent issues impacting a large number of young people.

Three main eating disorders are recognised: Anorexia, Bulimia and Binge eating. Each one consists of a different set of habits, but the warning signs are similar: extreme focus on weight and fear of changing weight; avoiding mealtimes; excessive exercise.

This article aims to delve into the history and nature of eating disorders, as well as explore different types of support systems available to people struggling with these disorders.

History of classification

Eating disorders – characterised as ‘a range of psychological conditions that cause unhealthy eating habits to develop’ – have roots dating back to Hellenistic and medieval times. Historical descriptions mention ancient Romans gorging and purging themselves, only to return to a feast. It took hundreds of years to assign specific terms to these conditions.

Anorexia was the first eating disorder to be attributed a medical description back in 1689 by Richard Morton who noted it being of a “nervous consumption.”

The second disorder to be named, in 1979, was Bulimia nervosa, which British psychiatrist Gerald Russell described as a “powerful and intractable urges to overeat” and “a morbid fear of becoming fat,” followed by purging and trying to rid oneself of food.

In 1987, Binge eating was recognised in the Statistical Manual of Mental Disorders (DSM) for the first time but as a feature of Bulimia with its cycle of bingeing and purging. It was not until 2013, in the fifth edition of the DSM, that Binge eating was recognised as its own disorder, one that is now the most common type in the US.

The diagnosis and treatment of eating disorders have improved significantly since their initial recognition. Two of the most common types (Anorexia and Bulimia) were for a long time considered ‘physical conditions’, with some even theorising that Anorexia was a form of tuberculosis.

Causes

Eating disorders are complex and have many causes. However, some evidence suggests that genetics can make a person predisposed to the disorder.

Research found that female relatives of Anorexia sufferers were 11.4 times more likely to develop Anorexia themselves; female relatives of those with Bulimia were 3.7 times more likely to develop Bulimia. It is important to note that it is not clear how much of this link is genetic and how much is due to other factors.

Personality traits are another factor contributing to the development of an eating disorder. In particular, those who are inclined to perfectionism and impulsivity are often linked to having a higher risk of developing unhealthy eating habits.

Between 55–95% of people diagnosed with an eating disorder also receive another mental health diagnosis. Underlying mental health problems can complicate the path to recovery as well as increase the risk of developing a disorder. Mental illnesses can significantly worsen the outcomes of patients with eating disorders.

Risks and dangers

Anorexia is one of the most dangerous mental disorders, resulting in approximately 10,200 deaths each year. It is reported that up to 5–10% of individuals with Anorexia die within 10 years of a diagnosis while this percentage increases to 18–20% over a 20 year period.

It is important to note that the second leading cause of death people for people diagnosed with Anorexia is suicide. Between a quarter and a third of those with Anorexia, Bulimia or Binge eating disorders have thought about or attempted suicide.

Among other dangers an eating disorder poses are heart failure, endocrine disorders, gastrointestinal disease and refeeding syndrome, which is heart failure caused by eating too much too quickly.

Prevalence of eating disorders among youth

Around 70mn people worldwide are struggling with an eating disorder as of 2024.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), a US non-profit specialising in eating disorders, a 2023 study shows that 12% of adolescent girls (ages 10 to 19) struggle with some form of eating disorder, and 22% of children and adolescents have unhealthy eating behaviours that could lead to or indicate one. For people aged over 50, the study shows that 41% of women have current or previous core eating disorder symptoms.

Studies reveal the average age of onset for eating disorders is 18–20 years old. But even girls as young as 10 can start to worry about their weight or dislike their bodies; by the age of 14, up to 70% are trying to alter their appearance.

The same survey found that 45% of children are bullied for how they look. Among this number, bullied girls were found to be 1.5 times more likely to use unhealthy weight control methods.

The role of social media

The idealisation of thinness and the promotion of beauty ideals in the media can help in the spreading of disordered eating.

“While our study does not prove social media use causes eating disorders, it raises a red flag,” stated one of the authors involved in the examination of the relationship between social media use and disordered eating among young adolescents.

Supporting a person with an eating disorder

It can be challenging to spot the warning signs because concerns about weight, diet and appearance can blur the lines between an eating disorder and self-consciousness.

Educating oneself is an essential part of being a good supporter. Many eating disorder organisations with informative websites can help with learning about this issue.

Here are key things a person wanting to help should know:

• It is important to speak up because people who have an eating disorder can be reluctant to ask for help
• Do not get discouraged when a person denies having an eating disorder
• Offer your support and encourage treatment. Having supportive relationships is vital
• Interact outside of meals, and find activities that don’t revolve around eating

Knowing what not to do is also important. Don’t:

• Comment on the appearance and weight of somebody with an eating disorder
• Shame someone who has an eating disorder
• Give simple solutions
• Give an ultimatum

Where to seek professional help

It is important to have a team of professionals a person can consult. Around the world, numerous organisations specialise in guiding individuals through recovery.

In the US, these include the National Eating Disorders Association (NEDA) and the National Alliance for Eating Disorders. Additionally, helplines are available in every European country.

Similar resources can be found in Australia, Southeast Asia, Africa and South America.