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Eating disorders: understanding them, recognising them, getting help

Anorexia, bulimia, binge eating disorder and the others: what we know today, what helps people recover, and how to support someone close to you

Marie-Agnès Thulliez

By Marie-Agnès Thulliez · Author · Publishing Director11-minute read

A young woman and her mother sitting side by side, in a calm conversation

Thinking constantly about food, about your body, about what you have or have not eaten. Eating in secret, or no longer managing to eat in front of others. Feeling imprisoned by rules you no longer choose. Eating disorders take hold of the person who suffers from them, far beyond their willpower.

They are real illnesses, affecting both body and mind, often for years. They can be treated, and full recovery is possible. This article sets out what international research says, to help you understand, recognise the signs and find help.

Real illnesses that nobody chooses

Eating disorders are serious mental health conditions. They combine disturbed eating behaviours with an all-consuming preoccupation with food, weight or appearance. They have a strong biological component, and nobody chooses them.

In 2015, several international organisations of clinicians, patients and families, brought together by the Academy for Eating Disorders, summarised current knowledge as "Nine Truths". The main ones:

  • a person can look healthy and be seriously ill;
  • families are not to blame for the disorder, and can be the best allies in treatment;
  • these disorders affect all genders, all ages, all body shapes and sizes and all backgrounds;
  • genes and environment both play a part;
  • full recovery is possible, and early help matters (Schaumberg et al., 2017).

The main forms

DisorderWhat characterises it
Anorexia nervosaRestriction of food intake leading to a weight that is too low, an intense fear of gaining weight that persists despite weight loss, and a disturbed perception of the body.
Bulimia nervosaRepeated episodes of eating a large amount in a short time with a sense of loss of control, followed by behaviours intended to "compensate". Self-esteem depends heavily on weight and body shape. Weight often stays within the average range, which makes the disorder hard to see.
Binge eating disorderRepeated binge episodes with loss of control, without compensatory behaviours, often experienced in shame and secrecy. It is the most common of the named disorders.
ARFID (avoidant/restrictive food intake disorder)Very limited eating driven by the texture or taste of foods, a fear of choking or vomiting, or little interest in eating, rather than by a fear of gaining weight. It can appear at any age.
Other specified disordersForms that do not fit neatly into the categories above, but cause just as much suffering. These are the most common.

The disorder can change form over time. And an eating disorder can occur at any body size: for example, we speak of "atypical" anorexia when a person shows all the signs of anorexia without being underweight. They are in just as much danger: a study of adolescents and young adults found as much bradycardia (an abnormally slow heart rate, a sign of medical danger) in this group as in underweight young people (Garber et al., 2019).

Who is affected?

Eating disorders are common. A large international review estimates that around 8% of women and 2% of men experience one during their lifetime, and that the proportion of people affected at any given time increased between 2000 and 2018 (Galmiche et al., 2019). According to the Global Burden of Disease Study, more than 40 million people in 2019 had binge eating disorder or another specified eating disorder, two forms long missing from the statistics, in addition to the roughly 14 million cases of anorexia and bulimia already counted (Santomauro et al., 2021).

They are often illnesses of youth: nearly half begin before the age of 18, and more than eight in ten before 25 (Solmi et al., 2022). During the Covid-19 pandemic, hospital admissions for eating disorders rose sharply, by around 48% on average according to one review (Devoe et al., 2023).

Boys and men are affected too, but are less often identified: for them, the preoccupation sometimes centres on muscularity rather than thinness (Brown and Keel, 2023). LGBT+ people are at greater risk, probably because of the stress associated with discrimination (Parker and Harriger, 2020).

In France, an estimate that is now quite old suggested that only about one in two people affected received care (Santé publique France, 2008).

Where do these disorders come from?

There is always more than one cause. Eating disorders arise from the meeting of a vulnerability and an environment.

The biological share is significant. Twin studies estimate that genetic factors account for around half, or slightly more, of the risk of anorexia. A large genetic study showed that anorexia shares genetic foundations both with other mental health conditions and with metabolism: it is partly a "metabo-psychiatric" illness (Watson et al., 2019). Genes alone, however, decide nothing.

Environment matters too. A large review of all the studies on risk factors identifies two of the best-supported factors: having been teased about one's appearance or weight, associated with all eating disorders, and having experienced childhood sexual abuse, associated with bulimia (Solmi et al., 2021). Dieting, pressure about appearance and certain sports in which body shape matters are other fertile grounds.

And social media? Studies show a link, though a modest one, and they do not allow us to say that social media alone causes an eating disorder. Comparing oneself with others and internalising ideals of thinness or muscularity appear to play a role; learning to step back from images and appreciating one's body appear to be protective (Dane and Bhatia, 2023; Zhang et al., 2021).

The family is not the cause. International specialists reject the models that held parents responsible for the disorder. They recommend, on the contrary, involving them in treatment (le Grange et al., 2010).

Eating disorders and trauma

The links between trauma and eating disorders are now well documented. A 2017 review shows that childhood maltreatment is associated with all types of eating disorder, with an earlier onset and more severe disorders, all the more so when the maltreatment was extensive (Molendijk et al., 2017). According to a synthesis of prevalence studies cited in Convertino and Mendoza's review, around one in five to one in four people with an eating disorder may also have post-traumatic stress disorder (Convertino and Mendoza, 2023), and the link with trauma appears most consistently in forms involving binge eating or purging (Molendijk et al., 2017).

For some people, controlling food, or on the contrary eating to soothe themselves, becomes a way of bearing emotions or memories that are too heavy. Understanding this link helps to treat the disorder better. To find out more: What is trauma?.

Research is advancing on forms of care that treat both at once. In a first randomised trial, adding trauma-focused work to eating disorder therapy reduced post-traumatic stress more effectively, with no demonstrated difference on the eating disorder itself, and participants expressed a stronger preference for this integrated approach (Trottier et al., 2022). The trial was small, but this is a serious avenue. When trauma is present, it is therefore helpful to talk about it with the care team.

Serious illnesses

Eating disorders affect the whole body: the heart, bones, teeth, digestive system and hormones. Anorexia is one of the most serious mental health conditions: the risk of death is around six times higher than in the general population, and some of these deaths are suicides (Arcelus et al., 2011). Bulimia and other eating disorders also increase this risk. If you are having suicidal thoughts, contact a crisis line, day or night: 988 (US/Canada), Samaritans 116 123 (UK and Ireland), or find a local helpline at findahelpline.com. In France: 3114.

This is why regular medical follow-up is always part of treatment, even when the person seems to be doing well.

Warning signs

No single sign, on its own, is enough for a diagnosis. But several of these changes, when they last, are worth talking about:

  • an all-consuming preoccupation with food, weight, body shape or "eating healthily";
  • skipped or avoided meals, excuses for not eating with others, increasingly strict food rules;
  • food going missing, hidden binges, behaviours to "compensate" for what has been eaten;
  • excessive physical activity, or exercise experienced as an obligation, even when ill or injured;
  • changes in mood: irritability, sadness, anxiety around meals, withdrawal;
  • physical signs: tiredness, dizziness, feeling the cold, menstrual problems, significant weight changes in either direction.

Denial is often part of the illness: the person may not feel ill, or may be too ashamed to talk about it.

What helps people recover

The earlier treatment begins, the better the chances of recovery. In France, the Haute Autorité de santé (the national health authority) recommends multidisciplinary care: medical follow-up, psychological follow-up and nutritional support, coordinated with one another, with the family involved in treatment, including for adults where possible (HAS, 2010; HAS, 2019a). Most often, care is provided on an outpatient basis; hospital admission is sometimes necessary.

International guidelines agree on the psychotherapies to offer first:

SituationWhat has proven effective
Anorexia in children and adolescentsEating-disorder-focused family therapy, in which parents are helped to support their child's eating
Anorexia in adultsSpecific psychotherapies: eating-disorder-focused cognitive behavioural therapy, MANTRA, specialist supportive clinical management; as a second option, focal psychodynamic therapy
BulimiaIn adults, guided self-help (a workbook supported by short sessions with a professional), then, if that is not enough, eating-disorder-focused cognitive behavioural therapy; in adolescents, family therapy
Binge eating disorderEating-disorder-focused cognitive behavioural therapy, or interpersonal therapy, individually or in a group; guided self-help is a possible first step

Sources: American Psychiatric Association, 2023; NICE, 2017; NICE, n.d.; Monteleone et al., 2022.

Medication has a limited role: it complements psychotherapy. In bulimia, in adults, an antidepressant, fluoxetine, can be added to reduce the frequency of binges (ANSM, n.d.).

Recovery is possible, even after many years. In a study that followed women for 22 years, around two in three had recovered from anorexia or bulimia (Eddy et al., 2017). For many, the road is long, with ups and downs. A relapse is a common stage in recovery, and the journey continues.

For family and friends

Watching someone you love suffer from an eating disorder is distressing. Your support counts for a great deal, alongside treatment.

  • Choose a calm moment, away from mealtimes, and talk one to one rather than in a group.
  • Talk about what you feel and notice, rather than about food or weight: "You've seemed sad and tired lately, and I'm worried about you."
  • Avoid any comment on appearance, even a positive one: "you're looking well" can be very hard to hear.
  • Leave monitoring of meals to the care plan, and never present a diet as a solution. For a child or adolescent, the care team will help you, if needed, to take charge of meals again, within a framework agreed with them.
  • Be patient with denial: it is part of the illness. Come back to the person, without forcing.
  • Offer to go with them to the doctor.
  • Look after yourself: family associations offer a listening ear and support groups.

Sources: Beat, n.d.; HAS, 2019b.

If your child is affected, rest assured that you are not responsible for their illness, and that parents are now considered essential allies in treatment.

Where to find help in France

  • Your GP (médecin traitant): a first point of contact, who can carry out an assessment and refer you to a specialist team.
  • The FFAB (Fédération française anorexie boulimie): a directory of specialist centres and teams at ffab.fr.
  • Anorexie Boulimie Info Écoute: 09 69 325 900, standard-rate number, Monday, Tuesday, Thursday and Friday from 4 pm to 6 pm, staffed depending on the day by psychologists, doctors or family and service-user associations (fna-tca.org).
  • Fil Santé Jeunes: 0 800 235 236, free and anonymous, for 12- to 25-year-olds, every day from 9 am to 11 pm (sante.fr).
  • Mon soutien psy: up to 12 reimbursed sessions a year with a partner psychologist, for mild to moderate psychological difficulties (info.gouv.fr). Severe forms call for specialist teams.

In the event of feeling faint, severe weakness, chest pain or fainting, call 15 in France (or your local emergency number elsewhere) without delay.

Need help now?

If you are having suicidal thoughts, contact a crisis line: 988 (US/Canada), Samaritans 116 123 (UK and Ireland), or find a local helpline at findahelpline.com. In France: 3114. Family and friends can call too.

If you are in immediate danger, call your local emergency number (999 in the UK, 911 in North America, 112 in the EU).

Eating disorder helplines: Beat in the UK (0808 801 0677 in England; numbers for Scotland, Wales and Northern Ireland at beateatingdisorders.org.uk), the National Alliance for Eating Disorders in the US (1-866-662-1235); in France, 09 69 325 900, Anorexie Boulimie Info Écoute (Monday, Tuesday, Thursday and Friday, 4 pm to 6 pm).

Key points

  • Eating disorders are real illnesses, rather than choices or a lack of willpower.
  • They affect all ages, all genders and all body sizes, and often begin before the age of 25.
  • Genes and environment both contribute; the family is an ally in treatment, never the cause.
  • Trauma, particularly in childhood, increases the risk: it is helpful to talk about it with the care team.
  • Early, multidisciplinary care, with specific psychotherapies, offers the best chances of recovery.
  • Full recovery is possible, even after many years.

References

  1. American Psychiatric Association (2023) The American Psychiatric Association Practice Guideline for the Treatment of Patients with Eating Disorders. 4th edn. Washington, DC: American Psychiatric Association. Available at: https://doi.org/10.1176/appi.books.9780890424865.
  2. ANSM (n.d.) Résumé des caractéristiques du produit : fluoxétine [Summary of product characteristics: fluoxetine]. Available at: https://agence-prd.ansm.sante.fr/php/ecodex/rcp/R0262589.htm (accessed 15 October 2026).
  3. Arcelus, J. et al. (2011) 'Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies', Archives of General Psychiatry, 68(7), pp. 724–731. Available at: https://doi.org/10.1001/archgenpsychiatry.2011.74.
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  5. Brown, T.A. and Keel, P.K. (2023) 'Eating disorders in boys and men', Annual Review of Clinical Psychology, 19, pp. 177–205. Available at: https://doi.org/10.1146/annurev-clinpsy-080921-074125.
  6. Convertino, A.D. and Mendoza, R.R. (2023) 'Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: a systematic review', International Journal of Eating Disorders, 56(6), pp. 1055–1074. Available at: https://doi.org/10.1002/eat.23933.
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  13. Haute Autorité de santé (HAS) (2019a) Boulimie et hyperphagie boulimique : repérage et éléments généraux de prise en charge [Bulimia and binge eating disorder: identification and general principles of management]. Recommandation de bonne pratique [Good practice guideline]. Available at: https://www.has-sante.fr/jcms/c_2581436/fr/boulimie-et-hyperphagie-boulimique-reperage-et-elements-generaux-de-prise-en-charge (accessed 15 October 2026).
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This article offers general guidance, up to date at the date of publication. It is no substitute for the advice of a doctor, who alone can make a diagnosis, or for support from a psychologist or psychotherapist.

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