Tag: Eating Disorders

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Healing from Childhood Trauma: Caitlyn Boardman’s 12 Lessons from Alcoholism and Borderline Personality Disorder Recovery

In a world that often demands perfection, especially when it comes to recovery, the story of Caitlyn Boardman—a mental health and sobriety advocate—is a powerful testament to the messy, non-linear reality of healing. As a guest on the Recoverycast podcast, Caitlyn shared her deeply personal journey through adoption trauma, the early loss of a parent, a turbulent relationship with alcohol and substances, and a complex interplay of mental health conditions, including Borderline Personality Disorder (BPD) and an eating disorder. Her path, marked by relapse, divorce, and the grief of losing both adoptive parents, is a striking example of persistence over perfection.

Her message, distilled from years of struggle and eventual triumph, offers a crucial anchor for anyone feeling lost: “Just to not give up hope. And that, you know, despite all the things life throws at you, there is hope on the other side, even when it feels like there is none at all.” Caitlyn’s willingness to embrace the imperfections of her journey—from being the “girl with the alcohol in her closet” to a public advocate—shows that true strength lies not in avoiding the fall, but in constantly choosing to get back up. This comprehensive article delves into the core challenges Caitlyn faced and builds on her story to offer 12 critical takeaways for navigating co-occurring disorders, trauma, and the continuous fight for a better life.

1. Recognizing the Indirect Impact of Childhood Trauma and Adoption

Caitlyn’s childhood, while seemingly stable, was underpinned by the indirect trauma of early life experiences. Adopted from South Korea and raised in a white family, she initially believed her adoption didn’t affect her. It wasn’t until she reached adulthood and sought therapy that the deeper emotional roots of her struggles began to surface.

Caitlyn’s therapist posed a critical question that unlocked a deeper understanding: “You’re adopted, but where were you the first four months of your life?” This led to the discovery that she had been in a foster home, a separation that her therapist linked to her adult trust issues. This experience highlights a crucial aspect of trauma: it doesn’t have to be a direct, dramatic event to leave a lasting impact. The pre-verbal separation from her birth mother and subsequent placement created an emotional blueprint that affected her ability to form secure attachments later in life.

Compounding this was the loss of her adoptive father at the tender age of six. She recalls: “I remember running away as a kid. I was just really upset and my mom, she let me cry, but you know, then it was just, we never really talked about it.” The lack of open communication about grief meant that she and her brother “suffered in silence,” a common experience in families where emotional expression is suppressed.

Explore trauma treatment options.

2. Early Onset Alcoholism and the Search for Numbing

The seeds of addiction were planted early for Caitlyn, fueled by a combination of easy access to alcohol and an internal struggle to cope with her feelings of loneliness and grief. She recounts starting to drink around age 13 and drinking alone. Access was made easy because her mother kept alcohol in the house “all the time.”

Her habit quickly progressed from experimentation to a pattern of isolation and concealment: “I remember I would take alcohol from my mom, I’d put it in water bottles… and stuff it in my closet. Like my friends used to joke around, like they’d be like, oh, you’re the girl with the alcohol in her closet.” This early reliance on alcohol to numb difficult emotions is a classic red flag for a developing substance use disorder.

The interviewer rightly pointed out the heartbreaking realization in hindsight: “That’s a kid really struggling, grabbing for alcohol and substance to try and numb that, that’s extremely tough.” This pattern of self-medication would continue for years, culminating in a period where she felt destined to suffer: “I feel like I’m meant to suffer. So that’s why I drank. I was like, I, I feel like I’m just not meant to be happy.” This belief—that she was unworthy of happiness—drove her substance use, highlighting the deep connection between self-worth and addiction.

3. Navigating the Complexities of Co-Occurring Disorders

Caitlyn’s journey is a powerful case study in comorbidity, or the co-occurrence of substance use disorders with mental health conditions. She battled alcoholism alongside an eating disorder and was later diagnosed with Borderline Personality Disorder (BPD).

The Eating Disorder and Body Image

Her struggle with the eating disorder intensified after having her children, driven by a hyper-focus on weight loss. This pursuit of “skinny” led to severely restrictive behaviors, eventually causing her to view herself as overweight even at a critically low weight of 98 pounds. This distorted self-perception is a hallmark of eating disorders, where the underlying issue is not truly about food or weight, but about control, self-criticism, and emotional regulation.

See eating disorder treatment options.

The Borderline Personality Disorder (BPD) Diagnosis

Caitlyn pursued psychiatric help after feeling “off” her whole life due to severe mood swings. She was diagnosed with Borderline Personality Disorder (BPD), a condition that the clinician linked directly to her trauma. BPD is characterized by unstable moods, behavior, relationships, and self-image, often leading to impulsive behavior, intense emotional responses, and difficulties with secure attachments—all of which factored into Caitlyn’s self-destructive patterns. The self-harm that started in middle school evolved into physically hitting and bruising herself, particularly when alcohol was involved, demonstrating the volatile synergy between her substance use and mental health struggles. She noted that BPD, unlike some other disorders, “you get it from trauma.”

4. The Deepening of Addiction and Rock Bottom

The full severity of Caitlyn’s addiction surfaced after her third child, following a messy breakup with the children’s father. The intermittent drinking of her early motherhood quickly escalated to drinking “all day, every day”. The day-to-day struggle was marked by extreme self-harm and an inability to maintain stability. She lost one job and narrowly avoided being fired from another after showing up to work “blackout drunk” and messing up “every table’s order.”

The turning point—or “rock bottom”—was a dramatic, frightening moment in 2021, a month after the birth of her fourth child. A volatile argument with her partner while both were drinking led to a frightening climax that resulted in the police being called for the third time. The police’s warning about the potential involvement of Child Protective Services served as a stark and terrifying wake-up call.

Find integrative alcohol addiction treatment options.

5. Choosing Sobriety and Embracing New Habits

After the incident with the police, Caitlyn embarked on her recovery journey. Despite having no formal treatment or therapy at the time—a testament to her sheer willpower and underlying resilience—she stopped drinking daily. She noted that while she didn’t experience the severe physical withdrawals many do, she was immediately plagued by intense cravings, which often manifest as a craving for sweets in early sobriety.

To fill the void left by alcohol, she actively jumped into new habits and tools:

  • Fitness Shift: She completely changed her focus in the gym, moving from working out “to be skinny” to working out “to be strong, not skinny.” This complete mindset switch reflected a fundamental move toward self-care and health, resulting in a healthy weight gain of 15 pounds.
  • Mindfulness and Meditation: Overcoming the initial difficulty of sitting with a “sober brain” and a head full of trauma-driven thoughts, she credits meditation as a “key to so many things,” especially for managing her BPD symptoms. She also highlighted the importance of breathwork to calm her nervous system in daily situations.

6. The Necessity of Environmental and Relational Changes

Maintaining sobriety demanded a complete overhaul of her social life. Since her entire friend circle drank, she had to stop going out, which inevitably led to losing many friends. While this loss hurt, she adopted a mature perspective: “I was like, you know what? They weren’t my friends in the first place.” This realization is a vital lesson in recovery: true friends support your health, while drinking companions only support the addiction.

This principle was painfully tested in her marriage, which had begun and was largely fueled by alcohol during the COVID-19 pandemic. She eventually found herself navigating a divorce from a partner who repeatedly lied about his own sobriety. “I found out later on that he had drank and lied to me about it… that was hard to deal with.” The pain and harassment from the dissolution of that toxic relationship made her “want to drink so bad,” but she persevered.

The anchor that kept her from drinking during the immense stress of divorce and the grief of her mother’s passing was her children. She intentionally chose to provide them with a different, more emotionally available experience of grief than the one she had as a child: “I wanted to be strong for them. And, you know, not go down that dark path.”

7. The Power of Advocacy and Vulnerability on Social Media

In an age where public figures often curate perfect narratives, Caitlyn’s decision to share her raw journey publicly has been a source of healing and connection. Starting with a single TikTok post about being “one month sober” in 2021, her vulnerability resonated with a massive audience.

What’s interesting is the contrast she found in sharing: she describes herself as a private person in her day-to-day life, yet an “open book” on social media. This distinction is common for advocates who find safety and connection in a digital community. The feedback and messages she received affirmed that her story was making a difference, transforming her personal struggle into a source of public hope.

8. Understanding the Nature of Relapse: A Non-Linear Journey

Caitlyn’s most recent experience highlights a key message: recovery is not linear, and relapse is often a process that begins long before the first drink is taken.

In a situation that many in sobriety fear, she was mistakenly served a full-alcohol beer instead of the non-alcoholic (NA) beer she ordered. While she noticed the strong taste, she initially rationalized it. Her therapist offered a profound concept: “Relapse before you relapse.” Caitlyn realized that for a month beforehand, she had been “looking for something,” having bought and kept a miniature bottle of liquor in her fridge. This pre-relapse mental softening meant that the accidental exposure became a justification: “I was like, gotcha. This is the perfect opportunity. You know? You were justifying in your head.”

The Three-Day Wake-Up Call

The accidental slip quickly spiraled into a full, short-lived relapse. The severity of the incident—which involved her being so drunk she ended up in the hospital after friends reported her banging her head on the floor—served as a definitive reminder of where her addiction leads. After a brief period of continued drinking for three days, the physical illness from dehydration and the shame of the behavior quickly brought her back to the clarity of sobriety: “This is not it. Like we didn’t do this. We can go back now.”

The non-linear nature of recovery means a slip doesn’t erase the progress made. It’s a data point, not a destination.

9. The Importance of an Open Dialogue on Grief

The most moving part of Caitlyn’s story is the conscious choice to heal her own past by changing her present and future. Reflecting on the silent suffering after her father’s passing, she made a deliberate choice to be “very open” with her children following the loss of her adoptive mother: “I was like, we need to talk about it.”

This act of providing emotional space for her children is profoundly healing. As she put it, “It feels really good to be able to like, have those tools from that experience to like give that to my kids while they’re going through this.” This breaks the generational cycle of emotional avoidance and is a powerful act of self-compassion directed at the child version of herself.

10. The Simple Power of Persistence

Caitlyn’s entire narrative is summed up by her core message: persistence. She didn’t have a magical, instant recovery. She battled on and off for years, from her early teens until she got sober in 2021, a five-year period of severe struggle after her third child. Her persistence was not a sudden burst of perfect effort, but the quiet, daily commitment to “keep fighting every day, kept showing up until one day I was like, I’m sober.”

This relentless showing up, even when things felt utterly hopeless, is the essence of her success. For anyone feeling overwhelmed by the length and difficulty of their own recovery journey, Caitlyn’s story is proof that showing up for yourself is the single most important action you can take.

11. The Protective Role of Parenthood in Sobriety

While a challenging relationship with her children’s father fueled some of her heaviest drinking, her children ultimately became her most powerful protective factor. When faced with the immense grief and stress of her mother’s passing, they were her anchor, keeping her from drinking.

She is honest about this reality: “I feel like if I didn’t have my kids, I probably would’ve drank.” For many parents, the desire to provide a stable, loving environment becomes the “reason” that outweighs the addiction’s pull. It transformed her motivation from self-loathing (“I’m meant to suffer”) to service (“I wanted to be strong for them”).

12. Never Give Up Hope: A Final, Powerful Word

Caitlyn’s journey from a self-harming, isolated child with a hidden stash of alcohol to a strong, vulnerable mother and advocate is a roadmap for those navigating the darkest of paths. Her entire message hinges on this simple, profound instruction: Don’t give up hope.

The most compelling quote from her experience encapsulates the dark mental state of addiction and the breakthrough of recovery: “I’ve been in such a dark place, I’ve been like that in that area of my life where I’m like, things will never get better. I’ll never be happy… And that’s why I kept drinking.” Her eventual turn—the decision to keep fighting despite this deep-seated belief—is the persistence that turned her life around.

Her story is a living example of a fundamental truth: no matter how complex the mental health issues (BPD, eating disorder, alcoholism, trauma) or how difficult the circumstances (loss, divorce, relapse), the persistence to show up every day leads to the other side. Healing is messy, but it is always possible.

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Alyson Stoner on Navigating Trauma and an Eating Disorder in the Hollywood Spotlight

Alyson Stoner, a familiar face from childhood classics like Cheaper by the Dozen, Step Up, and Camp Rock, knows the intense, often unsustainable, pressures of the entertainment industry firsthand. Starting at a young age, Stoner was immersed in 80-hour work weeks, financial responsibilities, and constant public scrutiny that extended to their body and personal life, leading to struggles with disordered eating, severe anxiety, and a deep lack of personal boundaries.

Now, as a certified mental health practitioner, policy advocate, and New York Times bestselling author of the memoir Semi Well Adjusted, Despite Literally Everything, Stoner has transformed their experience into a powerful platform for change. They are the founder of Movement Genius, a digital platform offering therapist-led content, and a mental health coordinator for film productions.

On Recoverycast, Stoner shared the profound lessons learned from their journey through the Hollywood pressure cooker and into a life of proactive wellness. Their story offers a crucial window into how systemic issues in high-demand environments can impact a developing mind, and more importantly, how healing, agency, and recovery can be found, even when your foundation has been constantly shifting.

Recognizing That Traumas Can Become “Superpowers”

A key theme in recovery is learning to re-contextualize the coping mechanisms and survival strategies developed during times of stress. What was once necessary to survive can, with conscious effort, be channeled into something productive.

“That’s where you take the hypervigilance that was once suggested a survival strategy and apply it in a proactive way,” Stoner notes. They reflect that many qualities others praise in their career—their “superpowers”—are actually rooted in the very traumas they experienced. For instance, the constant need to be adaptable and ready for change on set, while initially creating an imbalance, can be reframed as a high degree of flexibility and responsiveness in their adult work as a practitioner and advocate.

This process involves recognizing that the drive, attention to detail, or ability to anticipate problems (hypervigilance) isn’t inherently bad; the problem lies in the source and the intensity of its demand. By becoming aware of the origin, one gains the choice to use the skill purposefully rather than being driven by a subconscious need to survive.

Understanding the Child Performer’s First Map of the World

For any child, repeated experiences and absorbed messages form the foundational “map of the world.” For a child performer, this map is drawn under extreme and often unnatural conditions, leading to distorted perceptions of self and safety.

Stoner outlines the key differences between a typical childhood foundation and one built in the entertainment industry:

  • Lack of Routine and Consistency: Instead of reliable school schedules and a consistent home life, Stoner was working 80-hour weeks on constantly changing sets, eliminating the stability necessary for a secure attachment.
  • Blurred Identity: Young children lack a formed sense of self and primarily absorb external messages. Playing multiple characters without tools to differentiate led to blurred lines between their own thoughts and those of a role. Stoner felt like “tofu in essence,” absorbing the flavor of whatever role or environment surrounded them.
  • Reversed Caregiver Roles: Child performers can become financially responsible for a team of adults, placing the child in a position of power and vulnerability simultaneously. This compromises the safe, trustworthy space a young person needs from attuned caregivers.
  • Public Scrutiny: Dealing with public criticism and lack of privacy from a very young age teaches the child that the external world is a primary source of threat and judgment.

The Shift from Human Being to Product

The most detrimental implicit shift, Stoner explains, was learning to see themselves as an object:

“I came to know my body, my mind and body as an object to fix or a project to complete, because I was the product.”

This realization, driven by constant demands for modification in auditions and performances, replaced listening to their basic human needs. The self became a tool—something to be molded, starved, or overworked to meet an external standard. This environment cultivated a deep lack of boundaries, where they were programmed to be “fully available and accessible to everyone at all times,” often overlooking their own health and well-being.

Recognizing the “Toddler to Train Wreck Pipeline”

Stoner coined the term “toddler to train wreck pipeline” to describe the repeating spiral of young high-performing individuals (in arts, sports, or academics) who experience an early peak and then undergo a public downward spiral involving mental health crises, exploitation, or addiction.

This pipeline, Stoner argues, is not due to personal failure, but to major systemic variables that are not addressed in the industry. It’s a preventable crisis. By analyzing media culture, industry protocols, and child labor laws, Stoner recognized that proactive intervention is possible. Their current work as a mental health coordinator for film productions addresses these very gaps, creating protocols to support the psychological safety of cast and crew.

Coping Strategies as Natural Responses to Extreme Circumstance

The struggles with disordered eating and over-exercising were not random but were “responses to really extreme and bizarre circumstances.” In an environment where control over life, safety, and identity was nonexistent, these behaviors provided a false sense of agency and control.

Stoner also highlights the high-octane nature of the work itself, which contributed to an addictive high pattern:

“I think that too, as a child, I didn’t realize what was happening, but I was developing that sort of addictive high pattern… So even when I wasn’t booking work anymore, or as regularly, I would find other things to do that would give me that same spike.”

Performing in front of thousands of people offers an adrenaline and dopamine rush that is followed by a natural dip, known as a post-tour depressive period. Without tools to understand or manage this cycle, the body seeks that high through other means. The eating disorder, therefore, became an unconscious attempt to keep it all together and suppress emotions that would have interfered with the job.

The Need for Proactive Mental Health Coordination

The lack of mental health support on sets was a significant factor in the toll taken on Stoner and their peers. At the time, creative spaces prioritized the story’s intensity over the human cost.

This problem extended beyond the child actor to every member of the production. This includes crew members setting up scenes that might trigger past trauma, editors working in dark rooms cutting intense material for long hours, and even the audience, whose constant consumption of intense, violent material leads to desensitization and dissociation. Stoner’s work as a mental health coordinator is now focused on ensuring ethical media creation for everyone involved, from the performers to the crew and the audience.

The Journey to Treatment: Repairing the “Instrument”

At 17, after realizing their disordered eating had taken control and following a significant audition, Stoner entered treatment. Initially, the goal was merely to “repair my instrument, and then get back out in the game”—a reflection of the product mentality.

However, treatment provided a radically different experience, including a steady, structured schedule, adults not on the payroll who were invested in their human development, and the space to ask: “What do you want for your life?” This environment allowed the deeper, years-long conditioning to begin to unravel.

The first day was incredibly difficult, marked by chemical and emotional withdrawal from the dependencies they had built. “It felt like my body was on fire,” Stoner recalls, a testament to how physically hard it is to quit a survival mechanism.

Cognitive Behavioral Therapy (CBT) as the First Step

In early recovery, the focus shifted to cognitive tools to manage the racing thoughts that drove the unhealthy behaviors. Stoner found immense utility in Cognitive Behavioral Therapy (CBT), particularly the creation of trigger cards. This involved assessing triggers, naming old ways (the historical, non-serving response), and then establishing highly specific replacement strategies for that particular trigger. The consistent, moment-to-moment practice of “catching the thought as it happens, challenging the truth of it, and changing it in real time” was a critical early intervention.

Embracing Somatic Tools to Regulate the Nervous System

While CBT helped with the mind, the body needed a different approach. After leaving the structured environment of treatment and re-engaging with life’s stressors, Stoner shifted to somatic tools—practices that focus on the mind-body connection—to handle the inevitable discomfort.

Somatic work teaches a person how to feel discomfort without immediately needing to run away or fix it with a coping mechanism. This is a difficult pivot, especially when society often equates meditation with “emptying your mind,” which is nearly impossible for someone with an activated nervous system.

The Power of Titration and Patience in Healing

Working with a somatic psychotherapist, Stoner was introduced to the concept of titration—a technique for managing intense emotional experiences by working in small, manageable doses.

Imagine being in a pot of hot water. When the stress (“heat”) becomes too much and you start to “boil over,” titration involves using small techniques to dial down the heat to a manageable level before dipping back into the difficult work.

For Stoner, this meant a session might only involve noticing that their hand formed an angry fist when a difficult topic was raised. That’s it. The session’s goal was not a breakthrough but to feel and name the physical reaction without escalating. This slow, steady process acknowledges that the body will resist change if pushed too far, viewing it as unsafe.

Finding Your Path: The Diverse Faces of Recovery

Stoner emphasizes that there is no single path to healing. Recovery is not a one-size-fits-all process.

For some, it means walking away from the source of trauma forever. For others, it might mean doing the deep work to heal and then using that knowledge to become an advocate or an agent of change within the very system that caused the harm. The key is developing the wisdom and discernment to know what is best for your current stage of healing, and to avoid re-traumatizing yourself by rushing to turn pain into purpose.

The ability to pivot from a life of intense performance to one of thoughtful practice and advocacy has allowed Stoner to help the next generation avoid the pitfalls they experienced. By sharing their story, they offer both a mirror for those who recognize their own struggles and a window for others to understand the vital need for systemic change in high-pressure industries.

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Kelly U’s 5 Insights on Navigating Binge Eating Disorder, Depression, and Codependency

https://youtu.be/NItyDrgCp1w

The journey to mental wellness is rarely a straight path. It is often a complex and winding road filled with unexpected detours and challenges. For many, this journey begins in childhood, rooted in silent struggles and emotional turmoil that manifest in adulthood. The story of Kelly U, a mental health and wellness advocate, is a powerful testament to this reality. Her raw and honest conversation on the Recoverycast podcast sheds light on the origins of her disordered eating, her battles with codependency, and her ultimate triumph in finding sobriety and self-acceptance. By delving into her personal narrative, we can uncover key insights into how early life experiences can shape our mental health and how the right tools and support can lead to profound healing.

1. The Genesis of Disordered Eating: An Origin Story

At the tender age of 10, a seemingly innocuous comment from a boy at school served as a catalyst for what would become years of struggle with disordered eating for Kelly. While the remark “you got like really chubby” was the trigger, it was the underlying family tension and a household where emotions were suppressed that created fertile ground for her to seek control through food. This experience highlights a critical truth about eating disorders: they are not simply about food or body image; they are often a coping mechanism for deeper emotional distress.

“His comment didn’t cause me to develop an eating disorder. That you just sort of would, just needed the perfect thing to light the fire.”

The real fuel was an inability to process and communicate about the “brooding feel” of tension in her home. Children, especially, are highly attuned to their environment and will often internalize the emotional climate of their household, even when the issues are never directly spoken about. Kelly’s desire to numb out and escape into a “fantasy world” through reading was an early sign of her struggle to cope, a behavior that would later escalate into more harmful forms of avoidance.

The story also touches on the complex role of family dynamics in shaping a person’s relationship with their body. Kelly’s mother, a former beauty pageant queen, was highly aware of her appearance and her own struggles with body image. While she never commented on Kelly’s body, her mother’s own anxieties created a template for Kelly to internalize. When the boy’s comment came, it validated an unspoken anxiety that was already present in her environment. This shows that even without direct criticism, parental behaviors and self-perceptions can profoundly influence a child’s body image and self-worth.

2. When Coping Becomes the Problem

Kelly’s journey from restriction to binging illustrates the vicious cycle of disordered eating. After being “forced to just eat,” she swung from anorexia to binge eating, finding a new form of escape. She describes the experience of binge eating Captain Crunch cereal at age 12, not as a moment of indulgence, but as a form of dissociation.

“When I was binge eating, I could also fully not be in the room because I’m. Literally shoving food in my face and covered in shame.”

This powerful description reveals that the act of binging was a means to “fully not be in the room,” a way to distract herself from the constant fear, guilt, and emotional turmoil of her life. The shame that followed the binge eating created a constant “freak out” that consumed her mental space, leaving no room to deal with her parents’ fighting or her own inner struggles. This cycle of binging and shame became its own kind of “drug,” a destructive mechanism that allowed her to avoid her real-life problems.

The podcast also touches on the complex relationship between disordered eating and substance use, specifically marijuana. For Kelly, smoking weed provided a “high of permission” to engage in binge eating, escalating a behavior she already struggled with. This highlights how different vices can become intertwined, each one reinforcing the other and creating a more difficult path to recovery. Her story serves as a reminder that when we seek to numb our pain, we often create new problems that compound the original issues.

Explore treatment options for eating disorders and marijuana addiction.

3. The Role of Codependency and Abusive Relationships

As Kelly transitioned into adulthood, her struggles with self-esteem and codependency became evident in her romantic relationships. Her seven-year relationship with a “narcissistically abusive” partner became a new arena for her emotional turmoil. In this dynamic, she sought the love and acceptance she felt was lacking in her life, but instead, she found manipulation and control.

“I was so mentally unwell and I was super codependent. So I played such a part in that relationship keeping, keeping it alive because I was so desperate for him to just love me and accept me.”

This quote is a stark admission of how codependency can lead a person to stay in an unhealthy relationship. Kelly’s desire for love and acceptance from her partner mirrored her earlier attempts to seek a sense of control and stability in her life. The relationship provided a twisted sense of purpose, even if it was a negative one. She was so consumed with trying to “fix” the relationship and gain his affection that she lost herself in the process.

The abusive nature of the relationship, with constant cheating and emotional manipulation, further eroded her self-worth. Her partner’s gaslighting tactics, like saying “you’re not supportive of me by you being upset with me,” are classic signs of narcissistic abuse. This type of emotional manipulation is designed to make the victim feel responsible for the abuser’s actions, trapping them in a cycle of self-blame and emotional distress. It was only when a couples therapist directly confronted her with the diagnosis of codependency and narcissism that she began to see her situation clearly.

See codependency treatment centers.

4. Embracing Therapy and Finding Your Voice

Despite being in a toxic relationship, Kelly’s ex-boyfriend was the one who encouraged her to go to therapy. This seemingly contradictory act was the key that unlocked her healing journey. While she initially sought therapy to “fix” her binge eating, her therapist’s first question—”What’s your relationship with your dad like?”—shifted her focus from symptoms to root causes.

“I’m really grateful that she asked me that because from then on for years, I’d been unraveling a lot of that and healing a lot of that and working with my family on that.”

This moment was a turning point. It forced her to look beyond the surface-level issues and confront the deeper familial trauma that had been silently influencing her life. Therapy became a safe space to unravel her past, set boundaries with her family, and eventually find a more compassionate way to approach her relationships.

A pivotal moment in Kelly’s recovery was when she began to share her story on social media. What started as an accountability tool became a powerful way to connect with others and realize she wasn’t alone. When she posted about her struggles with binge eating, the outpouring of support and shared experiences validated her and encouraged her to be more honest with herself. This act of vulnerability was a radical departure from a life spent hiding and enabled her to reclaim her narrative.

5. The Power of Sharing and the Freedom of Self-Expression

For Kelly, sharing her story publicly became a form of both self-preservation and advocacy. Her YouTube diary series, in which she documented her recovery journey, was a way to hold herself accountable and stay on the path of healing. The online community she built provided a sense of connection that had been missing for most of her life.

“I started to document what I was learning in therapy in a YouTube diary series. . . I wanted to stay accountable to something.”

Her social media presence became a direct threat to the manipulative control her ex had over her. The letter he slid under her door, begging her not to “post a video that our friends and family will see,” was a final, desperate attempt to maintain his facade. Kelly’s decision to keep that letter, and other mementos from the relationship, was not an act of malice but an act of self-preservation—a physical reminder of how far she had come and why she should never go back.

This final act of defiance and self-expression solidified her recovery journey. It was a declaration of her own truth, one that could no longer be silenced or controlled by others. By sharing her story, she not only helped herself but also became a beacon of hope for others who are navigating similar struggles. Kelly’s story shows us that finding our voice, even when it’s hard, is a crucial step toward freedom and lasting recovery.

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How to Help Someone With an Eating Disorder: 5 Practical Tips

Helping a loved one with an eating disorder can feel overwhelming, but with the right knowledge and compassion, you can make a meaningful difference.

Whether the person you’re supporting is struggling with anorexia nervosa, bulimia nervosa, binge eating disorder, weight loss challenges, ARFID, body image, or a mental illness causing disordered eating behaviors, offering support starts with knowing the warning signs, being informed about professional treatment options, and promoting positive self-esteem.

These 5 practical steps can help guide you in supporting your partner, friend, or family member through their journey toward recovery:

1. Recognize the Signs and Symptoms

Understanding the signs of an eating disorder is the first step in offering meaningful support. While behaviors can vary, the National Eating Disorders Association (NEDA) recognizes the following behaviors as some of the common symptoms to watch for:1

  • Avoiding mealtimes
  • Losing interest with food or change in eating habits
  • Significant weight loss
  • Excessive exercise or laxative use
  • Intense fear of gaining weight
  • Restricting foods or food groups

If someone exhibits these signs, it’s important to approach the situation with sensitivity and care. Remember, eating disorders are often coupled with mental health challenges, so it’s essential to be patient and avoid shaming.

For a deeper understanding of what causes eating disorders, we’ve included a comprehensive list of risk factors below that explores biological, psychological, and cultural influences.

2. Approach With Empathy and Compassion

The way you approach someone with an eating disorder2 can significantly impact their willingness to seek help. It’s crucial to approach the conversation with empathy and compassion, making it clear that you’re concerned for their well-being.

  • Choose a calm, private time to talk.
  • Express your concern using “I” statements.
  • Firmly state facts you have observed while avoiding blaming or criticizing their eating habits.
  • Offer support rather than solutions by simply letting them know you’re there for them.

Remember, eating disorders often stem from complex mental issues or unprocessed difficult emotions. Rather than drawing attention to these internal challenges, focus on your desire to empower their ability for self-help.

3. Encourage Professional Help

Though eating disorders impact physical health, they are ultimately serious mental health conditions; eating disorder treatment requires professional intervention. Encourage your loved one to seek help from a mental health professional who specializes in eating disorders.

Here are some steps to guide them toward getting help:

  • Acknowledge that your loved one may feel intense fear about taking the first step in seeking appropriate healthcare professionals.
  • Ask your loved one if they’d like your help researching therapists, support groups, outpatient programs or treatment centers.
  • Let them know it’s okay to take small steps, but don’t let their excuses block their path to treatment.
  • Offer to attend appointments for support.

If they resist getting help, stay patient and continue to offer support. Empower their journey by regularly checking in with questions like “How are you feeling today?” or “What kind of support would be most helpful right now?” When discussing their condition, gently remind them about health concerns without becoming demanding or judgmental. Remember that being too pushy might cause your loved one to withdraw from your support completely.

Professional help provides the structure, guidance, and therapeutic environment essential for recovery. Mental health professionals specializing in eating disorders have the expertise to create personalized treatment plans and support your loved one through each stage of the healing process.

4. Support Positive Changes in Eating Habits

NEDA makes it clear that an active support network plays a crucial role in eating disorder recovery.3

Affirm your loved one as they develop a balanced relationship with food by encouraging small, manageable changes. These could include:

  • Encouraging regular meals: Help them get into the habit of eating regular, balanced meals and snacks.
  • Promoting variety: Encourage them to eat a wide range of foods to shift away from restricting.
  • Being patient: Overcoming disordered eating behaviors takes time.

In supporting your loved one, focus on the importance of nourishment and self-care as they work to establish and maintain a healthy weight.

5. Encourage Ongoing Self-Compassion

Recovering from an eating disorder is a long-term journey, and learning self-compassion is essential for healing.4

Encourage your loved one to be gentle with themselves and celebrate all their successes and accomplishments, no matter how big or small. Remind your them that setbacks are a normal part of the process, and to stay focused on their progress. 

You can support this process by:

  • Offering words of encouragement
  • Demonstrating self-kindness
  • Modeling mindfulness
  • Gently reminding them that they are more than their eating disorder

Remind them as often as necessary that healing is a marathon, not a sprint—and can only happen one step at a time.

Understanding the Roots of Eating Disorders

While the practical steps above provide guidance on how to support someone, knowing why eating disorders develop can deepen your empathy and effectiveness as a support person. The following risk factors help explain the complex origins of these conditions.

Biological Risk Factors

Behavioral Risk Factors

  • Fixed mindset: Rigid thinking and difficulty switching between tasks are risk factors for developing an eating disorder.
  • Perfectionist tendencies:7 People who generally set high expectations for themselves are at a greater risk for developing an eating disorder.
  • Rashness: People who make spontaneous, rash, or impulsive decisions8—especially in negative emotional states, without thinking through the outcomes or repercussions—are more likely to develop an eating disorder.
  • Dysregulated emotions:9 People who are less emotionally aware or lack tools for processing emotions are higher risk of developing an eating disorder.
  • Avoidant personality traits: Some people have a pattern of avoiding things that could be stressful or uncomfortable. These people may be more likely to develop an eating disorder. Research shows that about 19% of people with restricting-type anorexia also have avoidant personality disorder.10 However, these personality traits relate more to negative mood states than to eating disorder symptoms themselves. 
  • Negative body perception: Many people experience feelings of body discomfort and dissatisfaction with their appearance without developing an eating disorder. However, people with an eating disorder diagnosis have more severe body image disturbance11 compared to the general population.
  • Dieting patterns: People who restrict food, diet frequently, or focus intensely on maintaining a certain weight are more likely to develop an eating disorder.
  • History of mental health disorders: Not all people who experience mental health challenges will develop an eating disorder. But many people with eating disorders have a history of mental health challenges.
  • Substance use disorder: Eating disorders and substance use disorders12 frequently co-occur.

Cultural Risk Factors

  • Fat shaming: Thin-ideal messaging in media can fuel your body dissatisfaction and eating disorder risk. Direct teasing or bullying about your body can similarly trigger disordered eating patterns.
  • Loneliness: Research shows you’re more likely to experience social impairment and mental health issues when struggling with an eating disorder. Your feelings of isolation can both trigger disordered eating behaviors13 and result from them.
  • Trauma: Not all people who experience trauma will develop an eating disorder. That being said, many people with eating disorders have a history of physical, emotional, or sexual trauma.14
  • Nutritional knowledge gap: People who are less informed about proper nutrition15 are also at higher risk for eating disorders.

Neurodivergence and Eating Disorders

Some people experience discomfort when eating due to conditions like autism16 or ADHD. As a result, these people are more likely to develop an eating disorder.

These steps can provide clarity and confidence in helping your loved one establish sustainable wellness practices amidst intense fear and potentially life-threatening conditions.

Supporting a Loved One

Offering support to a loved one with an eating disorder requires patience, compassion, dedication, and understanding. While the path to recovery can be challenging, your support can be a guiding light in their journey.

Remember, your role is to listen, encourage, and help them seek the right professional help to achieve lasting healing. The first professional you connect with may or may not be appropriate; stay committed to finding the right healthcare professional.

By focusing on empathy and practical steps to establish well-being, you can help your loved one navigate the process toward a healthier relationship with food, wellness, and themselves.

Ready to take action? Find an eating disorder treatment center near you and speak with a trained professional who can point you in the right direction.

FAQs

Q: What are some coping strategies for eating disorders?


A: Effective coping strategies include developing healthy routines, practicing mindfulness, engaging in therapy (such as cognitive behavioral therapy), setting realistic goals, building a support system, and journaling emotions instead of suppressing them. Professional treatment is often essential for long-term recovery.

Q: What not to do to help someone with an eating disorder?


A: Avoid making comments about their weight, appearance, or food choices. Don’t try to force them to eat, guilt them, or assume recovery is a matter of willpower. Instead, focus on being a compassionate, nonjudgmental listener and encourage professional support.

Q: How to help someone who doesn’t want to eat?


A: Offer support without pressure. Sit with them during meals, ask open-ended questions, and focus on how they’re feeling rather than what they’re eating. Encourage them to speak with a mental health professional who specializes in eating disorders.

Q: How to help someone with binge eating disorder?

A: Encourage open communication without shame or blame. Offer support in seeking therapy, particularly cognitive behavioral therapy, which is effective in treating binge eating. Avoid food policing or diet talk and promote body neutrality and balanced eating.

Q: How to help someone with disordered eating?


A: Start by expressing concern in a kind, non-confrontational way. Help them find professional treatment and educate yourself on disordered eating behaviors. Validate their feelings and avoid making assumptions about their motivations or health.

Q: What causes an eating disorder?

A: Eating disorders are caused by a combination of genetic, biological, psychological, and environmental factors. Low self-esteem, trauma, societal pressure, perfectionism, and family dynamics can all contribute to the development of these disorders.

Q: What causes anorexia nervosa?

A: Anorexia nervosa can stem from a mix of biological predispositions (like genetics and neurobiology), personality traits such as perfectionism, and environmental influences including trauma, cultural ideals of thinness, and family expectations.

Q: Can you prevent anorexia nervosa?

A: While not all cases are preventable, early education on body image, promoting healthy coping strategies, reducing exposure to harmful media messages, and fostering open communication can help reduce risk, especially in adolescents.

Q: Do you need help supporting a loved one?

A: If you’re struggling to support someone with an eating disorder, consider joining a support group, speaking with a therapist, or contacting an eating disorder helpline. Your emotional well-being is important too, and guidance can help you better assist your loved one.

Q: What are the signs and symptoms of bulimia nervosa?

A: Common signs include frequent episodes of binge eating followed by purging (vomiting, laxatives, excessive exercise), preoccupation with weight and body image, swollen cheeks, damaged teeth, callused knuckles, and secretive eating behaviors.

Q: When Is National Mental Health Awareness Month?

A: National Mental Health Awareness Month is observed in May. It promotes understanding, reduces stigma, and encourages access to mental health care for all individuals.

Q: How can I support a friend recovering from an eating disorder?

A: Be patient, nonjudgmental, and consistent. Listen actively, avoid commenting on food or appearance, and celebrate non-appearance-based victories. Encourage professional help and remind them that recovery is a journey, not a straight line.

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Do I Have Anorexia? 10 Warning Signs to Recognize

Anorexia nervosa is a deeply paradoxical disorder. What begins as an attempt to control the body often results in the mind losing control.

Far more than simply refusing to eat, anorexia nervosa is characterized by an intense fear of gaining weight, extreme restriction of food intake, and a distorted body image, often leading to dangerous weight loss and physical and psychological consequences.

It fundamentally disrupts a person’s relationship with nourishment, transforming it into a source of anxiety, guilt, and self-punishment.

This illness carries one of the highest mortality rates among psychiatric disorders and often coexists with other mental health conditions such as anxiety, depression, or obsessive-compulsive disorder.

Infographic titled Red Flags of Anorexia showing warning signs including rapid weight loss, extreme food restriction, social isolation, ritualized eating habits, loss of menstruation, slow heartbeat, and body checking, with illustration of a person pushing food away.

What Is Anorexia?

Clinically, anorexia nervosa1 is diagnosed using criteria outlined in the DSM-5-TR, which includes persistent restriction of caloric intake, significantly low body weight, intense fear of gaining weight,2 and a distorted perception of body image or failure to recognize the seriousness of low weight. 

The disorder is further categorized by severity based on body mass index (BMI),3 though recent studies suggest that this numerical scale captures only part of the picture. Updates in diagnostic criteria have led to a 60% increase in lifetime prevalence estimates, underscoring how many people may have previously gone undiagnosed and untreated.

Infographic titled Recognizing Anorexia with sections for key symptoms and key behaviors. Symptoms include significant weight loss, distorted body image, persistent fatigue, hair thinning, and feeling cold. Behaviors include calorie restriction, ritualistic eating, exercising and purging, social avoidance, and body checking, with illustration of a broken plate and spoon.

In anorexia nervosa, the pursuit of control becomes the ultimate loss of control, where the quest for perfection becomes a dance with self-destruction.

More than simply “not eating,” anorexia nervosa is a complex psychiatric illness associated with food restriction and high mortality that transforms the fundamental human relationship with nourishment into a battlefield of the mind.

Clinical Symptoms

According to the DSM-5-TR,4 anorexia nervosa is clinically defined by three core criteria that paint only the surface of this enigmatic disorder. Healthcare providers diagnose anorexia nervosa based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). 

The three criteria include: 

  • Self-induced calorie restriction, leading to significant weight loss or a failure to gain weight in growing children, accompanied by typically, a low body weight based on age, sex, height and stage of growth, 
  • Abnormal obsession with body weight and intense fear of gaining weight or becoming “fat”
  • Distorted self-image or an inability to acknowledge the seriousness of their condition.

The disorder’s severity is now classified using BMI thresholds:

Mild: BMI greater than or equal to 17 kg/m2

Moderate: BMI 16–16.99 kg/m2

Severe: BMI 15–15.99 kg/m2

Extreme: BMI less than 15 kg/m2

However, these numbers tell only part of the story—recent research reveals that the lifetime prevalence of anorexia nervosa increased by 60% using the new DSM-5-TR definition, highlighting how many individuals previously suffered in diagnostic shadows.

Anorexia is a mental illness typically rooted in deeply ingrained emotional patterns, where controlling food intake and body image can become almost addictive, often leaving you feeling depleted. Recovery takes dedication and patience; with steady effort, you can develop a healthier relationship with yourself and your body.

Mindful strategies for anorexia recovery infographic with tips including seek professional help, journal meals and moods, maintain a meal schedule, practice grounding exercises, limit body-checking behaviors, discover healthy coping mechanisms, lean on trusted supporters, and monitor triggers and warning signs. Illustration shows a plate with bread, eggs, and salad alongside utensils.

Here are 10 symptoms and signs of anorexia that you might notice in yourself or a loved one.

1. Fear of Weight Gain

An intense fear of gaining weight, despite being underweight, is a key symptom of anorexia. This fear often leads to extreme avoidance of certain foods, purging, or using laxatives.

A fear of gaining weight can look like avoiding foods you think are, “fattening,” taking laxatives as a way to temporarily reduce water-weight from the body, and/or purging. The fear of weight gain and desire to maintain a low body weight can become an obsession.

This fear of gaining weight stems from a distorted body image and an overwhelming preoccupation with weight and appearance.5 This fear is essentially an attempt to establish control over your life and appear perfect. Underlying psychological factors such as anxiety or low self-esteem also play a role.

Maintaining weight loss, though a form of malnutrition, can become a way to feel a distorted sense of achievement over your life.

The sense of control gained from restricting food can temporarily mask emotional pain or discomfort, requiring proper eating disorder treatment in order to break free from the cycle.

2. Extreme Weight Loss

Extreme and unexplained weight loss6 can be a warning sign of anorexia, leading to malnutrition and serious health risks. If your weight loss is unexplained, it could be a symptom of anorexia, bulimia nervosa, atypical anorexia, binge eating disorder, or other health problems.

Medical professionals generally agree that losing more than 5% of your body weight within a 6-12 month period is considered extreme. This means that a person with a healthy weight of 160 lbs would lose 8 lbs (dropping to 152 lbs), or someone with a healthy weight of 200 lbs would lose 10 lbs (dropping to 190 lbs) in 6-12 months.

Such drastic weight changes, especially when not intentional or accompanied by a clear medical reason, can indicate an underlying health issue, including eating disorders.

If you or someone you know is experiencing significant weight loss without a clear cause, it’s crucial to seek medical advice as early intervention can be key to recovery.

3. Excessive Exercise

Too much of anything is rarely beneficial. Continuing to exercise despite physical exhaustion or injury can be a sign of anorexia nervosa.

Excessive exercise,7 even when tired or injured, is a common symptom of anorexia. It’s often driven by a need to control body image rather than improve physical fitness. Additionally, a high level of exercise may stem from a deep-seated fear of weight gain or it may be tied to underlying issues such as anxiety and low self-esteem.

In many cases, the drive to exercise excessively is not about improving physical fitness, but rather about maintaining a sense of control over one’s body.

Over time, this can lead to physical harm (like stress fractures or cardiovascular strain) and extreme exhaustion. Exercising may even take priority over social functioning, work, and/or school commitments.

Recognizing the psychological motivations behind excessive exercise is important for determining an appropriate treatment plan.

4. Distorted Body Image

If you look in the mirror and perceive yourself as overweight, despite being dangerously underweight, you may have anorexia nervosa.

This distorted body image or body dysmorphia is central to anorexia and can drive you to continue restricting food intake, even when faced with obvious health consequences.

Body dysmorphia8 is  or body dysmorphic disorder (BDD), is a mental health condition in which individuals become preoccupied with perceived flaws or perceived defects in their appearance. This preoccupation can cause significant emotional distress and interfere with daily functioning.9

BDD is classified under obsessive-compulsive and related disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It affects both men and women and often begins in adolescence, a period when appearance-related concerns tend to intensify.

Your distorted body image may be influenced by cultural or familial beliefs about what the “ideal” body looks like. Social media10 is also impacting body image and playing a contributing role in the development of eating disorders, specifically for adolescents. While you may believe you’re simply trying to maintain an “ideal” appearance, this behavior can lead to dangerous malnutrition.

The disconnect between how you see yourself and reality can make it difficult to seek help, as you might not recognize the seriousness of your condition. A trusted healthcare provider can help you recognize the signs and find a healthier path.

5. Restriction of Food Intake

Severe limitation of food intake, such as skipping meals, eating very small amounts, or using supplements as meal replacements, can lead to malnutrition and even life-threatening health conditions. This restriction is often driven by a fear of gaining weight and a need for control.

If your food restriction stems from an attempt to exert control or define your self-worth through food, you may have anorexia nervosa. In such cases, mental health professionals are essential to support your healing and recovery.

However, if you avoid certain foods due to sensory characteristics like taste, texture, or smell, or because of a negative past experience (such as choking), it is more likely that you have Avoidant/Restrictive Food Intake Disorder (ARFID).11

Unlike anorexia, individuals with ARFID do not have a distorted body image or a fear of gaining weight. While ARFID can still lead to nutritional deficiencies, it is not driven by a desire to lose weight.

The Neurobiology of Restriction

Anorexia nervosa is fundamentally a complex neuropsychological disorder12 where the brain itself becomes rewired.

Research reveals that among individuals with AN, dorsal front striatal circuits play a greater role in guiding decisions regarding what to eat than among healthy individuals. This means that food choices become driven more by rigid, habit-based neural pathways than by the flexible reward systems that typically govern eating.

The disorder involves gray and white matter reduction13 correlating with the extent of malnourishment and is mostly reversible with recovery. At the same time, functional brain imaging shows increased amygdala activation and altered cingulate cortex activation when patients encounter food-related stimuli. The altered dopamine status of patients with anorexia may result from a brain abnormality that underlies the disorder, suggesting that neurobiological differences may precede rather than result from the starvation process.

6. Preoccupation With Food

Even if you refuse to eat, you may still have obsessive thoughts about food, dieting, and body weight. These thoughts can be all-consuming and constantly present. You might also engage in activities such as counting calories or categorizing foods as “safe,” “dangerous,” “good,” or “bad.”

This preoccupation with food is often linked to the obsessive-compulsive tendencies that frequently accompany anorexia. It may lead you to fixate on eating behaviors, avoid certain food groups, or excessively research food-related topics. These behaviors can reinforce your disordered relationship with food and make it more difficult to focus on other aspects of life.

This obsessive thinking about food, dieting, and body image can become all-consuming. Seeking professional help is essential to break the cycle of obsession and establish a healthier relationship with food.

7. Physical Symptoms

Anorexia nervosa causes devastating physical effects14 throughout the body as malnutrition and starvation take their toll on every organ system. Starvation induces protein and fat catabolism that leads to loss of cellular volume and function, resulting in adverse effects on, and atrophy of, the heart, brain, liver, intestines, kidneys, and muscles.

Additional physical symptoms may help indicate anorexia: fatigue, dizziness, bloating, constipation, hair thinning, brittle nails, osteoporosis, anemia, and the loss of menstrual periods (amenorrhea) in women.

These symptoms are direct consequences of malnutrition15 and extreme food restriction. When the body does not receive adequate nutrition, it slows down many of its functions in an attempt to conserve energy, compromising overall physical health.

Specifically, fatigue and dizziness16 can be linked to low blood pressure, a direct result of malnutrition. Hair thinning and brittle nails are also signs that the body is not getting the necessary nutrients for healthy growth and repair, further affecting physical health.

Osteoporosis and anemia are also common results of long-term malnutrition, as the body prioritizes basic functions over bone and blood health. Hormonal imbalances, including the loss of menstrual periods (amenorrhea) in women, occur as the body prioritizes survival over reproductive function, reducing the production of key hormones like estrogen.

These physical changes are signals that the body is struggling to function properly due to extreme malnutrition, which makes early intervention crucial, highlighting the importance of early intervention to protect long-term physical health.

8. Feelings of Control

From the outside, anorexia nervosa may appear disorganized, with behaviors that don’t seem to make sense.

However, if you are struggling with anorexia and feeling overwhelmed in other areas of your life, you might believe that controlling your eating behaviors provides a sense of stability. When everything else feels chaotic, restricting food intake can seem like the only way to assert control.

This need for control may offer temporary relief but is often misguided. Over time, this obsession with control can deepen feelings of anxiety and isolation. Ultimately, this false sense of control perpetuates the cycle of anorexia, which is why proper intervention is crucial for recovery.

A trusted healthcare provider like a dietitian or psychotherapist can help you to break free from the cycle. If you feel fear creep in as you go to take the first step towards finding the appropriate eating disorder treatment for you, remember to take it one step at a time.

9. Social Withdrawal

Social withdrawal is a common symptom of anorexia nervosa. This can look like distancing yourself from your friends, family members, and/or social activities. Often feelings of shame, embarrassment, or a fear of being judged for eating habits and body image issues fuel isolating behaviors.

Social situations, especially those involving food, can trigger anxiety or discomfort, leading to a desire to avoid gatherings altogether.

This isolation can be both a result of the disorder and a contributing factor to its progression. As you withdraw, you may feel increasingly alone and disconnected, which can exacerbate feelings of depression or anxiety.

The lack of support from loved ones can make it harder to recognize the need for help or to seek medical care, ultimately perpetuating the cycle of anorexia.

10. Perfectionism

Many individuals with anorexia nervosa exhibit perfectionistic tendencies; perhaps you set extremely high and often unrealistic expectations for yourself.

While this drive for perfection may be particularly prominent in your eating habits, it likely extends into other areas of your life, too. Maybe you strive to achieve academic or professional achievements, constantly pushing yourself to meet unattainable expectations. When you inevitably fall short, you feel guilty, like a failure, and self-criticise.

With regard to body image, you may become obsessed with achieving a thin or lean body, believing that it is an “ideal” body shape. This desire to achieve a certain body shape leads to rigid and inflexible eating habits.

If you constantly strive for unrealistic standards of beauty or achievement, you might experience guilt or self-criticism when you don’t meet them. Psychotherapy and/or nutrition counseling can provide you with the space to work toward developing healthier, more flexible perspectives on eating habits, body image, and self-worth.

Ready to Take the First Step Toward Healing?


If you or a loved one may be struggling with anorexia nervosa, you are not alone. Help is available. Explore qualified eating disorder treatment programs near you that provide compassionate care, personalized support, and proven paths to recovery.

Find eating disorder treatment options near you today.

FAQs

Q: How do I know if I’m anorexic?


A: Anorexia is characterized by an extreme fear of gaining weight, severe food restriction, and a distorted body image. Key signs include drastic weight loss, excessive exercise, and obsession with food.

Q: What are 4 signs of anorexia?

A: Four common signs of anorexia include extreme weight loss, excessive exercise, distorted body image, and obsessive thoughts about food and dieting.

Q: What qualifies you as an anorexic?

A: To be diagnosed with anorexia, one typically restricts food intake, fears gaining weight, and has a distorted view of their body. These behaviors often lead to severe physical and emotional health consequences.

Q: What is anorexia nervosa?

A: Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight and a distorted body image, which leads individuals to restrict food intake severely. This can result in extreme weight loss, malnutrition, and severe physical and emotional health issues. Treatment from healthcare professionals is crucial for recovery.

Q: What are the signs and symptoms of anorexia?

A: Common signs of anorexia include extreme weight loss, excessive exercise, distorted body image, social withdrawal, obsession with food and dieting, and various physical symptoms like hair thinning, brittle nails, and hormonal imbalances. If you recognize these signs, seeking professional help is essential.

Q: Can I have anorexia if I’m not underweight?

A: Yes, anorexia can be present even in people who are not underweight. The key factor is the overwhelming fear of gaining weight and the extreme restrictions placed on food intake, which may still harm physical and mental health.


Q: Can I have anorexia if I still eat regularly?

A: Even if you eat regularly, you can still have anorexia if the food choices are extremely restrictive, and the primary goal is weight loss or maintaining an unnaturally low body weight. The key lies in the underlying fear of gaining weight and a distorted body image.

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Do I Have Body Dysmorphia? 13 Signs You Shouldn’t Ignore

It’s normal to have days when we feel uncomfortable in our own skin. But for some, those feelings go far beyond everyday insecurity. If you find yourself obsessing over perceived flaws in your appearance—flaws that others may not even notice—you might be wondering if it’s something more serious.

Body dysmorphic disorder (BDD) is a mental health condition that affects the way people see and think about their bodies, often causing them significant distress and interfering with their daily life. In this article, we’ll explore what body dysmorphia really is, how to recognize the signs, and when it’s time to seek support.

Mental health awareness illustration featuring a person looking at their distorted reflection in a mirror, accompanied by quote: You can't fix a distorted mirror by changing your body. You have to heal the lens you're looking through.

What Is Body Dysmorphia?

Body dysmorphic disorder (BDD)1 is a mental health condition “where a person experiences a preoccupation with a perceived defect or flaw in one’s physical appearance when, in fact, they appear normal.”

People with BDD tend to fixate on specific body parts or features, most commonly the skin, nose, hair, or body shape. This obsessive focus often leads to repeated behaviors such as mirror checking, grooming, or comparing themselves to others in an attempt to “fix” or hide the flaw. It can also cause the person a lot of stress.

What sets BDD apart from general body dissatisfaction is the intensity and persistence of these thoughts. The distress caused by the perceived imperfection can interfere with your daily life, relationships, and emotional well-being.

Body dysmorphia vs insecurity comparison infographic explaining self-image disorders, frequency patterns, and reassurance responses for mental health awareness.

BDD isn’t just about wanting to look better or not being happy with a part of your body. It’s about feeling unable to stop thinking about the flaw, no matter how many times others reassure you or how much effort you put into changing it.

Signs and Symptoms of BDD

Many people struggle for years before realizing their intense appearance concerns have a name—recognizing these signs of BDD2 can be validating and the first step toward getting help: 

1. Excessive Worry About a Specific Part of the Body

People with BDD experience intense, uncontrollable worry about a particular body part. They feel unable to calm or manage these concerns, no matter how hard they try.

2. Hiding or Concealing Perceived Flaws

People with BDD go to great lengths to conceal the area they’re focused on. They use hats, scarves, makeup, strategic clothing, or certain hairstyles to mask or distract from the perceived imperfection.

3. Dismissing Compliments or Reassurances

It feels impossible to believe when loved ones say you look fine or beautiful. People with BDD often dismiss positive feedback, convinced that others are just being kind or dishonest.

4. Avoiding Social Situations

Intense self-consciousness or shame leads to skipping school, work, dates, or social events. The fear of being seen or judged becomes overwhelming and interferes with normal activities.

5. Feeling Distress Over Photos

Many people with BDD feel extreme anxiety or panic at the thought of having their picture taken. They fear that images will highlight or expose their perceived flaw to others.

6. Engaging in Repetitive Appearance-Related Behaviors

These behaviors include frequently checking mirrors or avoiding them entirely, skin picking, excessive grooming, or constantly trying to “fix” the perceived flaw. People may spend hours using makeup, adjusting clothing, or even seeking cosmetic procedures.

7. Seeking Constant Reassurance

People with BDD repeatedly ask friends, family, or even strangers for validation about their appearance. They hope to feel better, though any relief is typically short-lived and the need for reassurance returns quickly.

8. Constantly Comparing Yourself to Others

People with BDD obsessively compare their appearance to others on social media or in real life. These comparisons often leave them feeling inferior or deeply flawed, reinforcing their negative self-perception.

Mental health infographic displaying signs of body dysmorphia including fixation on flaws, mirror checking, hiding with clothes, rejecting compliments, avoiding photos, constant comparison, repetitive grooming, and feeling ashamed.

9. Feeling Defined by the Perceived Flaw

It’s common for someone with BDD to believe that their “flaw” makes them unlovable, broken, or even repulsive. This belief persists despite reassurances from others who don’t see the same imperfection.

10. Overexercising or Overtraining

Some people have muscle dysmorphia,3 which involves a preoccupation with the idea that their body build is too small or insufficiently muscular. This may lead to excessive exercise, steroid use, or unhealthy supplement usage in an attempt to control their body’s appearance.

11. Seeking Multiple Healthcare Providers

People with BDD visit numerous dermatologists, cosmetic surgeons, or other specialists in search of a “fix” for their perceived flaw. They continue this search even after being told repeatedly that nothing is wrong.

12. Undergoing Unnecessary Cosmetic Procedures

Some people pursue plastic surgery or aesthetic treatments that aren’t medically needed. These procedures rarely provide lasting relief and may worsen distress when the results don’t “solve” the internal struggle, often causing the obsession to shift to different body parts.

13. Having Thoughts of Self-Harm or Suicide

In severe cases, the emotional pain becomes overwhelming and leads to feelings of hopelessness and worthlessness. Some people may experience thoughts of self-harm or suicide as a way to escape the distress caused by their body image concerns.

Thoughts of suicide and self-harm are serious warning signs that should never be ignored. If you or someone you know is experiencing these thoughts, seek immediate help by calling the 988 Suicide & Crisis Lifeline (call or text 988) or contact your local emergency services. Remember that these feelings are symptoms of the disorder, not a reflection of reality, and professional help can provide relief.

Could I Have Body Dysmorphia? A Quick Self-Reflection Quiz

This brief quiz is based on common diagnostic criteria and clinical observations from the DSM-5-TR used to identify body dysmorphic disorder (BDD).4 It’s not a diagnostic tool, but it can help you reflect on whether your body image concerns may warrant further support from a mental health professional.

Instructions

For each statement, answer Yes or No.

  1. Do you often worry about a specific part of your appearance that others say looks fine or don’t seem to notice?
  2. Do you frequently check mirrors, photos, or reflective surfaces to look at this area of concern?
  3. Do you avoid social situations, photos, or video calls because of how you feel about your appearance?
  4. Do you spend more than an hour a day thinking about your appearance or trying to “fix” your flaw?
  5. Have you tried to hide or cover up this part of your body with makeup, clothing, or accessories?
  6. Do you seek frequent reassurance from others about how you look, but rarely feel reassured?
  7. Have you seen multiple doctors, dermatologists, or plastic surgeons about this concern?
  8. Have you ever felt hopeless, depressed, or had thoughts of self-harm related to your appearance?

Scoring

  • 0–2 “yes” answers: You may have occasional appearance concerns, which are common.
  • 3–5 “yes” answers: Your concerns might be affecting your quality of life. It may be helpful to talk to a therapist.
  • 6+ “yes” answers: You may be experiencing signs consistent with body dysmorphic disorder. Consider seeking professional support.

Note: This quiz is inspired by the Body Dysmorphic Disorder Questionnaire (BDDQ) and clinical criteria in the DSM-5. It is for educational use only and is not a substitute for a professional diagnosis.

What Causes Body Dysmorphic Disorder?

The exact cause of body dysmorphic disorder (BDD) is not fully understood, but several risk factors5 are believed to contribute:

  • Genetics: A family history of BDD, obsessive-compulsive disorder (OCD), or other mental health conditions may increase the risk.
  • Brain chemistry: Imbalances in serotonin, a neurotransmitter that affects mood and anxiety, may play a role.
  • Trauma or bullying: Negative experiences, such as childhood trauma or being bullied for appearance, can increase the likelihood of developing BDD.
  • Cultural factors: Societal pressures and unrealistic beauty standards in media can exacerbate body image concerns and may contribute to the development of BDD.

When Should You Seek Help?

If you’re experiencing any of the signs or symptoms of body dysmorphic disorder (BDD), it’s important to know that you don’t have to manage it alone. While everyone has moments of insecurity or self-doubt, BDD can be overwhelming and may require professional support to manage.

Here are some signs that it’s time to seek help:

The Distress Affects Your Daily Life

If your preoccupation with your appearance is interfering with your ability to work, study, maintain relationships, or enjoy social activities, it’s a clear indication that your body image concerns may be more than just a passing insecurity.

Repetitive Behaviors Are Difficult to Control

If you find yourself unable to stop behaviors like mirror checking, skin picking, or seeking constant reassurance, and these actions are consuming a significant amount of time each day, it might be time to reach out for help.

Seeking Medical or Cosmetic Treatments Does Not Bring Relief

If you’ve tried multiple cosmetic procedures, seen various healthcare providers, or spent significant time and money trying to “fix” a perceived flaw, but continue to feel unsatisfied or worse, this is a signal that the issue is rooted in a deeper psychological concern, not a physical flaw.

Reassurance From Others Doesn’t Ease Your Anxiety

If loved ones consistently reassure you that you look fine or that your concerns are unfounded, but you continue to feel distressed, it may indicate the need for professional intervention. BDD is not about vanity—it’s a mental health issue that requires treatment.

Self-Harm or Suicidal Thoughts Arise

If you experience thoughts of self-harm or suicide due to your appearance or body image distress, it is critical to seek immediate support. These thoughts are a sign of the severe emotional toll BDD can have and should be addressed by a mental health professional right away.

How Is BDD Treated?

Seeking help is a positive step toward healing. Body dysmorphic disorder (BDD) can be a challenging condition to manage on your own, but effective treatment options6 are available. The goal of treatment is to help people recognize and address the distorted thoughts and behaviors that fuel their distress, allowing them to improve their quality of life.

Common treatment approaches for BDD include:

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy helps people challenge distorted thoughts and behaviors related to their body image concerns. This evidence-based approach teaches patients to recognize and change negative thought patterns that fuel their distress. 

Medication

Medication can be a helpful part of treatment, particularly when someone also has symptoms of related disorders like anxiety, depression, or obsessive-compulsive disorder (OCD), which often co-occur with BDD. Psychiatrists also commonly prescribe a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) to help manage these symptoms. While medication can provide relief from the emotional distress and obsessive behaviors associated with BDD, it’s usually most effective when combined with psychotherapy.

Support Groups

Participating in support groups can be beneficial for people struggling with BDD. Being able to share experiences with others who understand the challenges of living with BDD provides emotional support and a sense of community. These groups offer a safe space to discuss body image struggles and help people feel less isolated in their journey toward recovery.

Family Therapy & Education

BDD can significantly impact your relationships, making it incredibly helpful to involve family members in the treatment process. Family therapy helps your loved ones understand the condition and learn how to provide positive, supportive responses. Educating family members about the nature of BDD reduces misunderstandings and helps them better support your recovery journey.

Lifestyle Changes

Exercise, mindfulness, and relaxation techniques can help manage the anxiety and stress that often accompany BDD. Regular physical activity improves mood, boosts self-esteem, and reduces compulsive behaviors. Mindfulness practices such as meditation or deep breathing exercises help individuals manage intrusive thoughts and stay grounded in the present moment, rather than becoming fixated on appearance-related concerns.

Getting the Help You Deserve

If you recognize these signs in yourself, remember that BDD is a real and treatable condition: You’re not being vain, and you’re not alone in your struggle. 

Taking the step to acknowledge these symptoms shows incredible strength and self-awareness. Reaching out to a mental health professional who specializes in body image disorders or BDD can be life-changing. With the right support and treatment, you can find relief from the distressing thoughts and behaviors that have been controlling your life, and start to see yourself with greater compassion and clarity.

FAQs

Q. How is BDD different from low self-esteem or insecurity?

A. While many people experience occasional doubts about their appearance, BDD involves obsessive, uncontrollable thoughts about perceived flaws that consume hours each day and significantly interfere with daily functioning. Unlike general insecurity, BDD typically focuses on specific body parts and drives compulsive behaviors like excessive mirror checking, grooming rituals, or seeking multiple cosmetic procedures. The emotional distress is much more severe than typical self-esteem issues and can lead to social isolation, depression, and in severe cases, thoughts of self-harm.

Q. Am I insecure or do I have body dysmorphia?

A. While insecurity about appearance is common, BDD involves obsessive, overwhelming thoughts about perceived flaws that significantly interfere with your daily life, relationships, and functioning. If your appearance concerns consume hours of your day or cause you to avoid social situations, it may be more than typical insecurity.

Q. Do people with body dysmorphia realize they have it?

A. Many people with BDD are unaware of their condition and don’t recognize that their perception of their appearance is distorted. The shame and isolation associated with BDD makes it difficult to see that their concerns are excessive, and they often believe others notice their perceived flaws just as intensely as they do.

Q. Can you self-diagnose body dysmorphia?

A. You cannot reliably self-diagnose BDD, as it requires identifying complex patterns of thought and behavior that are difficult to recognize in yourself. While you may notice some symptoms, only a mental health professional can properly diagnose BDD, rule out other conditions, and recommend appropriate treatment.

Q. Is it body dysmorphia or dysphoria?

A. The correct term is “body dysmorphia” or “body dysmorphic disorder (BDD),” not “body dysphoria.”

Q. How is an eating disorder different from BDD?

A. Eating disorders primarily focus on weight and food intake, while BDD involves obsessive preoccupation with specific body parts or features like skin, nose, or hair that are unrelated to weight.

Q. How do I help a loved one showing signs of body dysmorphia?

A. Approach them with patience and empathy and avoid phrases like “it’s not a big deal” that minimize their concerns. Gently encourage professional help from a mental health specialist, offer to help them find a therapist, and provide emotional support while emphasizing that professional treatment is necessary for recovery.

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Saad’s 7 Steps to Starting Your Mental Health and Wellness Recovery Journey

Saad’s powerful story of overcoming significant health challenges and transforming his life offers a beacon of hope for anyone facing similar struggles. His journey, marked by weight gain, injury, mental health issues, and job loss, led him to a profound realization: recovery is possible through a combination of inner faith, practical action, and a shift in perspective.

Saad vividly recalls his lowest point: “I completely hit the rock bottom…I started hating my body the way I looked. I hid behind those baggy clothes, always trying to cover your area of your, you know, belly avoiding mirrors. Fear of confrontation of your to yourself had very low self-esteem.” This feeling of despair and self-loathing is a common experience for many who find themselves struggling with their physical and mental well-being. However, Saad’s story underscores that this “rock bottom” can also be the catalyst for profound change.

1. Shift Your Mindset and Perspective

Saad emphasizes the crucial role of changing his mentality. He realized that his previous approach of self-punishment through extreme diets was unsustainable. Instead, he focused on understanding his body’s needs and cues. This shift in perspective is fundamental to long-term recovery. Instead of viewing lifestyle changes as restrictive punishments, consider them acts of self-care and investment in your well-being. Recognize that recovery isn’t about perfection, but about progress with self-compassion.

2. Take Practical, Sustainable Actions

Saad didn’t just rely on a change in mindset; he took concrete steps to improve various aspects of his life. He focused on nutrition, sleep, emotional health, exercise, movement, and mobility – all factors that contribute to functional metabolism and long-term health. This holistic approach is vital. Recovery isn’t just about addressing one symptom; it’s about nurturing your overall well-being through consistent, sustainable habits. Consider incorporating small, manageable changes into your daily routine, such as a short walk, a healthier meal, or a few minutes of mindfulness.

3. Listen to Your Body’s Cues

One of Saad’s key learnings was the importance of listening to his body. He moved away from rigid rules about “good” and “bad” foods and instead focused on mindful eating and understanding his body’s signals of hunger and fullness. Developing this awareness is crucial for sustainable health and well-being. Pay attention to how different foods make you feel, notice when you feel truly rested, and acknowledge any discomfort or pain signals your body might be sending.

4. Find Your “Why” and Cultivate Purpose

Saad found motivation in wanting to help his family and others. Helping his mother reverse her type 2 diabetes fueled his passion and provided a strong sense of purpose. Having a clear “why” can be a powerful driving force in your recovery journey. What motivates you to change? Is it your health, your relationships, your aspirations? Connecting with this purpose can provide the resilience needed to navigate challenges.

5. Embrace Learning and Seek Knowledge

Saad’s journey involved extensive learning about functional metabolism, clinical research, and health and wellness coaching. While you don’t need to become a certified expert, actively seeking knowledge about mental health, nutrition, and well-being can empower you to make informed decisions about your recovery. Explore Recovery.com’s Resource Library to gain a better understanding of your challenges and potential solutions.

6. Understand That Shame and Isolation Are Harmful

Saad’s powerful statement, “shame and isolation are more harmful than food,” highlights the detrimental impact of negative self-talk and social withdrawal. Shame can erode self-esteem and hinder progress, while isolation deprives you of crucial social support. Be kind to yourself, practice self-compassion, and actively seek connection with supportive individuals. Consider exploring support groups or therapy as avenues for reducing isolation and processing difficult emotions. Recovery.com can help you find treatment centers and support networks.

7. Ask for Help and Break Free from Ego

Saad emphasizes the importance of asking for help when needed. “No matter how far gone you feel, there is always a solution out there. You just have to ask for help when you need to ask. Do ask. Don’t get that ego in the middle. Don’t hold yourself back.” Overcoming the fear of vulnerability and reaching out to trusted individuals, professionals, or support systems is a sign of strength, not weakness. Just as Saad sought guidance, allow yourself to lean on others during your journey.

Saad’s journey is a testament to the power of resilience and the possibility of profound transformation. He reminds us that “you are not broken, just a bit overwhelmed by the situation and the circumstances.” By starting small, taking practical steps, listening to your body, finding your purpose, seeking knowledge, combating shame and isolation, and asking for help, you too can embark on a meaningful and sustainable recovery journey. Remember, as Saad wisely advises, “just start. You’ll be amazed by the capacities your body’s built in. You’ll be amazed on how your mind is capable of what extent it can go to achieve something.”

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Maureen’s Journey in Eating Disorder Recovery and Self-Love

The Giving Voice to Mental Health Podcast recently shared a deeply personal story of resilience with Maureen, who recounted her journey through an eating disorder that began during her time as a ballet dancer in the 1980s. Her powerful narrative offers crucial understanding and hope for individuals facing similar challenges and those who support them. Hosts Terry McGuire and Caroline Beidler guided a conversation that illuminated the isolation of struggling with an eating disorder when awareness was limited, contrasting it with the growing resources available today.

More Than Just Food: Understanding the Core of Recovery

Maureen thoughtfully described her experience not as a “battle,” but as “working through” an eating disorder. This highlights the ongoing and internal nature of recovery, extending beyond just physical health to encompass self-image, self-esteem, and, most importantly, self-love.

“I feel that I am recovering from a combination of… not understanding how to take care of myself. It’s beyond the amount of food that you put in your body, for example, it’s really about self-image and self-esteem and self-love…”

Her words emphasize that true recovery involves a fundamental shift in how one perceives and values themselves.

The Weight of External Expectations: Body Image and Triggers

As a ballet dancer in the 1980s, Maureen faced immense pressure regarding her body image. This environment became a significant trigger, highlighting how external expectations can contribute to the development of eating disorders.

“As a young person in college, I was a dancer, a ballet dancer in the 1980s and at that time, body image was a huge thing and you had to look a certain way and be a certain way in order to perform…”

This experience underscores the importance of recognizing and addressing societal and environmental factors that can fuel disordered eating.

A Long and Winding Road: The Reality of Ongoing Recovery

Maureen’s journey to self-acceptance has spanned decades, illustrating that recovery is rarely a straight path. It involves continuous effort, with challenges and negative thoughts potentially resurfacing.

“It’s taken me this much of my life to arrive at being okay with myself, you know? And even that gets challenged all the time… I’m always in recovery. I’m always working on recovery.”

Her strength lies in her ability to identify unhealthy patterns and consciously choose a healthier direction, affirming, “You’re okay. You’re good just the way you are.”

Explore eating disorder treatment options.

The Harmful Words: What Not to Say to Someone Struggling

Well-intentioned but misguided advice, such as “just eat more,” can be detrimental to someone with an eating disorder. Maureen emphasized the importance of avoiding comments about food altogether.

“Teachers didn’t really know what to do with me. They didn’t know what to say. They just kept saying, well, you have to eat more. You have to eat more. It’s not what, it’s not the right thing to say… Don’t say anything about food. Leave it alone and let me figure it out.”

Instead, she suggests expressing non-judgmental support and focusing on aspects of their life unrelated to food or body image. Suggesting alternative activities, like “Let’s go for a walk,” can be far more helpful.

Finding Support: The Power of Connection

While formal therapy wasn’t consistently available to Maureen in the early stages, she found crucial support in friends, particularly within the modern dance community, which offered a more accepting environment. This highlights the significance of supportive relationships in recovery.

“I found support in friends and interestingly in among dancer friends… I found a really wonderful, supportive community there.”

The lack of readily available professional help in the 1980s underscores the progress made in providing resources today.

A World of Options: Hope for Today and Tomorrow

Maureen reflected on the lack of treatment options available when she was struggling, a stark contrast to the resources that exist now. Today, individuals have access to information, various therapies, peer support groups, and treatment facilities.

“If it happened to me now, I wouldn’t hesitate to look around for a place to go, you know, somebody to talk to or a situation to take care of myself…”

Caroline emphasized the wealth of information available on https://recovery.com/resources/ and the importance of educating ourselves and others about eating disorders and available support.

Embracing Life: Finding Joy in Self-Acceptance

Maureen’s journey ultimately led her to a powerful realization: life is truly good when you treat yourself with kindness and embrace self-acceptance.

“Oh. ’cause life is so good when you’re, when you’re able to treat yourself well. When you’re able to love yourself and accept yourself, life is really, really great.”

This message of hope and the possibility of a more positive and vibrant life serves as an encouragement for anyone currently struggling to believe in their own potential for recovery and self-love.

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Anorexia vs. Bulimia: Knowing These 4 Key Differences Can Improve Your Recovery

You might think anorexia and bulimia are pretty much the same thing, but actually, they work in very different ways. Learning about these differences isn’t just about knowing medical facts—it can help you spot warning signs in yourself or someone you care about. 

Let’s look at how anorexia and bulimia compare and what physical signs, behaviors, thinking patterns, and health risks are unique to each condition. We’ll also explain treatment options and where to find help, whether you’re trying to understand your own experiences or are concerned about a loved one. 

Before getting into the specific differences between anorexia and bulimia, what exactly is an eating disorder, and what makes them so serious?

What Are Eating Disorders?

Eating disorders are serious mental health conditions that involve harmful eating habits and troubling thoughts about food and eating, as well as distorted body image. About 9% of people in the U.S. will have an eating disorder in their lifetime.1 Women and girls are diagnosed more often, but anyone can develop these conditions.

Anorexia nervosa and bulimia nervosa are 2 of the most well-known eating disorders. They share some features but work differently in terms of eating behaviors, symptoms, and health effects. Other types include binge eating disorder and avoidant/restrictive food intake disorder (ARFID).

Eating disorders aren’t choices or phases—they’re complex conditions influenced by genes, biology, psychology, and social factors. They can seriously harm people’s physical health, emotional well-being, and everyday life. But with quality treatment and support, people can and do recover—though that journey looks different for each person.

Infographic showing the top underlying causes of both anorexia and bulimia, including distorted body image, fear of weight gain, perfectionism, low self-worth, personal shame, anxiety or depression, and unresolved trauma, illustrated with symbolic icons and rooted fork and knife.

Anorexia Nervosa: Key Characteristics

Anorexia involves severely limiting food and having an intense fear of gaining weight, even when you’re already underweight. People with anorexia usually see their bodies differently than others do. For example, they may think they look fat even when they’re actually very thin.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), to be diagnosed with anorexia,2 someone must eat so little that they’re at an unusually low weight, be terrified of gaining weight, and have a distorted view of their body. There are 2 main types: The restricting type (mostly limiting food) and the binge-eating/purging type (restricting but sometimes also bingeing and purging).

Physical signs of anorexia3 include:

  • Extreme weight loss
  • Always feeling tired or dizzy
  • Complaining about being cold all the time
  • Development of fine hair all over your body
  • Constipation
  • Brittle nails
  • Dry skin
  • Stopped menstruation

Many people who struggle with anorexia create strict food rules, like cutting food into tiny pieces, only eating at certain times, or avoiding meals with others.

The mental side often includes:

  • Constantly thinking about food, calories, and weight
  • Feeling a sense of control or achievement when restricting food
  • Difficulty recognizing how serious your condition is
  • Reluctance to ask for help

How can clinicians better identify bulimia given its “hidden” nature compared to the more visible signs of anorexia?

Being direct and sensitive when asking about binging or purging is important. It can be easy to dance around the topic, but it’s important to bring light to it in sessions so clients can be challenged. There is a delicate line to balance here, and it can be managed with tone, building trust, and appropriate timing. Clinicians can also ask about their recent diet history and exercise patterns. This may not directly or completely uncover behaviors, but it can be a leading indicator of areas where there may be some concerns.

Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-C

Bulimia Nervosa: Key Characteristics

Bulimia involves cycles of eating huge amounts of food (binging) and then trying to prevent weight gain through behaviors like throwing up. During binges, someone eats an excessive amount of food in a short window and feels like they can’t stop or control their eating.

After binging, people with bulimia try to “undo” the calories they ate by making themselves throw up, taking laxatives or diuretics, fasting, or exercising too much. Unlike people with anorexia, those with bulimia usually stay at a normal weight or slightly above, which makes the condition a lot harder for others to notice.

Physical signs of bulimia4 might include:

  • Puffy cheeks
  • Dental problems from stomach acid
  • Calluses on knuckles from self-induced vomiting
  • Weight that fluctuates up and down
  • Stomach problems
  • Imbalanced electrolytes
  • Acid reflux
  • Chronic sore throats
  • Heartburn

The binge-purge cycle often happens in secret and makes people feel disgusted, guilty, or ashamed. Despite these negative feelings, the cycle is hard to break because both binging and purging can temporarily make emotional pain feel better. Like anorexia, bulimia involves intense worry about body shape and weight, but the approach to food is very different.

Infographic comparing anorexia and bulimia, showing anorexia involves severe food restriction and symptoms like always feeling cold, strict food rituals, and negative body talk; while bulimia involves overeating with compensatory behaviors and symptoms like frequent bathroom trips after meals, puffy cheeks, and hiding food.

Major Differences Between Anorexia and Bulimia

Physical Appearance

The most obvious difference is how people with these disorders typically look. Those with anorexia are usually very underweight, while people with bulimia may maintain their normal weight or be slightly overweight. This means you can often see anorexia, while bulimia can stay hidden for years.

Eating Patterns

The eating patterns are also quite different. People with anorexia mainly restrict their food intake,5 eating very little or avoiding certain foods completely. People with bulimia swing between episodes of binge eating (eating large amounts of food at a time) and compensatory behaviors to try to get rid of those calories.

Relationship to Food

These conditions cause different feelings about food, too. People with anorexia tend to create strict rules about food and may feel anxious about eating. Those with bulimia typically feel out of control during binges, often eating foods they normally avoid, then desperately trying to counteract what they’ve eaten.

Emotional Experience

The emotional experience is different as well. Anorexia often brings a sense of accomplishment from restricting food and losing weight, while bulimia usually involves intense shame around binging and purging. 

Binge eating disorder (BED) and orthorexia survivor Elisa Aas describes how shame fueled the cycles of her disordered eating:6 

You feel you abused food and your body so much you don’t deserve to enjoy food again.

Both of these conditions make people feel unhappy with their bodies, but how that shows up in behaviors is quite different.

Finding and diagnosing these disorders also follows different paths. Anorexia tends to be diagnosed earlier on7 because of visible weight loss, while bulimia’s secretive nature and normal-looking weight make it harder to notice from the outside. This difference can affect how quickly someone gets help, and what kind of help they need.

Infographic illustrating the top health risks of anorexia and bulimia; anorexia risks include heart problems, weakened bones, organ failure, hormone disruption, and muscle breakdown, while bulimia risks include digestive damage, tooth erosion, swollen glands, kidney strain, and electrolyte imbalance.

Key Similarities Between Anorexia and Bulimia

Though they may look different, anorexia and bulimia have important similarities. Both involve judging your self-worth largely based on your weight and body type. People with either condition often measure their value as a person by how they look8 or how well they can control their eating.

Risk Factors

Both anorexia and bulimia can come from similar risk factors,9 including genetics, personality traits like perfectionism, history of dieting, and cultural pressures around thinness. Traumatic experiences, family dynamics, and other mental health issues like anxiety or depression can contribute to both disorders.

What are the most promising developments in eating disorder treatment that address both the physical and psychological aspects of these conditions?

The most promising development I have seen in eating disorder treatment for Anorexia and Bulimia is the increase in adoption of the Health at Every Size Approach.  So often, patients living in larger bodies have fallen by the wayside due to the stereotypes of what an eating disorder ‘should look like,’ when eating disorders are, first and foremost, mental illnesses that have a physical impact. 

By treating the physical impacts of the disorder but not using them to determine the severity of one patient’s condition over another, and incorporating a variety of therapies (such as DBT, ACT, CBT, and family therapy), eating disorders are being treated at all angles.  As a person in recovery who has lived in a larger body for most of my life, paired with my professional experience, I have witnessed how the Health at Every Size Approach leads to creating more inclusive treatment plans and lasting positive outcomes.

Sage Nestler, MSW | Releasing the Phoenix

Coping Mechanisms

There’s significant overlap between eating disorders,10 especially among people with anorexia. One study found that of the participants with anorexia, over half switched between the restricting and binge-eating/purging, and one-third developed bulimia. But interestingly, people initially diagnosed with bulimia nervosa rarely developed anorexia. So while diagnostic crossover is common in eating disorders, it tends to follow specific patterns. 

Both of these sets of behaviors serve as strategies for coping with difficult emotions and life stress. Behaviors like restricting food or binge-purge cycles temporarily relieve anxiety, distress, or emptiness. That emotional relief and sense of control11 make both conditions very hard to overcome without addressing the underlying psychological needs they’re meeting.

Impacts on People’s Lives

Finally, both of these common eating disorders seriously impact people’s quality of life, causing distress and making it hard to function at work or in social settings. They isolate people from their support networks at a time when they need connection the most.

Health Risks and Complications

Anorexia and bulimia both cause serious health problems, but in different ways. 

Health Risks of Anorexia

Anorexia has the highest death rate12 of any mental illness, with risks coming mainly from malnutrition that affects every system in the body. Severe malnutrition can cause: 

  • Heart problems
  • Bone loss
  • Muscle wasting
  • Hormone imbalances
  • In the worst cases, organ failure

Health Risks of Bulimia

Bulimia’s health risks13 come mainly from purging behaviors. Frequent vomiting can cause:

  • Irregular heartbeat from electrolyte imbalance
  • Cardiac arrest in severe cases
  • Damage to the digestive system
  • Tooth erosion
  • Swollen salivary glands

Overusing laxatives or diet pills can lead to:

  • Laxative dependence
  • Chronic digestive problems

Hormonal Imbalance

Both disorders can affect fertility and hormones. In anorexia, periods often stop14 due to low body weight and fat percentage. While people with bulimia may continue having periods, hormone disruptions can still happen, which can affect their fertility and bone health.

Long-Term Problems

Long-term problems differ somewhat between these 2 conditions. With anorexia, long-term malnutrition15 can lead to: 

  • Permanent bone density loss and an increased risk of fractures
  • Heart complications (bradycardia, arrhythmias, hypotension)
  • Brain changes and cognitive impairment
  • Reproductive issues 
  • Pregnancy complications 
  • Gastrointestinal problems
  • Weakened immune function
  • Electrolyte imbalances that affect multiple organ systems
  • Increased overall mortality risk if left untreated

Bulimia’s long-term effects16 include: 

  • Chronic digestive problems
  • Dental complications (tooth decay, gum disease)
  • Higher risk of esophageal cancer from repeated exposure to stomach acid
  • Osteoporosis due to nutritional deficiencies
  • Menstrual irregularities and reproductive problems
  • High cholesterol 
  • Increased risk of diabetes
  • Heart irregularities and arrhythmias
  • Severe dehydration and electrolyte imbalances
  • Anemia

While some health issues like amenorrhea, acute dehydration, and certain heart problems may go away after recovery, others like osteoporosis, reproductive issues, diabetes risk, and cholesterol problems may need ongoing medical monitoring.

Medical Emergencies

If you experience fainting, chest pain, difficulty breathing, seizures, or blood in vomit, please seek emergency medical care immediately—these are not symptoms to ignore or push through. These signs indicate your body is in serious distress and requires urgent professional attention. We know reaching out to someone about an eating disorder can feel overwhelming, but regular medical supervision is absolutely essential to monitor and address these potentially life-threatening complications.

What approaches are most effective for families supporting a loved one in the early stages of eating disorder recovery?

It is important for families of loved ones in eating disorder recovery to be gentle and firm simultaneously. Be gentle in a way that validates one’s feelings, but be firm in not accommodating anxiety around eating. What would that look like? One may say to their loved one, ‘I can understand how you feel, and it is important to follow your therapist’s recommendations and eat to nourish your body.’ Using the word ‘and’ instead of ‘but’ validates both aspects of one’s experience and their long-term goal.

Jennifer Chicoine, MA, LCPC, CCTP | Peaceful Healing Counseling Services

Treatment Approaches

There’s real hope for recovery from eating disorders—both anorexia and bulimia respond well to proper treatment,17 and many people go on to live healthy, fulfilling lives free from these struggles. While the journey has its challenges, effective treatments exist and are continually improving.

Treatment approaches for anorexia and bulimia share some similarities, but also have important differences tailored to each condition. For someone with anorexia, especially when their weight has become dangerously low, the first priority is ensuring medical stability and safety. This compassionate healthcare might include time in a hospital or inpatient treatment center where a team of medical professionals can help restore weight in a gentle, supportive way.

With bulimia, treatment typically focuses on breaking the cycles of binging and purging and rebuilding a healthier relationship with food. Outpatient therapy is often the starting point, but some people might need additional medical support to address health complications. 

People can and do recover, and build lifelong healthy relationships with food.6 As Aas says,

You deserve to eat, you deserve to recover from an eating disorder, you are worthy of love, you are worthy of acceptance—mainly from yourself.

Learn more about evidence-based approaches that can transform your journey to recovery in our guide to finding treatment for eating disorders.

Therapy

Both conditions benefit from psychotherapy, but the approaches might differ. For people with anorexia, family-based treatment (FBT)18 shows strong results, especially for adolescents. This approach empowers their family members to take an active role in their recovery.

For bulimia, cognitive behavioral therapy (CBT) is often the go-to treatment. It helps people identify unhelpful thought patterns, develop regular eating habits, and learn healthier ways to cope with their feelings. 

Both conditions can also benefit from dialectical behavior therapy (DBT),19 which teaches skills for managing emotions and relationships.

Nutritional Counseling

Nutritional counseling plays a major role in treating both disorders, though the goals differ. For anorexia, the focus is on gradually increasing food intake and expanding variety. For bulimia, establishing regular eating patterns and challenging food rules is key to breaking the binge-purge cycle.

Medication

Medication has a more established role in bulimia treatment, with certain antidepressants showing effectiveness in reducing binge-purge behaviors.20 For anorexia, medication is less commonly the primary treatment but may help with co-occurring conditions like anxiety or depression.

Compassionate, Comprehensive Recovery and Support for Eating Disorders

Healing from an eating disorder takes both professional guidance and loving support. The journey looks different for everyone—people with anorexia may start with rebuilding their physical health, while people with bulimia may focus on establishing gentle routines.

When friends and family create spaces free of food judgment, recovery flourishes. And with compassionate professionals by your side, even setbacks become stepping stones.

Many people with these conditions find their way to complete recovery. Your struggle isn’t a personal failure—it’s a health condition that responds to care. If you’re suffering, find an eating disorder treatment program that meets your needs and reach out to a specialist today. 

You deserve support, and healing is within reach.

FAQs

Q: What causes anorexia and bulimia? 

A: These eating disorders develop from a mix of genetics, personality traits, family dynamics, and social pressures. Things like perfectionism, stress, and cultural beauty standards also play a huge role. They’re not choices or personality flaws—they’re serious health conditions that need supportive care.

Q: How do you know if someone has bulimia? 

A: Signs of bulimia include sneaking off to the bathroom after meals, swollen cheeks, calluses on knuckles, excessive exercise, dental issues, and missing food. People with bulimia often succeed in keeping it hidden because their weight might not change much, but they struggle in secret.

Q: Will I ever accept being at a normal body mass index (BMI)? 

A: Healing takes time, but yes, many people learn to feel comfortable in their bodies with the right support. Therapy helps challenge negative thoughts, and focusing on what your body can do instead of just how it looks can make a big difference.

Q: What are the first steps in getting help? 

A: Start by talking to your therapist, doctor, or someone you trust. You can also use an independent, non-biased treatment finder or call the National Eating Disorders Association helpline (1-800-931-2237). A specialist can help figure out the best plan for you. 

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Katlyn’s 9 Steps Towards Healing from Trauma, Abuse, and an Eating Disorder

In a deeply candid and moving conversation, Katlyn, a survivor in recovery from narcissistic abuse, Complex PTSD, and anorexia, shared invaluable insights into her journey. Her words offer a beacon of hope and practical guidance for anyone grappling with the aftermath of trauma and the challenging path of recovery.

Katlyn’s experience highlights the tumultuous nature of healing, emphasizing that it’s not a linear ascent but rather a complex dance of progress and setbacks. Yet, through vulnerability and the development of crucial coping mechanisms, a more grounded and present life is possible.

1. Recognizing the Need and Finding Inner Strength

Before recovery, Katlyn described emotional instability and chaos, feeling disconnected from the present. The turning point came when she recognized her strength in escaping a harmful situation. “Once I got myself out of that situation, it was a wake up call for me that I had the strength and resilience to remove myself from the situation to even identify the abuse as it is.” This acknowledgment of inner resilience is the crucial first step towards healing.

2. Seeking Support and Building a Foundation

A cornerstone of Katlyn’s recovery was actively seeking support from trusted individuals and professionals. “To help set myself on a path to recovery, I reached out for help, first of all, to people that I trusted with my vulnerable state. Um, I then got myself into some therapy specifically for what I am going through in recovering from.” Therapy, support groups, and even nutritional guidance create a vital network for navigating the complexities of trauma recovery.

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3. Establishing Structure and Self-Care Rituals

Creating daily routines provided Katlyn with stability and fostered self-care. “Just kind of establishing daily rituals for myself, kind of a container and structure for my day…made me feel healthy, clean, loved, and taken care of by myself.” Consistent rituals, even small ones, offer comfort and reinforce self-compassion.

4. Processing Emotions Through Expression

Katlyn found significant benefit in expressing her emotions, whether through journaling or talking. “I think journaling was something else that I started doing daily…my main advice would be to get it out, vomit out the emotion, however you need to do that.” Externalizing feelings prevents them from becoming internalized and allows for greater self-awareness and emotional regulation.

5. Rebuilding the Self with Compassion and Connection

Recovery involves redefining one’s relationship with oneself, moving away from being defined by trauma. “Seeing me for the first time with all of the things that I’ve experienced as a beautiful, strong person versus feeling like those things are me, are defining me.” Connecting with others who have similar experiences breaks isolation and reinforces that healing is possible. Group and family therapy can provide a safe place to foster meaningful connections. Cultivating self-compassion is also key.

6. Allowing Time and Embracing the Nonlinear Journey

Katlyn emphasized the importance of patience in the healing process. “That’s something else that I learned that helped me stay in recovery is that I need time. Time changes things. It gives us new perspectives.” Trauma processing is not linear; it involves ups and downs. Accepting this reality and allowing time for healing is crucial.

7. Cultivating Present Moment Awareness and Reclaiming Joy

Finding grounding in the present and rediscovering joy are vital aspects of recovery. “Having started my recovery journey, my life now is definitely a lot more present…my life is filled with…just a lot of good freaking food.” Engaging with the present and allowing oneself to experience pleasure, even in small ways, counteracts the negative impacts of trauma.

8. Setting Boundaries and Communicating Needs

Learning to identify fear, set boundaries, and communicate needs empowers survivors. “I have had to retrain myself to defend myself and recognize when I’m having, um, an intuition of fear…I have the tools and, um, capacity to communicate that versus being stuck.” Developing these skills is essential for self-protection and building healthy relationships.

9. Embracing Change and Recognizing Inner Strength

Katlyn offered a powerful message of hope and resilience. “The advice that I would give someone who is a survivor of anything traumatic is that things will change and that you deserve to see out the change…remind yourself how strong you are, how worthy you are.” Recognizing one’s inherent strength and the impermanence of difficult times fuels the ongoing journey of recovery. Even acknowledging the desire for change is a significant and brave first step.

Katlyn’s journey underscores that healing from trauma is a multifaceted process that requires courage, support, and self-compassion. By embracing these essential steps, individuals can begin to find their footing and move towards a more grounded and hopeful future.