Serious mental illnesses are characterized by insufficient or excessive food intake, affecting one’s mental and physical health, impacted by psychological, biological, and social factors. These include Anorexia Nervosa, Bulimia Nervosa, Other Specified Feeding or Eating Disorder (OSFED), and Binge Eating Disorder.

An estimated 10 million females and 1 million males struggle with an eating disorder in the U.S. (Wade, Keski-Rahkonen, & Hudson, 2011) (EDNOS is now recognized as OSFED, other specified feeding or eating disorder, per the DSM-5) ​ The prevalence of eating disorders is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, with the exception that anorexia nervosa is more common among Non-Hispanic Whites (Hudson et al., 2007; Wade et al., 2011) ​ Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives. (Neumark-Sztainer, 2005) ​ 35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives. Overweight girls are more likely than normal-weight girls to engage in such extreme dieting (Boutelle, Neumark-Sztainer, Story, & Resnick, 2002; Neumark-Sztainer & Hannan, 2001; Wertheim et al., 2009). 81% of 10-year-old children are afraid of being fat (Mellin et al., 1991). *For more information visit the National Eating Disorders Association’s website.

A disorder characterized by self-induced starvation, refusal to maintain normal body weight, serious and potentially life-threatening. ​ A review of nearly fifty years of research confirms that anorexia nervosa has the highest mortality rate of any psychiatric disorder (Arcelus, Mitchell, Wales, & Nielsen, 2011). ​ Signs & Symptoms Dramatic weight loss Intense fear of weight gain and being fat when not overweight Distortion of body weight or body image Preoccupation with food/calories/nutrition Development of food rituals Excuses to avoid mealtimes Denial of hunger Excessive and rigid exercising Frequent weighing Excessive dieting Feeling bloated or nauseated after eating normal or less than normal amounts of food Withdrawal from usual friends and activities Feeling cold even though the temperature is normal Interruption of menstrual cycle in females Health Consequences & Complications Depression Fatigue Constipation Hair loss, dry hair and skin Severe malnutrition Loss of muscle and weakness Increased susceptibility to infection Severe dehydration (possible kidney failure) Abnormally slow heart rate and low blood pressure, increase risk for heart failure Fainting Appearance of fine body and facial hair (Lanugo) Osteoporosis (reduction of bone density) Death

A disorder characterized by episodes of rapid consumption of excessive amounts of food (bingeing) that lead to guilt and efforts to get rid of food (purging). Signs & Symptoms Feeling out of control in situations involving food Frequent weight fluctuations Excessive concerns about weight Reacting to emotional stress by overeating Expressing guilt or shame about eating Strict dieting followed by periods of binge eating Compensatory behaviors include: Self-induced vomiting Diuretic abuse Fasting Obsessive or compulsive exercise Laxative abuse Self-induced vomiting Depressive moods Swelling of the cheeks or jaw area Calluses on the back of the hands and knuckles from self-induced vomiting Staining of the teeth Health Consequences/Complications Electrolyte abnormalities/imbalances Dehydration Chronic irregular bowel movements and constipation relative to laxative use Dental Decay from stomach acids released during vomiting Esophageal inflammation, tears, and rupture Swollen glands Cardiac arrhythmias Pancreatitis Death

What is Binge Eating Disorder?? A disorder characterized by repeated episodes of bingeing but without purging. ​ Signs & Symptoms Episodes of eating large quantities of food during a short period of time Feelings of shame or disgust related to behavior Eating in the absence of hunger Feeling out of control when eating Feeling guilty about eating Eating during stressful times to feel better Eating in secret Health Consequences/Complications High cholesterol High blood pressure Heart disease Gallbladder disease Obesity Increased risk of type 2 diabetes

Unhealthy eating habits or body image that has not become a recognized eating disorder. ​ Signs & Symptoms Yo-yo dieting Eliminating entire food groups Obsessive thoughts about exercise Occasional binge eating or purging Off-balanced approaches to nutrition Health Consequences & Complications Developing an eating disorder Gallstones Decreased metabolism

Other Specified Feeding and Eating Disorders What is OSFED? A person with Other Specified Feeding or Eating Disorder (OSFED) may experience significant distress from symptoms of other eating disorders such as anorexia nervosa, bulimia nervosa or binge eating disorder but will not meet the full criteria for diagnosis of these disorders. A common misconception about OSFED is that it is less severe or not as dangerous because it does not fall within the other diagnosis categories. OSFED has significant health risks and accounts for the highest percentage of all eating disorders. Signs & Symptoms Individuals with OSFED may struggle with extremely disturbed eating habits, distorted body image, overvaluation of body shape and weight, and an intense fear of gaining weight. Other signs & symptoms may include: Preoccupation with food and eating Preoccupation with body shape or weight Extreme body dissatisfaction Depression, anxiety, or irritability Heightened anxiety and/or irritability around meals Highly rigid rules or refusal to eat certain foods Low self-esteem Secretive behavior around food and/or bathroom usage Self-consciousness when eating in front of others Mood swings Tiredness Social withdrawal Difficulty concentrating Health Consequences/Complications • Amenorrhea • Reflux/regurgitation • Chronic constipation • Elevated Creatinine • Metabolic disturbance • Lanugo • Weight fluctuations • Bradycardia • Syncope • Dehydration

Avoidant Restrictive Food Intake Disorder What is ARFID? Avoidant/Restrictive Food Intake Disorder is the clinical term for "extreme picky eating", a pattern of eating that is limited in variety and/or volume and that is not attributed to another health condition. It is often associated with anxiety as well as OCD, Autism, and/or ADHD. It is different from other eating disorders because people with ARFID do not worry much about how they look, or how much they weigh. Signs & Symptoms Sensory sensitivities (taste, texture, smell) Lack of motivation or drive to eat Fear of aversive consequences (vomiting, choking, or allergic reactions) Absence of hunger cues or forgetting to eat Reliance on "same" or preferred foods Social isolation especially around food-related events/meals due to embarrassment Denial of hunger if procurement and/or preparation of food seems overwhelming Extreme anxiety with trying new foods Weight loss/underweight, however not always present Avoiding foods that made them sick Feel as if eating is a chore Difficulty with or avoidance of cooking Symptoms can increase during times of stress or transition Health Consequences & Complications Many of the physical manifestations seen in Anorexia Nervosa are also seen in ARFID due to the restrictive nature of the illness. Sometimes, a mixed presentation will exist, where people display symptoms of AN along with ARFID traits Low mood, irritability, anxiety, apathy, difficulty concentrating Fatigue Constipation Hair loss, dry hair and skin Nutrient deficiencies Osteoporosis (reduction of bone density) Death