EATING DISORDERS 101

If you or someone you love is struggling with food, body, or weight in a way that has started to take over daily life, please read this slowly. Eating disorders are serious, treatable medical and psychiatric illnesses. They are not a phase, a diet gone too far, a cry for attention, or a failure of willpower. They have biological roots, and they respond to real treatment.

At Inland Psychiatric Medical Group (IPMG), we evaluate and care for patients across San Bernardino and Riverside counties who are living with eating disorders or worry they may be. This guide is written for you — whether you are the one struggling, a parent, a partner, or a friend trying to understand. You will not find numbers here that you could use as a target. You will find honest information and a clear path forward.

What eating disorders really are

Eating disorders are mental illnesses with a strong biological basis and serious effects on the body. Modern research — from twin studies, brain imaging, and genome-wide studies — shows that eating disorders run in families and involve real differences in how the brain processes hunger, fullness, reward, anxiety, and body perception. They are not caused by vanity. They are not caused by bad parenting. They are not chosen.

What eating disorders do is hijack the systems that keep a person alive: appetite, energy, mood, sleep, hormones, heart rhythm, and the ability to think clearly. Once the cycle starts, the illness tends to defend itself. Many people with eating disorders feel deeply ashamed and hide what is happening. That is part of the illness, not a character flaw.

The good news is the most important sentence in this essay: eating disorders are treatable, and people recover. Recovery is not a straight line, but it is real, and starting care earlier makes it easier.

The full spectrum of eating disorders

We use the categories below for clinical clarity. None is “better” or “worse” than another. All can be life-threatening, and all deserve full care.

Anorexia nervosa (AN)

Anorexia involves restricting how much a person eats, intense fear of weight gain or of becoming “fat,” a distorted sense of body shape or weight, and behaviors that prevent weight gain. There are two recognized patterns: a restricting type, and a binge-eating/purging type. Anorexia carries the highest death rate of any eating disorder, mostly from medical complications and suicide.

Atypical anorexia

Atypical anorexia meets every feature of anorexia nervosa — the restriction, the fear, the body-image disturbance, the medical consequences — except the person’s weight is not classified as low. This is a diagnosis that gets missed constantly, because clinicians and families assume someone “can’t” have anorexia at a higher body weight. The 2022–2024 literature is clear: people with atypical anorexia experience the same patterns of medical instability — low heart rate, low blood pressure, electrolyte problems, hormonal disruption — and the same psychological severity as people with classic anorexia. If you have been losing weight rapidly or restricting severely and have been told you “don’t look sick enough,” please take this seriously.

Bulimia nervosa (BN)

Bulimia involves repeated episodes of binge eating — eating an objectively large amount of food with a sense of loss of control — paired with repeated compensatory behaviors meant to “undo” the eating. Bulimia carries significant medical risk, including dangerous changes in heart rhythm caused by electrolyte loss.

Binge eating disorder (BED)

BED involves repeated binge episodes without the compensatory behaviors seen in bulimia. It is the most common eating disorder in the United States. It is also the only eating disorder with a medication specifically approved by the FDA — lisdexamfetamine (Vyvanse) — which we discuss below.

ARFID (Avoidant/Restrictive Food Intake Disorder)

ARFID is restriction of food intake that is not driven by body image. It is usually one of three patterns: extreme sensory sensitivity to taste, texture, smell, or appearance of food; very low interest in eating or low appetite; or fear of a bad consequence from eating (such as choking or vomiting) often following a frightening experience. ARFID can cause serious weight loss, nutritional deficiencies, and growth problems. It is common in autistic children and adults and in other neurodivergent people, and it occurs in adults as well as kids. ARFID is real, it is not “picky eating,” and it has its own treatment approaches.

OSFED (Other Specified Feeding or Eating Disorder)

OSFED is a real diagnosis for people whose symptoms cause significant distress and medical risk but do not fit neatly into one of the categories above. It is just as serious as the named disorders. Many people with full-blown eating disorders are first diagnosed here.

Pica and rumination disorder

Pica is the repeated eating of non-food substances (such as ice, paper, chalk, or dirt). Rumination disorder is the repeated bringing up of food that has already been swallowed, without nausea or apparent cause. Both deserve medical evaluation.

Who gets eating disorders

The honest answer is: anyone. A landmark economic analysis commissioned by STRIPED at the Harvard T.H. Chan School of Public Health and the Academy for Eating Disorders (Deloitte Access Economics, The Social and Economic Cost of Eating Disorders in the United States of America, June 2020) estimated that 9% of Americans — about 28.8 million people — will experience an eating disorder in their lifetime. A simulation of a nationally representative U.S. cohort published in JAMA Network Open (Ward ZJ et al., 2019) estimated that by age 40, 19.7% of female individuals and 14.3% of male individuals will have had an eating disorder.

The stereotype of the thin, white, teenage girl is wrong, and it costs lives. The truth:

All genders. Men, boys, transgender people, and nonbinary people develop eating disorders at significant rates and are massively underdiagnosed. In a national college sample (Diemer EW et al., Journal of Adolescent Health, 2015), 15.8% of transgender students reported a past-year eating disorder diagnosis, and transgender students were 4.6 times as likely as cisgender students to be diagnosed with one.
All races and ethnicities. Black, Latine, Asian, Native, Pacific Islander, and Middle Eastern patients develop eating disorders at rates similar to or higher than white patients for several disorders, including BED and bulimia — but are diagnosed later, treated less often, and referred to specialty care less often.
All body sizes. Eating disorders are not visible from the outside. People in larger bodies can be severely medically ill from restriction. People at “average” weight can be in crisis.
All ages. Onset is often in adolescence but mid-life onset and late-life relapse are common. Children younger than 12 can develop eating disorders, including ARFID. Older adults can develop them for the first time.
Common co-occurring conditions. Eating disorders often travel with anxiety disorders, depression, OCD, PTSD, ADHD, substance use disorders, and autism. Treating both sides of the picture matters.

How dangerous are eating disorders, really?

Honestly. Eating disorders carry some of the highest death rates of any psychiatric illness. The most recent meta-analysis (Krug et al., Clinical Psychology Review, 2025) found a weighted standardized mortality ratio of 3.39 across all eating disorders, with anorexia nervosa carrying the highest of any ED. Most deaths are from medical complications — heart problems, electrolyte disturbances, complications of refeeding when the body is finally given nutrition — and from suicide. An eating disorder is a medical emergency in slow motion. It is not something to “wait out” or “see if it gets better on its own.”

This is not said to frighten you. It is said because too many people, and too many clinicians, treat eating disorders as a behavior problem instead of as an illness that can take a life. If you are reading this and you have been minimizing what is happening to you or to someone you love, please let this section be permission to take it seriously.

Eating disorders and suicide

People living with eating disorders, particularly anorexia and bulimia, have an elevated risk of suicidal thoughts and suicide. If you are having thoughts of suicide or self-harm right now, please call or text 988 (the 988 Suicide & Crisis Lifeline). You are not alone, and help is available 24/7. Crisis resources are listed at the bottom of this page.

Why eating disorders happen

The current scientific understanding is biopsychosocial — meaning biology, psychology, and the world around us all contribute.

Biology. Twin studies place the heritability of anorexia nervosa around 50–60%, with some estimates up to roughly 80% (Bulik et al.; Himmerich et al., Ther Adv Psychopharmacol, 2019). Bulimia heritability is in a similar range, BED around 40–60%, and ARFID approximately 79% (Dinkler et al., JAMA Psychiatry, 2023). Brain studies show real differences in reward, interoception (how the body senses itself), and anxiety circuits. Some people are born more vulnerable.
Psychology. Perfectionism, anxiety, trauma histories, and difficulty tolerating intense emotions all raise risk. None of these cause an eating disorder by themselves.
Environment. Dieting culture, weight stigma, social media, food insecurity, athletic environments that emphasize leanness, and adverse childhood experiences all play a role.

Two myths we need to bury:

“Bad parents cause eating disorders.” They do not. This idea has been disproven for decades. In fact, modern adolescent treatment relies on parents as the most powerful tool for recovery.

“It’s just attention-seeking.” Eating disorders are illnesses people typically work very hard to hide. The shame is part of the disease.

Evidence-based treatment in 2026

There is no single right treatment for every person. The right treatment depends on the diagnosis, age, medical status, co-occurring conditions, and what is available locally. Below is the current evidence base, drawn from the 2023 American Psychiatric Association Practice Guideline (4th edition), the UK NICE NG69 guideline (last updated December 2020; 2024 exceptional surveillance review confirmed no full update needed), and the most current trials.

For anorexia nervosa

Family-Based Treatment (FBT, also called the Maudsley approach) is the leading, evidence-based outpatient treatment for adolescents and young adults who live at home. Parents are coached to take temporary leadership of meals and recovery, then gradually return control to the child as health improves. FBT is not about blaming families — it is about using the family as the strongest possible support system. The APA guideline rates FBT as a moderate-confidence recommendation, the highest level it assigns for adolescent anorexia.
Enhanced Cognitive Behavioral Therapy (CBT-E), developed by Christopher Fairburn at Oxford, is a leading individual therapy for adults with eating disorders, including anorexia.
MANTRA (Maudsley Anorexia Nervosa Treatment for Adults) and SSCM (Specialist Supportive Clinical Management) are two other evidence-based adult anorexia therapies recommended by NICE NG69.
Medication. No medication is FDA-approved for anorexia. The atypical antipsychotic olanzapine has the strongest off-label evidence for modest weight gain in adults — Attia et al. (American Journal of Psychiatry, 2019) randomized 152 adult outpatients to olanzapine versus placebo over 16 weeks and found significantly greater weight gain in the olanzapine group, though effects on eating-disorder psychopathology were not significant. SSRIs are generally not effective in underweight patients with anorexia and are not first-line. Decisions about medication are individualized and made with full informed consent about benefits and side effects.

For bulimia nervosa

CBT-E is the first-line psychotherapy.
Interpersonal Therapy (IPT) is a well-supported alternative.
Dialectical Behavior Therapy (DBT) adapted for eating disorders has growing evidence, particularly when emotion regulation is a major driver.
Fluoxetine (Prozac) is the only FDA-approved medication for bulimia nervosa, typically at higher doses than are used for depression.

For binge eating disorder

CBT-E or guided self-help based on CBT are first-line.
Lisdexamfetamine (Vyvanse) is the only medication FDA-approved for moderate-to-severe BED in adults; the FDA granted that approval on January 30, 2015. It is a stimulant, requires careful screening (including cardiovascular history and any history of substance misuse), and is not appropriate for everyone.
Topiramate is sometimes used off-label.
GLP-1 medications (semaglutide, tirzepatide — Ozempic, Wegovy, Mounjaro, Zepbound) are an emerging and very actively debated area. The first systematic review and meta-analysis of GLP-1 agonists in eating disorders (Khalooeifard et al., Eating and Weight Disorders, 2025) found only 5 studies totaling 182 participants; pooled Binge Eating Scale scores improved by −8.14 points versus controls (95% CI −13.13 to −3.15), but heterogeneity was high (I² = 59.88%) and the authors concluded “further comprehensive clinical trials are recommended.” There are no large, long-term, placebo-controlled trials in BED, and these medications are not FDA-approved for any eating disorder. Published case reports describe people with a history of anorexia experiencing a return of restrictive behaviors after starting a GLP-1. We do not recommend starting a GLP-1 to treat an eating disorder, and we evaluate any patient with an eating disorder history carefully before considering one for any reason.

For ARFID

CBT-AR (Cognitive-Behavioral Therapy for ARFID), developed by Drs. Jennifer Thomas and Kamryn Eddy at Massachusetts General Hospital, has growing evidence in children, adolescents, and adults ages 10 and older.
Feeding therapy and occupational therapy approaches can address sensory sensitivity and feeding skills, especially in younger children.
ARFID often co-occurs with autism, anxiety, and gastrointestinal conditions. A 2025 meta-analysis (Sader et al., Int J Eat Disord) estimated autism in roughly 16% of people with ARFID and ARFID in roughly 11% of autistic people. Coordinated care matters.

Hospitalization and higher levels of care

Treatment for eating disorders happens across a stepped system of care:

Outpatient — regular visits with a treatment team
Intensive Outpatient Program (IOP) — several hours, several days a week
Partial Hospitalization Program (PHP) — most of the day, most of the week
Residential — 24-hour structured care in a non-hospital setting
Inpatient medical or psychiatric hospitalization — for medical stabilization or acute psychiatric safety

Medical hospitalization is sometimes necessary, especially when vital signs are unstable, electrolytes are dangerously off, or weight loss has been rapid. Refeeding syndrome — the dangerous shifts in fluid and electrolytes that can occur when a malnourished body is given nutrition too quickly — is a real risk and is why medically supervised refeeding matters. Hospitalization is not a punishment. It is medicine.

Access to eating disorder care in the Inland Empire

Specialty eating disorder care is unevenly distributed in Southern California. Many of the deepest specialty programs sit in Los Angeles and Orange County, and Inland Empire families sometimes travel for residential or PHP care. That said, local options exist:

Loma Linda University Behavioral Medicine Center in Redlands runs a partial hospitalization eating disorder program with a multidisciplinary team (psychiatry, therapy, nursing, dietetics, occupational therapy, art therapy), historically for ages 13–20.
Arrowhead Regional Medical Center (ARMC) in Colton opened a dedicated Adolescent Behavioral Health Unit (ages 13–17) on August 7, 2025.
Outpatient psychiatry and therapy — including evaluation, medication management, and care coordination — are available through groups like IPMG and many community providers across San Bernardino and Riverside counties.

California’s mental health parity law (Senate Bill 855, in effect since January 1, 2021) requires most California-regulated health plans to cover medically necessary treatment for all DSM-recognized mental health and substance use disorders, including eating disorders, at every appropriate level of care — including residential. Most commercial insurance plans, IEHP (Inland Empire Health Plan), and Medi-Cal can cover eating disorder treatment when it is medically necessary. If your plan tells you otherwise, that may be a parity violation worth challenging.

If you need help figuring out where to start, we are happy to be your first call: IPMG (909) 707-6261.

What to expect from treatment

Honest expectations protect recovery.

Treatment usually takes longer than people expect. Many people are in active treatment for one to two years or more. That does not mean recovery is failing — it means the illness is being addressed at depth.
Recovery is the rule, not the exception, for people who engage in care. A meaningful majority of patients who receive evidence-based treatment recover.
Earlier intervention makes treatment easier. If symptoms began recently, please do not wait. If symptoms began long ago, please also do not wait. Long-standing eating disorders are still very treatable. The door is not closed.
Relapse can happen, and it does not erase progress. A return of symptoms is information, not a verdict. Many people who fully recover went through relapses on the way.
You will not be tricked. Good treatment is collaborative. You will know what your team is recommending and why.

Supporting someone with an eating disorder

If someone you love is struggling, here is what helps:

Do not comment on body, food, weight, or appearance — even with intended compliments. “You look healthy” and “you look great” can both be heard as “you’ve gained weight” by an eating-disorder brain.
Express concern about wellbeing, not about specific behaviors. “I love you and I’m worried about you” lands better than “I see you not eating.”
Educate yourself. F.E.A.S.T. (feast-ed.org) is a free, evidence-based caregiver resource built by parents who have been there.
If the person is an adolescent or young adult living at home, learn about Family-Based Treatment. Parents are often the most powerful part of recovery, not the cause of the illness.
Encourage professional evaluation. You do not need to diagnose. You just need to help them get to someone who can.
Take care of yourself. Supporting a loved one through an eating disorder is hard. You deserve support too.

Closing

Eating disorders are serious illnesses. They are also illnesses we know how to treat. If something in this essay made you stop and recognize yourself or someone you love, that recognition is the beginning of recovery — not the end of normal life.

If you are in San Bernardino or Riverside County and you are not sure where to start, please call IPMG at (909) 707-6261. We will help you figure out the right next step, whether that is evaluation with us, medication management, or referral to specialty eating disorder care. You do not need to have everything figured out before you pick up the phone.

You deserve a full life. Recovery is possible. We would be honored to help.

Frequently asked questions

“I’m not ‘thin enough’ to have an eating disorder. Could I still have one?” Yes. Eating disorders occur at every body size. Atypical anorexia — which meets every feature of anorexia except low weight — causes the same medical complications as classic anorexia. Bulimia, BED, ARFID, and OSFED also occur at every size. Please do not let your body size, or anyone’s comment about it, talk you out of being evaluated.

“Can men get eating disorders?” Yes. Men and boys develop every type of eating disorder. The JAMA Network Open modeling study by Ward et al. (2019) estimated that 14.3% of male individuals will have had an eating disorder by age 40 — about one in seven. Men are massively underdiagnosed because clinicians often do not think to ask and patients often do not feel safe disclosing. If you are a man wondering whether what you are experiencing “counts,” the answer is yes, and you deserve care.

“What if my child needs hospitalization — will that traumatize them?” Hospitalization, when it is needed, is a medical decision made to protect your child’s life. The eating disorder will tell your child (and sometimes you) that hospitalization is punishment or overreaction. It is not. Many young people come out of hospitalization stabilized and ready to engage in outpatient recovery in ways they could not before. We work to make sure higher levels of care are coordinated, brief when possible, and bridged to good outpatient follow-up.

“Are weight-loss medications like Ozempic safe if I have a history of an eating disorder?” This is a serious question and deserves a careful answer. GLP-1 medications (semaglutide, tirzepatide, and others) are not FDA-approved for any eating disorder. The total published evidence in eating disorders is small (the 2025 Khalooeifard meta-analysis pooled only 182 participants across 5 studies) and short-term. Published case reports describe people with a history of anorexia experiencing a return of restrictive behaviors after starting a GLP-1. If you have any eating-disorder history and are considering a GLP-1 for any reason, please talk with a clinician who knows eating disorders before starting one. The decision is individual, but the conversation matters.

“Will I have to gain a specific amount of weight?” We do not set numeric targets in this essay, and we approach this individually in care. For some patients, weight restoration is a necessary part of medical recovery, because the body cannot heal or the brain cannot think clearly without enough nutrition. For other patients, weight is not the focus at all. Your treatment team will talk with you honestly about what your body needs and why.

“How do I help a friend without making it worse?” Lead with love, not body talk. Tell them you care, that you have noticed they seem to be struggling, and that you want to help them get evaluated. Do not try to be their therapist. Do not police their meals. Stay present even if they pull away. Sharing this essay, or the F.E.A.S.T. resources, can be a gentle way to open the door.

“Can someone fully recover, or is it managed forever?” Full recovery is possible and happens regularly. Some people describe themselves as “in recovery” long-term, the way someone might describe sobriety; others describe the eating disorder as a chapter that closed. Both are legitimate. The brain and body can heal. Relationships with food, body, and self can be rebuilt. We see it in our practice.

If you or someone you love is in crisis

Eating disorder–specific support

National Alliance for Eating Disorders Helpline — 1-866-662-1235, Monday–Friday, 9 a.m.–7 p.m. ET. Staffed by licensed therapists who specialize in eating disorders; free referrals to all levels of care. allianceforeatingdisorders.com

ANAD Helpline — 1-888-375-7767, Monday–Friday, 10 a.m.–10 p.m. ET. Peer support and treatment referrals.

F.E.A.S.T. — feast-ed.org. Free caregiver resources, online support groups, and family guides for those supporting a loved one with an eating disorder.

24/7 mental health crisis support

988 Suicide & Crisis Lifeline — call or text 988. 988 en Español — call 988 and press 2. Veterans Crisis Line — call 988 and press 1, or text 838255.

The Trevor Project (LGBTQ+ youth) — 1-866-488-7386, or text START to 678-678.

Crisis Text Line — text HOME to 741741.

California Peer-Run Warm Line — 1-855-845-7415, non-crisis peer support.

Inland Empire local crisis resources

San Bernardino County DBH ACCESS Line — 888-743-1478 (24/7).

San Bernardino County Mobile Crisis Response — call 800-398-0018 or text 909-420-0560 (24/7, all ages, English & Spanish).

San Bernardino County SARC (Screening, Assessment & Referral Center, substance use) — 800-968-2636 (24/7).

Riverside University Health System CARES Line — 800-499-3008 (24/7, confidential).

Inland SoCal Crisis Helpline — 951-686-HELP (4357), 24/7, bilingual.

Arrowhead Regional Medical Center (ARMC), Colton — 909-580-1000. ARMC’s Adolescent Behavioral Health Unit (ages 13–17) opened in August 2025.

Loma Linda University Children’s Hospital Emergency Room (pediatric, including psychiatric emergencies) — 909-651-6233.

If you or your loved one has chest pain, fainting, seizures, severe weakness, confusion, signs of refeeding syndrome, or any other life-threatening symptom, call 911 or go to the nearest emergency room. Eating disorders are medical illnesses, and medical emergencies are common.

Sources

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