by Perlea, Victor ¹, Mayer, Gwendolyn ¹

• ¹ Universitätsklinikum Heidelberg

This is the extended version, for the abridged version click here
The introduction and overview can be found here

Disclaimer:We have compiled this information to the best of our knowledge based on current scientific literature (as of May 2026). However, we do not provide diagnosis or treatment recommendations. If you notice any mental health concerns in yourself or in a child or adolescent in your care, please consult a medical doctor.

Diagnostic criteria

• The ICD-11 and DSM-5 distinguish between 3 major types of eating disorders – anorexia nervosa, bulimia nervosa and binge eating disorder.
  
• Anorexia nervosa is characterised by restrictive energy intake relative to requirements resulting in a significantly low body weight in the context of age, sex, developmental trajectory, and physical health, a fear of gaining weight, despite being underweight, and a body image disturbance, disproportionate influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight (Kölch et al., 2020).
  
• Bulimia nervosa consists in recurring episodes of large amount food intake within a 2-hour period and sense of lack of control as well as recurring inappropriate compensatory behaviour (e.g. vomiting, laxatives, exercise, diet pills). Both binge eating and compensatory behaviours occur, on average, at least once a week within a period of three months; additonally, self-evaluation is unduly influenced by body shape and weight (Kölch et al. 2020).
  
• Binge eating disorder is characterised by both large amount food intake in a discrete period, and a sense of lack of control over eating during the episode as well as eating rapidly and/or eating beyond fullness and secret eating marked with distress around binges. Frequency: At least once a week for three months (Kölch et al., 2020).

Prevention measures

• Universal/school‑based body‑image and dissonance‑based programs that target thin‑ideal internalization and dieting are shown to reduce the onset of eating pathology in adolescents (Strice et al., 2021)
  
• Family‑focused and media‑literacy interventions addressing appearance‑related pressures and weight‑teasing show preventive effects on body dissatisfaction and disordered eating. (Bennett et al., 2023; Liu et al., 2025)
  
• Early identification and brief interventions in primary care and school settings for high‑risk youth (e.g. severe dieting, high body dissatisfaction) help prevent progression to full‑threshold disorders (Wong et al., 2024; Berry et al., 2025).

Risk factors

• Sociocultural: internalization of thin or muscular ideals; appearance‑focused social comparison; exposure to weight‑stigmatizing media content (Varela et al., 2023).
  
• Interpersonal/family: weight‑related teasing, parental encouragement to diet, family stress, low cohesion; parental overinvolvement and anxiety increase risk, whereas family warmth/cohesion are protective (Varela et al., 2023).
  
• Individual: female sex (though male risk is substantial), dieting, negative affect, low self‑esteem, body dissatisfaction, and perfectionism associated with increased risk of eating pathology (Strice et al., 2021; Varela et al., 2023).

Treatment approaches

• Family‑based treatment (FBT) as a guideline‑recommended first‑line outpatient treatment for adolescents with anorexia nervosa and bulimia nervosa (Goldschmidt et al., 2023; Haas el al., 2023; Hagan et al., 2023).
  
• CBT and FBT can produce comparable improvements in weight and eating‑disorder psychopathology in adolescents, suggesting that patient and family characteristics should guide treatment selection. CBT is shown to effectively reduce binge eating, purging and overvaluation of weight/shape (LaGrange et al., 2022).

References for this article are here