We also classify several specific feeding or eating disorders as eating disorders, and they include pica, rumination disorder, avoidant/restrictive food intake disorder, and others. Although we think of pica as primarily associated with infants and toddlers, there are adults who consume non-nutritive substances such as clay, corn starch or laundry starch. According to medical professionals, a diet lacking in particular nutrients is the root cause of the desire to eat laundry starch.

According to the National Eating Disorders Association, anorexia, bulimia, and binge-eating disorders affect about 30 million people in the United States. Also, it is estimated that 28.8 million Americans, or 9% of the country’s population, will experience an eating problem in their lives.

A recent study of 12,000 teenagers ages 13 to 18 found that almost 4% of teenage girls and 1.5% of teenage boys have eating disorders. Also, according to a survey of 9,282 individuals, roughly 10 million men and 20 million women in the United States have an eating disorder that is clinically serious in their lifetime.

It is crucial to remember that not everyone who has an eating problem has a medical diagnosis of being underweight; in fact, less than 6% of eating disorder sufferers have this diagnosis. Genetic heredity also affects the risk for eating disorders, with 28–74% of the risk being genetic.

Overall, eating disorders are serious problems that can endanger a person’s health, emotions, and ability to do basic things that are necessary for life. It’s critical to get professional help if you or someone you love is dealing with an eating disorder in order to recover and control symptoms.

But now we also have to deal with avoidant/restrictive food intake disorder (ARFID) and atypical-type anorexia nervosa (AN), which are two more types of unusual eating. ARFIDs are mainly characterized by a clear lack of interest in food, avoiding food products because of their color, shape, or packaging, or avoiding food because of phobic-like symptoms, such as after-choking episodes.

ARFID, or avoidant/restrictive food intake disorder, makes it difficult to meet one’s nutritional and/or energy needs and results in at least: nutritional deficiencies, weight loss or failure to gain the right amount of weight, a need for enteral feeding or nutritional supplements, or significant disruption of daily activities.

Psychological symptoms of ARFID include avoiding or limiting certain foods or textures, feeling anxious around mealtimes, being sensitive to sensory input, being afraid of choking or throwing up, and other things.

People with ARFID may wear layers to hide weight loss or stay warm. They may also complain of constipation, abdominal pain, cold intolerance, lethargy, and/or too much energy, and they may have recurring gastrointestinal problems (upset stomach, feeling full, etc.) around mealtimes for no known reason.

Some people with ARFID may also show signs of anorexia nervosa, like worrying about their body size and weight, avoiding meals with a lot of calories, being against being fat, and having a bad body image that isn’t distorted.

It’s crucial to remember that ARFID can manifest in people of all ages and may share characteristics with other eating disorders like anorexia nervosa. In cooperation with a healthcare practitioner, a proper diagnosis and treatment strategy should be created.

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Erin Reynolds had battled bulimia since childhood, but the weeks before she entered treatment were among her worst. At 22, she was preparing to leave her home in Helena, Montana, for an inpatient program in New Jersey with round-the-clock medical care.

Looking back six years later, Reynolds said seeking help was one of the most difficult parts of the recovery process. “I just kept bingeing and purging because I was so stressed,” she said. “I’m leaving my job that I love, leaving all my friends and my town and saying goodbye to normal life.”

Eating disorders, including anorexia, bulimia, and binge-eating disorder, are some of the most fatal mental illnesses. Yet treatment options are sparse, particularly in rural states such as Montana.

Emergency department visits for teenage girls dealing with eating disorders doubled nationwide during the pandemic, according to a study from the Centers for Disease Control and Prevention. The same report notes that the uptick could be linked to reduced access to mental health services, a hurdle even more acute in rural states.

The National Eating Disorders Association’s provider database shows only two certified providers across all of Montana, the country’s fourth-largest state as measured by square miles. By comparison, Colorado, which is nearly three-quarters of the size of Montana but has five times the population, shows nine providers.

That means many people like Reynolds must leave Montana for treatment, particularly true for those seeking higher levels of care, or drive for hours to attend therapy. It also means more individuals go untreated because they lack the flexibility to give up a paying job or leave loved ones behind.

“A lot of people are not able to access treatment, just given the geography and vast ruralness of the state,” said Caitlin Martin-Wagar, a University of Montana assistant professor and psychologist who specializes in eating disorder research.

The most intense treatment involves inpatient or partial hospitalization programs, best for those in need of round-the-clock care and acute medical stabilization. Residential treatment is a step down from there, usually outside a hospital setting at a place akin to a rehab facility.

Once a person in recovery can manage with less hands-on care, a variety of outpatient options may include therapy, meal support, or group counseling. “Finding people with those specialties and availability is often a challenge,” said Lauren Smolar, vice president of mission and education at the eating disorders association.

When Reynolds sought treatment in 2016, not one facility in Montana offered inpatient care, residential treatment, or partial hospitalization. Only one came close: the Eating Disorder Center of Montana, a treatment program based in Bozeman and established in 2013.

Jeni Gochin, who co-founded the center, said there were many barriers to starting an eating disorder treatment facility in Montana, where there were none. There was no licensure process, and challenges abounded, from insurance coverage to the high level of specialization required to provide appropriate care.

The Eating Disorder Center of Montana added a partial hospitalization program in 2017, which provides housing for out-of-towners and requires five to seven days of nearly all-day treatment programming led by a team of experts. The center also plans to open an outpatient therapy facility 200 miles west in Missoula later this year.

A third of people with eating disorders are men, a group that is underdiagnosed and undertreated. Although Black, Indigenous, and other people of color are no less likely to develop an eating disorder, they are half as likely to be diagnosed or receive treatment.

A few studies have shown a higher rate of eating disorders in urban centers, but it’s difficult to know whether that’s due to reduced stigma and more treatment options in metropolitan areas compared with rural settings.

“We know eating disorder rates are quite high,” Martin-Wagar said. “We’ve been seeing them rise pretty consistently, so this isn’t a niche or specialty issue. It’s something that’s impacting lots and lots of folks.”

The pandemic has made telehealth treatment options more common, which could relieve bottlenecks at treatment facilities. For example, the Eating Disorder Center of Montana is launching virtual outpatient care for any Montana resident this month. Emily Wish treatment center in Great Falls, Montana, provides telehealth appointments for individual, family, and group therapy. But telehealth treatment for eating disorders is limited in its effectiveness. Many interventions are best in person, such as meal support and helping people establish healthier patterns around eating.

Cost is a barrier to treatment everywhere, but especially in a place like Montana, where about 1 in 5 residents are covered by Medicaid or Healthy Montana Kids, the state’s Children’s Health Insurance Program. It can cost thousands of dollars and take many months for a person to receive adequate care, whether a person is insured or not. And there’s no formula to know how long treatment will take, or how many times a patient will have to move up and down the ladder of levels of care.

Few insurance companies provide meaningful coverage. Their reimbursement might time out after only a few weeks — far sooner than the average course of treatment takes — or not cover it at all.

Martin-Wagar, the University of Montana researcher, said that eating disorder research also receives very little funding relative to other mental health concerns. Without federal and state dollars going directly into treatment and research, eating disorder symptoms can’t be identified early in adolescents, the easiest way to drive down the costs of overall treatment; stigma is harder to combat; and there’s little incentive for new providers to create treatment programs in places outside urban areas with well-documented demand.

“Even if we create more eating disorder centers, if people can’t afford them, then we are only servicing the most privileged in our society,” Martin-Wagar said. “And that means we are not doing a good job.”

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