Even those with fame and fortune can be ravaged by eating disorders that too many dismiss.

Eating disorders are not lifestyle choices or extreme diets—they are severe psychiatric illnesses with multi-system medical consequences and elevated mortality risk. Recent epidemiology underscores the scope: the Global Burden of Disease (GBD) study estimated 13.6 million people worldwide were living with anorexia nervosa (AN) or bulimia nervosa (BN) in 2019. The study is six years old, and we are left wondering whether there has been an increase or a decrease in these disorders.

When binge-eating disorder (BED) and “other specified feeding or eating disorders” (OSFED) are added, an additional 41.9 million people were considered at risk.

Eating disorders are associated with some of the highest mortality rates of any mental illness. A landmark meta-analysis reported standardized mortality ratios and approximately one in five deaths among people with AN because of suicide.

The 1983 death of singer Karen Carpenter at age 32 became a cultural inflection point, abruptly exposing the lethality of anorexia to a wider public. Contemporary reporting and later analyses described cardiac failure in anorexia nervosa; media attention after her death spurred awareness and advocacy that changed how clinicians and the public talk about these illnesses. This eating disorder, in particular, has a cardiac component.

Individuals who have anorexia are often totally unaware that although muscles in the arms and legs may atrophy, the one muscle the disease attacks is the heart, which will begin to shrink.

Celebrity openness and breaking stigma

While Carpenter’s death brought the illness into tragic focus, other public figures have helped turn that attention toward understanding and prevention. Actor and director Diane Keaton, in her memoir and later interviews, spoke candidly about her own battle with bulimia in her twenties.

Her disclosures stripped away the glamour that often hides pain. Keaton spoke about consuming massive amounts of food in secret, describing how, “Typical dinner was a bucket of chicken, several orders of fries with blue cheese and ketchup, a couple TV dinners, a quart of soda, pounds of candy, a whole cake and three banana-cream pies.”

Like so many others with this particular eating disorder, she was careful not to be discovered. She revealed the secrecy that defined her illness: “I became a master at hiding. Hiding any evidence — how do you make sure no one knows? You live a lifestyle that is very strange. You’re living a lie.” By acknowledging the deception and despair that accompany eating disorders, Keaton gave voice to millions who suffer in silence. It was a brave move on her part.

Her willingness to speak out, like Carpenter’s story before her, has helped broaden the conversation and made treatment discussions more compassionate. High-profile openness can encourage earlier intervention and reinforces that eating disorders cross fame, gender, and class boundaries. Too many of us may believe that the rich and famous don’t share the same disorders the rest of us do, but that is a myth. When a high-profile person comes out, the myth is shattered.

Historically framed as illnesses of young women, eating disorders are now recognized across genders and ages. When I was writing my dissertation and doing my research on binge eating in women over 30, the oldest woman who submitted materials was 76. Most of the women in my convenience sample were nurses and teachers.

Reviews and public-health tracking show that boys and men account for a substantial share of cases but have been systematically underrepresented in research; that gap is finally narrowing. Clinical and surveillance data indicate rising hospitalizations among boys and young men, and distinct male presentations (e.g., drive for muscularity, anabolic misuse) that can delay diagnosis.

What causes an eating disorder?

No single theory explains all eating disorders. Instead, converging models — biological, psychological, and sociocultural — describe how risk accumulates and symptoms are maintained. Biological and neurodevelopmental theories emphasize heritability, temperament, and neurocircuitry differences in reward and interoception. Cognitive-behavioral theories, especially the transdiagnostic model (CBT-E), propose that overvaluation of weight/shape and rigid dietary rules lead to cycles of restriction and binge eating.

Sociocultural theories highlight appearance norms, social comparison, and media exposure — now amplified by social media. In line with the socio-cultural, we should note that recent trends in fashion, especially in fashion show catwalks, are returning to the thin or super thin model and away from the more ample woman. This cannot be good and may, once again, push fashion to glamorize the Twiggy look.

Family-systems and interpersonal theories add that conflict and secrecy in relationships can maintain symptoms, while interpersonal psychotherapy (IPT) can relieve them by improving communication and role transitions.

Regardless of the pathway, malnutrition and compensatory behaviors can destabilize the body. That’s why protocols emphasize early detection, medical monitoring, and evidence-based therapy. When physiological instability is present — bradycardia, hypotension, electrolyte derangements — hospitalization may be life-saving; when weight is restored and behaviors remit, the brain and body can heal.

At the symptom level, mind and body feed each other. Starvation blunts hunger cues (as in the Keys starvation experiment) and heightens rigidity, making refeeding feel terrifying; purging briefly relieves distress but worsens electrolyte imbalance and cardiac risk. Teeth also suffer with this disorder because stomach acid eats the enamel from them.

Yet outcomes improve markedly with earlier intervention, family-based treatments for adolescents, and therapies for adults such as CBT-E. As indicated, public figures who speak openly about recovery help counter the secrecy that keeps people sick.

Even counting eating disorders accurately is challenging. Narrow definitions underestimate true prevalence by omitting BED and OSFED; broader definitions capture more cases but vary by method. How can we know how pervasive they are if we have trouble deciding on when one is or isn’t an eating disorder?

If you or someone you know is struggling, evidence-based care works — and the earlier, the safer. Someone’s life can be at risk, and you may be the person who will save them. Understandably, it is a challenge because of the secrecy these individuals maintain, and they may not respond positively initially to your wish to help.