Getting Disability for Eating Disorders as an Adult

Used as a medical term, "anorexia" refers to a loss of appetite, generally as a symptom of another condition. For example, a doctor might refer to a patient as "presenting with bloating, nausea, and anorexia" when attempting to diagnose a digestive disorder.

While a temporary loss of appetite isn't abnormal, a more severe form of restrictive eating, called anorexia nervosa, can be a disabling mental condition.

The Social Security Administration (SSA) recognizes that eating disorders such as anorexia can substantially interfere with your ability to complete basic daily tasks and work full-time. If you have an eating disorder that lasts longer than twelve months and keeps you from earning wages above the level of substantial gainful activity, you may qualify for disability benefits.

Types of Eating Disorders

Social Security considers eating disorders to be mental health conditions. Here are some examples of specific eating disorders that can be potentially disabling:

• Anorexia nervosa is characterized by extremely limited food intake, excessive weight loss, and an irrational fear of gaining weight.
• Bulimia nervosa is characterized by binging and purging through vomiting, laxatives, or extreme exercise.
• Binge-eating disorder is characterized by frequently consuming unusually large amounts of food and feeling unable to stop eating.
• Avoidant restrictive food intake disorder (ARFID), previously referred to as selective eating disorder, is an extreme aversion to food unrelated to concerns about body image.
• Pica is characterized by eating non-food substances such as ice, clay, soil, or paper.

Adults with severe eating disorders often have physical and mental symptoms that interfere with their ability to work. Several eating disorders can be present at the same time (such as anorexia and bulimia), which increases the chance of complications.

Medical Problems Caused by Anorexia Nervosa and Related Eating Disorders

People struggling from anorexia nervosa, with or without other eating disorders, are typically diagnosed by dramatic weight loss and very low body weight. Because restrictive eating affects almost every body system, these disorders tend to have a higher mortality rate than other mental health impairments.

Complications of anorexia, bulimia, and other disordered eating diagnoses may include:

• cardiovascular diseases, such as irregular heartbeats, abnormal blood pressure, and heart failure
• musculoskeletal problems, including reduced muscle strength, weakened bones, and tooth loss
• hormonal changes involving the reproductive, thyroid, and adrenal systems
• psychological effects such as depression, anxiety, and substance abuse
• neurological and cognitive disorders, such as seizures, trouble concentrating, and peripheral neuropathy
• blood problems like anemia or pancytopenia
• organ failure caused by an imbalance of essential minerals, and
• damage or rupture of the esophagus.

Make sure to document any treatment you've received for the above complications. Social Security will review your medical records for evidence that your eating disorder has "more than a minimal impact" on your ability to do work-related activities, and having physical symptoms of your mental disorder strengthens your case.

Qualifying for Disability Benefits

When anorexia, bulimia, or a related eating disorder begins to affect your ability to function or maintain a job, you might qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). You'll need to establish your financial eligibility for the type of disability benefit you're applying for—SSDI is based on your work history, while SSI is subject to income and asset limits.

Both SSDI and SSI applicants must show that they either meet the requirements of a disability listing or are unable to do any work in order to receive benefits.

Getting Disability by Meeting the Listing for Eating Disorders

"Listed impairments" are conditions that Social Security has determined are severe enough to be automatically disabling. Each listing has a set of requirements that must be present in your medical records in order for you to "meet the listing" (and qualify for disability without having to show that you can't work at all).

In order to meet the criteria for listing 12.13, Eating disorders, you'll need to have medical documentation of an eating disorder that significantly impairs your physical or mental health. Examples of signs and symptoms that Social Security will be on the lookout for include:

• restricting your caloric intake beyond what you need to function
• self-induced vomiting
• excessive exercise
• misuse of laxatives
• mood disturbances, such as social withdrawal or irritability
• not getting your period
• dental problems, and
• cardiac abnormalities.

Evidence of the above criteria can be found in your doctor's notes or in lab tests. But Social Security also requires that you have significant limitations in your mental functioning, which can be found in your activities of daily living form. You'll need to show that you have a "marked" limitation in two, or an "extreme" limitation in one, of the following areas:

• understanding, remembering, or using information (the ability to understand instructions, learn new things, apply new knowledge to tasks, and use judgment in decisions)
• interacting with others (the ability to use socially appropriate behaviors)
• concentrating, persisting, or maintaining pace in performing tasks (the ability to complete tasks), and
• adapting or managing oneself (having practical personal skills like paying bills, cooking, shopping, dressing, and good hygiene).

Note that marked is worse than moderate—you can think of it as seriously limiting. Extreme doesn't mean a complete loss of an ability, but it's worse than marked. "Marked" and "extreme" are matters of professional judgment used by a psychiatrist or psychologist when reviewing the medical evidence.

Getting Benefits Because Your Functional Capacity Rules Out All Work

You shouldn't assume that you'll be denied benefits if you don't meet the listing criteria—the majority of applicants who are awarded disability don't meet a listing. Instead, they're able to show that their residual functional capacity (RFC) keeps them from working. Your RFC is a set of restrictions that reflect the most you're capable of doing, physically and mentally, in a job setting.

Many people who've had successful treatment for anorexia recover to a point that they don't meet the listing for eating disorders, but they still have leftover functional limitations. For example, muscle weakness and anemia can limit your ability to stand or walk for prolonged periods or lift heavy objects. Lingering mental problems have an impact on your ability to work around others or follow instructions.

How Social Security Determines Your RFC

Social Security considers any medically documented functional limitations you have when assessing your RFC. You might have mental limitations—such as not being able to concentrate or complete tasks—as well as physical restrictions like not being able to stand or walk for more than two hours. The agency will look at opinions from your treating doctors and consultative examiners to help determine what work restrictions you have, and incorporate their recommendations into your RFC.

How Social Security Uses Your RFC

Social Security will review your work history and compare the duties of your past jobs with the restrictions in your RFC to see whether you could do those jobs today. If you can't return to your past work, the agency will consider your age, education, and work experience to see if other jobs exist that you can do.

People 50 years of age and older have an easier time showing that they can't do other work, thanks to a special set of rules known as the medical-vocational grid. Applicants younger than 50 generally need to show that they can't do even the easiest, sit-down jobs before Social Security will award them benefits.

Increasing Your Chances of Getting Disability for Eating Disorders

Qualifying for SSDI or SSI based on an eating disorder can be challenging. Here are some tips to help make your case stronger to a disability claims examiner or administrative law judge.

• Mention all your health concerns. Disordered eating is often comorbid (occurring at the same time) with other mental health impairments, and frequently results in physical conditions as well. Social Security is required to consider your combined impairments when determining disability, so you can make sure the agency has a better picture of your limitations by listing every recent medical provider you've seen.
• Talk to your doctor. Don't assume that your treating doctor knows everything you want Social Security to know. The agency can't consider any limitations that aren't medically documented when assessing your RFC, so even symptoms that you consider small (like slight hand tremors) can have a big effect on your disability decision.
• Hire an attorney. Many people, denied after the initial and reconsideration levels, get discouraged and give up on a potentially successful claim. But most claims are won at the hearing level, and having an attorney present who knows how to cross-examine the vocational expert is a valuable asset to have.

For more information, see our set of articles on mental disorders and disability.

_{Updated August 30, 2023}