Getting Disability for Eating Disorders as an Adult

Anorexia simply means loss of appetite, and is not abnormal if it's only temporary. But when anorexia becomes so extreme that the physical and mental health of a person is affected, a mental disorder can be diagnosed. A mental disorder is present when a person falsely perceives themselves as overweight due to distortion of their own body image (when there is no objective physical cause of anorexia such as a chronic illness or medication). This is anorexia nervosa, the most serious of the eating disorders, and has a high mortality.

Anorexia nervosa is characterized by extremely limited food intake, excessive weight loss, and an irrational fear of gaining weight. Bulimia is an eating disorder characterized by binging and purging through vomiting, laxatives, or extreme exercise. These two eating disorders often occur together and increase the complications that can occur for an individual.

Adults who have severe anorexia nervosa and/or bulimia can have physical and mental symptoms that interfere with their ability to work. Although anorexia nervosa and bulimia are the most common, there are also other types of eating disorders, such as binge eating and avoidant/restricting disorders and pica (eating non-food materials).

Problems Caused by Anorexia Nervosa

Those who suffer from anorexia nervosa, with or without other eating disorders, can often be easily identified by their major weight loss and low body weight. There are numerous possible complications from anorexia nervosa, which explains the high mortality.

Complications may include:

• Heart disease, including:
  • dangerous heart rhythms, including slow heart beat
  • low blood pressure, and
  • heart failure.
• Musculoskeletal problems, including:
  • loss of muscle tone and strength
  • osteopenia, which is the loss of bone minerals
  • osteoporosis, which is the loss of bone density, and
  • dental problems.
• Changes in hormones, including:
  • reproductive hormones
  • thyroid hormones, and
  • stress hormones.
• Psychological effects, including:
  • depression
  • anxiety, and
  • drug and alcohol abuse.
• Neurological problems
  • seizures
  • difficulty organizing thoughts, and
  • numbness and tingling in the hands and feet.
• Blood problems, including:
  • anemia, and
  • pancytoperia, a decrease in the production of blood cells by the bone marrow, which can be life threatening.
• Organ failure or dehydration caused by imbalance of electrolytes such as potassium, sodium, and magnesium, which are vital to proper tissue and organ function.
• Esophageal problems, including rupturing of the esophagus (with bulimia).

Qualifying for Disability Benefits

When anorexia, bulimia, or a combination of the two begins to affect your ability to function or maintain a job, you may be eligible to receive Social Security Disability benefits. In order to qualify for Social Security disability or SSI disability benefits, you must meet the requirements of a disability listing or prove that you are unable to do any work because of physical or mental limitations. (This article discusses how an adult can qualify for disability benefits; for information on getting disability benefits for someone under 18, see our article on SSI benefits for children or teenagers with eating disorders.)

Binge eating, pica, and avoidant/restricting disorders alone almost never qualify for disability benefits, because they are just not usually severe enough to prevent "gainful" employment. It would also be unusual for bulimia alone to qualify for benefits. Anorexia nervosa is a different matter. If the diagnosis is valid, all or nearly all such cases would qualify for disability benefits. The only exception would be for those who are under treatment and are stabilized nutritionally and psychologically.

Meeting the Listing for Eating Disorders

Social Security created a new disability listing for eating disorders in 2017, listing 12.13. To satisfy the eating disorder listing, Social Security doctors will first decide whether an applicant has an eating disorder that significantly impairs the applicant's physical or mental health. After that is done, a judgment is then made about the person's ability to function. The applicant must show significant deficits in current functioning, manifested by either an extreme limitation in one of the following areas of mental functioning or a "marked" limitation in two 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/or
• adapting or managing onself (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 is less severe than a complete loss of an ability, but worse than marked. Marked and extreme are matters of professional judgment used by a SSA psychiatrist or psychologist when reviewing the medical evidence.

Getting Benefits Because of "Residual Functional Capacity"

If your eating problem is not severe enough to satisfy the listing, Social Security will consider the medical limitations you do have in combination with your age, education, and work experience to see whether there is any type of job you can do. You might have limitations such as not being able to concentrate or complete tasks, or not being able to stand or walk for more than two hours. Since many claims are allowed the basis of limitations, you should not assume you will be denied benefits if your impairments don't satisfy the listing.

For instance, individuals with anorexia nervosa who have had treatment and have recovered to a point that they don't satisfy the listing for eating disorders can still have residual limitations. Muscle weakness and anemia can limit the ability to stand or walk for prolonged periods or lift heavy objects. Lingering mental problems can limit the ability to work around others or follow instructions.

Doctors working for Social Security evaluate your medical impairments and note your medical limitations on a document known as a residual functional capacity (RFC) form. Then disability examiners (or specialists known as vocational analysts) evaluate the nonmedical parts of your application, in combination with your RFC. If the examiner cannot show there is a job you can with your limitations, you can be allowed disability benefits. This is called getting a "medical-vocational allowance" and the more severe your medical limitations, the more likely you will qualify.

You should not assume that your treating doctor knows everything you want Social Security to know, especially problems you have standing, walking, and in use of your hands. Such limitations can still have a big effect on your disability decision. For example, an inability to stand or walk at least six hours a day will automatically reduce your RFC to sedentary work, which allows lifting to a maximum of ten pounds and standing or walking only two hours daily. Unless you are highly educated and skilled, this limitation could easily result in an approval of benefits if you are also age 55 or older. The vocational analyses that the SSA does can be complex, so don't assume you know which of your limitations are important; what is important is that your treating doctor agrees you have the limitations and includes them in your medical records.

For more information on how Social Security uses a formula to assess your RFC, age, and education to determine whether you are entitled to disability benefits, see our section on how Social Security decides if you can work.