Eating Disorders

The main types of eating disorders include:

• Anorexia Nervosa: Characterised by energy intake restriction, intense fear of weight gain, and a distorted body image. Individuals may be underweight but perceive themselves as overweight.
• Bulimia Nervosa: Involves episodes of binge eating followed by compensatory behaviours such as vomiting, fasting, or excessive exercise to prevent weight gain.
• Binge Eating Disorder (BED): Recurrent episodes of eating large quantities of food in a short period, accompanied by a sense of loss of control and distress, without purging behaviours.
• Other Specified Feeding or Eating Disorders (OSFED): Clinically significant eating issues that don't meet full criteria for the above categories but still require treatment.
• Avoidant/Restrictive Food Intake Disorder (ARFID): Often diagnosed in younger individuals, this condition involves avoidance of food based on sensory characteristics or fear of adverse consequences, leading to nutritional deficiencies.

Symptoms vary by type but may include:

• Preoccupation with food, weight, calories, and dieting
• Refusal to maintain a healthy weight
• Recurrent binge eating or purging behaviours
• Excessive exercise despite fatigue or injury
• Significant weight loss or weight fluctuations
• Avoiding meals or eating in secret
• Gastrointestinal complaints with no medical cause
• Menstrual irregularities or amenorrhea
• Low self-esteem tied to body shape or weight

Eating disorders typically develop due to a combination of genetic, psychological, social, and cultural factors:

• Genetics: A family history of eating disorders or other mental illnesses increases risk.
• Psychological traits: Perfectionism, low self-esteem, anxiety, or obsessive-compulsive tendencies.
• Environmental: Exposure to trauma, bullying, or family dynamics around food or body image.
• Sociocultural: Societal pressures and media ideals that equate thinness with success or worth.
• Neurobiological: Emerging evidence suggests alterations in brain structure and neurochemistry.

Eating disorders can cause serious short- and long-term effects, including:

• Malnutrition and vitamin deficiencies
• Heart problems (e.g. bradycardia, arrhythmias)
• Bone density loss (osteopenia, osteoporosis)
• Electrolyte imbalance
• Gastrointestinal disturbances
• Menstrual dysfunction or infertility
• Cognitive impairment
• Increased risk of depression, suicide, and substance use disorders

Diagnosis involves a comprehensive psychiatric and medical assessment. It includes:

• Clinical interviews with the individual (and often family)
• DSM-5-TR diagnostic criteria
• Standardised tools such as the Eating Disorder Examination (EDE) or SCOFF questionnaire
• Physical exams to assess BMI, vital signs, and signs of medical instability
• Blood tests to monitor organ function and electrolytes
• Collaboration between psychiatrists, GPs, dietitians, and psychologists is often required.

Treatment depends on severity and diagnosis but often involves:

• Psychotherapy: First-line evidence-based treatments include Enhanced Cognitive Behaviour Therapy (CBT-E), Family-Based Therapy (FBT), and Dialectical Behaviour Therapy (DBT).
• Nutritional rehabilitation: Involves structured meal planning with dietitians to restore nutritional balance and support healthy eating habits.
• Pharmacotherapy: Antidepressants (e.g. SSRIs) may be prescribed for comorbid conditions like depression or OCD. Antipsychotics like olanzapine may be used in anorexia nervosa.
• Medical monitoring: Regular health checks to manage risks such as refeeding syndrome, electrolyte imbalance, and cardiac complications.
• Inpatient or Day Programs: Recommended when outpatient treatment is insufficient or when medical risk is high.