Eating Disorders

What are eating disorders?

Eating disorders are serious mental-health conditions. They involve severe problems with thoughts about food and eating behaviours. A person may eat much less or much more than the body needs.

Eating disorders are medical conditions, not a lifestyle choice. They affect the body's ability to get proper nutrition and can lead to heart and kidney problems, and in severe cases, death. Treatments can help — and early treatment works better.

What are the types of eating disorders?

Common types include:

• Binge-eating disorder — out-of-control eating, continuing past the point of fullness, often to the point of discomfort. People often feel guilt, shame, or distress afterwards. Binge-eating disorder is the most common eating disorder worldwide.
• Bulimia nervosa — periods of binge-eating followed by purging (vomiting or laxative use), over-exercise, or fasting. People with bulimia can be underweight, normal weight, or overweight.
• Anorexia nervosa — severely restricting food or avoiding food. People with anorexia may see themselves as overweight even when they are dangerously underweight. Anorexia is less common but has the highest death rate of any mental disorder.

What causes eating disorders?

The exact cause is unknown. They result from a complex mix of genetic, biological, behavioural, psychological, and social factors — including body-image pressures, family dynamics, trauma, and in India increasingly, media and social-media influences.

Who is at risk for eating disorders?

Anyone can develop an eating disorder, but they are more common in women. They often begin in the teen years or young adulthood, but can start in childhood or later in life.

What are the symptoms of eating disorders?

Symptoms vary by disorder.

Binge-eating disorder symptoms:

• Eating unusually large amounts in a short time (e.g. 2 hours)
• Eating when full or not hungry
• Eating quickly during a binge
• Eating until uncomfortably full
• Eating alone or in secret
• Feeling distressed, ashamed, or guilty about eating
• Repeated dieting without weight loss

Bulimia nervosa symptoms — include binge-eating symptoms plus attempts to get rid of the food or prevent weight gain:

• Self-induced vomiting or laxative/enema use
• Intensive or excessive exercise
• Fasting

Bulimia nervosa can cause, over time:

• Chronically inflamed throat
• Swollen salivary glands
• Tooth enamel wear and decay (from stomach acid)
• Acid reflux (GERD) and other digestive problems
• Severe dehydration
• Electrolyte imbalance (sodium, potassium, calcium), which can cause heart rhythm problems or stroke

Anorexia nervosa symptoms:

• Eating very little, to the point of starvation
• Intensive and excessive exercise
• Extreme thinness
• Intense fear of gaining weight
• Distorted body image — seeing oneself as overweight even when severely underweight

Anorexia nervosa can cause:

• Bone thinning (osteopenia, osteoporosis)
• Mild anaemia
• Muscle wasting and weakness
• Thin, brittle hair and nails
• Dry, blotchy, or yellowish skin
• Fine hair growth on the body (lanugo)
• Severe constipation
• Low blood pressure
• Slow breathing and pulse
• Feeling cold all the time
• Dizziness, faintness, weakness
• Fatigue
• Infertility
• Heart damage
• Brain and multi-organ complications

Anorexia nervosa can be fatal — from starvation complications or from suicide.

Eating disorders often occur alongside depression, anxiety, or substance use.

How are eating disorders diagnosed?

If you or a loved one think there is a problem, it's important to seek help. Diagnosis can involve:

• Medical history and symptom review — be honest about eating and exercise patterns
• Physical examination
• Blood or urine tests to rule out other causes
• Tests for complications — kidney function, electrocardiogram (ECG)

What are the treatments for eating disorders?

Treatment plans are tailored to the person. You'll likely have a team — doctors, nutritionists, nurses, and therapists. Treatment may include:

• Psychotherapy (individual, group, or family) — cognitive behavioural therapy is a mainstay, helping identify and change unhelpful thoughts and behaviours.
• Medical care and monitoring for complications.
• Nutrition counselling — doctors, nutritionists, and nurses help establish healthy eating patterns and reach a healthy weight.
• Medicines — antidepressants, antipsychotics, or mood stabilisers may help some people, and also treat co-occurring depression and anxiety.

Severe cases may need hospital or residential care. Start with a doctor or general psychiatry department; they can refer to specialist services where needed.