A common misconception of eating disorders is that eating disorders are a lifestyle decision. Though no one chooses to have an eating disorder, it’s crucial to understand that what frequently begins as a simple diet to “get healthy” can turn into a dangerous and even fatal condition. This significant disturbance results from distortions in an individual’s thoughts and emotions, making rehabilitation difficult and time-consuming.
Anorexia Nervosa
An eating disorder characterized by an intense fear of gaining weight, a distorted body image, and persistent restriction of food intake, leading to significantly low body weight relative to age, sex and developmental stage. Individuals with anorexia nervosa often obsess about their weight and what they eat and engage in behaviors such as excessive exercise or fasting to maintain their low weight.
This is often triggered by societal pressure, trauma or perfectionism related to body image. The prevalence is 0.3% – 1% with it being more common in adolescents and young adults, especially females (10% times more than males).
The diagnostic criteria looks at:
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health
B. Intense fear of gaining weight or becoming fat, even when significantly underweight
C. Disturbance about body weight or shape, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of current low body weight
These must be present for at least 3 months.
Some symptoms of anorexia nervosa may include:
- Low body weight
- Excessive physical activity
- Denial of hunger
- Fixation with making food
- Abnormal, obsessive, or ritualized eating behaviors
- Anxiety, depression, slow heart rate
- Fatigue
- Low blood pressure
- Feeling cold
Treatments for anorexia could utilise psychoeducation through which the patient is taught about the disorder, challenges harmful beliefs replacing myths with evidence-based knowledge, and involves family. Giving the family information on the causes, symptoms, and effects of anorexia can help them be more understanding and receptive, which can improve treatment results overall.
Bulimia nervosa
An eating disorder involving uncontrolled repeated episodes of binge eating, where a person consumes a large amount of food within a short period, followed by compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives, fasting or excessive exercise.
This cycle of bingeing or purging is often accompanied by feelings of shame and loss of control and can be triggered by stress, dieting or emotional distress. This has a prevalence of 1%-2% in adolescents and young adults with some overall with anorexia nervosa.
The diagnostic criteria include:
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
- Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
B. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
C. Self-evaluation is unduly influenced by body shape and weight.
D. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Symptoms may include:
- Abdominal pain or digestive issues
- Severe tooth decay and gum disease due to frequent periods of forced vomiting
- Self-induced vomiting (often in secret)
- Excessive exercise.
- Excessive fasting.
- Specific eating habits or rituals.
- Anxiety, depression, or other personality disorders
The difference from anorexia nervosa is that Anorexia is self-starvation. Bulimia is a disorder in which a person eats large amounts of food (“bingeing”) and then rids the body of that food before it can be absorbed (“purging”). A person who is bulimic purges either by vomiting or using laxatives or diuretics (water pills).
Grounding methods help people with bulimia stay in the present and cut down on dissociation or cycles of bingeing and purging that are caused by anxiety. The person focusses on their surroundings by listing five things they see, four things they touch, three things they hear, two things they smell, and one thing they taste. This approach helps to redirect attention away from distressing ideas about food or body image and reconnect them to the present moment, hence decreasing impulsive behaviours.
Some deep breathing exercises, like the 4-7-8 method, can help you deal with worry and anxiety before or after a meal. The patient inhales deeply for four seconds, holds their breath for seven seconds, and exhales slowly for eight seconds. This approach stimulates the parasympathetic nervous system, which promotes relaxation and reduces anxiety associated with eating or body dissatisfaction. Deep breathing exercises before meals can help the patient approach food with a calmer mindset and minimise emotional bingeing or purging desires.
Avoidant/restrictive food intake
Avoidant/restrictive food intake disorder (ARFID) is a fairly new eating disorder. A condition where individuals avoid or restrict food intake due to lack of interest in eating, sensory aversions (e.g. texture or smell), or concern about potential adverse effects of eating (choking or vomiting).
Children with ARFID are extremely selective eaters and sometimes have little interest in eating food. They may eat a limited variety of preferred foods, which can lead to poor growth and poor nutrition
There is no specific duration for ARFID but it must persist long enough to cause significant interference. Symptoms may include:
- Sudden refusal to eat foods. A person with ARFID may no longer eat food that they ate previously.
- Fear of choking or vomiting.
- Losing appetite for no known reason.
- Eating very slowly.
- Thin body hair
- Feeling cold all the time.
- Poor wound healing.
- No growth or delayed growth
The diagnostic criteria include:
A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or
faltering growth in children). - Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
- Significant weight loss (or failure to achieve expected weight gain or
B. The disturbance is not better explained by lack of available food or by
associated culturally sanctioned practice.
C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
Exposure therapy allows people with ARFID to gradually introduce feared or avoided foods in a safe, supportive environment. The process includes a small, consistent exposure to help the patient to desensitise their fear response, gradually developing tolerance over time. The procedure begins with low-anxiety foods and progresses to increasingly demanding meals. Repeated exposure normalises eating experiences and changes the patient’s view of food from scary to neutral or delightful.
A food and thought journal is used to record emotions before and after eating, assisting the patient in identifying patterns of fear, anxiety, or avoidance. A progress tracker is used to reinforce beneficial eating habits, with incentives for sampling new foods and finishing meals. This organised method boosts confidence while decreasing fear-based avoidance, making food exposure more manageable over time.
Eating disorders are treatable, and with the right support and interventions, individuals can continue to lead a fulfilling and healthy lifestyle. It is essential to discuss these disorders more openly to reduce the stigma and erase any harmful misconceptions that may arise. Every person deserves to be met with compassion and understanding on their journey towards healing.
