Source: # Eating Disorders *Food, body image, and a body that must be kept alive* ## 26.1 What they are Eating disorders are serious mental health conditions involving disturbed eating behaviours and preoccupation with food, weight, and body image. They have physical and psychological components and can be life-threatening. They often begin in the teenage years. Anorexia nervosa, bulimia nervosa and binge-eating disorder all need early help, as do substance use and self-harm. Social comparison and body image are part of the same picture. That is not vanity. It is a health risk. ## 26.2 Anorexia nervosa - Restriction of energy intake leading to significantly low body weight. - Intense fear of gaining weight. - Distorted body image (seeing self as fat when underweight). - Often excessive exercise. - Physical complications: malnutrition, heart problems, osteoporosis, infertility, organ failure. - Mortality: highest mortality rate of any psychiatric disorder. Treatment includes: medical stabilisation, nutritional rehabilitation, psychotherapy, family-based treatment for adolescents. Low weight is a medical emergency when the heart is slow, electrolytes are wild, or fainting has begun. This is a medical emergency, not a matter of willpower; get medical help now. ## 26.3 Bulimia nervosa - Recurrent binge eating (a large amount with a sense of loss of control). - Recurrent compensatory behaviours (vomiting, laxatives, excessive exercise, fasting). - Self-evaluation unduly influenced by body shape and weight. - Often normal or above-normal weight — so the body can hide the danger. - Physical complications: electrolyte imbalances, dental erosion, oesophageal damage, heart problems. Treatment includes: CBT-E (enhanced cognitive behavioural therapy), SSRIs when a clinician chooses them, nutritional counselling. ## 26.4 Binge eating disorder - Recurrent binge eating without regular compensatory behaviours. - Eating rapidly, until uncomfortably full, when not hungry. - Feeling disgusted, depressed, or guilty afterwards. - Often leads to obesity. Treatment includes: CBT, interpersonal therapy, sometimes medicines. ## 26.5 ARFID and OSFED Avoidant/Restrictive Food Intake Disorder (ARFID): a person eats very little because they have no interest in food, cannot bear certain textures or smells, or fear what might happen, such as choking. It is not about body image. It can lead to poor nutrition and weight loss. It is common in children and in autistic people. Treatment includes nutrition support, gradual exposure to new foods and family involvement. Other Specified Feeding or Eating Disorder (OSFED): symptoms cause significant distress but do not meet full criteria for the types above. Still serious. Still requires treatment. A missing label is not a mild illness. ## 26.6 What sits underneath - Genetic predisposition. - Cultural pressure about thinness. - Perfectionism, low self-esteem. - Trauma history. - Co-occurring anxiety, depression, OCD. - Family dynamics. ## 26.7 Treatment principles - Medical monitoring is essential. - A multidisciplinary team: therapist, dietitian, physician, psychiatrist. - Address underlying psychological issues. - Nutritional rehabilitation. - Family involvement, especially for adolescents. - Support groups. Do not run a home diet plan as treatment. Food here is medicine. Weight restoration, when needed, is not a cosmetic project. ## 26.8 A short story A STORY FROM ORDINARY LIFE — MEERA’S PLATE Meera’s school said she was disciplined. Her mother saw the sleeves in May. The paediatrician did not praise the number on the scale. She checked pulse, asked what disappeared after dinner, and sent them the same week to a team that included a dietitian. Meera was angry. The plan was boring: regular meals, no extra running at 5 a.m., a therapist who did not argue about the mirror. Six months later the heart was quieter. The mirror was not kind yet. The plate was no longer a battlefield every night. ## Key points to remember - Normal weight does not rule out bulimia. - ARFID is not anorexia; body image is not the engine. - OSFED still needs care. - Highest psychiatric mortality is a reason to go to a clinic, not to wait for insight. **IF TONIGHT IS DANGEROUS** Fainting, chest pain, vomiting blood, or a person who cannot keep water down: casualty. 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