Eating Disorders

Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant/restrictive food intake disorder, and they share disturbed eating behaviour with disproportionate influence of weight or shape on self-evaluation. Two facts drive clinical urgency. First, anorexia nervosa has one of the highest mortality rates of any psychiatric illness, from both medical complications and suicide. Second, appearance is a poor guide: people at normal or higher weight can be severely medically compromised, and binge eating disorder is the most common eating disorder overall. Medical monitoring focuses on electrolytes, cardiac status and refeeding risk. Purging drives hypokalaemia and metabolic alkalosis; restriction drives bradycardia, hypotension, hypoglycaemia and bone loss; refeeding after prolonged restriction can precipitate dangerous phosphate, potassium and magnesium shifts, which is why nutritional restoration is done under supervision rather than self-directed. Treatment that works is psychological and structured: family-based treatment for adolescents with anorexia, CBT-E for bulimia and binge eating disorder, with lisdexamfetamine and SSRIs having specific roles. The supplement industry intersects badly with this population. Appetite suppressants, laxative teas, diuretics, thermogenic fat burners and detox products can all function as purging or restriction tools and worsen the illness. Legitimate nutritional supplementation — thiamine before refeeding, phosphate monitoring, vitamin D and calcium for bone protection, multivitamins during restoration — belongs within a supervised treatment plan.

• •Preoccupation with weight, shape or food rules
• •Restriction, bingeing or compensatory behaviours
• •Rigid rituals around eating and avoidance of eating with others
• •Frequent weighing or body checking
• •Dizziness, cold intolerance, hair loss or amenorrhoea
• •Dental erosion or swollen salivary glands with purging
• •Marked guilt or distress after eating

• •Genetic and heritable vulnerability
• •Dieting as the most common proximal trigger
• •Perfectionism and anxiety traits
• •Trauma and adverse childhood experience
• •Weight stigma and appearance-focused environments
• •Type 1 diabetes (insulin omission)
• •Sport and occupational weight pressures

Substantial heritability interacts with restriction-driven neurobiological change: starvation itself amplifies rigidity, obsessionality and food preoccupation, creating a self-perpetuating loop. Altered reward and interoceptive processing, anxiety-driven avoidance, and reinforcement of behaviours that temporarily reduce distress maintain the disorder independently of the initial trigger.