Eating Disorders

Eating disorders are serious mental health conditions that involve complex relationships with food, body image, and self-worth. They are not about vanity or choice. These conditions can cause profound emotional distress and carry significant risks to physical health.

Although they are often associated with young women, eating disorders affect people of all genders, ages, and backgrounds. Early intervention can greatly improve outcomes, and with the right support, recovery is entirely possible.

Anorexia Nervosa

Anorexia nervosa is characterised by a persistent restriction of energy intake, leading to significantly low body weight. Individuals often have an intense fear of gaining weight and a distorted perception of their body shape or size. Contrary to some misconceptions, anorexia can affect individuals whose weight is not visibly low, particularly in the case of “atypical anorexia”, which is equally serious and medically risky.

People with anorexia may avoid eating, drastically reduce portion sizes, or follow rigid dietary rules. Exercise may become compulsive. Social withdrawal, perfectionism, and anxiety around food are common. The condition can have severe physical consequences, including electrolyte imbalances, slowed heart rate, reduced bone density, infertility, and increased risk of mortality.

According to the NICE guidelines, psychological therapy is the cornerstone of treatment. For adults, recommended therapies include Cognitive Behavioural Therapy for Eating Disorders (CBT-ED), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM). MANTRA, developed at the Maudsley Hospital in London, focuses on the individual’s thinking style, emotional regulation, and interpersonal relationships, helping them to understand the functions of their eating disorder and develop new coping strategies. For children and adolescents, Family-Based Therapy (also known as the Maudsley Model) is the first-line treatment. This approach supports parents in taking an active role in restoring their child’s nutritional health while gradually handing back control to the young person.

Medical monitoring is essential, particularly in cases where weight is very low or where there are signs of physical deterioration. The MEED (Medical Emergencies in Eating Disorders) guidelines offer a detailed framework to assess medical risk and ensure that individuals who need urgent physical health interventions are identified and treated appropriately.

Bulimia Nervosa

Bulimia nervosa involves repeated episodes of binge eating, during which an individual feels out of control and consumes large quantities of food in a short period of time. This is typically followed by compensatory behaviours to try to ‘undo’ the binge, such as vomiting, fasting, excessive exercise, or misuse of laxatives or diuretics. While individuals with bulimia may be of average weight, or even above average, the condition can still be life-threatening due to its impact on the heart, gastrointestinal system, and electrolyte balance.

People living with bulimia often experience overwhelming guilt and shame related to eating. There may be secrecy around eating habits, frequent trips to the bathroom after meals, or signs of dental damage from repeated vomiting.

The NICE guidelines recommend guided self-help and CBT-ED as the first-line treatments for bulimia in both adults and adolescents. This structured approach helps individuals understand and change the patterns of thinking and behaviour that maintain the eating disorder. Treatment focuses on developing regular eating patterns, challenging distorted thoughts about food and body image, and building healthier coping mechanisms for emotional distress. If psychological therapy alone is not sufficient, a multidisciplinary team, including psychiatrists, dietitians, and GPs, may be involved in supporting physical recovery and managing comorbid conditions such as anxiety or depression.

Binge Eating Disorder (BED)

Binge Eating Disorder is the most common eating disorder and is often under-recognised. It is characterised by regular episodes of eating large quantities of food, often quickly and to the point of physical discomfort. These episodes are associated with a sense of loss of control, and they typically occur in secret. Unlike bulimia, there are no regular attempts to compensate for the binges through purging or excessive exercise. People with BED often feel deep shame and distress, and many struggle with low self-esteem and chronic dieting.

NICE recommends a stepped-care approach for BED. For many individuals, guided self-help based on cognitive behavioural principles can be effective as a first step. For those with more severe symptoms or coexisting mental health issues, full CBT-ED is the treatment of choice. This therapy focuses on reducing the frequency of binge episodes, improving emotional regulation, and developing a more balanced and compassionate view of food and the body.

In some cases, medication may be considered as an adjunct to therapy. Certain antidepressants, such as SSRIs, may help reduce binge frequency and improve mood. However, medication is not a substitute for therapy and is not routinely recommended as the sole treatment.

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID is a relatively newer diagnosis included in DSM-5 and ICD-11, and it differs significantly from other eating disorders. It involves highly selective eating or a lack of interest in food, leading to nutritional deficiency, weight loss (or failure to grow in children), and significant interference with daily life. Importantly, ARFID is not driven by concerns about weight or body shape.

Some individuals may avoid food due to sensory sensitivities (such as texture or smell), while others may have developed a fear of choking or vomiting after a traumatic incident. ARFID can appear in early childhood or later, and is sometimes seen in individuals with neurodevelopmental conditions such as autism spectrum disorder.

Treatment for ARFID is usually multidisciplinary and may involve a combination of psychological therapy (including CBT adapted for ARFID), occupational therapy for sensory issues, and nutritional support. For younger individuals, family involvement is vital, and Maudsley-based family approaches can be helpful even when body image is not a central concern. Treatment focuses on gradually expanding the range of accepted foods, managing anxiety around eating, and restoring nutritional health.

Other Eating Disorders and Atypical Presentations

Not everyone with a serious eating disorder meets the exact criteria for anorexia, bulimia, or BED. Many individuals fall into what DSM-5 refers to as Other Specified Feeding or Eating Disorders (OSFED). This includes presentations such as atypical anorexia (where someone has all the psychological symptoms of anorexia but is not underweight), purging disorder (where purging occurs without bingeing), or night eating syndrome. These conditions can be just as distressing and dangerous as the more well-known disorders.

Treatment is tailored to the individual but typically follows similar principles: evidence-based psychotherapy (often CBT-ED), nutritional rehabilitation, support for emotional wellbeing, and medical monitoring as needed. It is important that these conditions are taken seriously and not dismissed because they don’t fit a classic pattern.

Treatment for Eating Disorders

Treatment often begins with a thorough assessment, including a detailed clinical history, exploration of eating behaviours and body image, physical health screening, and risk assessment. Integrated care and multidisciplinary approach, especially in cases where physical health may be compromised, is of utmost importance.

In younger individuals, families are usually involved in treatment planning and delivery. In adults, both individual and, where beneficial, family or couples-based interventions are recommended. Throughout treatment, the progress should be monitored carefully, and approach adapted as needed to ensure that therapy remains effective, supportive, and goal-oriented.

Hope and Recovery

It’s important to know that recovery from an eating disorder is possible. While the journey may not be linear, many people go on to lead fulfilling, healthy lives. What makes the difference is timely, tailored support and the understanding that eating disorders are treatable.

Whether symptoms are recent or longstanding, mild or severe, it is never too early or too late to seek help.

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