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Anorexia Nervosa

Anorexia nervosa is a severe and potentially deadly mental health condition characterized by an all-consuming fixation on body weight and an overwhelming dread of gaining fat, often resembling a phobia. Individuals with anorexia pursue extreme thinness through self-imposed starvation and drastic weight loss.

Those with Anorexia Nervosa typically exhibit:

  • Consistent limitation of energy intake, resulting in a body weight far below what’s considered healthy for their age, sex, growth path, and physical condition.
  • Either a profound fear of weight gain or becoming fat, or ongoing actions that prevent weight gain despite already being dangerously underweight.
  • A distorted perception of their body weight or shape, an excessive focus on these factors in judging their self-worth, or a continuous failure to acknowledge the gravity of their low weight.

How anorexia might manifest for you (symptoms):

  • Intentionally consuming fewer calories than needed daily, resulting in significant or striking weight loss.
  • Fixating on calories, food, or anything tied to eating.
  • Feeling intense dread about gaining weight and taking extreme measures to prevent it.
  • Having a deeply negative view of your body.
  • Struggling with very low self-worth.
  • Finding it hard to recognize how serious the situation is or feeling helpless to change it.

Indicators to watch for (Red Flags)

  • Significant loss of body weight.
  • Preoccupation with dieting, fasting, or extreme methods to shed pounds quickly.
  • Avoiding specific foods or entire food groups (e.g., cutting out carbs, dairy, or abruptly adopting a vegan diet).
  • Anxiety about being “fat” or overweight, even when clearly underweight.
  • Intense fear of putting on weight or becoming “fat.”
  • Ignoring or denying feelings of hunger.
  • Adopting unusual food habits (e.g., eating in a strict sequence, chewing excessively, or rearranging food on the plate).
  • Regularly dodging mealtimes or food-related occasions with excuses.
  • Following a strict, unrelenting exercise routine—ignoring weather, exhaustion, sickness, or injury—to “erase” consumed calories.
  • Pulling away from typical social circles and hobbies.
  • Overall, showing signs through actions and mindset that weight loss, food restriction, and control are taking over as top priorities.

Potential outcomes and health issues

  • Slowed pulse and decreased blood pressure, signaling changes in the heart muscle. As these levels drop further, the chance of heart failure increases.
  • Digestive troubles, including constipation and bloating.
  • Hormonal disruptions, such as missed periods or shrinking of ovaries and testes.
  • Weakened immune system and anemia.
  • Loss of bone strength (osteoporosis), leading to fragile, brittle bones.
  • Muscle wasting and reduced strength.
  • Extreme dehydration, potentially causing kidney damage or failure.
  • Episodes of fainting, exhaustion, and general feebleness.
  • Dry, thinning hair and skin, with hair loss being frequent.
  • Appearance of a soft, fuzzy layer of hair known as lanugo across the body, including the face, as a means to retain warmth.
  • Deep feelings of depression.

Bulimia Nervosa 

Bulimia nervosa is a severe and potentially fatal eating disorder marked by a pattern of excessive eating followed by actions like self-induced vomiting to counteract or offset the bingeing.

 

Diagnostic Requirements:

Per the DSM-5 guidelines, a diagnosis of Bulimia Nervosa requires the following:

Repeated instances of binge eating, defined by:

  1. Consuming, within a specific timeframe (e.g., a 2-hour window), a quantity of food clearly greater than what most people would eat in similar conditions and time.
  2. A feeling of being unable to stop or manage what or how much is eaten during the episode.
  • Frequent use of unsuitable methods to avoid weight gain, such as self-triggered vomiting, overuse of laxatives, diuretics, or other drugs, fasting, or intense exercise.
  • Both the binge eating and these compensatory actions happening, on average, at least weekly for three months.
  • An excessive focus on body shape and weight in judging self-worth.
  • These behaviors not occurring solely during periods of Anorexia Nervosa.

 

Indicators to notice (Red flags)

 

  • Signs of binge eating, such as large quantities of food vanishing quickly or finding hidden food wrappers and containers hinting at secret eating.
  • Clues of purging, like frequent bathroom visits after meals, traces or odors of vomiting, or finding stashes of laxatives or diuretics.
  • Rigid, excessive exercise habits, persisting despite harsh weather, tiredness, sickness, or injury, driven by an urgent need to “erase” calories from bingeing.
  • Red, bloodshot eyes, often due to tiny blood vessel ruptures from repeated vomiting.
  • Puffiness around the cheeks or jawline.
  • Rough, callused skin on the backs of hands or knuckles from inducing vomiting.
  • Teeth showing discoloration or stains.
  • Structuring daily routines or habits to carve out time for binge-and-purge cycles.
  • Pulling away from regular social circles and interests.
  • Overall, actions and mindsets suggesting that weight loss, food restriction, and control are taking priority.
  • Noticeable changes in weight.

How bulimia might feel for you (Symptoms)

 

  • An irresistible urge to keep eating, regardless of hunger or fullness, until the binge ends—sometimes snapping out of it like emerging from a daze.
  • A sense of powerlessness during binge episodes, as if you’re unable to stop or choose otherwise until it runs its course.
  • Self-worth and confidence tied tightly to your body and struggles with body image, where every emotion boils down to feeling “fat.”
  • A total disconnect from emotions before a bulimic episode, followed by an intense flood of self-directed negativity—like shame, disgust, anger, and sadness—once it’s over.
  • A desperate drive to purge not just the food but the emotions tied to a binge, needing to expel everything until you feel completely empty inside and out.
  • Bulimia can turn into a hidden companion, always available when you seek it, offering a strange comfort and necessity—yet also leaving you isolated and alone with the struggle.

Potential Effects and Health Risks

 

Bulimia nervosa takes a heavy toll on the body. The cycle of bingeing and purging can throw the digestive system into chaos, while purging habits can cause imbalances in electrolytes and chemicals, impacting the heart and other vital organs. Some issues that may stem from bulimic patterns include:

  • Retinal displacement. The forceful pressure from vomiting often leads to bloodshot eyes as a common symptom, though it can also cause rarer, severe damage needing surgical repair.
  • Electrolyte disruptions, which may trigger irregular heart rhythms, potentially leading to heart failure or even death. These imbalances stem from dehydration and the loss of potassium and sodium through purging.
  • Swelling or even tearing of the esophagus due to repeated vomiting.
  • Tooth decay, enamel erosion, and discoloration from stomach acid brought up by frequent vomiting.
  • Persistent irregular bowel habits and constipation, worsened by laxative overuse.
  • Stomach rupture, though rare, can happen in extreme situations.

BINGE EATING DISORDER 

Binge Eating Disorder, though less frequent than simple overeating, is far more intense and troubling. It brings significant emotional strain tied to eating habits and often comes with additional mental health challenges.

 

Diagnostic Requirements

Per the DSM-5 guidelines, a diagnosis of Binge Eating Disorder requires:

  • Repeated bouts of binge eating, defined by both:
  1. Consuming, in a set timeframe (e.g., within a 2-hour span), a quantity of food well beyond what most would eat in similar conditions and time.
  2. A sense of losing control during the episode, feeling unable to halt or manage what or how much is eaten.
  • Binge eating episodes linked to three or more of these:
  1. Eating far faster than usual.
  2. Eating until uncomfortably stuffed.
  3. Consuming large amounts despite not being hungry.
  4. Eating on your own due to shame about the quantity consumed.
  5. Feeling self-disgust, depression, or intense guilt afterward.
  • Notable distress about the binge eating.
  • Bingeing happening, on average, at least weekly for three months.
  • Binge eating not tied to regular compensatory actions (like vomiting) seen in Bulimia Nervosa, nor occurring only during Bulimia Nervosa or Anorexia Nervosa.

How Binge Eating Disorder Might Feel (Symptoms)

  • An unstoppable urge to eat, ignoring hunger or fullness, until the binge ends—sometimes like snapping out of a dreamlike state.
  • A sensation of helplessness during binge episodes, as if continuing is inevitable until it stops on its own.
  • Self-worth and identity heavily tied to body image struggles, with emotions boiling down to feeling “fat.”
  • Unlike Bulimia or Anorexia, no efforts to offset the eating through actions like purging, restricting, or excessive exercise.
  • Stashing or hiding food for secret eating later.
  • A habit of eating at night.
  • Constant thoughts about food, eating, and the next binge, taking over as a central focus in your mind.

Potential Indicators of Binge Eating Disorder:

  • Signs of binge eating, such as large quantities of food vanishing quickly or discovering hidden wrappers and containers hinting at secret eating.
  • Feelings of guilt, shame, or frustration tied to eating patterns.
  • Structuring daily routines or habits to carve out time for binge episodes.
  • Drifting away from regular social circles and interests.
  • A general, urgent need to manage weight and eating, paired with a persistent sense that dieting is essential.
  • A feeling of powerlessness as weight climbs.
  • Health issues (e.g., diabetes, etc.).

Potential Effects and Health Risks

 

The unhealthy eating patterns typical of binge eating disorder can spark serious medical concerns. The primary complications often stem from obesity and include:

  • Diabetes
  • Elevated blood pressure
  • High cholesterol levels
  • Gallbladder issues
  • Heart conditions
  • Breathing difficulties
  • Specific cancers
  • Irregular menstruation
  • Reduced movement and chronic fatigue
  • Sleep disturbances, such as sleep apnea

Disordered Eating

Disordered Eating refers to a broad spectrum of irregular eating habits, many of which align with the signs used to identify eating disorders.

What sets an eating disorder apart from disordered eating, though, is the intensity and regularity of these actions. A person might occasionally binge, purge, use laxatives or diet pills, or skip meals, but not to the extent that it meets the threshold for a formal eating disorder diagnosis.

Such habits are fairly common and often emerge after a tough life event or sickness. For most, these patterns are temporary, and they eventually resume typical eating and behavior.

It’s crucial to spot—whether in yourself or someone else—when these disordered tendencies risk tipping into a full-fledged eating disorder. If they start affecting everyday life, relationships, or other behaviors, it’s wise to consult a GP or reach out to us for guidance.

 

As with most things, stepping in early is key to prevent these habits and thought patterns from taking root too firmly.

Your eating habits might not fit the criteria for a clinically recognized eating disorder, but you or those around you might still feel uneasy about certain unhealthy patterns related to food. It’s worth noting that these behaviors can sometimes signal the early stages of an eating disorder and deserve attention.

 

If any of the following resonate with you, please consider speaking to your GP:

 

  • A relentless focus on dieting, which might involve cutting back drastically, missing meals, fixating on calorie counts, or steering clear of specific food types. This could also include using laxatives, diet pills, or diuretics, and pushing exercise to extremes.
  • A fixation on “clean” or “healthy” eating—sometimes casually called “Orthorexia”—where someone avoids foods or entire categories deemed unhealthy. This might mean dropping fats or carbs, leaning heavily on supplements, protein powders, or trendy “health” foods.
  • Alongside Orthorexia, signs of other compulsive tendencies, like excessive or intense exercise.
  • Emotional overeating—turning to food based on mood rather than physical hunger.
  • Compulsive overeating—a milder version of what might feel like Binge Eating Disorder.
  • A struggle to keep a balanced connection with food, even when health issues or risks are present. This might, though not always, serve as a way to cope with emotions.

OFSED
Other Specified Feeding or Eating Disorder

Diagnostic Requirements

 

For a diagnosis of OSFED, a person must exhibit feeding or eating behaviors that cause notable distress and disrupt daily life, yet don’t fully align with the criteria for other specific feeding or eating disorders.

 

Examples of conditions that might fall under OSFED include:

 

  • Night Eating Syndrome – Frequent, troubling episodes of eating late at night or after waking during the night.
  • Pica – Ongoing consumption of non-food items like ice, sawdust, or cotton wool instead of typical meals, unrelated to cultural norms. This can appear during pregnancy (often stopping afterward) or alongside other mental health conditions.
  • Rumination Disorder – Habitual bringing up of food, which may be chewed again, swallowed, or spit out, not caused by a medical issue like a digestive problem, and sometimes linked to other mental health issues.
  • ARFID (Avoidant/Restrictive Food Intake Disorder) – Formerly called Selective Eating Disorder (SED), where food choices are restricted based on factors like look, taste, smell, or texture, possibly stemming from a past unpleasant encounter with that food.
  • Atypical versions of Anorexia Nervosa or Bulimia Nervosa – such as when these behaviors happen less often or when body mass index (BMI) stays within a normal range.

These disorders might stand alone as eating disorders or be part of a broader eating disorder picture. They can also overlap with other mental health issues. If you sense your specific struggle doesn’t neatly fit into a recognized category, it’s crucial to reach out to your GP as soon as possible. Highland Eating Disorder Services offers private counseling for OSFED, supporting you in restoring a balanced connection with food.

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