Eating disorders — not about food alone
Eating disorders (EDs) are serious mental illnesses centred on eating behaviours, weight, and shape — with profound physical consequences.
~1.25 million UK — rising — all genders, ages, ethnicities — peak adolescence but adult onset common.
Main diagnoses
Anorexia nervosa
- energy restriction → low weight
- intense weight fear
- body image distortion
- restricting or binge-purge subtype
Highest psychiatric mortality — starvation, suicide
Bulimia nervosa
- recurrent binges
- compensatory vomiting/laxatives/exercise
- weight often normal — hidden
Binge eating disorder (BED)
- recurrent binges without regular compensation
- distress, no anorexia-level restriction
OSFED
Other specified — atypical but severe — equally treatable
Warning signs
Behavioural:
- skipping meals, rituals
- food rules, calorie counting obsession
- bathroom after meals (vomiting)
- laxative/diuretic use
- social withdrawal around food
- excessive exercise — despite injury
Physical:
- weight loss or failure to grow (teens)
- dizziness, syncope
- cold hands, lanugo
- amenorrhoea
- ** dental erosion**, parotid swelling (bulimia)
Medical risks
| Mechanism | Complication |
|---|---|
| Starvation | Bradycardia, hypotension, osteoporosis |
| Vomiting/laxatives | Hypokalaemia → arrhythmia, ** sudden death** |
| Refeeding | Refeeding syndrome — phosphate drop — supervised renourishment |
ECG, U&Es, ** phosphate**, glucose — mandatory assessment
Treatment
Tier 4 inpatient — medically unstable — MARSIPAN guidelines
Outpatient specialist ED service:
- medical monitoring
- dietitian — structured meal plans
- CBT-E — transdiagnostic evidence-based
- FBT/Maudsley — adolescent anorexia — family empowers refeeding
Medication:
- SSRIs — bulimia, BED — limited anorexia evidence
- not weight loss drugs
Myths
“Just eat” — not willpower failure — complex biopsychosocial
“Only thin people” — atypical anorexia — restrictive at normal weight — equally serious
“Vanity” — genetic + psychological vulnerability
Getting help
Beat helpline — youthline
GP — referral — don’t delay for lower weight
Confidentiality — young people — GP navigates with safety
Common questions about eating disorders
- What are the signs of anorexia nervosa?
- Severe food restriction, low body weight or failure to gain expected weight in adolescents, intense fear of gaining weight, distorted body image, missing periods in women, excessive exercise, hiding food. Physical signs — dizziness, cold intolerance, fine body hair (lanugo), slow heart rate.
- What is bulimia nervosa?
- Recurrent binge eating — large amounts with sense of loss of control — followed by compensatory behaviours — self-induced vomiting, laxative misuse, fasting, or over-exercise. Weight may be normal — hidden condition common. Russell sign — knuckle calluses from vomiting.
- How are eating disorders treated on the NHS?
- Specialist eating disorder teams — medical monitoring, dietetic support, CBT-E (enhanced CBT for eating disorders), family-based treatment for adolescents with anorexia, guided self-help for binge eating disorder. Hospital or day patient admission if medically unstable — very low weight, abnormal bloods, suicide risk.
- Can you recover from an eating disorder?
- Yes — full recovery possible though takes time — relapses can occur during stress. Early specialist treatment improves prognosis. Anorexia recovery often 1 to 5+ years — patience and multidisciplinary support essential.
- What physical complications can eating disorders cause?
- Heart arrhythmias and sudden death (electrolytes from vomiting), osteoporosis, fertility problems, dental erosion (bulimia), refeeding syndrome if renourishment too fast in severe malnutrition — requires medical supervision.
Sources
How we reviewed this page
Medically reviewed by Dr Neil Singh, MBChB, nMRCGP
General Practitioner · GMC 7039648
Dr Neil Singh is a General Practitioner based in Yorkshire with over a decade of experience working in UK primary care.
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