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.
Chapter 12 already named them in the teen years: anorexia nervosa, bulimia nervosa, binge-eating disorder — and asked for early intervention beside substance use and self-harm. Social comparison and body image sit in the same chapter. 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 you named: 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. That is Chapter 18, not a debate about willpower.
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 you named: 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 you named: CBT, interpersonal therapy, sometimes medicines.
26.5 ARFID and OSFED
Avoidant/Restrictive Food Intake Disorder (ARFID): limited food intake due to lack of interest, sensory issues, or fear of consequences. Not driven by body-image concerns. Can lead to malnutrition and weight loss. Common in children and on the autism spectrum. Treatment: nutritional support, exposure therapy, 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
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.
This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.