Content warning: Please be aware that this article contains discussions relating to eating disorders and self-harm that some people may find distressing or triggering.
What is an Eating Disorder?
Eating disorders are complex mental illnesses, influenced by a range of factors. An eating disorder is an illness marked by irregular eating habits, distress about eating and an obsession with body weight (Rittenhouse 2024; Eating Disorders Victoria 2024a).
It’s commonly observed that eating disorders are a combination of biological, psychological, environmental and socio-cultural factors (Rittenhouse 2024).
Eating disorders create both considerable psychological impairments and stress, and wide-ranging medical complications (NEDC 2021).
Eating disorders are very serious, have severe health complications and can even be fatal (NIMH 2024).
While eating disorders are particularly common among young women, people of any age, gender, or economic or cultural background can develop an eating disorder (NEDC 2023).
The Prevalence of Eating Disorders in Australia
It’s estimated that 4.5% of Australians are currently living with an eating disorder (Butterfly 2024a).
Furthermore, almost one-third of Australian adolescents (31.6%) are estimated to engage in behaviours of disordered eating (that do not meet the criteria for an eating disorder) (NEDC 2021).
Anorexia nervosa has the highest mortality rate of any psychiatric illness (Edakubo & Fushimi 2020).
Types of Eating Disorders
The following are the most common eating disorders, recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR):
Anorexia Nervosa
Anorexia nervosa is a disease characterised by having an obsessive fear of gaining weight, restricting food and water intake, and disturbance in self-perceived weight or body shape (Rittenhouse 2024).
Types of Anorexia Nervosa
There are two recognised subtypes of anorexia nervosa:
Restricting type: Where a person severely restricts their food intake. This restriction can take several forms (e.g. obsessive and rigid eating rules, skipping meals, counting calories).
Binge-eating/purging type: Where a person restricts their food intake but also engages in binge-eating or purging behaviours.
(Butterfly 2021a; Eating Disorders Victoria 2024b)
Signs of Anorexia Nervosa
Severely restricting food intake
Change in food preferences
Emaciation (extreme thinness)
Decreased performance at school or work
Distorted body image
Depression
Anxiety
Rigid ‘black and white’ thinking about foods (e.g. good or bad foods)
Making excuses not to eat or avoiding social situations involving food
Mood swings
Self-harm or suicide attempts
Fear of being overweight even when severely underweight
Lethargy.
(Rittenhouse 2024; Butterfly 2021a; NIMH 2024; Eating Disorders Victoria 2024b)
Potential Complications of Anorexia Nervosa
Brain damage
Multi-organ failure
Loss of bone calcium
Anaemia
Depression
Anxiety
Lethargy
Heart difficulties
Fainting and/or dizziness
Infertility
Secretive eating and/or exercise behaviours
Disturbance of menstrual periods
Loss of libido
Compromised immune system
Intestinal problems and/or abdominal pain
(Rittenhouse 2024; Butterfly 2021a; Eating Disorders Victoria 2024b)
Bulimia Nervosa
Bulimia nervosa is an illness associated with binge eating followed by behaviours to compensate for overeating, such as forced vomiting, excessive exercise or using laxatives or diuretics (Butterfly 2021b).
Signs of Bulimia Nervosa
Self-induced vomiting
Frequent trips to the bathroom, particularly after eating
Fluctuations in weight
Mood swings
Depression
Anxiety
Food avoidance and/or dieting behaviour
Laxative misuse
Self-harm or suicide attempts
Fasting
Excessive exercise
Secretive eating and/or exercise behaviours
Use of drugs, illicit, prescription and/or over the counter inappropriately for weight control
(Rittenhouse 2024; NEDC 2021; Butterfly 2021b; APA 2023)
Potential Complications of Bulimia Nervosa
Chronic sore throat, indigestion, heartburn and reflux
Inflammation/rupture of oesophagus
Stomach/intestinal ulcers
Stomach rupture
Irregular or slowed heartbeat and cardiac arrest
Loss of libido
Depression
Lethargy
Anxiety
Gum disease and/or tooth decay
Bowel issues
Severe dehydration
Osteoporosis
Disturbance of menstrual periods
Increased risk of infertility in men and women.
(Butterfly 2021b; APA 2023; Eating Disorders Victoria 2024c)
Binge Eating Disorder
A person with binge eating disorder will eat large amounts of food in a short time frame. They may feel that their eating is out of control. People with binge eating disorder do not engage in compensatory behaviours after binge eating (Butterfly 2024b).
Signs of Binge Eating Disorder
A preoccupation with eating, food, body shape and weight
Low self-esteem
Irritability
Erratic behaviour
Repeated episodes of binge eating
An apparent loss of control when eating
Eating rapidly
Difficulty sleeping
Increased isolation
Feeling bloated, constipated and/or developing intolerances to food
Anxiety
Depression
Self-harm or suicide attempts
Expressing shame or guilt about eating
Secretive eating behaviours
Increased sensitivity to questions about food.
(SANE 2017; Butterfly 2024b; Eating Disorders Victoria 2022d)
Potential Complications of Binge Eating Disorder
Osteoarthritis
Obesity
Cardiac arrest
Anxiety
Depression
Lethargy
Loss of libido
Cardiovascular disease
Hypertension
Disturbance of menstrual periods
Chronic kidney problems or kidney failure.
(Butterfly 2021c; Eating Disorders Victoria 2024d; APA 2023)
Avoidant Restrictive Food Intake Disorder (ARFID)
Avoidant restrictive food intake disorder (ARFID) is a newly defined eating disorder characterised by a disturbance in eating habits, which results in a persistent failure to meet nutritional needs (APA 2023; Eating Disorders Victoria 2024e).
This avoidant behaviour is not related to body image. Instead, people with ARFID may display disturbed eating patterns due to factors such as:
Fear of eating-related consequences such as choking or food poisoning
Phobia of certain foods or the act of eating
Sensory sensitivity to certain textures, smells etc.
Lack of interest in eating (e.g. forgetting to eat, not feeling hungry).
(Eating Disorders Victoria 2024e; APA 2023)
Signs of Avoidant Restrictive Food Intake Disorder
Fear of eating and drinking-related consequences
Being a ‘picky eater’ or seeming fearful of certain foods
No signs of anxiety related to body image
Avoiding situations where food may be served
Becoming distressed if preferred foods are unavailable
Anxiety about food and eating
Sensory sensitivity
Feeling prematurely full while eating
Low appetite
Lack of interest in food or eating
Skipping meals or not eating enough
Not engaging in weight control behaviours
Forgetting to eat
Requiring nutritional supplements
Malnutrition.
(Eating Disorders Victoria 2024e; APA 2023)
Potential Complications of Avoidant Restrictive Food Intake Disorder
Headaches
Dry skin
Brittle nails
Hair loss and/or thinning
Bruising easily
Yellow complexion
Thin white hair (lanugo) growing on the body
Sensitivity to cold
Poor circulation
Hypotension
Dehydration
Kidney failure
Muscle loss
Loss of bone calcium
Anaemia
Depression
Anxiety
Lethargy
Heart difficulties
Fainting and/or dizziness
Infertility
Disturbance of menstrual periods
Loss of libido
Intestinal problems and/or abdominal pain.
(Eating Disorders Victoria 2024e)
Other Specified Feeding and Eating Disorder (OSFED)
People with this disorder may display characteristics of other eating disorders but do not meet the full criteria for diagnosis of one or more of these disorders (SANE 2017).
Eating Disorder Recovery
Recovering from an eating disorder can be a long and challenging process, but it is possible, even if the person has been living with the condition long-term (NEDC 2021).
Treatment options include:
Psychotherapy
Cognitive behaviour therapy
Attending a clinic for eating disorders
Seeing a dietitian and receiving nutritional counselling
Medications (such as antidepressants).
(Butterfly 2022; APA 2023; Eating Disorders Victoria 2022f)
A nine-year-old boy is a ‘picky-eater’ who refuses to eat many types of food. He is not concerned about his body weight or shape, but his refusal to eat a wide variety of foods is causing him to lose weight and become malnourished. What is the most likely diagnosis?
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