Section 13about 5 min · no rush

A gentle note before you read: symptom lists make almost everyone recognise themselves somewhere. That is a normal effect of reading, not a diagnosis. If something here sits on your mind, a conversation with a professional helps more than re-reading.

13

Feeding & eating disorders

Anorexia nervosa has one of the highest mortality rates of any mental disorder: around 5% per decade. Never manage it alone; refer medically early.

Fainting, chest pain, a very slow heartbeat, or not keeping food or water down is a medical emergency: go to a hospital today. For low mood or thoughts of self-harm, call 1166.

Significantly low body weight? restriction · fear of gain · body-image disturbance YES NO ANOREXIA NERVOSA even if she binges or purges: low weight wins (binge/purge subtype) Recurrent binges (≥1/wk, 3 mo)? large amount + loss of control + compensation no compensation BULIMIA NERVOSA vomiting · laxatives · fasting · exercise; weight normal or high BINGE-EATING DISORDER distress + 3 of 5 markers; no regular compensation
The three-question sorting of the big eating disorders. Low weight takes priority once the anorexia criteria (fear of gaining, disturbed body experience) are met: a person of significantly low weight who binges and purges has anorexia (binge/purge subtype), not bulimia.

The criteria in brief; AN · BN · BED

Beyond curriculumF50.0x · F50.2 · F50.81
Anorexia Nervosa
  1. Restriction of energy intake leading to significantly low body weight for age, sex, development, and health.
  2. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even at low weight.
  3. Disturbance in how weight or shape is experienced, undue influence of weight/shape on self-evaluation, or persistent lack of recognition of the seriousness of the low weight.

Subtypes:

  • Restricting
  • Binge-eating/purging

Severity by BMI.

Medical red flags:

  • Bradycardia
  • Lanugo
  • QTc prolongation
  • Bone loss
Bulimia Nervosa
  1. Recurrent binge episodes: eating, in a discrete period, an amount definitely larger than most people would, with a sense of loss of control.
  2. Recurrent inappropriate compensatory behaviour: self-induced vomiting, laxatives/diuretics, fasting, excessive exercise.
  3. Both at least once a week for 3 months.
  4. Self-evaluation unduly influenced by shape and weight.
  5. Not exclusively during episodes of anorexia nervosa.

Purging dangers:

  • Hypokalaemia (arrhythmia)
  • Metabolic alkalosis
  • Dental erosion
  • Russell's sign (knuckle calluses)
Binge-Eating Disorder
  1. Recurrent binge episodes (as in bulimia).
  2. ≥3 of 5: eating much more rapidly than normal · until uncomfortably full · large amounts when not hungry · alone out of embarrassment · disgust, depression, or guilt afterward.
  3. Marked distress about the bingeing.
  4. At least once a week for 3 months.
  5. No regular compensatory behaviour; not exclusively during bulimia or anorexia.

Also in this chapter:

  • ARFID (avoidant/restrictive intake without body-image disturbance)
  • Pica (eating non-food substances ≥1 month, developmentally inappropriate, not culturally supported)
  • Rumination disorder (repeated regurgitation)
International

Long framed as a Western thin-ideal illness, but Hong Kong research (Sing Lee) described non-fat-phobic anorexia: restriction explained as stomach bloating or loss of appetite, no expressed fat fear, which DSM-5's Criterion B accommodates via "persistent behaviour that interferes with weight gain". Eating disorders are rising fastest in Asia's urbanising economies.

Nepal

No national prevalence figure exists. Expect the non-fat-phobic presentation; distinguish disorder from poverty-driven undernutrition and from religious fasting (bartha): DSM-5 excludes culturally sanctioned practice. Urban private-school girls and gym-going young men (muscle-focused restriction, supplements) are the visible emerging groups. Weight loss + amenorrhoea in a young woman deserves an eating-disorder question before a TB work-up ends the conversation. See Nepal in numbers for what the survey did measure.

A skill to try · two minutes

A self-compassion pause. One hand over the heart. Three quiet lines: "This is a hard moment. Hard moments are part of being human. May I be kind to myself in this one." Body-focused meditation can backfire here, so the kindness goes to the person, not the mirror.

A coping skill, not a treatment: it supports care, it does not replace it.

Key points
  1. Anorexia is restriction with fear of weight gain; bulimia is bingeing and purging at normal weight; binge eating is bingeing without purging.
  2. These are medical as much as mental conditions; slow heartbeat, fainting and fasting need a doctor early.
  3. In Nepal, separate disorder from poverty and religious fasting, and watch private-school girls and gym-going young men.
Quick check

Three friendly questions to settle what you just read. This is reassurance, not a test: a wrong tap is part of learning, and you can try again.

Significantly low weight + bingeing and purging =

Frequency criterion for bulimia and BED:

In Nepal and much of Asia, anorexia often presents:

Learn more

Pick one, not all: these are chosen to be light, not exhaustive.

Video · 10 minEating & Body Dysmorphic Disorders (Crash Course #33): AN, BN, BED and BDD in one animated pass.
ArticleSing Lee's Hong Kong studies (non-fat-phobic anorexia): Search "Sing Lee non-fat-phobic anorexia": the Asian presentation you will actually see.

That is plenty for one sitting. Whatever brought you here, reading about the mind with care is itself an act of care.