# 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](tel:1166).

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

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](https://manoatlas.com/data.md) 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.
Learn more

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

Video · 10 min[Eating & Body Dysmorphic Disorders (Crash Course #33)](https://www.youtube.com/watch?v=eMVyZ6Ax-74): AN, BN, BED and BDD in one animated pass.

Article**Sing Lee's Hong Kong studies (non-fat-phobic anorexia)**: Search "Sing Lee non-fat-phobic anorexia": the Asian presentation you will actually see.


---

*Source: https://manoatlas.com/eating · Licence: CC BY-NC-SA 4.0. Mano Atlas is an educational resource, not a diagnostic tool.*