Eating Disorders I work With

Anorexia nervosa can lead individuals to significantly restrict the amount they eat or drink. People may also develop rigid rules around food, such as what they can eat, when they can eat, or where eating is “allowed.” Anorexia can affect anyone, regardless of age, gender, ethnicity, or background. Although it is often associated with low body weight, people can be very unwell at any weight. Some individuals experience the same symptoms without being underweight; this is known as atypical anorexia, which is a related diagnosis. It is important to remember that a person’s appearance or weight does not reflect how unwell they may be.

There are two main subtypes of anorexia nervosa:

• Restricting subtype (AN-R): This involves severe restriction of food intake and type of food consumed. Behaviours may include skipping meals, calorie counting, and following strict food rules.
• Binge–purge subtype (AN-BP): This also involves restriction, but may include periods of binge eating (eating large amounts of food with a sense of loss of control), followed by behaviours such as excessive exercise, self-induced vomiting, or misuse of laxatives in an attempt to compensate for eating.

AN-BP can sometimes be confused with bulimia nervosa. The key difference is that in anorexia nervosa (including the binge–purge subtype), there is ongoing restriction of intake and individuals are often underweight, whereas in bulimia nervosa, weight is typically within or above the expected range. Both conditions are serious and require appropriate support and care.

Bulimia Nervosa can affect people of any age, gender, ethnicity, or background. It is characterised by a repeated cycle of bingeing—eating large amounts of food in a short period—and then compensating for this through behaviours such as vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise, known as purging. Early intervention offers the best chance of achieving a quick and lasting recovery.

Occasionally eating more than usual or “overindulging” is a normal behaviour and does not indicate an eating disorder. This is different from a binge eating episode. Binge eating is often driven by emotional distress, with individuals feeling compelled to eat in response to feelings such as stress, anger, or sadness. During a binge, a person may feel a loss of control over what or how quickly they are eating, and some describe feeling detached from the experience. The foods consumed may include items they would normally avoid.

These episodes are often highly distressing and can leave individuals feeling stuck in a cycle of bingeing and purging. People with bulimia may place a strong emphasis on body weight and shape and may perceive themselves as larger than they are in reality.

The binge–purge cycles commonly seen in bulimia can take over a person’s daily routine and make relationships and social situations increasingly difficult. The condition can also lead to significant physical health complications. Frequent vomiting may damage the teeth, and individuals may engage in behaviours to induce vomiting that can be harmful. Misuse of laxatives can have serious effects on both the heart and digestive system. People with bulimia may also experience a range of physical symptoms, including fatigue, bloating, constipation, abdominal pain, irregular menstrual cycles, and swelling in the hands or feet.

Because individuals often remain a “normal” weight and may go to great lengths to conceal their difficulties, bulimia nervosa can be very hard to identify from the outside. In addition, people affected are often hesitant to seek support. As with other eating disorders, those close to the person may notice changes in mood and emotional wellbeing before any physical signs become apparent. There may also be increased secrecy around food, preoccupation with eating, and discomfort or self-consciousness when eating in front of others. Low self-esteem, irritability, mood swings, and feelings of guilt, shame, and anxiety, particularly following binge episodes are also commonly experienced.

The binge–purge cycles associated with bulimia nervosa can take over everyday life and create significant difficulties in relationships and social situations. Bulimia nervosa can also lead to serious physical health complications. Frequent vomiting may damage teeth, and individuals may engage in harmful behaviours in attempts to purge. Misuse of laxatives can have a serious impact on both the heart and digestive system. People with bulimia may also experience a range of physical symptoms, including fatigue, bloating, constipation, abdominal pain, irregular menstrual cycles, and swelling in the hands or feet. However, because individuals are often a “normal” weight and may go to great lengths to conceal their difficulties, bulimia can be very hard to detect from the outside. People experiencing bulimia are also often reluctant to seek help. As with other eating disorders, those close to the person may notice changes in mood and emotional wellbeing before any physical signs become apparent. They may become preoccupied with food, eat in secret, or feel anxious and self-conscious about eating in front of others. Low self-esteem, irritability, mood swings, and feelings of guilt, shame, and anxiety, particularly following a binge, are also commonly experienced.

Binge Eating Disorder (BED) is a condition where individuals consume very large amounts of food while feeling a loss of control over their eating. It can affect people of any age, gender, ethnicity, or background, and research suggests it is more common than other eating disorders. People with BED experience episodes of eating a large quantity of food within a short period of time, known as binge eating. Unlike bulimia nervosa, these episodes are not followed by compensatory behaviours such as vomiting, although some individuals may restrict their intake or fast between binges.

BED is not simply about eating large portions or “overindulging.” Instead, binge episodes are typically very distressing and involve eating far more than the person intended or feels comfortable with. Many people find they are unable to stop once a binge has started, even if they want to. Some also describe feeling detached during the episode or having difficulty recalling what they have eaten afterwards.

A binge eating episode is typically characterised by eating much more quickly than usual, eating until uncomfortably full, consuming large amounts of food when not physically hungry, eating in secret due to embarrassment, and experiencing feelings of guilt, shame or disgust during or after the episode. A diagnosis of binge eating disorder is usually considered when someone experiences at least one of these distressing episodes per week over a period of three months or more. Binge episodes may be planned in advance, almost like a ritual, with individuals purchasing specific “binge foods,” or they may happen more spontaneously. Some people may go to great lengths to obtain food, including eating discarded food or food that does not belong to them. Although binges often occur in private, individuals may still eat regular meals at other times. It is also common for people to alternate binge eating with restrictive eating patterns or rigid food rules, which can increase hunger and feelings of deprivation and, in turn, trigger further binge episodes. This cycle is often reinforced by intense feelings of guilt and disgust following binges.

There are many different triggers that can lead to binge eating. These may include difficult or overwhelming emotions such as feeling low, anxious, angry, bored or upset. In some cases, binge eating can also occur during positive emotional states, such as excitement or happiness. Episodes may also become habitual or planned rather than impulsive, for example as a way of numbing emotions, coping with distress, or taking advantage of being alone with access to food. For some individuals, the reasons for binge eating may feel unclear or hard to identify.

Anorexia, bulimia, and binge eating disorder are diagnosed based on a set of expected behavioural, and physical symptoms. However, some individuals do not fully meet the criteria for any one of these specific diagnoses. In these cases, they may be diagnosed with “other specified feeding or eating disorder” (OSFED).

OSFED is very common and represents the largest proportion of eating disorder diagnoses. It can affect people of any age, gender, ethnicity, or background. It is just as serious as anorexia, bulimia, or binge eating disorder, and can sometimes develop from one diagnosis or progress into another. Individuals with OSFED require and deserve the same level of care and treatment as anyone else with an eating disorder, as the symptoms can be highly distressing and significantly impact many areas of life.

Because OSFED is an umbrella term, experiences can vary widely between individuals. It is also used when someone presents with significant eating disorder symptoms but does not meet the full criteria for another specific diagnosis.

Examples of OSFED include:

• Atypical anorexia: where all the features of anorexia are present, except that the person’s weight remains within or above the “normal” range.
• Bulimia nervosa (low frequency and/or limited duration): where the symptoms of bulimia are present, but bingeing and purging occur less often or over a shorter period than required for diagnosis.
• Binge eating disorder (low frequency and/or limited duration): where binge eating behaviours are present but occur less frequently or for a shorter duration than diagnostic criteria require.
• Purging disorder: where purging behaviours (such as self-induced vomiting or laxative use) are used to influence weight or shape, but without accompanying binge eating episodes.
• Night eating syndrome: where a person repeatedly eats during the night, either after waking from sleep or by consuming a large amount of food after the evening meal.

Like all eating disorders, OSFED is a mental health condition that goes beyond difficulties with food. It is often linked to underlying emotional distress, difficult thoughts, or a need for control, with eating behaviours sometimes serving as a coping mechanism.

People with OSFED may go to great lengths to conceal their difficulties, and it is common for the condition to be present for some time before any physical signs become noticeable. Symptoms can mirror those seen in anorexia, bulimia, or binge eating disorder, carrying the same short- and long-term health risks. As with other eating disorders, changes in behaviour, emotions, and attitudes are often noticed before any physical changes become apparent.

Avoidant/Restrictive Food Intake Disorder, commonly referred to as ARFID, is a condition where a person avoids certain foods or food groups, eats a very limited range of foods, or restricts the amount they eat, or a combination of these behaviours. ARFID can affect people of any age and is seen in children, teenagers, and adults. While some individuals may experience weight loss or have a low body weight, this is not a defining requirement of the condition. ARFID can occur in people of any weight and varies widely from person to person. People may avoid or restrict their food intake for a variety of reasons. These are often grouped into three main patterns, sometimes referred to as subtypes of ARFID:

Some individuals are highly sensitive to specific sensory aspects of food, such as taste, texture, smell, appearance, or even temperature. This sensitivity can make certain foods feel overwhelming or intolerable, leading to selective eating or avoidance based on sensory characteristics. Others may develop fears around eating following a distressing experience, such as choking, vomiting, or severe abdominal pain. This can result in anxiety and worry linked to food or eating, causing them to avoid particular foods or textures. In some cases, the fear is more general and difficult to describe, but still leads to eating only what feels “safe.” This type of restriction is driven by concern about potential negative consequences of eating.

A third group may have a limited awareness of hunger cues or a consistently low appetite. For these individuals, eating may feel like a chore rather than an enjoyable activity, making it difficult to eat enough. This can result in reduced intake due to low interest in food. It is important to recognise that these reasons are not mutually exclusive. A person may experience one, two, or all three of these patterns at the same time, and in some cases there may be no clear identifiable trigger. As a result, ARFID can present very differently from one person to another, which is why it is often described as an “umbrella” term covering a range of eating difficulties. Despite this variation, the core feature is consistent: avoidance or restriction of food intake, whether in amount, variety, or both.

ARFID can occur on its own or alongside other conditions, particularly anxiety disorders, autism, ADHD, and various medical conditions. For some people, these eating difficulties begin in early childhood and persist over many years, while for others they may develop later in life. ARFID would not be diagnosed when food avoidance is due solely to religious or cultural practices, lack of access to food, or avoidance linked exclusively to allergies. It would also not be diagnosed when another clear medical condition explains the eating difficulties, such as one that directly affects appetite or digestion.

ARFID can have a significant impact on both physical health and psychological wellbeing. In children and young people, it may lead to poor weight gain and can interfere with normal development, including slowed growth in height. When a person’s diet is restricted to a very small range of foods, they may not obtain the essential nutrients needed for healthy growth, daily functioning, and overall wellbeing. In more severe cases, this can result in notable weight loss or nutritional deficiencies that require medical intervention. Where food intake is very limited, nutritional supplements may be recommended, and in more serious situations, tube feeding may be necessary to reduce physical risk.

A restricted diet can also have a wide-ranging impact on everyday life, affecting experiences at home, school or college, work, and in social settings. It may also influence mood and overall day-to-day functioning. Many people with ARFID find it challenging to eat away from home, travel, or go on holiday, and social situations involving food can feel particularly difficult or overwhelming. These challenges can also affect relationships, as sharing meals often plays an important role in social connection and building relationships with others.