There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder.
Obsessions with food, body weight, and shape may also signal an eating disorder.
The two specific diagnosis noted in the DSM-IV include anorexia nervosa, bulimia nervosa, and binge-eating disorder.
- Anorexia Nervosa
- Bulimia Nervosa
- Compulsive Overeating or Binge Eating Disorder
- Obesity (Overeating Associated with Other Psychological Disturbances)
- Psychogenic Vomiting
- Dramatic weight loss in a relatively short period of time.
- Wearing big or baggy clothes or dressing in layers to hide body shape and/or weight loss.
- Obsession with weight and complaining of weight problems ( even if “average” weight or thin).
- Obsession with continuous exercise.
- Frequent trips to the bathroom immediately following meals (some- times accompanied with water running in the bathroom for a long period of time to hide the sound of vomiting).
- Visible food restriction and self-starvation.
- Visible bingeing and/or purging.
- Use or hiding use of diet pills, laxatives, ipecac syrup ( can cause im- mediate death !) or enemas.
- Isolation. Fear of eating around and with others.
- Unusual food rituals such as shifting the food around on the plate to look eaten; cutting food into tiny pieces; making sure the fork avoids contact with the lips (using teeth to scrap food off the fork or spoon); chewing food and spitting it out, but not swallowing; dropping food into napkin on lap to later throw away.
- Obsession with calories and fat content of foods.
- Hiding food in strange places ( closets, cabinets, suitcases, under the bed) to avoid eating (Anorexia) or to eat at a later time (Bulimia).
- Flushing uneaten food down the toilet (can cause sewage problems).
- Vague or secretive eating patterns.
- Keeping a “food diary” or lists that consists of food and/or behaviours (i.e., purging, restricting, calories consumed, exercise, etc.)
- Preoccupied thoughts of food, weight and cooking.
- Visiting websites, which promote unhealthy ways to lose weight.
- Reading books about weight loss and eating disorders.
- Self-defeating statements after food consumption.
- Hair loss. Pale or “gray” appearance to the skin.
- Dizziness and headaches.
- Frequent soar throats and/ or swollen glands.
- Low self-esteem. Feeling worthless. Often putting themselves down · and complaining of being “too stupid” or “too fat” and saying they do not matter. Need for acceptance and approval from others.
- Complaints of often feeling cold.
- Low blood pressure.
- Loss of menstrual cycle.
- Constipation or incontinence.
- Bruised or calluses knuckles; bloodshot or bleeding in the eyes; light bruising under the eyes and on the cheeks.
- Perfectionist personality.
- Loss of sexual desire or promiscuous relations.
- Mood swings, depression, fatigue.
- Insomnia. Poor sleeping habits.
The two specific diagnosis noted in the DSM-IV include anorexia nervosa, bulimia nervosa, and binge-eating disorder.
1. Anorexia nervosa:
This Eating Disorder is characterized by refusal to maintain a minimally normal body weight.
Prominent clinical features:
It occurs much more often in females as compared to the males. The common age of onset is adolescence (13-19 years of age). 
There is an intense fear of becoming obese. This fear does not decrease even if body becomes very thin and underweight. 
There is often a body-image disturbance. The person is unable to perceive own body size accurately. 
New research indicates that for a percentage of sufferers, a genetic predisposition may play a role in a sensitivity to develop Anorexia, with environmental factors being the trigger. 
People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, and eat very small quantities of only certain foods. They may be afraid of losing control over the amount of food they eat, accompanied by the desire to control their emotions and reactions to their emotions. 
Anorexia nervosa has the highest mortality rate of any mental disorder. While many young women and men with this disorder die from complications associated with starvation, others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.
With a low self-esteem and need for acceptance they will turn to obsessive dieting and starvation as a way to control not only their weight, but their feelings and actions regarding; the emotions attached. 
Some also feel that they do not deserve pleasure out of life, and will deprive themselves of situations offering pleasure (including eating). 
Amenorrhoea, primary or secondary, is often present in females. Women with anorexia nervosa can present with poor sexual adjustment, with conﬂicts about being a woman and fear of pregnancy. 
Some of the behavioural signs can be: obsessive exercise, calorie and fat gram counting, starvation and restriction of food, self-induced vomiting, the use of diet pills, laxatives or diuretics to attempt controlling weight, and a persistent concern with body image. 
If untreated, the weight loss can become marked. Death may occur due to hypokalaemia (caused by self-induced vomiting), dehydration, malnutrition or congestive cardiac failure (caused by anaemia). 
- Extremely restricted eating
- Extreme thinness (emaciation)
- A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
- Intense fear of gaining weight.
- Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight.
2. Bulimia nervosa:
It is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. 
There is an intense fear of becoming obese. There may be an earlier history of anorexia nervosa.
It is usually body-image disturbance and the person is unable to perceive own body size accurately. 
There is a persistent preoccupation with eating, and an irresistible craving for food. There are episodes of overeating in which large amounts of food are consumed within short periods of time ( eating binges). 
This can be indirect relation to how they feel about themselves, or how they feel over a particular event or series of events in their lives. 
New research indicates that for a percentage of sufferers, a genetic predisposition may play a role in a sensitivity to develop Bulimia, with environmental factors being the trigger. 
Men and women suffering Bulimia are usually aware they have an eating disorder. 
Fascinated by food they sometimes buy magazines and cookbooks to read recipes, and enjoy discussing dieting issues. 
Some of the behavioural signs can be: Recurring episodes of rapid food consumption followed by tremendous guilt and purging (laxatives or self-induced vomiting), a feeling of lacking control over his or her eating behaviours, regularly engaging in stringent diet plans and exercise, the misuse of laxatives, diuretics, and/or diet pills and a persistent concern with body image can all be warning signs someone is suffering with Bulimia. 
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration from purging of fluids
- Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to stroke or heart attack.
3. Compulsive Overeating or Binge Eating disorder :
Binge-eating disorder is the most common eating disorder in the U.S. People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting.
As a result, people with binge-eating disorder often are overweight or obese. 
Additionally, there also may be eating of large amounts of food throughout the day with no planned meal times, eating alone because of being embarrassed, and/or feeling guilty and depressed after overeating. 
The disorder is not listed separately in ICD-10 and symptoms of binge eating are also seen in bulimia nervosa. 
Fear of not being able to control eating, and while eating, not being able to stop. 
Isolation. Fear of eating around and with others. 
Chronic dieting on a variety of popular diet plans. 
Holding the belief that life will be better if they can lose weight. 
- Eating unusually large amounts of food in a specific amount of time
- Eating until you are uncomfortably full.
- Feeling distressed, ashamed, or guilty about your eating.
- Frequently dieting, possibly without weight loss.
- Hiding food in strange places ( closets, cabinets, suitcases, under the bed) to eat at a later time. Vague or secretive eating patterns. 
- Self-defeating statements after food consumption. 
- Eating even when you’re full or not hungry.
- Eating fast during binge episodes.
- Blames failure in social and professional community on weight. 
- Holding the belief that food is their only friend. 
- Frequently out of breath after relatively light activities. 
- Excessive sweating and shortness of breath. 
- High blood pressure and/or cholesterol. 
- Eating alone or in secret to avoid embarrassment.
- Leg and joint pain. 
- Weight gain. 
- Decreased mobility due to weight gain. 
- Loss of sexual desire or promiscuous relations. 
- Mood swings, depression, fatigue. 
- Insomnia, poor sleeping habits. 
4. Obesity (Overeating Associated with Other Psychological Disturbances):
Obesity caused by a reaction to distressing events is included here. It caused by drugs or endocrinal factors, or due to constitutional factors is not considered a psychiatric disorder. 
5. Psychogenic Vomiting:
This is clinical syndrome in which biopsychosocial factors interact to produce symptoms which are often mistaken for upper gastrointestinal tract disease, anorexia nervosa, dissociative (conversion) disorder, somatization disorder, or malingering.
The characteristic clinical features include:
- Repeated vomiting, which typically occurs soon after a meal has begun or just after it has been completed.
- Vomiting often occurs in complete absence of nausea o rretching (Patients say that food just seems to come back up).
- Vomiting is often self-induced and can be suppressed, if necessary.
- Despite repeated vomiting, weight loss is not usually signiﬁcant.
- The course of illness is usually chronic with frequent remissions and relapses.
- Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life.
- These disorders affect both genders, although rates among women are 2½ times greater than among men.
- Like women who have eating disorders, men also have a distorted sense of body image.
- For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular.
- Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors.
- Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.
- Brain imaging studies are also providing a better understanding of eating disorders.
- For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women.
Treatment of anorexia nervosa:
It can be considered in two phases, which often merge into each other.
- Short-term treatment: to encourage weight gain and correct nutritional deﬁciencies, if any.
- Long-term treatment: aimed at maintaining the near normal weight achieved in short-term treatment and preventing relapses. 
1. Behaviour therapy (BT):
Behavioural treatments are based on providing positive reinforcements (and at times, negative reinforcements) contingent on weight gain by the patient.The weight gain should not exceed 1.5 to 2 kg in a fortnight. As patients are usually unable to eat a large meal, especially in the initial part of treatment, it is advisable to suggest more number of meals (about six) per day.
Occasionally, forceful Ryle’s tube feeding may be needed initially, in resistant patients. 
2. Individual psychotherapy:
It is often helpful in addition to supportive physical treatment. This could involve psychotherapy with a focus on cognitive behaviour therapy, psychodynamic principles or supportive measures. 
Hospitalisation with adequate nursing care for food intake and weight gain, can be helpful in short-term treatment as well as prevention and/ or treatment of complications. It is important to keep a close eye on water and electrolyte balance, need for supplementation with vitamins and minerals, and prevent osteoporosis. 
Chlorpromazine is rarely used these days. Olanzapine has efﬁcacy in improving weight gain but it is important to be aware of possibility of prolongation of QTc particularly in patients with low BMI.
(such as fluoxetine, clomipramine) for treatment of anorexia nervosa and/ or associated depression.
This is particularly helpful in inducing weight gain, decreasing depressive symptoms and increasing appetite, if anorexia is actually present. The usual dose is 8-32 mg/ day, in divided doses.
5. Group therapy and family therapy:
It can be helpful in psycho-education for the patient and carers/ family about nature of anorexia nervosa and its treatment. Psycho-education may also include discussion of current social norms of slimming and ﬁtness. 
Treatment of Bulimia Nervosa and Binge Eating disorder:
1. Behaviour therapy:
This is based on providing positive reinforcements (and at times negative reinforcements) contingent on the control of binge eating by the patient. 
2. Individual psychotherapy.
3. Antidepressant drugs:
They are an important adjunct to other modes of therapy.
A Selective serotonin uptake inhibitor (SSRI) such as Fluoxetine (in doses of 20-60 mg) is particularly useful as it can cause loss of appetite at least in the initial phase of treatment, along with its antidepressant effect.
The drugs used in the past have included tricyclic antidepressants such as imipramine, though they are currently not widely used. 
4. Group therapy and family therapy:
These methods are used for psycho-education of patient and carers/family about nature of bulimia nervosa and its treatment. 
Treatment of Obesity (Overeating Associated with Other Psychological Disturbances):
Treatment options depend on the underlying cause; for example, psychotherapy (for present or past psychological distress), antidepressants (for depression), advice from dietician, drug treatment, or even bariatric surgery. 
Treatment of psychogenic vomiting:
1. The ﬁrst and most important step is correct diagnosis and exclusion of other physical and/or psychiatric causes.
2. Identiﬁcation of psychosocial stressor.
3. Environmental manipulation and encouragement of coping strategies to deal with stress.
4. Psychotherapy of either cognitive behavioural or psychodynamic nature. 
Anorexia Remedies: 
Extreme fastidiousness especially about germs and dirt. Anorexia coupled with fear of being poisoned. Fear of getting certain diseases so they start starving.
Obsessive compulsive disorder. Perfectionism, fear of becoming fat, fear of rejection. Etiology-abuse, grief or fears, often related to weight. Chronic insomnia, workaholics.
Anorexia plus mania, insanity, fear of being poisoned. Could have pathological jealousy, over concern about weight and getting fat.
Perfectionism, fear of becoming fat, fear of rejection. Hysteria loss of control of emotions, fainting. Etiology-grief or big disappointment, often related to weight.
Most often indicated remedy in anorexia, a lot of guilt. Fear of being rejected, hurt easily, very self-conscious. Dry lips, emaciate, and dry skin, constipated, lose appetite. Behind this is perfectionism and fear of becoming fat. Nat mur have more confidence.
Etiology-grief with loss of appetite with emaciation, pining away from loss of love, second stage they get indifferent to all emotions and food. Deadness inside (Sepia, Aurum met). Grief anorexia than some chronic disease.
Obsessed with their appearance, fear of becoming fat. Very obsessive and impulsive personality, egocentric and arrogant, all tied up with their sexuality, religious mania.
Feeling of worthlessness, unloved, loneliness, fixed ideas about. Food especially certain foods are bad, than amount of foods that are bad grows, fear of gaining weight, pulsatilla gain weight easily, they can eat a pastry and swear they gained weight. Ignatia, Puls. and Nat. mur. Are constantly weighing themselves. Scanty menses.
Anorexia plus hormonal problems, nausea, sensitivity to smell. Disgust for food, worse since childbirth, hormones causes lack of appetite.
Acute of Carcinosin, more visible, visibly upset. Carcinosin can control it more, Staph. may it more. Deep sense of worthlessness and depression, even suicidal. Humiliation, mortified, put down, criticized, zero confidence. Fear of becoming fat and neglected by others.
Fear of being impure, dirty blood, anxiety about health, obsessed with idea of have to clean them out. Fear of eating more and becoming fat.
Religious mania, loquacious, end of world is coming. Punish themselves, fast to appease god. Behind this you see guilt. 
Bulimia Remedies: 
Binging especially with chocolate, fixed ideas, impulsive behaviour, anticipation, overriding impulses for certain foods, chocolate, salty foods, they will eat a whole box of chocolates until they get sick.
Obsessive compulsive disorder. Perfectionism, fear of becoming fat, fear of rejection. Etiology-abuse, grief or fears, often related to weight.
Perfectionism, fear of becoming fat, fear of rejection. Hysteria-loss of control of emotions, fainting. Etiology-grief or big disappointment, often related to weight.
Ups and down in the person’s energy, very outgoing for 2 or 3 days than wiped out for several days and with that their diets fluctuate from good to binging. Bulimia also with alcohol and drugs.
Often indicated remedy in anorexia, a lot of guilt. Fear of being rejected, hurt easily. Very self-conscious of their weight.
Fear of being abandoned and unloved. Fixed ideas about food, their weight, they gain and lose weight easily, eat and binge to console themselves, binges out of loneliness, or depression, then they get guilt and fear about it and then suppress it.
Binging out of guilt, depression. Poor self-confidence and worthlessness. It is out of self-denial, they do not deserve that -lemon meringue pie so they suppress their desire for it, and then binge on it.