Eating disorders: recognising the signs and pointing to care

Meals skipped in secret, daily weighing, binges in front of the fridge, guilt after every bite: eating disorders (ED) affect hundreds of thousands of people, mostly young women, and they kill. Anorexia nervosa has the highest mortality of any psychiatric condition. These are neither whims nor diets gone wrong: they are psychiatric illnesses with identified mechanisms, which can be recognised and treated.

Eating disorders: psychiatric illnesses, not choices

The core of an ED is not food: it is the relationship to food, turned into the instrument of a failing emotional regulation. Restriction, the binge, purging are strategies for managing anxiety, shame, the feeling of control, which have rigidified into pathology.

The terrain is multifactorial: genetic vulnerability (the heritability of anorexia is comparable to that of depression), personality traits (perfectionism, anxiety, alexithymia), sociocultural factors (the thinness ideal, the cult of ‘clean eating’), and often a trigger: a diet, a remark, a period of stress.

Anorexia, bulimia, BED, orthorexia: the map

Anorexia nervosa: severe restriction, intense fear of gaining weight, denial of thinness, distorted body image. Malnutrition sets in with its consequences: amenorrhoea, bradycardia, early osteoporosis, measurable brain volume loss on MRI.

Bulimia nervosa: episodes of rapid ingestion of large quantities, followed by compensatory behaviours (vomiting, fasting, exercise, laxatives). Weight is often normal, which makes it invisible.

Binge eating disorder (BED): the same binges, without compensation. The most common disorder, associated with overweight and shame.

Orthorexia: the obsession with ‘eating well’, which progressively excludes whole food families in the name of purity. Not recognised as an official entity but clinically real, often a gateway to anorexia.

ARFID: restriction through fear (choking) or sensory disgust, without weight concern; to be distinguished from the selectivity of autism spectrum disorder with which it partially overlaps.

The SCOFF: screening in five questions

The SCOFF questionnaire is the validated screening tool in primary care:

1. Do you make yourself Sick because you feel uncomfortably full?
2. Do you worry you have lost Control over how much you eat?
3. Have you recently lost more than One stone (about 6 kg) in three months?
4. Do you believe yourself to be Fat when others say you are too thin?
5. Would you say that Food dominates your life?

Two positive answers signal a suspicion worth a specialist opinion. The SCOFF does not diagnose: it opens the door of the consultation.

The TCM reading: Blood Deficiency, Heart Fire, the thought that injures the Spleen

TCM reads eating disorders in the language of terrain, without psychologising but without ignoring the psyche: emotions are movements of Qi.

Obsessive thought injures the Spleen: in Chinese thought, rumination (思, the thought that loops) is the function that wears down the Spleen, the organ of transformation. The ED is the extreme picture of thought attacking digestion: the food obsession disorganises the organ of feeding.

Blood Deficiency: prolonged restriction produces a documented Blood Deficiency: amenorrhoea (Blood no longer fills the Chong Mai), dull complexion, insomnia, anxiety, brittle nails. Anorexia is the physiological demonstration that Blood is nourished by food.

Heart Fire and Stagnation: bulimia with agitation and impulsivity belongs to Heart Fire flaring; obsessive restriction with rigid perfectionism is a hardened Qi stagnation, where Liver Qi no longer circulates.

Pointing to care without stigmatising: the role of family and friends

Those close to the person are the first link in recognition, and their stance often determines access to care. Signs that should raise concern: drastically changed meals, disappearing to the toilet after eating, growing social isolation, compulsive exercise, repeated negative body comments, rapid weight change.

The stance that helps: naming the observed behaviour without judging the body (‘I notice you no longer eat with us’ rather than ‘you are too thin’), acknowledging the suffering without confirming it through scrutiny, offering help without imposing it. What makes things worse: commenting on the body, policing the plate, bargaining over quantities, inducing guilt.

What requires medical advice

EDs are treated by a team: GP, specialist psychiatrist or psychologist, eating-disorder dietitian, dedicated services. Severe malnutrition, bradycardia, vomiting with electrolyte disturbance are vital emergencies. Early referral improves the prognosis.

FAQ: eating disorders

Can an eating disorder be cured?

Yes: full recovery exists and most patients recover with appropriate care, often over years. Relapse is part of the journey and does not signal failure.

Is orthorexia a real disorder?

Not yet in the official classifications, but the picture is clinically real: restriction in the name of purity, isolation, anxiety at transgression. It can be the gateway to anorexia when restriction becomes the goal.

What do you say to someone you suspect has an ED?

Name the behaviour without commenting on the body, voice the worry without accusing, offer to help them find care without forcing. The sentence that helps: ‘I’m worried about you, can I help you find some support?‘

Is it an illness of the young?

It often begins in adolescence but persists or appears in adulthood; the menopause transition is an underestimated window of vulnerability. Men represent a growing proportion of cases, often diagnosed late.

Eating disorders: when the relationship to food breaks

Eating disorders hold a particular place in an encyclopaedia of dietetics: they show what happens when the relationship to food breaks. Early recognition and referral to specialist teams save lives. To situate your relationship to terrain without pathology: the Yin Shi energy test offers a reading grid, never a diagnosis.