Eating disorders are complex mental illnesses which can affect people of all ages, gender, ethnicity or background.
People with eating disorders often have significant concerns about shape or weight which they strive to manage through strict dieting, restriction or other weight control behaviors such as self-induced vomiting, laxative misuse or excessive exercise. For some individuals, such strict behavior results in binge eating – eating large quantities of food, often in secret and accompanied by a sense of loss of control. An eating disorder can lead to serious complications both physically and psychologically.
However, it’s important to remember that eating disorders aren’t just about food or weight. They are often an outward sign of the inner distress an individual is experiencing and may represent a way to feel in control or cope with overwhelming and difficult feelings.
We want to emphasise that an eating disorder is never the fault of the person experiencing it or their family. Eating disorders are not a lifestyle choice, or a reflection of vanity. Everyone with an eating disorder deserves compassion and kindness to support them in their recovery.
Eating disorders often begin during adolescence, a time of big physical, emotional, and social changes. Genetics and biology play an important role—some people are more vulnerable because of their genes, brain differences, or hormonal changes during puberty. These factors interact with psychological and social pressures, like cultural ideals about appearance, family influences, bullying, or low self-esteem. Moving to a new country, starting school or university, exams or family breakdown may all act as stressors. When these elements come together, especially in the teen years, they can trigger or intensify eating problems, leading to the development of an eating disorder.
Emerging evidence suggests that eating disorders in the Arab world are on the increase. Binge eating disorder appears to be the most common disorder, but other disorders such as anorexia nervosa, bulimia nervosa and ARFID are also present. One explanation for this increase might be linked to the rapid sociocultural and economic changes arising from industrialization and globalisation. Additionally, 25-50% of the Arab Gulf population is under 25, and therefore, at increased risk for eating disorders. This increasing prevalence highlights the need for increased awareness and education, alongside culturally sensitive assessment and treatment.
Psychological therapies are the main treatment for eating disorders. These therapies help people understand the thoughts and feelings that keep the eating disorder going, and support them to make healthier changes. Common approaches include Cognitive Behaviour Therapy for Eating Disorders (CBT-ED), which focuses on changing unhelpful patterns of thinking and behaviour, and Family-Based Therapy (FBT), which involves the family in supporting recovery, especially for young people. Another therapy for people aged 16+ is the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), which focuses on the role traits such as certain thinking or emotions regulation styles have on the development and maintenance of anorexia nervosa. Other therapies such as Dialectical Behaviour Therapy (DBT) and Schema Focused Cognitive Behavioural Therapy (SFCBT) may also be used to support individuals with eating disorders. Therapy can help improve eating habits, body image, and emotional wellbeing.
Nutritional support is also important. Specialist dietitians help people restore regular eating patterns, work towards a healthy weight if needed, and reduce fears around food. This support often includes education about nutrition and gentle, step-by-step plans to make eating feel safer and more manageable.
Medical monitoring helps keep people physically safe during recovery. Eating disorders can affect the heart, bones, hormones, and other organs, so regular health checks are important. Doctors may monitor weight, blood tests, heart rate, and other signs to catch any problems early.
Medication is not a primary treatment for eating disorders but can sometimes help with related issues like anxiety, depression, or obsessive thoughts. It is usually used alongside therapy, not instead of it.
Anorexia nervosa (AN) is a serious mental illness, characterized by severe energy intake restriction, an intense fear of weight gain and an inability to maintain a healthy body weight. The individual will often experience severe body image dissatisfaction and distortion.
People with anorexia nervosa usually restrict the type of food they eat and/or their daily caloric intake. They may develop “rules” around what they feel is OK to eat, or avoid food groups such as carbohydrates or fats. In addition to limiting their intake, individuals with anorexia may engage in unhealthy weight loss methods such as making themselves sick, laxative/ diuretic abuse, or excessive or compulsive exercise.
Anorexia nervosa has many serious physical and psychological consequences and in very severe cases, may be fatal. Research shows us the intervening early offers the best chance of sustained recovery.
Anorexia nervosa and all eating disorders can affect anybody, at any age, from all genders, sexual orientations, races, ethnicities and any socioeconomical status. Although girls and women are most affected by anorexia nervosa, we are seeing increasing rates of boys and men presenting for treatment.
Anorexia nervosa typically begins in early to mid-adolescence; however, without treatment, it can persist well into adulthood.
Anorexia nervosa is a complex multifactorial illness. Biological, psychological and sociocultural factors contribute to the development of the illness. Genetics play a role in vulnerability to anorexia, so individuals may be more likely to have a family member with an eating disorder.
Some personality traits appear to be common among those at a higher risk of developing anorexia nervosa such as perfectionism, high harm avoidance, low self esteem, difficulty seeing the “big picture”, rigidity and anxiety. Living in a society and culture that is obsessed with appearance, values thinness and muscularity, and promotes unrealistic beauty standards, generally leads to increased body dissatisfaction, weight concern and fat phobia. Stressors such as exams, transitions, friendship difficulties or family discord may play a role. Dieting, or developing an illness which affects appetite (e.g., gastric flu), or engaging in a hobby with a significant appearance or weight focus (e.g. ballet, boxing, gymnastics) may also have an impact.
Losing an abnormal amount of weight in a short period of time or failing to grow and develop properly.
Inadequate and insufficient food intake: severe restriction of food and caloric intake. Beginning to cut out food groups or develop rules.
Intense fear of weight gain, obsession with weight and persistent abnormal behaviours to prevent weight gain (excessive exercising, purging, laxative or diuretic use)
In females, loss of periods (secondary amenorrhea) or not starting them as would be expected (primary amenorrhea)
Engaging in some food rituals (eating slowly, cutting the food in very small pieces), water loading, tricking hunger with excessive coffee, tea, diet drinks, and sweeteners.
Obsessions over food: looking up recipes, cooking, feeding others, asking frequent questions or seeking reassurance about what they have eaten.
Some people with anorexia nervosa may also start to binge eat.
Physically, the individual may become more fatigued or weaker, experience dizziness, stomach pain or constipation, and will often be cold.
Psychological signs include changes in personality such as becoming more moody, irritable and anxious, and possibly isolating themselves from friends and family. You may also notice increased perfectionism and low self-esteem.
People suffering from anorexia nervosa would self-starve by excessively restricting their food intake. The body is deprived of the energy and essential nutrients needed to function normally, so it enters the starvation state and is forced to slow down and shut down some of its systems and processes to conserve energy and only maintain the vital ones.
This starvation state can have serious physical and medical consequences. Abnormal and irregular heart rate, low blood pressure, increased risk of heart failure, reduction of bone density (osteoporosis/ osteopenia- Increased risks of bone fracture), muscle loss and weakness, severe dehydration- Increased risks of kidney failure, dizziness, fainting, fatigue, and overall weakness, dry hair and skin, hair loss is common, feeling cold- bluish discoloration of extremities fingers and nails, growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm, absence of menstruation (in some cases), delayed gastric emptying and slow digestive system- bloating and severe constipation.
Due to the complexity of this condition, anorexia recovery requires comprehensive treatment from an experienced, multidisciplinary treatment team, including medical and psychiatric stabilization, nutritional intervention and psychological support.
Treatment guidelines recommend family based treatments for adolescents and the following therapies are recommended for older adolescents and adults: Cognitive Behaviour Therapy for Eating Disorders (CBT-E or CBT-ED), Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) or Specialist Supportive Clinical Management (SSCM).
ARFID is an eating or feeding disturbance that is characterized by a persistent failure to meet appropriate nutritional and/or energy needs.
It is the second most common eating disorder in children 12 years and younger but unfortunately largely under diagnosed: 63% of pediatricians are unfamiliar with this diagnosis.
Individuals with ARFID differ from other eating disorders because they do not experience body image dissatisfaction or a drive for thinness. Instead, they may sometimes be self-conscious about being too thin. Those with ARFID will have a very limited range of foods they can eat, be very frightened of trying new foods and may even only accept particular brands. Acceptable foods may have a tendency to be bland and beige.
ARFID is more than just “picky eating”; children do not grow out of it and often become malnourished because of the limited variety of foods they will eat. Overtime, it has significant psychosocial impacts with young people unable to manage school trips or sleepovers, for example.
The true prevalence of ARFID is still being studied, but preliminary estimates suggest it may affect as many as 5% of children.
ARFID is the second most common eating disorder in children 12 years and younger.
In contrast to other eating disorders, more males may have ARFID than females.
In some cases, underlying anxiety, autism, or other developmental differences can play a role.
It is mainly a disorder of early childhood but can be diagnosed past age 6 and in adolescents and adults.
There are a few different reasons for ARFID. Some people avoid certain foods due to sensory sensitivities, for example, strong reactions to taste, texture, smell, or appearance. Others may have had a negative or frightening experience with food, such as choking, vomiting, or stomach pain, which leads them to avoid eating to prevent it happening again. ARFID can also be linked to low interest in food or eating, where a person doesn’t feel much hunger or finds eating effortful. Anxiety, autism, or other mental health differences can make ARFID more likely. Unlike anorexia, it’s not about wanting to be thin, but it can still affect health, growth, and daily life.
Individuals may display some of the signs below:
Eats only a very small range of foods and avoids many others.
Reacts strongly to certain tastes, textures, smells, or colors of food.
Shows little interest in eating or doesn’t feel hungry.
Worries about choking, vomiting, or getting sick from food.
May have slow growth, lose weight, or need supplements to stay healthy.
Feels anxious or stressed at mealtimes, which can make social eating hard.
The health risks and developmental consequences for children and adolescents with ARFID can be serious and long lasting. As a further complication, ARFID is difficult to accurately diagnose. Assessment by a clinical professional trained in the disorder is essential. A form of Cognitive Behavioural Therapy known as CBT-ARFID (CBT-AR) shows good promise in treating ARFID. Treatment often involves parents, especially in young children, and focuses on increasing understanding and gradual exposure to new foods.
Binge Eating Disorder (BED) is a serious mental illness characterized by recurrent episodes of binge eating followed by marked distress, guilt, shame and embarrassment. In contrast to bulimia nervosa, individuals with BED do not engage in compensatory behaviours such as restriction or purging. This can mean that people with BED tend to fall in the normal weight or overweight range. BED is not widely recognised among the general population, resulting in many people being unaware that they are affected. Instead, sufferers may criticize themselves for not having enough will power to control their eating or believe that they cannot change their behaviour.
BED and all eating disorders can affect anybody, at any age, from all genders, sexual orientations, races, ethnicities and any socioeconomical status. Compared to other eating disorders, more males suffer from BED.
BED affects 3.5% of women, 2% of men, and up to 1.6% of adolescents.
BED typically begins in late adolescence and early adulthood for women, however in men is more common in midlife.
Binge eating disorder can develop for many different reasons — it’s rarely caused by just one thing. For some people, it starts as a way to cope with difficult emotions like stress, sadness, loneliness, or boredom. Eating can bring short-term comfort or distraction, but over time it can become a habit that’s hard to control. Low self-esteem, body dissatisfaction, or a history of dieting can also play a role. Biology matters too: genetics and brain chemicals linked to appetite, reward, and impulse control can make some people more vulnerable. Finally, experiences such as childhood teasing about weight, trauma, or growing up in a family where food was used for comfort can increase risk.
Recent research has suggested that individuals with Attention Deficit Hyperactivity Disorder (ADHD) may also be more vulnerable to developing BED. People with ADHD can struggle with impulsivity, difficulty delaying gratification, and problems with regulating emotions — all of which can make it harder to control eating urges once they start. In addition, ADHD can make it tough to stay organized around meals or notice hunger and fullness cues, leading to irregular eating patterns that increase the risk of bingeing. The brain’s reward system also plays a role: both ADHD and binge eating involve differences in how the brain responds to rewards like food, which can make eating feel especially satisfying or soothing in the moment.
Binge eating means having repeated episodes of eating a very large amount of food in a short time (for example, within two hours). People feel out of control while eating and experience strong distress or discomfort afterward.
Eating in secrecy and afraid of eating in public or with others because of feeling embarrassed by the quantity of food eaten.
Feeling disgusted with oneself, ashamed, guilty and depressed following the binge episode.
Binge eating episodes may disrupt normal life, for example, cancelling plans in order to binge.
The binge eating episodes are not followed by the recurrent use of compensatory behaviours such as purging, as seen in bulimia nervosa.
Individuals with BED may base their self-worth on their weight and have a strong desire to lose weight. Societal stigma around weight may further reinforce these beliefs.
Physical and psychological effects of BED include:
Due to binge eating, some individuals with BED may be overweight or obese
Cardiovascular diseases, hypertension, insulin resistance, and/or diabetes
Joint pain
Mood swings and Depression
Anxiety, stress
Effective evidence-based treatments are available for binge eating disorder. Cognitive behaviour therapy for eating disorders (CBT-ED) supports the individual by regularising eating and understanding and addressing emotions and thoughts linked to bingeing.
Bulimia nervosa is an eating disorder characterized by a cycle of binge eating episodes followed by purging episodes, with the association of extreme concerns over body shape and weight. In bulimia nervosa, a binge is defined as eating an unusually large amount of food in a short period of time, often within 2 hours, accompanied by a feeling of loss of control over eating. It’s not just eating a lot—it’s the sense that you cannot stop or control what or how much you’re eating, even if you’re not physically hungry. Binge episodes are often followed by guilt, shame, or distress, and may lead to compensatory behaviors like vomiting, excessive exercise, or restrictive eating. Bingeing is often driven by the strict dieting the individual engages in as they strive to lose weight.
Bulimia nervosa and all eating disorders can affect anybody, at any age, from all genders, sexual orientations, races, ethnicities and any socioeconomical status.
Around 80% of patients suffering from bulimia nervosa are females.
Bulimia nervosa typically begins in late childhood or early adulthood, typically between the ages of 18 to 25.
People suffering with bulimia nervosa generally appear to be of normal body weight or overweight range.
Bulimia nervosa occurs because of a mix of different factors. Some people may be more vulnerable because of their genes, particularly if there is a family history of eating or mood disorders, or how their brain controls appetite and mood. Low self-esteem, perfectionism, anxiety, or trouble managing emotions can also play a role, and impulsivity or difficulties with mood regulation may increase the risk. It is also suggested that early body image dissatisfaction or exposure to appearance related criticism is relevant. Social pressures about being thin or dieting, or teasing about weight, may contribute. Dieting is a significant risk factor for bulimia. Co-occurring difficulties such as anxiety, depression, ADHD, or substance misuse also makes it more likely. Some individuals with anorexia nervosa may migrate to a bulimia nervosa diagnosis over time as it becomes harder to maintain restriction.
Binge eating: Eating a lot of food in a short time and feeling out of control while doing it.
Compensatory behaviors: Trying to “undo” the binge, such as vomiting, excessive exercise, or using laxatives.
Preoccupation with weight and shape: Feeling very concerned about body size or appearance.
Secretive eating or hiding food: Eating alone or hiding what or how much is eaten.
Emotional changes: Feeling guilty, ashamed, anxious, or depressed after eating. Self-esteem is tied to weight, and other positive characteristics are overlooked.
Physical signs: Sore throat, dental problems, stomach issues, fluctuations in weight, or feeling tired and weak.
Bulimia nervosa can be extremely harmful and dangerous to the body. Purging behaviours are ineffective methods to get rid of extra calories consumed, and are extremely dangerous and life-threatening. They can lead to electrolyte and chemical imbalances in the body (loss of potassium and sodium) that affect the heart and other major organ functions such as the kidneys and liver.
Irregular heartbeats and possibly heart failure due to electrolyte imbalance.
Tooth decay, staining and dental erosion due to stomach acids released during frequent vomiting.
Gastrointestinal complications: chronic irregular bowel movements and constipation as a result of laxative abuse.
Inflammation and possible rupture of the oesophagus from frequent vomiting.
Gastric rupture is an uncommon but possible side effect of binge eating.
Muscle weakness and cramps.
Leading treatments for bulimia nervosa are Cognitive Behaviour Therapy-Enhanced (CBT-E) or Cognitive Behaviour Therapy for Eating Disorders (CBT-ED). Interpersonal Therapy (IPT) is also effective. Therapy focuses on regularizing eating to disrupt the restrict-binge-purge cycle, followed by addressing maintaining issues such as low self-esteem or body dissatisfaction.
OSFED stands for Other Specified Feeding or Eating Disorder. It describes eating problems that cause significant distress or impairment but don’t fit neatly into the criteria for disorders like anorexia nervosa, bulimia nervosa, or binge eating disorder. For example, someone might have all the symptoms of anorexia but still have a “normal” body weight, or they might binge and purge less frequently than required for a bulimia diagnosis. It also includes Night Eating Syndrome, which entails recurrent episodes of night eating after awakening from sleep or after the evening meal, and Purging Disorder, in which an individual is not underweight and doesn’t binge but does however purge via self-induced vomiting or laxative misuse.
Anyone can develop OSFED — people of any age, gender, body size, or cultural background. OSFED is actually the most common eating disorder diagnosis and accounts for approximately 30% of diagnoses. Research shows us that the distress, impairment and health consequences associated with OSFED are comparable to other eating disorders.
Because OSFED is a broad and varied category, with many different ways the illness can appear, a one-size-fits-all approach to understanding or treatment doesn’t work. Instead, your clinician will carefully assess your individual difficulties and recommend a treatment that best fits your needs. For example, if you experience all the symptoms of anorexia but maintain a ‘normal’ body weight, your clinician may use an anorexia-focused approach adapted to your situation. Likewise, if your main challenges involve binge eating, your treatment will focus on addressing those patterns. The exact symptoms and treatment plan will depend on your unique clinical presentation, however, clinicians are experienced in OSFED and treatment will support your difficulties.
We often hear these terms in the media, however they are not official diagnostic terms. Perhaps they are popular because they capture the essence of the difficulty. These presentations may actually fall under the diagnosis of OSFED or they may be sub-clinical. Bigorexia may be used to describe muscle dysmorphia, a disorder in which the individual believes themselves to be too small. They become preoccupied with building muscles and leanness, often rigidly sticking to meal plans, managing macros and counting carbohydrates, alongside spending hours in the gym, and in some cases misusing steroids or supplements. Orthorexia refers to having very strict rules around avoiding all processed food, and limiting certain food groups such as fats or sugars.