Eating disorders: anorexia, bulimia, binge eating and ARFID
Eating disorders are serious mental health conditions in which eating, weight and body shape take over a person's thoughts and behaviour. The main types are anorexia (eating too little), bulimia (bingeing then vomiting, using laxatives or over-exercising), binge eating disorder (repeated loss of control over eating), and ARFID (avoiding foods for reasons other than weight). They can damage the heart, bones and hormones and can be fatal, but most people recover with the right treatment — family-based therapy for young people and eating-disorder-focused CBT for adults.
Health writers · Aslam Clinic
An is a mental illness in which food, weight and body shape start to control a person's thoughts and actions — not a diet that went too far, a phase or a bid for attention. The main types are anorexia, bulimia, binge eating disorder and ARFID. They can cause lasting physical harm, and anorexia is one of the leading causes of death related to mental health problems. The more hopeful fact is that, with treatment, most people recover, and the earlier help starts, the better.
Eating disorders are easy to miss in Pakistan, where they are still thought of as a Western problem of very thin girls. They are not. They affect boys and men, married women and older adults, and people who look an ordinary or heavier weight.
The main types
| Type | What happens | Weight |
|---|---|---|
| Anorexia nervosa | Eating very little, often with intense fear of gaining weight and a distorted view of one's own body; sometimes over-exercise or vomiting | Low, or falling fast |
| Bulimia nervosa | Episodes of eating large amounts with a sense of lost control, followed by vomiting, laxatives, fasting or over-exercise | Often normal, so it is easily hidden |
| Binge eating disorder | Regular episodes of eating a lot quickly, past fullness, often alone, followed by shame — without purging | Any; often higher |
| ARFID (avoidant/restrictive food intake disorder) | Avoiding many foods or eating very little because of texture, smell, fear of choking or vomiting, or low interest in food — not about body shape | Low, or poor growth in children |
| Other specified feeding or eating disorder (OSFED) | Serious symptoms that do not fit neatly into one of the above; the NHS calls it the most common eating disorder | Any |
Not only thin teenage girls
NICE says eating disorders can start at any age but that the risk is highest for young men and women between 13 and 17. It also warns doctors not to use a single number such as to decide whether someone is ill enough for treatment: a person can be dangerously unwell at a normal weight, particularly with bulimia or after rapid weight loss.
- Boys and men are more likely to be preoccupied with muscle, 'cutting' and supplements than with thinness, and are less likely to be asked.
- People with type 1 diabetes may deliberately skip or cut to lose weight. This is a recognised and dangerous form of eating disorder that NICE asks diabetes and mental health teams to look for — it can lead quickly to diabetic ketoacidosis.
- People with long-term illnesses that involve diet, such as diabetes or coeliac disease, are at higher risk, and poor control can be the first sign.
- Children may show faltering growth or delayed puberty rather than obvious weight loss.
Warning signs
- Skipping meals, eating separately, or saying they have already eaten
- Cutting out whole food groups, or eating only a very small range of 'safe' foods
- Going to the bathroom straight after meals
- Constant talk of calories, weight or 'fat', and checking the body in mirrors
- Exercising hard even when ill or exhausted
- Food disappearing, hidden wrappers, or eating in secret
- Laxatives, diet pills or 'slimming teas' bought from pharmacies or online
- Loose clothes to hide weight loss, feeling cold all the time, dizziness, periods stopping
- Withdrawing from family meals, weddings and dawats where food is central
Why eating disorders are physically dangerous
Starvation affects every organ. The NHS lists heart problems — a slow or irregular heartbeat, low blood pressure and, in severe cases, heart failure — as well as weak bones (osteoporosis), fertility problems, poor concentration and, less often, fits. Repeated vomiting and laxative use drain potassium and other salts from the blood, which can upset the heart rhythm without warning, and stomach acid wears away tooth enamel and the lining of the throat. and low blood sugar () add to the danger.
Restarting food after severe starvation also carries a risk. A sudden return to normal eating can shift salts in the blood dangerously — so-called refeeding syndrome — which is why someone who is very underweight should begin eating again under medical supervision.
Pressure about weight, food and marriage in Pakistan
Eating disorders grow out of a mix of genes, personality (perfectionism and anxiety are common), life stress and the messages a person hears about bodies. In Pakistan those messages can be loud. In a 2025 study of young women in Azad Jammu and Kashmir, many linked beauty to a fair complexion and a certain body, and half said their lives — including their marriage prospects — would be better if they met these standards. Comments at a rishta visit, a relative saying a girl has 'got fat', or a mother-in-law's remarks can land hard on someone already vulnerable.
These problems are not rare here. In a 2024 study of 400 undergraduates at four public universities in Pakistan, about one in five scored above the clinical cut-off on a standard eating-disorder questionnaire. That is a screening result, not a diagnosis, but it shows how common troubled eating is among young adults — including young men.
Families can make a real difference by changing how they talk: praise people for who they are rather than how they look, stop commenting on anyone's weight at the dinner table, and treat 'health' as strength, energy and wellbeing rather than a number on the scale or a lighter skin tone.
Treatment that works
Treatment for eating disorders is psychological, supported by medical monitoring and nutrition. NICE is clear that medicine should never be the only treatment for anorexia or binge eating disorder, though an may help if there is also or anxiety.
| Condition | Main treatments (NICE, where its guideline applies) |
|---|---|
| Anorexia — children and teenagers | Anorexia-focused family therapy: parents are supported to take charge of meals at first, then control is handed back as the young person recovers; about 18 to 20 sessions over a year |
| Anorexia — adults | Eating-disorder-focused CBT (CBT-ED, typically up to 40 sessions), or MANTRA or specialist supportive clinical management (around 20 sessions); restoring a healthy weight is a central goal |
| Bulimia | Guided self-help first; if that does not work within about four weeks, individual CBT-ED, typically up to 20 sessions. Young people are offered family therapy |
| Binge eating disorder | Guided self-help, then group or individual CBT-ED. Weight loss is not the aim of treatment in itself |
| ARFID | Not covered by the NICE guideline; treatment is tailored after specialist assessment of the reason for avoidance, often with gradual, supported exposure to new foods and close attention to growth and nutrition |
Hospital or day-patient care is needed when someone is very ill or their physical health is at risk. In Pakistan, specialist eating-disorder services are few; a sensible route is a family doctor for the physical checks (weight, pulse, blood pressure, blood tests) together with a psychiatrist or clinical psychologist, many of whom now also work online.
When to see a doctor
- Weight loss you cannot explain, or periods that have stopped
- Making yourself sick, or using laxatives, diet pills or diuretics, even occasionally
- Bingeing once a week or more, for more than a few weeks
- Food rules that are limiting your life, studies or relationships
- A child who is not growing as expected or whose eating is getting narrower
- Anyone with diabetes who is skipping insulin to control weight
How to raise your concerns
- Choose a calm, private time — not during a meal and not in front of the whole family.
- Talk about what you have seen and how you feel, not about weight or looks: 'I've noticed you've been skipping meals and you seem so tired. I'm worried about you.'
- Expect denial, anger or tears. Do not argue about food or calories; stay kind and come back to it.
- Offer to go with them to a doctor, and make the appointment together if they will let you.
- If the person is a child or teenager, parents do not need their agreement to get help — act now.
- Look after yourself too. Supporting someone with an eating disorder is hard, and it is not your fault that it happened.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
