Psychology › Mental health & disorders › Mental disorders: what they are and how common
Eating disorders
· Condition or disorder
Well replicatedStrong, repeated evidence.
Serious illnesses of disturbed eating and body image, including anorexia, bulimia and binge-eating disorder.
See it on the Psychology map →What it says
Anorexia nervosa involves severe food restriction and fear of weight gain; bulimia nervosa, cycles of binge eating and purging; binge-eating disorder, recognized in DSM-5 in 2013 and the most common, recurrent binges without purging. Anorexia has one of the highest death rates of any psychiatric condition, roughly five to six times the expected rate. Eating disorders affect all genders, body sizes and ethnic groups. Family-based treatment helps teenagers with anorexia; a specialized CBT works well for bulimia and binge eating.
Why it matters
They often begin in adolescence, carry real medical danger, and are frequently missed in men and in people who are not visibly thin.
The evidence
Mortality meta-analyses (Arcelus and colleagues, 2011), the US National Comorbidity Survey, controlled treatment trials, and a 2019 genome study tying anorexia to metabolic as well as psychiatric genes.
Open questions
How genes, metabolism, perfectionism and cultural ideals of thinness combine is unclear, and treatments for adults with long-standing anorexia remain weak.
Connections (2)
▸Eating disorders include one of the deadliest Mental disorders: what they are and how commonWell replicated
The connection
Anorexia nervosa has one of the highest death rates of any mental disorder, from starvation's effects on the heart and other organs and from suicide. Eating disorders also commonly occur with anxiety, depression and OCD, and are often hidden.
Who showed it and when
Mortality meta-analyses, notably Jon Arcelus and colleagues in 2011, which pooled 36 studies following patients over time.
The evidence
Anorexia's death rate is about six times that of people the same age, and about one in five of those deaths is suicide.
Open questions
Calling anorexia 'the deadliest' overstates it: opioid use disorder has a higher death rate. Whether anorexia death rates have fallen with modern care is unclear.
▸Cognitive behavioral therapy (CBT; Beck, Ellis) is a leading treatment for Eating disordersWell replicated
The connection
Enhanced CBT (CBT-E) targets the core belief that self-worth depends on weight and shape. Patients establish regular eating, drop strict dieting rules that trigger binges, and tackle body-checking and shape worries. It is first-line for bulimia and binge-eating disorder and is used for anorexia in adults.
Who showed it and when
Christopher Fairburn at Oxford developed CBT for bulimia in the early 1980s and the broader CBT-E for all eating disorders in 2008.
The evidence
Controlled trials show many bulimia and binge-eating patients stop bingeing; the UK's NICE guidelines (2017) recommend eating-disorder-focused CBT.
Open questions
For anorexia, especially in teenagers, family-based treatment often works better, and why relapse is common after any treatment is poorly understood.