When describing mental illnesses, it is the current practice to describe them as brain disorders.  Personally, I prefer brain circuitry disorders as described here by Dr Thomas Insel, Head of NIMH.

So what are eating disorders and are they brain disorders?

The fact that eating disorders are part of the DSM IV published by the APA and currently described as a mental health disorder, should make it pretty clear that eating disorders are not a choice, any more than any of the other mental disorders on the list, from ADD, through Delirium, Dementia,  Psychosis, Adjustment, Personality, Sleep Disorders to Tics and Tourettes.


At the moment, under the DSM IV, eating disorders are divided into three categories: Anorexia Nervosa, Bulimia Nervosa and Eating Disorders not otherwise specified, which has proved to be highly inadequate, restricting and led to many misdiagnoses.  Luckily the DSM V (due out May 2013 and not a moment too soon) is able to redefine and widen the criteria, getting rid of the EDNOS category, including Binge Eating and showing the difference between a feeding/eating disorder and an avoidant/restrictive intake disorder.

The DSM is not particularly helpful for what to look out for apart from physical signs of extreme malnutrition and the best outcomes seem to be from early intervention.  So, if you are worried about a loved one, what should you be looking out for?

Here is a list from F.E.A.S.T. (an organisation for families and carers of children with an eating disorder)

Warning Signs of an Eating Disorder

Some of the behaviors a parent might be observing as a loved one develops an eating disorder. Some are related to food, and some are not. Some are present before an eating disorder comes into the picture, and some increase in intensity as the illness progresses.

Around food:

♦ Dieting
♦ Avoiding a widening range of foods
♦ Avoiding situations where communal eating is expected
♦ New interest in “healthy,” “low-fat,” “low-carb” or “vegetarian” diets
♦ Inflexibility about what or when or how much to eat
♦ Unnatural focus on what others are eating
♦ Need to know calorie content of all foods
♦ Never available for family meals
♦ New interest in cooking and recipes but avoiding eating the food
♦ Foods, especially carbohydrates, disappearing quickly from the house (secret bingeing)
♦ Secretive or ritualistic eating
♦ Avoiding food until certain hours
♦ Anger at others if pressed to eat something
♦ Fear of over-eating, or gaining weight from a particular meal or type of food

Around activity:

♦ Exercising intensely but without pleasure
♦ Needing to exercise to compensate for eating


♦ Failure to gain weight or height according to growth curve
♦ Weight loss at any time during childhood or adolescence


♦ A conviction that one is too large
♦ Unnatural focus on the flaws of a particular body part or aspect of the body
♦ Repetitive requests for reassurance about appearance


♦ Social withdrawal
♦ Reports others are newly judgmental or “not connecting”
♦ Inability to describe emotions

If a loved one shows only a few of the symptoms of an eating disorder, or denies that anything is wrong, this is not reason to put the issue aside. Denying and concealing symptoms are a common symptom of brain changes associated with eating disorders and resulting malnutrition, and many patients are unable to accurately report their thoughts or feelings. Early detection and assertive treatment are the best way to prevent chronic illness and death.



Charlotte Bevan, wife of a farmer, mother of teenagers, breast cancer survivor and parent advocate Secretary F.E.A.S.T. UK, Expert Carer, Echo Project, Institute of Psychiatry, talkhealth and Mumsnet Blogger

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