Types and warning signs
Anorexia nervosa involves restriction of food intake, intense fear of weight gain and a disturbed body image. Bulimia nervosa involves recurrent binge eating followed by purging, fasting or excessive exercise. Binge-eating disorder involves recurrent binges without regular purging. Avoidant/restrictive food intake disorder is driven by sensory or practical factors rather than body image.
Warning signs include secretive eating, food rituals, skipping meals, frequent weighing, purging, laxative or diet-pill use, excessive exercise, social withdrawal, irritability, low mood and preoccupation with shape or weight. Not everyone with an eating disorder is underweight.
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Medical risks
Eating disorders can cause dehydration, electrolyte abnormalities, low heart rate, low blood pressure, fainting, constipation, tooth erosion, osteoporosis and hormonal changes. Rapid weight loss, purging and severe restriction can be dangerous.
Refeeding syndrome is a potentially serious complication when nutrition is restarted in a malnourished person. Severe malnutrition, fainting, chest pain, confusion or very low heart rate needs urgent medical assessment, not outpatient psychiatry alone.
- Fainting, chest pain, palpitations or breathlessness
- Confusion, weakness or inability to stand
- Very low heart rate or blood pressure
- Persistent vomiting, purging or inability to keep fluids down
- Rapid weight loss or severe restriction
Assessment and treatment
The assessment reviews eating patterns, weight history, body image, exercise, purging, mood, anxiety, OCD, trauma, substance use and medical history. Height, weight, pulse, blood pressure and relevant blood tests are checked, and a physician is involved when medical risk is present.
Treatment usually combines psychotherapy, nutritional rehabilitation and medical monitoring. CBT-informed therapy addresses the thoughts and behaviours that maintain the eating disorder. Family-based principles are used for adolescents where appropriate. Medication may be used for co-occurring depression, anxiety or OCD, but it is not a stand-alone cure for the eating disorder.
Access and booking
Appointments are at Mind Wellness Center, Durbar Marg area, Kathmandu. Call +977-9747736624 or use /book-appointment. Telepsychiatry is available for appropriate follow-up and for patients who cannot attend in person. This is not an emergency service.