Eating Disorders (Anorexia and Bulimia Nervosa)

Eating disorders are serious mental health conditions characterised by persistent disturbances in eating behaviour, alongside distressing thoughts and emotions about food, weight, and body shape. The two most recognised forms are anorexia nervosa, involving severe food restriction and an intense fear of weight gain, and bulimia nervosa, involving cycles of binge eating followed by compensatory behaviours such as self-induced vomiting, laxative misuse, or excessive exercise. Eating disorders affect people of all genders, ages, and body sizes, and often go unrecognised in Nigeria, where symptoms may be dismissed as unusual dieting or attributed to spiritual causes rather than identified as a medical condition requiring treatment. They carry one of the highest mortality rates of any mental health condition when left untreated, underscoring the importance of early recognition.

Behavioural signs: • Extreme restriction of food intake, skipping meals, or rigid rules around eating • Episodes of eating unusually large amounts of food in a short period, often in secret, followed by guilt or shame • Compensatory behaviours after eating: self-induced vomiting, misuse of laxatives or diuretics, or compulsive excessive exercise • Preoccupation with food, calories, dieting, or body weight that dominates daily thinking • Withdrawal from social situations involving food Physical signs: • Significant, rapid weight loss or fluctuation, or failure to gain expected weight in adolescents • Fatigue, dizziness, or fainting • Menstrual irregularities or absent periods • Dental erosion, swollen salivary glands, or calluses on the knuckles (signs of frequent vomiting) • Feeling cold constantly, or noticing fine downy hair growth on the body (a response to malnutrition)

Eating disorders result from a complex interaction of biological, psychological, and social factors: • Genetic predisposition: eating disorders run in families and have one of the strongest genetic links among mental health conditions • Psychological factors: perfectionism, low self-esteem, anxiety, and a strong need for control are common underlying traits • Sociocultural pressure: exposure to idealised body images through media and social media, and cultural pressure around appearance and weight • Neurobiological factors: differences in brain circuits involved in reward, appetite regulation, and anxiety • Triggering events: dieting, significant life transitions, trauma, or bullying related to weight often precede onset

• Family history of eating disorders, depression, or anxiety • History of dieting or significant weight-related teasing or bullying • Perfectionistic or highly self-critical personality traits • Participation in activities that emphasise thinness or weight categories (modelling, certain sports, dance) • History of trauma or significant life stress • Adolescence and young adulthood, the most common period of onset

• Severe malnutrition, affecting the heart, bones, and every major organ system • Electrolyte imbalances from vomiting or laxative misuse, which can cause dangerous, potentially fatal heart rhythm disturbances • Osteoporosis and stunted growth, particularly when onset occurs during adolescence • Infertility and pregnancy complications from prolonged menstrual disruption • Severe dental damage from repeated exposure to stomach acid • Significantly increased risk of death, from both medical complications and suicide, making eating disorders among the most dangerous mental health conditions if untreated

Eating disorders cannot always be prevented given their genetic and psychological basis, but risk can be reduced: • Avoid framing food or body weight in moralising language ("good" or "bad" foods) at home, particularly around children and adolescents • Address weight-related teasing or bullying promptly • Build self-esteem around qualities unrelated to appearance • Seek help early at the first signs of disordered eating patterns, before they become entrenched, since early intervention significantly improves recovery outcomes Treatment: a combination of medical monitoring, nutritional rehabilitation, and psychological therapy (particularly Cognitive Behavioural Therapy and family-based therapy for adolescents) forms the foundation of effective treatment, ideally delivered by a multidisciplinary team.