Eating disorders: When food becomes more than just food
Have you ever seen some people eating soil or some other non- food items? I once saw a lady eating charcoal and seemed so addictive that she was unable to stop despite knowing that it could be harmful. Sounds strange, right? Not just this, I have also witnessed a person eating coloured threads from her scarf to such an extent that the length of her scarfs would reduce to half and sometimes she would even end up eating the whole scarf. During my school years, I have also seen many of my classmates had a habit of eating white pages of their notebooks and they would even encourage other kids too to do so. They would eat half of their notebooks before they could even finish writing on it. These eating behaviours are not simply unusual, they can be a sign of eating disorder known as pica, a medical condition where individuals repeatedly consume non-food items, such as soil, paper, chalk, clay, or charcoal.
Definition and types of eating disorders
As per Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Text Revision (DSM-5-TR), eating disorder is defined as the “persistent disturbance of eating or eating related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning” (American Psychiatric Association, 2022). Following are the major categories of eating disorders as per the DSM-5:
Anorexia Nervosa: It is characterised by severely avoiding or restricting the food intake due to a distorted self-image or an intense fear of gaining weight.
Bulimia Nervosa: People with this type of eating disorder do binge eating followed by compensatory behaviour such as self-induced vomiting or laxative misuse.
Binge Eating Disorder (BED): It is characterised by losing control of eating and consuming unusually large amounts of food.
Avoidant/ Restrictive Food Intake Disorder (ARFID): It is marked by limiting the amount and variety of food due to the anxiety or fear of consequences of eating or dislike of a food’s characteristics.
Pica: Pica is a feeding and eating disorder in DSM-5, and is defined as recurrent intake of non-nutritive, non-food substances (e.g., paper, soap) for at least 1 month, is inappropriate to the developmental stage of the individual, occurs outside of cultural norms, and occurs in the absence of another mental or physical condition (American Psychiatric Association, 2013).
Common signs and symptoms of eating disorder:
Eating disorders manifest through a combination of emotional, behavioural and physical signs that affect both mental and physical health:
Emotional and behavioural signs and symptoms:
Extreme consciousness about weight, body shape, and calories and frequent checking of mirrors or body parts.
Extreme fear of gaining weight.
Dissatisfaction with ones’ s body image.
Skipping meals, or avoiding certain food groups.
Eating uncontrollably large amount of food.
Unusual behaviours after eating, such as inducing vomiting, excessive exercise, or misuse of laxatives or diuretics.
Mood swings, irritability, anxiety or depression.
Avoiding situations involving food which later leads to social withdrawal.
Physical signs:
Gastrointestinal issues, such as, acid reflux, bloating, constipation, or diarrhoea.
Menstrual irregularities in females.
Either weight gain or weight loss.
Dizziness, fatigue or feeling cold.
Pains, tingling, or numbness in arms and legs due to poor circulation.
Palpitations (feeling the fast heartbeat).
Episodes of fainting.
Generalized weakness.
Causes and risk factors of eating disorders
Research suggests that eating disorders develop as a result of a complex interaction of biological, psychological, social and environmental factors rather than a single cause. Individuals who have a family history of eating disorders, depression, or substance abuse may be at greater risk of developing an eating disorder. A twin research study suggested that approximately 40% to 60% of the risk of anorexia nervosa, bulimia nervosa, and binge eating disorder arises from genetic influence. Diet culture, social media, and weight teasing are some of the environmental factors which predispose a person to develop eating disorders. People who struggle with anxiety, low self-esteem, perfectionism, or obsessive personality traits may be more likely to develop unhealthy relationships with food and body image. Additionally, traumatic experiences, including physical, emotional, or sexual abuse may also contribute to developing eating disorders.
Way to recovery:
The first step to recovery starts with acknowledging the disorder. Early recognition and intervention pave way to recovery and prevent the development of severe physical and psychological complications. Treatment and management typically involve the following:
Individual, group or family psychotherapy help challenge unusual thoughts, emotions or behaviours about food, eating or body image.
Nutritional counselling: It helps individuals restore healthy eating patterns and address nutritional deficiencies
Medical care and monitoring are crucial to treat the health consequences of an eating disorder and monitor the overall wellbeing.
Medication: Pharmacotherapy is recommended when psychotherapy is not sufficient or when medication treatment is preferred by the patient. There are only two medications approved by FDA for treatment of eating disorders, fluoxetine for Bulimia nervosa and lisdexamfetamine for Binge eating disorder.
In brief, eating disorders are much more than unusual habits or concerns about body weight. They are serious mental health disorders which can be life threatening if not manged and treated early. They develop as a result of complex interplay of genetic, psychological, environmental and social factors. Understanding these disorders and recognizing their warning signs are important first steps toward seeking help. Creating awareness about eating disorders can help reduce stigma and promote timely access to treatment for those who are struggling. With appropriate support and intervention recovery is possible and individuals can develop a healthy relationship with food and themselves.
References:
Allam, A. R., & Attia, E. (2026). Recent developments in treatments for eating disorders. Neurotherapeutics, 23(1), e00773. https://doi.org/10.1016/j.neurot.2025.e00773
Fairweather-Schmidt, A. K., & Wade, T. D. (2015). Changes in genetic and environmental influences on disordered eating between early and late adolescence: A longitudinal twin study. Psychological Medicine, 45(15), 3249–3258. https://doi.org/10.1017/S0033291715001257
InsideOut Institute. (2022, October 1). DSM-5-TR diagnostic criteria for eating disorders. InsideOut Institute. https://insideoutinstitute.org.au/resource-library/dsm-5-diagnostic-criteria-for-eating-disorders
Muhlheim, L. (2025, December 9). The different causes of eating disorders: The various pathways from the root to the fruit. Verywell Mind. https://www.verywellmind.com/what-causes-eating-disorders-4121047
National Eating Disorders Association. (n.d.). Warning signs and symptoms. National Eating Disorders Association. https://www.nationaleatingdisorders.org/warning-signs-and-symptoms/
National Health Service. (2024, January 23). Overview – Eating disorders. NHS. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/
National Institute of Mental Health. (2024). Eating disorders: What you need to know. U.S. Department of Health and Human Services, National Institutes of Health. https://www.nimh.nih.gov/health/publications/eating-disorders
Papini, N. M., Bulik, C. M., Chawner, S. J. R. A., & Micali, N. (2024). Prevalence and recurrence of pica behaviors in early childhood within the ALSPAC birth cohort. International Journal of Eating Disorders, 57(3), 543–552. https://doi.org/10.1002/eat.24111