Eating disorders

Also called Anorexia nervosa, ARFID, Binge eating disorder, OSFED

Not about vanity, and not a phase. The mental illness with the highest death rate.

What it is

Start with the fact that gets left out: anorexia nervosa has the highest mortality of any mental illness. Around 1.25 million people in the UK have an eating disorder of some kind.

They are not all about being thin. Anorexia involves restriction and a distorted body image. Bulimia involves bingeing and compensating. Binge eating disorder involves bingeing without it. ARFID, avoidant restrictive food intake disorder, is about sensory aversion and fear of choking or vomiting rather than body image at all, and it is strongly associated with autism.

That last one matters, because ARFID is routinely missed by services set up to look for body image concerns.

Signs you might notice

Rules about food multiplying. Foods removed one at a time with a plausible reason each time.

Eating alone, or eating rituals: cutting small, arranging, eating slowly.

Weight change, but do not rely on it. Most people with eating disorders are not underweight.

Withdrawal from meals with others, and from social life generally.

Preoccupation with cooking for other people while eating little.

Physically: feeling cold, fainting, hair thinning, periods stopping, fine downy hair on the body.

How it can affect day-to-day life

Time is the variable that matters most. Treatment within the first three years produces substantially better outcomes, and waiting for somebody to be ill enough to qualify is how people become chronically unwell.

BMI thresholds are used as gatekeeping and they should not be. Someone can be seriously medically unstable at a perfectly ordinary weight, especially if they have lost weight quickly.

Families get exhausted and blamed in equal measure. Neither helps.

Supporting someone well

Do not comment on anybody's body, ever, in either direction. Not the person's, not your own, not a celebrity's.

Talk about feelings and function rather than food and weight. "How is it going" beats "did you eat".

Do not negotiate at the table. Agree the plan away from mealtimes, and stick to it calmly at them.

Do not become the food police. Surveillance escalates concealment.

Get help early, and if you are told the person is not unwell enough, ask for that in writing. That request alone frequently changes the answer.

Take physical risk seriously: fainting, chest pain, an irregular pulse or confusion need urgent assessment.

Where to get help

A GP can refer to a community eating disorder service. In England, children and young people should be seen quickly under NHS access standards.

Beat's helpline is 0808 801 0677.

For ARFID specifically, say so at the referral, and mention autism if it applies. Services respond differently once they know.