What are eating disorders?

Eating disorders are serious mental health conditions characterised by persistent disturbances of eating behaviour that impair physical health, psychological health or social functioning. The main types: anorexia nervosa (severe restriction, low weight, distorted body image — highest mortality of any mental disorder); bulimia nervosa (binge-purge cycles); binge eating disorder (recurrent bingeing without purging — the most common); and ARFID (restrictive eating not driven by body image). They affect approximately 14 million people globally.

Eating disorders primarily affect adolescents and young adults — with peak onset at 14-18 years for anorexia and bulimia. The female:male ratio has historically been 9:1, but men are significantly underdiagnosed and underrepresented in research. Eating disorders are not limited to white, affluent, Western women — they affect all ethnicities, socioeconomic groups, sexual orientations and genders. They are increasing rapidly in previously low-prevalence regions including East and Southeast Asia.

Why does anorexia nervosa have the highest mortality?

Anorexia nervosa has the highest mortality of any mental health condition — crude mortality rate of 5-6% per decade. Deaths occur from: direct medical complications of starvation (cardiac arrest from electrolyte imbalance — particularly hypokalaemia and hypophosphataemia — causing fatal arrhythmia; bradycardia; QTc prolongation; multi-organ failure); and suicide (31-fold elevated risk). The chronic course, ego-syntonic nature (not perceived as unwanted) and high relapse rates further increase cumulative mortality.

What causes eating disorders?

Eating disorders are multifactorial — interacting biological, psychological and sociocultural factors. Biological: genetic predisposition (twin studies show 50-80% heritability for AN); reward pathway dysregulation; gut microbiome alterations. Psychological: perfectionism; harm avoidance; cognitive rigidity; early adversity; sexual trauma. Sociocultural: thin-ideal internalisation; social media (Instagram, TikTok promoting body dissatisfaction); diet culture; weight stigma. Eating disorders are NOT caused simply by dieting — they have complex biopsychosocial origins.

What is the treatment for anorexia nervosa?

Severe AN requires hospitalisation for medical stabilisation (refeeding, cardiac monitoring, electrolyte management). Nutritional rehabilitation must be gradual to prevent refeeding syndrome. Psychological treatment — family-based treatment (FBT) is first-line for adolescents; cognitive behavioural therapy — eating disorders (CBT-E) for adults; specialist supportive clinical management (SSCM); and Maudsley Anorexia Nervosa Treatment for Adults (MANTRA). No medications are approved for AN specifically. Treatment is prolonged; recovery takes years.

What is refeeding syndrome?

Refeeding syndrome is a potentially fatal complication of nutritionally rehabilitating severely malnourished patients — including those with severe anorexia nervosa. As nutrition is provided, cellular uptake of phosphate, potassium and magnesium causes severe electrolyte drops — leading to cardiac arrhythmia, respiratory failure, seizures and cardiac arrest. Prevention: gradual nutritional introduction (starting at 10-15 kcal/kg/day); daily electrolyte monitoring and replacement; thiamine supplementation. NICE and ESPEN provide specific refeeding syndrome prevention guidelines.

How do social media affect eating disorders?

Multiple large studies demonstrate that social media use — particularly image-focused platforms (Instagram, TikTok) — is associated with body dissatisfaction, dietary restraint and eating disorder onset, particularly in adolescents. Mechanisms: social comparison with idealised bodies; appearance-related comments; following "pro-eating-disorder" (pro-ana, pro-mia) content which normalises restriction and purging. The surge in eating disorder incidence among young girls during COVID-19 lockdowns — when social media use increased dramatically — provides real-world evidence of this link.

What is binge eating disorder?

Binge eating disorder (BED) — recognised in DSM-5 (2013) and ICD-11 — is the most common eating disorder, affecting approximately 1.9% of the population. It is characterised by recurrent episodes of eating large amounts rapidly, beyond comfortable fullness, with loss of control — at least once weekly for 3 months — WITHOUT the purging seen in bulimia. BED is strongly associated with obesity, type 2 diabetes, hypertension and psychiatric comorbidity. Treatment: CBT-E (first-line); interpersonal therapy; lisdexamfetamine (only FDA-approved medication for BED).

How are eating disorders treated?

Treatment is multidisciplinary: nutritional rehabilitation (dietitian-led); psychological therapy (CBT-E, FBT for adolescents, DBT for comorbid emotion dysregulation); psychiatric care (managing comorbid depression, anxiety, OCD); medical monitoring; and peer support. For bulimia: CBT-E and antidepressants (fluoxetine — FDA-approved for bulimia). For BED: CBT-E and lisdexamfetamine. Recovery is possible — approximately 50% of people with AN, 70% with BN and 80% with BED achieve full recovery, though this may take many years.

How does GMJ News cover eating disorders?

GMJ News covers WHO eating disorder data, anorexia nervosa mortality evidence, social media and body image research, treatment advances and the global spread of eating disorders. Eating disorders — rapidly increasing globally — are directly relevant to PHIG's adolescent and mental health priorities and the Georgian Medical Journal.

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Eating Disorders

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Eating disorders — including anorexia nervosa, bulimia nervosa, binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID) — collectively carry the highest mortality of any mental health condition: anorexia nervosa has a crude mortality rate of 5-6% per decade, primarily from medical complications and suicide (WHO). An estimated 14 million people are affected globally — predominantly young women but with increasing recognition in men, children and all demographics. Rates are rising dramatically in LMICs as body dissatisfaction, food insecurity and social media influence converge.

Key messages

Highest mortality of any mental disorder

Anorexia nervosa carries a crude mortality rate of 5-6% per decade — the highest of any mental health condition. Deaths occur from medical complications (cardiac arrest from electrolyte imbalance) and suicide, which is elevated 31-fold above the general population (WHO/Lancet).

14 million affected globally

Eating disorders affect an estimated 14 million people globally — though this is widely considered an underestimate due to profound under-recognition, particularly in men, older adults, non-white populations and LMICs (WHO).

Rising in LMICs

Eating disorders were historically described as "Western" diseases — but are increasing rapidly across Asia, Latin America and Africa as body dissatisfaction, social media influence and food insecurity combine. This is the "globalisation of the thin ideal."

Four main types

Anorexia nervosa (restrictive, dangerously low weight); bulimia nervosa (binge-purge cycles); binge eating disorder (BED — recurrent bingeing without purging — the most common, affecting 1.9% of adults); and avoidant/restrictive food intake disorder (ARFID — not driven by body image).

Early intervention is crucial

Duration of illness is the strongest predictor of outcome. Early identification and treatment produces the best recovery rates. Family-based treatment (FBT) is highly effective for adolescent anorexia; CBT-E is first-line for bulimia and BED.

Medical emergencies

Severe anorexia nervosa is a medical emergency — requiring hospitalisation for refeeding syndrome prevention, cardiac monitoring (QTc prolongation, arrhythmias) and medical stabilisation before psychological treatment can be effective.

Key statistics

14M

people with eating disorders globally

WHO

5-6%/decade

crude mortality rate of anorexia nervosa

WHO/Lancet

31x

higher suicide risk in anorexia vs general population

Lancet Psychiatry

9:1

female:male ratio (decreasing — men underdiagnosed)

WHO/NEDA

1.9%

of adults with binge eating disorder (most common)

WHO

Rising

incidence globally, especially in Asia and LMICs

Lancet 2020

Eating disorder types: estimated global prevalence (%) — WHO/GBD

Source: GBD Eating Disorders Collaborators. BED is most common; anorexia is rarest but most lethal.

Glossary of key terms

Anorexia nervosa (AN)
WHO/DSM-5Characterised by restricted energy intake, significantly low body weight, intense fear of weight gain, and disturbed body image. Two subtypes: restricting (dieting, fasting, excessive exercise) and binge-purge. The highest mortality of any psychiatric condition.

Bulimia nervosa (BN)
WHO/DSM-5Characterised by recurrent binge eating (eating large amounts rapidly with loss of control) followed by compensatory behaviours (self-induced vomiting, laxative misuse, excessive exercise) to prevent weight gain. Weight is typically in the normal range.

Binge eating disorder (BED)
WHO/DSM-5The most common eating disorder — characterised by recurrent binge eating episodes (at least once a week for 3 months) WITHOUT compensatory purging behaviours. Associated with obesity, diabetes and significant psychiatric comorbidity.

ARFID
WHO/DSM-5Avoidant/restrictive food intake disorder — characterised by extremely restricted eating based on sensory characteristics, concern about aversive consequences (choking, vomiting), or lack of interest in food — NOT driven by body image disturbance. Often in children and individuals with autism spectrum disorder.

Family-based treatment (FBT)
NICE/AEDFAThe evidence-based first-line treatment for adolescent anorexia nervosa — engaging parents as the primary agents of nutritional rehabilitation. In phase 1, parents take full control of eating; phases 2-3 gradually return autonomy to the adolescent. Superior to individual therapy for adolescent AN.

Refeeding syndrome
WHO/ESPENA potentially fatal metabolic complication of rapid nutritional rehabilitation in severely malnourished patients (including AN) — characterised by hypophosphataemia, hypokalaemia and hypomagnesaemia causing cardiac arrhythmia, respiratory failure and cardiac arrest. Requires careful, gradual refeeding with electrolyte monitoring and supplementation.