Eating disorders

Here's the fact that reframes the whole topic: anorexia nervosa has the highest mortality rate of any psychiatric disorder. Eating disorders aren't about vanity — they're among the most medically dangerous conditions counselors encounter, which is exactly why examiners flag them.

Three main presentations, and the trick is that weight and compensatory behavior tell them apart.

Anorexia nervosa = restriction of intake leading to significantly low body weight, an intense fear of gaining weight, and a disturbed body image. The defining feature is the low weight itself. Two subtypes: restricting type and binge-eating/purging type. Medically the most lethal — death from cardiac complications, electrolyte imbalance, and starvation.

Bulimia nervosa = recurrent binge eating followed by compensatory behavior (self-induced vomiting, laxatives, fasting, excessive exercise) to prevent weight gain, with self-evaluation overly tied to shape/weight. Key contrast: bulimic individuals are usually at a normal or near-normal weight, so it's easy to miss. Watch for medical signs of purging — electrolyte imbalance, dental erosion, parotid gland enlargement, Russell's sign (calluses on knuckles).

Binge-eating disorder (BED) = recurrent binge eating with marked distress but NO regular compensatory behavior. That absence of purging/compensation is the whole distinction from bulimia. BED is the most common eating disorder and is often associated with overweight/obesity.

Clinical Pearl: Sort by two questions. Low body weight? -> anorexia (most lethal — highest mortality of any mental disorder). Binge, then compensate? -> bulimia (usually normal weight). Binge with NO compensation? -> binge-eating disorder. The presence or absence of compensatory behavior is the bulimia-vs-BED discriminator; low weight is the anorexia flag.