Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Eating Disorders

—

In one line

·Eating disorders are brain-based mental illnesses that twist how someone sees their body and eats, causing serious harm to both the mind and the body.

—

Normal physiology

·Normally, eating gives the body fuel (calories) to power every cell, build and repair tissue, make hormones, and keep the brain and heart running. The hypothalamus (a small control center deep in the brain) watches how much energy is stored as fat and sends signals to make you feel hungry or full so your weight stays steady. Hormones like leptin (from fat cells, telling the brain 'we have enough fuel') and ghrelin (from the stomach, saying 'time to eat') talk to the hypothalamus to balance food in and energy out. Body image—the mental picture you have of your own body—is usually accurate and flexible. Most people see themselves as they really are and can handle small changes in weight or shape without panic.

—

What goes wrong

·In eating disorders, the brain's control centers for hunger, body image, and emotion stop working the way they should. Genes load the gun (some people inherit a higher risk for these illnesses), and then stress, trauma, dieting, or cultural pressure to be thin pulls the trigger. The result is a distorted body image. The person sees themselves as fat even when they are dangerously thin. They also have obsessive, rigid thoughts about food, weight, and control. The person restricts food, binges, purges (forces vomiting or abuses laxatives), or avoids eating—not because they want to hurt themselves, but because their brain is sending false alarm signals that eating or gaining weight is dangerous. This is a true mental illness, not a choice or a lack of willpower.

—

Hallmark signs

·Weight much lower than expected for age and height
·Intense fear of gaining weight or being fat, even when underweight
·Distorted view of body shape or weight (seeing self as fat when actually thin)
·Missing periods in girls and women who used to have regular cycles
·Binge eating (eating a very large amount in a short time) followed by guilt or shame
·Purging behaviors like self-induced vomiting, misuse of laxatives, diuretics, or extreme exercise to undo eating
·Preoccupation with food, calories, and eating rituals (cutting food into tiny pieces, eating very slowly, hiding food, avoiding meals with others)
·Social withdrawal and avoiding situations involving food

—

Red flags · escalate now

·Heart rate below 50 beats per minute or blood pressure dropping when standing (sign the heart muscle is too weak from starvation and cannot pump enough blood)
·Fainting, dizziness, or chest pain (the heart may develop dangerous rhythm problems from low potassium, magnesium, or phosphorus caused by purging or starvation)
·Vomiting blood, black or bloody stools, or severe stomach pain (purging can tear the esophagus or stomach lining, causing life-threatening bleeding)
·Thoughts of suicide or an active plan to hurt oneself (eating disorders have the highest death rate of any mental illness, so any suicidal thinking is an emergency)
·Severe dehydration, confusion, muscle weakness, or inability to stand (medical emergency requiring hospital care because electrolytes are dangerously out of balance)

—

Workup

·Complete blood count (CBC)
·Basic metabolic panel (sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose)
·Magnesium and phosphate levels
·Electrocardiogram (ECG)
·Thyroid-stimulating hormone (TSH) and free thyroxine (free T4)
·Bone density scan (dual-energy X-ray absorptiometry, or DEXA scan) if restricting food or missing periods for six or more months
·Pregnancy test (urine or serum human chorionic gonadotropin, hCG) in all females of childbearing age
·Liver function tests (alanine aminotransferase [ALT], aspartate aminotransferase [AST], bilirubin, albumin)

—

Treatment

·Hospital admission with continuous heart monitoring (telemetry) for anyone with BMI under 15 kg/m², heart rate under 50 beats per minute, systolic blood pressure under 90 mmHg, orthostatic low blood pressure (hypotension) (systolic drop over 20 mmHg or diastolic drop over 10 mmHg when standing), temperature under 96°F (35.6°C), QTc over 450 ms, or dangerous electrolyte levels (potassium under 3.0 mEq/L, phosphate under 2.0 mg/dL, magnesium under 1.5 mg/dL)
·Start refeeding at 1,000 to 1,500 kilocalories per day (or even lower, 400 to 800 kilocalories per day, if severely malnourished with BMI under 14 or weight loss over 15% in three months), then increase by 200 to 300 kilocalories every few days. Give phosphate (oral or intravenous to keep level above 3.0 mg/dL), magnesium (oral or intravenous to keep level above 2.0 mg/dL), potassium (oral or intravenous to keep level above 4.0 mEq/L), and thiamine (vitamin B1, 100 to 300 mg daily) supplements before and during refeeding.
·Family-Based Treatment (FBT, also called Maudsley therapy) for adolescents and young adults (typically under age 25) with anorexia nervosa
·Cognitive Behavioral Therapy for Eating Disorders (CBT-E, enhanced version) for adolescents and adults with any eating disorder (anorexia nervosa, bulimia nervosa, binge-eating disorder, or other specified feeding or eating disorder)
·Fluoxetine 60 mg daily (taken in the morning) for bulimia nervosa, started after nutritional rehabilitation if the person is underweight
·Lisdexamfetamine 50 to 70 mg daily (taken in the morning) for binge-eating disorder in adults
·Treat co-occurring depression, anxiety, or obsessive-compulsive disorder with selective serotonin reuptake inhibitors (such as sertraline 50 to 200 mg daily, escitalopram 10 to 20 mg daily, or fluoxetine 20 to 40 mg daily for depression and anxiety) or with cognitive behavioral therapy for the specific condition (CBT for depression, exposure and response prevention for OCD)

—

NCLEX trap

·Eating disorders grow from tangled roots in the mind—anxiety, obsession, depression, genes, life stress, and messages from culture about what bodies should look like. Feeding alone, without therapy and safety planning, will not fix it. You must treat the upstream break (the thoughts and fear driving the restriction), not just the downstream symptom (low weight).
·Refeeding syndrome can kill. When you feed someone whose body has been starving, the cells suddenly pull phosphate, potassium, and magnesium out of the blood to handle the incoming food (like a dry sponge soaking up water). That drains the blood levels and can stop the heart or trigger a seizure. Current guidelines (AED, APA) say: start slow (1000–1500 kcal the first day), replace phosphate and magnesium before or with the first meals, give thiamine to protect the brain, and watch the heart closely on a monitor.
·Eating disorder is a mental health condition with broken thought patterns about food, weight, and body. Normal weight and labs do not mean the thoughts or behaviors are fixed. The person may still be obsessing over calories, weighing themselves ten times a day, restricting in secret, or purging where no one sees. The mind takes months to years to heal. Keep watching for relapse and continue therapy (CBT-E or family-based therapy).
·Bulimia causes low minerals—especially potassium, magnesium, and chloride—that can stop the heart without warning (risk of torsades de pointes, a deadly spiral rhythm). Purging also tears the food tube (Mallory-Weiss tear at the junction where the esophagus meets the stomach; esophageal rupture, which spills stomach contents into the chest and can kill), wears tooth enamel to nothing from stomach acid, and swells the salivary glands (chipmunk cheeks). Bulimia is a medical emergency, not a vanity problem.
·Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder (ARFID, where someone avoids food because of texture, fear of choking, or lack of interest—not because of weight worry). They happen in boys, girls, men, women, all body sizes, all races, and all backgrounds. Do not miss it by stereotype: someone in a larger body can have anorexia (atypical anorexia, where all the restriction and fear are there but weight has not dropped to underweight yet), and boys and men can have bulimia or binge eating disorder.
·People with eating disorders often hide behaviors and feel deep shame. Ask screening questions gently and more than once: 'Do you worry a lot about your weight or shape?' 'Do you restrict food on purpose?' 'Do you ever binge—eat a huge amount in a short time and feel totally out of control?' 'Do you ever make yourself throw up or use laxatives to get rid of food?' 'Has anyone in your life worried about your eating?' Use a validated screening tool like SCOFF (five yes/no questions; two yes answers flag risk) or the Eating Disorder Examination Questionnaire (EDE-Q), not just one question. Build trust first—teens especially will not open up if they feel judged.

—

Install Maldek by Hill as an app — studies work even offline