Psychiatry: disorder groups
Feeding & eating disorders
Feeding and eating disorders, such as anorexia nervosa, bulimia nervosa and binge-eating disorder, combine disturbed eating with serious physical risks. Psychiatrists must manage both the psychological illness and dangerous medical complications, working closely with physicians, dietitians and families.
Depth by stage, Pre-U → Consultant (details)
What is it?
Eating disorders are serious mental illnesses, not lifestyle choices. In anorexia nervosa a person keeps their weight dangerously low through restriction, exercise or purging, often driven by intense fear of gaining weight. Bulimia nervosa involves repeated binges followed by vomiting, laxatives or fasting. Binge-eating disorder involves binges without regular compensation.
Avoidant/restrictive food intake disorder (ARFID) causes poor intake due to sensory sensitivity, fear of choking or lack of interest in food rather than body-image concerns, and is seen especially in children. Pica and rumination disorder are also in this group.
Anorexia nervosa has one of the highest death rates of any psychiatric condition, from starvation and suicide. Early treatment, especially family-based treatment for adolescents, improves outcomes.
Why does a psychiatrist need it?
Psychiatrists assess medical risk (heart rhythm, electrolytes, very low weight), decide when hospital admission or involuntary treatment is needed, recognise refeeding syndrome, and deliver or coordinate specialist therapies. Eating disorders are increasingly recognised among young Malaysians, including university students.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns nutrition, starvation physiology and electrolytes in physiology and biochemistry.
- ClinicalUnderstandsRecognises the main eating disorders and their physical signs; knows BMI and risk basics.
- HousemanshipAwareRecognises refeeding risk and electrolyte disturbances in medical or paediatric wards.
- Medical officerUnderstandsScreens for eating disorders and assesses medical risk with supervision.
- Psych traineeAppliesManages outpatient and inpatient cases with physicians and dietitians; examined in both MMed and MRCPsych.
- Specialist / consultantMasters / TeachesLeads complex and high-risk cases; subspecialists run dedicated services.
What are the key topics?
Conditions
- Anorexia nervosa (restricting and binge-purge patterns)
- Bulimia nervosa
- Binge-eating disorder
- Avoidant/restrictive food intake disorder (ARFID)
- Pica and rumination-regurgitation disorder
- Other specified feeding or eating disorders
Causes
- Genetic and temperamental factors (perfectionism, anxiety)
- Sociocultural pressures about weight and appearance, including social media
- Family and developmental factors; trauma in some cases
- Neurobiology of appetite and reward
Medical risk assessment
- Weight, BMI and rate of weight loss (BMI-for-age centiles in young people)
- Heart rate, blood pressure, temperature, ECG (QTc)
- Electrolytes: potassium, phosphate, magnesium
- Refeeding syndrome and its prevention
- Bone health, fertility and growth effects
- Risk frameworks such as the UK MEED guidance (Medical Emergencies in Eating Disorders)
Treatment
- Family-based treatment for adolescents with anorexia
- CBT-E (enhanced CBT for eating disorders) and other specialist therapies for adults
- Nutritional rehabilitation with dietitians
- Medical stabilisation and, when needed, inpatient care
- Limited role of medication; treating comorbid depression or anxiety
- Capacity, consent and use of mental health law for life-threatening cases
How is it learned and assessed?
- Physiology and biochemistry (nutrition, starvation) in pre-clinical years
- Undergraduate psychiatry and paediatric postings
- Trainee rotations in child and adolescent and liaison psychiatry
- MMed Part II; MRCPsych Paper B and CASC (e.g. eating disorder history, physical examination station)
Typical textbooks and resources
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- Cognitive Behavior Therapy and Eating Disorders — Christopher G. Fairburn, Guilford Press
- Medical Emergencies in Eating Disorders (MEED) guidance — Royal College of Psychiatrists
- NICE guideline on eating disorders — NICE (UK)
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Can eating disorders be fatal?
Yes. Anorexia nervosa in particular has a high death rate from medical complications such as heart rhythm problems, and from suicide. Early recognition and treatment are vital.
Do only young women get eating disorders?
No. They are more common in young women, but they affect men, children and older adults too, and are often missed in these groups.