Anorexia and eating disorders

Anorexia nervosa is a mental and behavioral disorder involving refusing or reducing food, distorted thoughts around eating or body weight for example fear of getting "fat" when underweight, and/or other thoughts and behaviors that lead to sufferer being significantly underweight.

Other eating disorders include:
 * bulimia nervosa, which involves intentional vomiting or purging food to avoid weight gain ;
 * binge eating disorder,
 * orthorexia: eating an extremely restricted diet based on fear of eating "unhealthy" foods),   and
 * other specified feeding or eating disorder (OSFED).

Anorexia and ME/CFS
Anorexia nervosa and eating disorders are not common in people with ME/CFS.Anorexia (appetite loss or abnormal appetite) is listed as a possible neuroendocrine system'' symptom in the Canadian Consensus Criteria for ME/CFS.

Digestive problems are very common symptoms in ME/CFS, and may some cause changes in eating behaviors or weight, for example because of food intolerances.

Severe myalgic encephalomyelitis/chronic fatigue syndrome can also cause
 * dysphagia (swallowing difficulties or an inability to swallow)
 * a symptom also found in some people after a stroke, and in multiple sclerosis and Parkinson's diseases

These swallowing and eating symptoms can lead to the sufferer becoming severely underweight; this can cause a misdiagnosis of anorexia or another eating disorder, which may lead to inappropriate treatment.
 * vomiting, which may be linked to vertigo
 * food or medication intolerance, which is found in approximately 50% of people with ME/CFS, may become severe
 * this may cause a reluctance to eat/swallow in severe cases

Some people severely affected by ME/CFS need feeding tubes or artificial nutritional, and may become severely underweight purely as a result of their ME/CFS symptoms, and may starve to death. This is also the case for some people with anorexia or eating disorders.

Children and "refusal" to eat
Some parents have reported that their child’s swallowing difficulties or vomiting have resulted in medical professionals interpreting these ME/CFS as an indicator of a mental disorder, for example some children originally diagnosed with chronic fatigue syndrome have had their diagnosis changed to Pervasive Refusal Syndrome because they were wrongly judged as "refusing" to eat, wash, or increase their activity levels.

Prevalence
Unknown.

Symptom recognition


Merryn Crofts was bedbound and unable to eat when she died of very severe ME. Merryn weighed six stone (84 lbs) at her death but did not have an eating disorder, she had severe gastrointestinal symptoms causing weight loss. Merryn's autopsy revealed ganglia inflammation. It is suspected that in the later years of her illness Merryn also suffered from EDS and MCAD. Her death certificate is the second in the UK publicly known to have been attributed to ME.

Anorexia is recognized as a possible symptom in the Canadian Consensus Criteria for ME, but is not regarded as a diagnostic symptom. A number of patient groups have raised concerns that anorexia may be a misdiagnosis in some patients with ME, particularly children or young people, and the severely ill.

Digestive symptoms problems are well recognized, particularly irritable bowel syndrome, and food intolerances, and are optional diagnostic criteria. Common ME/CFS symptoms which may cause changes in eating or weight include:
 * digestive problems
 * nausea
 * abdominal pain
 * new food or medication sensitivities
 * irritable bowel syndrome

Notable studies
There do not appear to be any significant studies assessing swallowing or eating issues in patients with ME/CFS, or investigating the presence of comorbid eating disorders, or the potential misdiagnosing of eating disorders, although there are many different accounts from patients or their carers/parents.

Byron and Hyde have started that enteroviruses may disrupt swallowing reflexes.

Learn more

 * KNOWLEDGE IN THE HOPE OF PROTECTING M.E. SUFFERERS FROM UNNECESSARY SECTIONING - The 25% ME Group


 * ME - The Illness and Common Misconceptions: Abuse, Neglect, Mental Incapacity. A summary originally produced for the legal profession - Tymes Trust
 * Wikipedia