Anorexia and eating disorders

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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.[1][2][3]

Other eating disorders include:

  • bulimia nervosa, which involves intentional vomiting or purging food to avoid weight gain[4][5];
  • binge eating disorder,[6][7]
  • orthorexia: eating an extremely restricted diet based on fear of eating "unhealthy" foods),[8][9][10] and
  • other specified feeding or eating disorder (OSFED).[11]


See also
Anorexia (appetite loss)
appetite loss causing an inability to eat, caused by a physical illness.


Anorexia and ME/CFS[edit | edit source]

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.[12]

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)[13]
a symptom also found in some people after a stroke, and in multiple sclerosis and Parkinson's diseases[14]
this may cause a reluctance to eat/swallow in severe cases[15]

These swallowing and eating symptoms can lead to the sufferer becoming severely underweight; this can cause a misdiagnosis of anorexia[16] or another eating disorder, which may lead to inappropriate treatment.

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.[17] This is also the case for some people with anorexia or eating disorders.

Children and "refusal" to eat[edit | edit source]

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.[18][16]

Our son’s main symptom was dizziness / orthostatic intolerance and abnormal gait which he adopted because of his dizziness. We were told that as neurological examination was normal there must be a psychological element to his problems (this was from a very eminent Consultant Paediatric Neurologist).

When we finally had to give in and admit him to hospital he was too weak to swallow his own saliva and had lost 20% of his body weight. Within 24 hours of admission he developed myoclonic jerks. We were asked whether he had a negative body image (ie was he anorexic) and whether we thought he was ‘putting on’ the muscle jerks. HELP! Please educate the Doctors and Nurses.

— From a family outside Essex, UK, Our needs, our lives (2003)[19]

Prevalence[edit | edit source]

Unknown.

Symptom recognition[edit | edit source]

Whitney Dafoe is an American photographer who has very severe ME, which causes him very severe gastrointestinal symptoms, because of this he is tube fed and remain severely underweight. Whitney can no longer speak, eat, or have contact with anyone but his parents due to visual dysfunction and very severe ME. Whitney was previously misdiagnosed with the eating disorder anorexia, which resulted in him being refused the surgery needing for a feeding tube and in-patient psychiatric care recommended instead. Whitney is now fed via a PEG, is still unable to even drink water, and he needs full time care.[citation needed]

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.[citation needed]

Anorexia is recognized as a possible symptom in the Canadian Consensus Criteria for ME, but is not regarded as a diagnostic symptom.[15] 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.[16]

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:

Notable studies[edit | edit source]

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.[14]

Possible causes[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ "Anorexia Nervosa". National Eating Disorders Association. February 25, 2017. Retrieved February 25, 2019.
  2. ↑ "Anorexia nervosa - Symptoms and causes". Mayo Clinic. Retrieved February 25, 2019.
  3. ↑ Harris, Peter; Nagy, Sue; Vardaxis, editor-Nicholas, eds. (2018). Mosby's Dictionary of Medicine, Nursing and Health Professions (Revised 3rd Anz ed.). Australia: Elsevier. p. 102. ISBN 978-0-7295-8691-7.CS1 maint: extra text: editors list (link)
  4. ↑ "Bulimia Nervosa". National Eating Disorders Association. February 26, 2017. Retrieved February 25, 2019.
  5. ↑ "Bulimia nervosa - Symptoms and causes". Mayo Clinic. Retrieved February 25, 2019.
  6. ↑ "Binge Eating Disorder". National Eating Disorders Association. February 26, 2017. Retrieved February 25, 2019.
  7. ↑ "Mental Health and Binge Eating Disorder". WebMD. Retrieved February 25, 2019.
  8. ↑ webMD.com https://www.webmd.com/mental-health/eating-disorders/what-is-orthorexiao. Retrieved February 21, 2021. Missing or empty |title= (help)
  9. ↑ Hill, Amelia (August 15, 2009). "Pure food obsession is latest eating disorder". The Observer. ISSN 0029-7712. Retrieved February 25, 2019.
  10. ↑ Bratman, Steven (January 23, 2014). "What is Orthorexia? | Orthorexia". www.orthorexia.com. Retrieved February 25, 2019. Cite has empty unknown parameter: |dead-url= (help)
  11. ↑ "Other Specified Feeding or Eating Disorder". National Eating Disorders Association. March 21, 2017. Retrieved February 25, 2019.
  12. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named CCC
  13. ↑ The Grace Charity for M.E.; The 25% ME Group (January 2019). "KNOWLEDGE IN THE HOPE OF PROTECTING M.E. SUFFERERS FROM UNNECESSARY SECTIONING". ... the terrible act of sectioning sound minded M.E. patients who are neither a threat to themselves nor to others ... Cite has empty unknown parameter: |1= (help)
  14. ↑ 14.0 14.1 The 25% ME Group (Summer 2018), "Drs. Byron Hyde and John Chia - Questions and Answers", The Quarterly Newsletter, 25 Percent ME Group, p. 10, Some M.E. specialist researchers believe that the gastric mucosa which is infected with enteroviruses may reach the brain by travelling up the vagus nerve, which controls the swallowing reflex.
  15. ↑ 15.0 15.1 15.2 Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, A C Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols (PDF). Journal of Chronic Fatigue Syndrome. 11. p. 7-115. doi:10.1300/J092v11n01_02.
  16. ↑ 16.0 16.1 16.2 Colby, Jane. "ME - The Illness and Common Misconceptions: Abuse, Neglect, Mental Incapacity. A summary originally produced for the legal profession" (PDF). Tymes Trust. Retrieved February 25, 2019. Cite has empty unknown parameter: |dead-url= (help)
  17. ↑ ME sufferer who was dismissed as hysterical vindicated in death’ The Times 29 May 2018 by Lucy Bannerman; also The Quarterly published by the 25% ME Group Summer 2018 pages 22-23 www.25megroup.org
  18. ↑ https://www.dailykos.com/stories/2018/10/10/1803351/-Karina-Hansen-is-FREE
  19. ↑ Tymes Trust (2003). "Our Needs Our Lives" (PDF).

neuroendocrine relating to hormones that influence the nervous system

enterovirus A genus of RNA viruses which typically enter the body through the respiratory or gastrointestinal systems and sometimes spread to the central nervous system or other parts of the body, causing neurological, cardiac, and other damage. Since the first reports of myalgic encephalomyelitis (ME), enteroviruses have been suspected as a cause of ME. Enteroviruses have also been implicated as the cause of Type I diabetes, congestive heart failure, and other conditions. Enteroviruses include poliovirus, coxsackieviruses, and many others. New enteroviruses and new strains of existing enteroviruses are continuously being discovered. (Learn more: viralzone.expasy.org)

Canadian Consensus Criteria (CCC) - A set of diagnostic criteria used to diagnose ME/CFS, developed by a group of practicing ME/CFS clinicians in 2003. The CCC is often considered to be the most complex criteria, but possibly the most accurate, with the lowest number of patients meeting the criteria. Led to the development of the International Consensus Criteria (ICC) in 2011.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

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