Eating disorders: signs, causes and treatment methods

Are you constantly concerned about your body weight and figure, endure strict diets or significantly limit yourself in food, and every breakdown in your diet is accompanied by a feeling of guilt? Or, perhaps, food has become a way for you to comfort yourself or escape from stress?

Such situations are familiar to many and often seem normal, especially in a world where the cult of health and beauty dictates strict standards. However, behind these, at first glance, “normal” habits, eating disorders may be hidden — severe mental conditions that affect both your body and emotional health.

The MEDplus editorial team asked psychotherapist and psychiatrist Yaroslava Marunkevych and Anastasia Krayevska, a clinical psychologist, psychotherapist, and specialist in ED, what an eating disorder really is, how to recognize it, and why it is important to seek help, — without shame and without self-blame.

Yaroslava Marunkevich

Psychiatrist, Psychotherapist, PhD, Associate Professor at Vinnytsia National Medical University

Anastasia Kraevska

clinical psychologist, psychotherapist, eating disorder specialist

“Every third or fourth client comes in with food-related problems. And many people don’t understand for years that their symptoms are not just “I can’t pull myself together”, but a serious signal,” emphasizes psychologist Anastasia Kraevska.

What is an eating disorder, and how do you understand that it is not just a love of food?

“Eating disorders (EDs) are mental disorders in which the relationship with food, the body, and oneself is disrupted. It is not just “I love sweets” or “I eat pizza once a week.” This is when food becomes the only way to calm down, punish yourself, or feel at least some control,” explains psychologist Anastasia Krayevska.

“This is a clinical diagnosis that a psychiatrist, based on diagnostic criteria, can only make,” adds psychotherapist Yaroslava Marunkevych.

According to experts, EDs may look different on the outside, but they always have one thing in common: food ceases to be a source of life and pleasure, and turns into a tool of punishment, comfort, or control. There are three main types of ED that are most often diagnosed:

• Anorexia nervosa — conscious restriction of food, distorted perception of one’s own body, menstrual cycle disorders in women, or decreased libido in men.
• Bulimia nervosa — periodic episodes of overeating with loss of control over the amount of food consumed, after which compensatory behavior occurs: inducing vomiting, taking laxatives, abstaining from food, or excessive physical exertion. Such episodes occur at least once a week for 3 months.
• Compulsive overeating — loss of control over the amount of food consumed, even if there is no physical hunger. Most often, such episodes are accompanied by strong internal tension before eating and a feeling of guilt, shame, or self-disgust after.

Psychologists are also now identifying a new type of eating disorder — “orthorexia.”

“This is an eating disorder characterized by an obsessive desire for exclusively “healthy” food. There is no official diagnosis yet, but it is a serious problem,” says Anastasia.

Orthorexia warning signs:

• compulsive reading of food ingredients
• shame and anxiety after “forbidden” foods
• exclusion of entire food groups (carbs, dairy, meat)
• obsessive following of “healthy” blogs
• high level of distress without “clean” foods

When should you start responding to the problem and seeking professional help?

“The indicative moment is when thoughts about food, body, and weight begin to occupy most of the space in the head. It’s not just a habit anymore, but a deeper story — often associated with emotions, trauma, the need for safety and acceptance,” says Anastasia.

Psychological causes of ED

“The desire for care and love, to be protected and valued, the fear of loss, of showing one’s emotions, as well as the fear of emptiness and loss of control, feelings of vulnerability, weakness, guilt, and shame or self-loathing are all emotions that typically underlie eating disorders,” Yaroslava psychiatrist says.

Many people think that ED is only about food. But in reality, it is about pain that has not found another way to be heard. In a culture where being weak is shameful and showing emotions is “indecent,” the body takes on all the burden.

“When there is no permission to get angry, a person begins to punish himself. When there is a lot of unexpressed longing, food gives a temporary feeling of warmth,” explains Anastasia.

“Silent” signals that indicate ED

Not everyone who has ED has noticeable weight loss or gain. Often, a person looks “normal” on the outside, but inside is waging a fierce battle with themselves.

Signals that should alert you:

• constant thoughts about food, planning “what to eat and what not to eat”;
• feelings of guilt or shame after eating;
• fear of “breaking down”;
• eating according to “black and white” schemes: either everything is allowed or nothing;
• lack of pleasure from food.

How to support a loved one with ED?

You need to start not with diets or advice, but with support and acceptance. ED is not a “whim” but a serious mental condition that requires professional help.

“Foremost, you need to delicately say that it is worth consulting a mental health specialist. Do not judge, do not devalue the problem. The best support is to say: I am there, I will go through this path with you,” advises Yaroslava.

Show the person your interest, explain that you are here and nearby, ready to listen and help. “I am worried because I see you are having a hard time. If you want to talk, I am there,” advises Anastasia.

Phrases that you should NOT say to a person with ED:

• “Just eat normally”
• “Think about the consequences”
• “You don’t look sick”
• “Look at how others live”
• “You just need to pull yourself together”

If you sincerely want to help the person and support them, it is better to say:

• “I see it is difficult for you”
• “I am here if you would like to talk”
• “It is important for me to supportyou”

What are the most common mistakes parents or partners make when trying to “save” someone?

The most common mistakes psychologists identify in people who are trying to help:

• excessive control over a person
• ultimatums, such as “eat, or we’ll go to the doctor”
• pressure on the body, such as “you used to be so beautiful”
• complete ignoring of the problem

Where does the path to recovery begin?

Psychologists identify several primary and important steps on the path to recovery from eating disorders:

Step 1. Awareness

The path to change begins with an honest phrase to yourself: “I don’t want to live like this anymore.” This is the moment when a person admits that there is a problem — and at the same time understands: it is not their fault.

Step 2. Working with nutrition

At the initial stage, it is important to restore normal, regular nutrition without diets, calorie counting, and strict restrictions. This is the basis for further therapy.

Step 3. Self-monitoring

You can start keeping a food and emotion diary — track what exactly provokes overeating or restriction. This helps to understand your triggers better.

Step 4. Seeking help

If you feel you can’t cope on your own, it’s time to seek help from a specialist. This is not a sign of weakness, but rather a conscious decision for the benefit of your own health and life.

How is ED treated?

“A team approach is essential in ED therapy: a psychotherapist, psychiatrist, nutritionist, endocrinologist, and family involvement. Treatment includes cognitive behavioral therapy (CBT) and, if necessary, medication,” says Yaroslava.

At all stages, psychoeducation is important — understanding what is happening and why.

“Full recovery from ED is possible. But it’s not about returning to your “old self,” but about a new, more profound relationship with yourself. Recovery is when food stops being an enemy or a comfort. When the body is not for control, but for life. This is freedom: to eat, feel, be yourself without constant fear and control,” Anastasia notes.

If you feel like “something is wrong” with you, it can be painful, scary, and embarrassing. But seeking help is not a defeat, but a step toward a life in which you are not your own enemy.

That’s why it’s critical to make a clear distinction between self-care and life-ruining control. “The key difference is in the feeling after the action. Care leaves warmth, peace, inner softness. Control exhausts, strains, generates shame or fear.

Care asks: “How can I take care of myself?” Control dictates: “You have to be better, thinner, more correct.” Out of self-love or self-hatred, that’s the key question,” explains psychologist Anastasia.

Advice from a psychologist for a person who is currently at the most tough point in their experience of struggling with an eating disorder:
“You are not broken. You are just at a point where it hurts a lot right now. But you can get out of it — step by step. It’s not your fault, and you’re not alone. I know how scary it is. But I also know that from this pain can be born a new life — soft, full, and real. You deserve it. And you definitely have enough strength.”
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