Associated Conditions

There are a number of issues people might experience in relation to food, eating, and exercise or how they experience their body, which can either make them feel uncomfortable or distressed. At times they might engage in behaviours, which can potentially cause serious symptoms and suffering. Some of these issues have so far not been formally defined or recognised as a diagnosable disorder but have nevertheless become known by a term used in the media or by clinicians.

Muscle Dysmorphia

Muscle dysmorphia (sometimes also called ‘Reverse Anorexia’ or ‘Bigorexia’) is a form of Body Dysmorphic Disorder (BDD). BDD is a diagnosable clinical disorder, which causes the sufferer to become excessively preoccupied with an imagined physical defect of their body leading to significant distress and impairment in daily functioning. Muscle dysmorphia primarily affects males but can also affect females. Sufferers develop a preoccupation with their muscularity, believing themselves to be small and weak and they may also see themselves as fat. The sufferers tend to engage in excessive exercising and often also develop a range of eating rituals. They often tend to lose weight and then end up suffering from the additional physical and mental effects of starvation, similar to anorexia. Cognitive Behaviour Therapy (CBT) can be an effective treatment for this condition.


Orthorexia refers to an obsession with eating ‘healthy’ food and avoiding ‘unhealthy’ food. It is not recognised as a clinical disorder but if left untreated can progress to a full clinical eating disorder.

Many individuals who have developed an ‘unhealthy obsession’ with ‘healthy’ eating would initially have only been motivated by the idea of wanting to live a healthy lifestyle. However, some of the underlying motivations might include a need of feeling in control, protecting oneself from fear of poor health, improving self-esteem, searching for spirituality or using food to create a sense of identity. Over time for some people the quest to develop the perfect diet ends up taking up a very large amount of their time and attention and they might experience strong feelings of guilt and self-blame when they don’t stick to their diet. The increasing rules and requirements of following their diet can also result in increasing social isolation.

In addition, many people can inadvertently end up following a diet that is low in important nutrients and therefore potentially affect their health.

Treatment usually includes psycho-education, CBT and often also nutritional consultations.


Diabulimia is a particularly dangerous condition, which can affect those suffering from insulin dependent Type 1 Diabetes. Sufferers deliberately reduce or omit insulin for the purpose of weight loss. This behaviour leads to a breakdown of muscle and fat and very high blood glucose levels. The consequences of this behaviour include fatigue, dehydration, weight fluctuations and early onset of complications of diabetes. High blood sugar levels can also lead to a dangerous life threatening condition called Diabetic Ketoacidosis (DKA) requiring hospital admission.

Diabulimia can be treated using psychological therapies similar to those used with bulimia nervosa. Because diabulimia involves two conditions, an eating disorder and diabetes, close communication is required between the professionals managing each of them. 

Problematic Emotional Eating

Human beings eat for a variety of reasons, hunger, to be social, and in response to both positive and negative emotions. Eating in response to negative emotions i.e. feeling sad or lonely, is normal in modern society. However, some people may find that eating in response to negative feelings is having a large and problematic impact on their life. This may lead to problems in their physical health, i.e. obesity, heart disease, diabetes and they may find that eating has become their only, or primary, coping strategy. When this is the case, a person may need help to develop other effective strategies to manage negative emotions when they arise.

Female Athlete Triade Syndrome

Female Athlete Triad refers to a combination of three conditions in female athletes: disordered eating leading to low energy availability, amenorrhea and low bone density leading to osteoporosis. A female athlete can have one, two, or all three parts of the triad.

This condition can affect women engaged in regular high-level exercise. It is not limited to professional athletes and can also affect women who exercise at a high level socially or as a hobby. Low energy availability occurs when a person does not eat enough food to fuel their physical activity to meet the functional needs of their body. This can lead to physiological adaptations that include reduction of reproductive hormones resulting in amenorrhea, loss of bone density resulting osteoporosis. These symptoms can occur even if the person maintains a ‘normal’ body weight. Low energy availability can also compromise a person’s training and sport performance. More information about the Female Athlete Triad Syndrome can be found at

Co-morbid Conditions i.e. anxiety, depression, obsessive compulsive disorder, self harm

Eating disorders are often associated with other mental health issues. These can include symptoms of anxiety, depression, obsessive compulsive disorder and self-harm. Often these issues resolve and improve alongside improvement of the eating disorder. However, occasionally separate targeted treatment may be needed.

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