Eating Disorders: Recognition and Treatment

Eating disorders are complex mental health conditions involving a disturbed relationship with food, body, and weight. They are not failed diets or vanity. They are serious illnesses requiring professional help. However, recovery is possible.

Different Forms of Eating Disorders

Anorexia nervosa: Intense fear of gaining weight, severely restricted eating, distorted body image. The person feels overweight even when severely underweight.

Bulimia nervosa: Recurring binge eating episodes followed by compensatory behavior such as vomiting, laxative use, or excessive exercise. Weight may be normal.

Binge eating disorder (BED): Recurring uncontrollable binge eating episodes without compensation. Often associated with shame, guilt, and overweight.

Atypical eating disorders: Not all eating disorders fit neatly into categories, and atypical forms (OSFED) are common. Orthorexia (compulsive healthy eating) is not an official eating disorder diagnosis; it is not in the ICD-11 or DSM-5 classifications. Compulsive eating patterns can still be harmful and may need support.

Warning Signs

Recognizing an eating disorder can be difficult because the sufferer often hides symptoms. Warning signs include:

• Significant weight changes
• Obsessive relationship with food, calories, or weight
• Extreme dietary restriction
• Hiding eating or avoiding mealtimes
• Excessive exercise
• Vomiting after meals
• Body image distortion
• Social withdrawal
• Mood changes, especially around mealtimes
• Physical signs: hair loss, dry skin, feeling cold, fatigue, dizziness

Who Develops Eating Disorders?

Eating disorders can affect anyone: young people, adults, women, men, all genders. Although most common in young women, eating disorders in men and older adults are increasingly recognized.

Risk factors include:

• Perfectionism and high demands
• Low self-esteem
• Bullying or body-related commenting
• Traumatic experiences
• Eating disorders or mental health problems in the family
• Sports or professions with particular attention to weight
• Genetic predisposition

Severity of Eating Disorders

Eating disorders are life-threatening illnesses. Anorexia nervosa has one of the highest mortality rates of all mental health disorders. Physical complications include:

• Heart problems
• Bone loss
• Kidney failure
• Hormonal damage and fertility problems
• Dental damage (bulimia)
• Digestive problems
• Brain function disorders

Treatment Options

Eating disorder treatment is multidisciplinary and individualized:

Psychotherapy: The central treatment form. Effective therapies include:

• Cognitive behavioral therapy (CBT-E, specifically tailored for eating disorders)
• Family therapy (especially for adolescents)
• Dialectical behavior therapy (DBT)
• Interpersonal therapy

Nutritional therapy: A nutrition therapist helps build a healthy and balanced relationship with food.

Medication: Particularly in treating bulimia and binge eating disorder, SSRI medications can be beneficial. In anorexia, medication's role is more limited.

Inpatient treatment: In severe cases, hospitalization may be necessary to stabilize the physical situation.

Recovery from Eating Disorders

Recovery is possible but often a long process. Recovery prospects vary with the type and severity of the eating disorder and with treatment: some people recover fully, some partially, and for some the symptoms are long-lasting. Seeking treatment early improves the outlook.

Important in recovery:

• Motivation for change, even though it is initially frightening
• Long-term commitment to treatment
• Social support from family and loved ones
• Patience: setbacks are part of the process
• Building a new identity without the eating disorder

How to Seek Help

If you suspect an eating disorder in yourself or a loved one:

1. Contact your health center or occupational health
2. Young people: contact school health services
3. Syömishäiriöliitto-SYLI ry (the Finnish eating disorder association) offers counselling and peer support; find the current helpline number and hours at syomishairioliitto.fi
4. Find a therapist experienced in eating disorder treatment

Therapy Costs

A therapy session typically costs 80–120 euros. Public healthcare also provides eating disorder treatment, and referral to specialized care is available.

Kela and rehabilitative psychotherapy

Kela's rehabilitative psychotherapy is available to people aged 16 to 67 whose ability to work or study is threatened by a mental health disorder. You must have been in appropriate care for at least 3 months, and a psychiatrist must have written you a B statement (B-lausunto). Kela covers up to 80 sessions per year and up to 200 sessions over three years. The reimbursement for individual therapy is 57.60 euros per session, and you pay the rest yourself. The therapist must be a Kela-approved provider, so check the therapist's eligibility in advance. Current conditions and reimbursement amounts are at kela.fi.

Where to find a therapist

You can look for a therapist in several places:

• Search services run by the Finnish Psychological Association (Psykologiliitto) and professional bodies.
• Kela's service provider search, if you are applying for rehabilitative psychotherapy (only Kela-approved therapists qualify for reimbursement).
• The Valitse Terapia service and other directories.
• Your own health centre, occupational health service or student health service (YTHS), which can refer you onward.

You can contact several therapists and see with whom the collaboration feels natural.

When emergency care is needed

An eating disorder can lead to life-threatening complications. Go to emergency care immediately or call 112 if you have, for example, fainting or loss of consciousness, a very slow or irregular heartbeat, chest pain, severe weakness, or signs of an electrolyte imbalance (for instance after repeated vomiting). These need urgent medical assessment.

Get help in a crisis now

If you are having thoughts of self-harm or are otherwise in an acute crisis, you do not have to face it alone.

• In an emergency, call 112.
• MIELI Mental Health Finland crisis line: 09 2525 0113 (English and Arabic), 09 2525 0111 (Finnish), 09 2525 0112 (Swedish).
• For under-29s: Sekasin chat (sekasin.fi).

Help is available anonymously, and you do not need to be sure your situation is serious enough.

An eating disorder steals life, but it does not have to continue indefinitely. Treatment is available, recovery is possible, and you deserve a life free from the eating disorder's chains.

Sources

• Current Care Guidelines: Eating disorders
• Mielenterveystalo (Mental Health Hub)
• MIELI Mental Health Finland
• Kela: Rehabilitative psychotherapy