Eating disorders on the wards

Picture this. Rebecca, a final year medical student, approaches an elderly patient on her ward. She has been asked to replace a cannula. They chat while Rebecca touches the woman's arm, deciding on a vein. To the woman, Rebecca's hands feel cold and bony. She looks at them. They are blue. Their faces are close. The woman sees Rebecca's pallid skin, her dark circled eyes, and what appears to be muscle fibres stretched across her hollow cheeks. She compares their arms as the cannula slips in-prominent veins; peeling skin; and fine, long hair. Rebecca finishes, thanks her, and walks away. The woman stares at her profile-her width, her lack of curves and shape-protruding bones, visible ribs, and a head that seems too large for its body.

Shocked? Well, how about this. Zoe drops into Tesco on her way home from the hospital. On returning to her flat she's ravenous. She eats, hurriedly shoving anything into her mouth, unable to stop. Urgency is followed by pain, self disgust, panic, and revulsion. She runs to the toilet, pushing her fingers down her throat. “Is it all out?” She's terrified: “Please, God, let it all be out.”

What have just been described are the unmistakeable conditions of anorexia nervosa, where an individual is malnourished and often visibly grossly underweight, and bulimia nervosa, in which someone remains discrete and hidden beneath their normal body weight. But what of someone who binges, fasts, or has strange eating patterns and habits and seriously misjudges their body size and figure? Sound all too common? Well, they most likely have an EDNOS (an eating disorder not otherwise specified), not really fitting the diagnosis of either anorexia or bulimia. In a previous …