Eating Disorders (Anorexia/Bulimia/Binge)

The Problem

Eating disorders have highest mortality rate of any psychiatric illness (anorexia—5-20% mortality, suicide and medical complications), treatment challenging, relapse common, Conventional approach appropriate (psychotherapy, nutritional counseling, medical monitoring essential) BUT: Often doesn't address: Zinc deficiency (PROVEN to improve appetite and weight gain in anorexia—rarely tested or supplemented), Other nutrient deficiencies (vitamin D, omega-3, B vitamins—common, affect brain function and mood), Gut health (damaged from restriction, purging—dysbiosis, inflammation affect neurotransmitters, rarely addressed), Neurotransmitter support (amino acid precursors, cofactors—may help mood, impulse control), Trauma (underlying in many cases—needs specific trauma therapy, sometimes overlooked), Medications: Fluoxetine modestly helpful for bulimia (reduces binge/purge frequency), other SSRIs mixed results, Olanzapine for anorexia: helps weight gain, reduces anxiety but significant side effects (metabolic syndrome, weight gain—distressing for ED patients), no magic bullet medication, Insurance barriers (treatment expensive, often inadequate coverage—residential/inpatient $30,000/month, many can't access needed level of care), Focus on weight (important but not only measure—mental health, behaviors, quality of life matter), Diet culture (pervasive—even in recovery, 'health' and 'wellness' rhetoric can be triggering), Treatment resistant cases (some patients chronically ill despite treatment—palliative/harm reduction approach may be appropriate vs. aggressive intervention), Recovery possible but difficult (requires: comprehensive treatment, multidisciplinary team, family support, long-term commitment, address all aspects—medical, nutritional, psychological, social).