We all tweak our eating habits now and then—to feel healthier, keep our BMI in check, or feel more confident in our bodies. But it’s not always easy to recognise when health-conscious choices cross a line.
Sometimes, what starts as a diet can become an all-consuming preoccupation with food, numbers, and appearance. Similarly, the habit of snacking during a rough day at work can evolve into a pattern of bingeing—or even purging.
So how do we know when a habit becomes harmful? Let’s take a closer look at what eating disorders are, how they show up in daily life, and the signs to watch for—in ourselves and in those we care about.
What are eating disorders?
Eating disorders are complex health conditions that deeply affect how someone thinks and feels about food, their body, and their appearance. These negative thoughts can lead to unhealthy eating habits or behaviours that harm both physical health and emotional well-being. It’s important to note that eating disorders don’t have a specific “look”—they can affect anyone, regardless of size or shape. They often begin during adolescence or young adulthood, and sometimes even before puberty. Beyond just food, eating disorders can have a significant impact on a person’s social life, mental health, and overall quality of life.
Types of eating disorders
Anorexia Nervosa
Anorexia involves maintaining an unhealthily low body weight through extreme behaviours like starvation, rigid dieting, or excessive exercise. It’s often driven by intense fear of weight gain and distorted beliefs about body size. Over time, it can severely impact physical health, mood, and daily life.
Bulimia Nervosa
Bulimia is marked by cycles of binge eating followed by purging—through vomiting, laxatives, or over-exercising. It’s often rooted in shame and harsh self-judgment about weight or body shape, leaving individuals feeling trapped in a cycle of secrecy and loss of control.
Binge Eating Disorder
This condition involves frequently eating large amounts of food in a short time, often rapidly and in secret. It’s commonly triggered by emotional distress, leading to intense guilt, shame, and a sense of losing control. Unlike bulimia, there are no purging behaviours afterward.
Other eating disorders
In addition to the main types, other eating disorders in the Diagnostic Statistical Manual, Fifth Edition, a handbook healthcare professionals use to diagnose mental health conditions, include:
- ARFID (Avoidant Restrictive Food Intake Disorder): Extreme restriction or avoidance of food, often due to sensory sensitivities or fear of choking, not related to body image.
- OSFED (Other Specified Feeding and Eating Disorder): Disordered eating patterns that don’t fully meet criteria for anorexia, bulimia, or binge eating disorder but still cause significant distress or impairment.
- Pica: Persistent eating of non-food items such as paper, dirt, or chalk, often unrelated to cultural practices or nutritional needs.
Eating disorders in Singapore
Eating disorders are more common than many realise. Here are some key facts and figures about their prevalence in Singapore:
- Eating disorder cases rose by 15% in 2021, according to Singapore General Hospital. This increase may be linked to the pandemic, showing how stress can quietly alter our relationship with food.
- New diagnoses among youths aged 11 to 18 more than doubled between 2017 and 2023, based on data from KK Women’s and Children’s Hospital (KKH).
- Between 6% and 15% of these cases involve males, challenging the misconception that eating disorders only affect females.
- An estimated 7.4% of females aged 12 to 26 are at risk of developing an eating disorder, according to a Singapore-based study in 2006.
Why eating disorders happen
Where does an eating disorder start? There is rarely a single cause. Instead, a mix of biological, psychological, and social factors can shape how a person relates to food and their body.
- Neurobiological factors: Genetics and brain chemistry can affect appetite, digestion, and how the body signals hunger and fullness.
- Unrealistic body ideals: Media, peer and family pressure, or personal perfectionism can fuel harmful beliefs about weight and appearance.
- Trauma and bullying: Being teased, bullied, or experiencing physical or sexual abuse can deeply impact body image and self-worth.
- Major life changes: Difficult transitions or emotional stress may lead someone to use food to cope or feel in control when life feels chaotic.
How eating disorders affect mental health
Eating disorders don’t just affect the body—they take a serious toll on mental and emotional well-being. In fact, anorexia nervosa has the highest mortality rate of any psychiatric condition, second only to opioid use disorder, and is often accompanied by symptoms of depression.
Eating disorders can also lead to:
- Fear, guilt, shame, and disgust around food: Eating often becomes emotionally distressing, leading to intense self-criticism and anxiety.
- A sense of losing control: Individuals may feel trapped in behaviours they can’t stop, which worsens feelings of helplessness.
- Isolation and loneliness: Because eating habits are often hidden, individuals may withdraw from others to avoid judgment.
- Strained relationships: Loved ones may struggle to understand, leading to conflict, frustration, or emotional distance.
- Impaired daily functioning: School, work, and social life can suffer as physical and mental health decline.
Over time, these effects can increase the risk of developing other mental health conditions, including anxiety disorders, depression, and obsessive-compulsive disorder (OCD).
Eating disorder symptoms
If you’ve ever wondered, “Am I developing an eating disorder?”, it’s important to know the red flags. The signs of an eating disorder often show up in subtle shifts in your thoughts, feelings, and behaviours—long before a diagnosis.
- Thoughts: Persistent fears about food being “bad” or harmful, a belief that your worth is tied to weight or eating habits, and obsessive thoughts about calories, numbers, or body image.
- Feelings: Intense guilt, shame, or anxiety after eating; fear of judgment from others; or a constant sense of not being “good enough” when it comes to food or appearance.
- Behaviours: Skipping meals, eating in secret, avoiding food-related social settings, overexercising, or following rigid food rules that interfere with everyday life.
The following eating disorders may be diagnosed when their respective symptoms are met:
Anorexia Nervosa symptoms
- You severely limit how much food you eat, leading to a weight that’s too low for your height, age, or physical health.
- You have an intense fear of gaining weight or becoming “fat,” which doesn’t go away even after losing weight.
- Even when you’re dangerously underweight, you still engage in behaviours like excessive exercise that prevent you from gaining weight.
- You don’t fully understand how serious it is that your weight is so low.
- You become overly focused on how you perceive your weight and shape, often checking your body or weighing yourself constantly, and obsessing over the calories you eat.
- Your self-worth is heavily tied to your weight and body shape, such as feeling proud of weight loss but ashamed of any weight gain.
Bulimia Nervosa symptoms
- You have recurrent episodes of binge eating, where you consume large amounts of food in a short time and feel like you have no control over what or how much you eat.
- After bingeing, you try to get rid of the food through behaviours like self-induced vomiting, using laxatives or diuretics, fasting, or excessive exercise. You might also obsessively count calories or weigh yourself often.
- Your weight and body shape have a major impact on how you see yourself, with weight loss being a source of pride and weight gain feeling like a failure.
- To be diagnosed, these behaviours need to happen at least once a week for 3 months.
Binge Eating Disorder symptoms
- You have recurrent episodes of binge eating, where you eat a lot more food than usual, and at least 3 of the following happen:
- You eat much faster than normal.
- You keep eating even when you’re uncomfortably full.
- You eat large amounts of food when you’re not actually hungry.
- You eat alone because you’re embarrassed by how much you’re eating.
- Afterward, you feel disgusted with yourself, guilty, or very down.
- You feel significant distress or upset about these binge episodes, but unlike bulimia nervosa, you don’t try to get rid of the food through vomiting, exercise, or other methods.
- For a diagnosis, these behaviours must occur at least once a week for 3 months.
How are eating disorders diagnosed?
A healthcare provider will diagnose an eating disorder by:
- Clinical interview: Discussing your symptoms, eating and exercise habits, and ruling out other mental health conditions (like depression) that may be affecting your eating.
- Collateral history: Gathering additional information from family, friends, or other healthcare providers to get a fuller understanding.
- Physical examination: Checking for any medical issues (such as gastrointestinal problems or hyperthyroidism) that might be affecting your health.
- Lab tests: Running tests like blood work, urine tests, or an electrocardiogram to rule out other causes and identify potential complications.
Your diagnosis will also include a severity level, which varies depending on the disorder:
- Anorexia Nervosa: For adults, severity is based on your current body mass index (BMI); for children and adolescents, it’s based on BMI percentile.
- Bulimia Nervosa: Severity depends on how often you engage in compensatory behaviours (like vomiting or overexercising) and how much the disorder affects your daily life.
- Binge Eating Disorder: Severity is based on the frequency of binge episodes and the impact on your daily functioning.
Can eating disorders be cured?
While the journey is not an easy one, recovering from an eating disorder is possible with the right support and intervention. Treatment outcomes vary depending on the type of eating disorder, the severity of symptoms, and how early support is accessed.
Below are the remission rates for the three eating disorders discussed in this article:
- 31.4% of participants with Anorexia Nervosa recovered by 9-year follow-up.
- 68.2% of participants with Bulimia Nervosa recovered by 9-year follow-up.
- 60-64% of participants with Binge Eating Disorder recovered at 6-year follow-up.
Eating disorder treatments in Singapore
Given that eating disorders often begin in adolescence, early intervention is especially important. In Singapore, treatment commonly begins with family-based and nutritional therapies.
For patients aged 18 and below, family-based therapy enlists parents or caregivers as active partners in recovery. Their role includes supporting regular eating patterns at home, monitoring behaviours, and helping the young person maintain a healthy weight in a structured and supportive environment.
Nutritional therapy complements this by equipping individuals and families with the knowledge and tools to restore balanced eating. Dietitians or nutritionists work closely with patients to develop personalised meal plans, address food fears, and offer practical guidance on meal preparation, grocery shopping, and navigating social situations involving food.
These foundational supports help stabilise physical health—paving the way for psychological interventions. Evidence-based treatments for eating disorders include:
Cognitive Behavioural Therapy
CBT works by identifying and challenging distorted beliefs related to food, body image, and self-worth, helping to restore healthier eating behaviors and a balanced relationship with weight. As an initial step, your therapist may ask you to keep a diary of your daily eating patterns along with the thoughts and emotions you experience around them. This record can provide valuable insights into the underlying issues that contribute to the eating disorder, such as perfectionism or difficulties in relationships.
Dialectical Behavioural Therapy
DBT is particularly effective for individuals who struggle with intense emotions or impulsive behaviours like bingeing or purging. In one technique, clients learn to “ride the wave” of distress—acknowledging urges without acting on them, using mindfulness and grounding skills. This builds emotional regulation and reduces reliance on harmful coping behaviours.
Interpersonal Therapy
IPT focuses on how relationship difficulties may trigger or maintain disordered eating. A common intervention involves role-playing emotionally charged conversations, such as addressing unresolved conflict with a family member. Through this process, clients learn healthier ways to navigate interpersonal stress, which in turn can lessen the emotional triggers for disordered eating.
Intellect Clinic: Managing eating disorders
Coming to terms with an eating disorder can feel overwhelming—but you’re not alone. At Intellect Clinic, our clinicians provide a safe, non-judgemental space and evidence-based care to support your recovery.
Even if you don’t meet the criteria for a formal diagnosis, you can still benefit from support in managing distressing thoughts, emotions, and behaviours around food and body image. If something doesn’t feel right, reach out today—healing starts with a conversation.
