Eating Disorders in Pakistan: Breaking the Silence on a Hidden Crisis

A Hidden Crisis

Eating disorders — including anorexia nervosa, bulimia nervosa, and binge eating disorder — are among the most serious mental health conditions. They carry the highest mortality rate of any psychiatric diagnosis, yet they remain profoundly under-recognised in Pakistan.

This is partly due to stigma, partly due to limited awareness, and partly due to the fact that eating disorders in Pakistan often look different from how they are portrayed in Western media.

What Eating Disorders Are (and Are Not)

Eating disorders are not about vanity, attention-seeking, or a preference for thinness. They are serious psychological conditions that involve a deeply distorted relationship with food, eating, and body image — often rooted in anxiety, trauma, perfectionism, and the need for control.

They include:

Anorexia Nervosa — severe restriction of food intake, intense fear of weight gain, distorted body image

Bulimia Nervosa — cycles of binge eating followed by compensatory behaviours (purging, excessive exercise, restriction)

Binge Eating Disorder (BED) — recurrent episodes of eating large quantities of food rapidly, with a sense of loss of control, followed by guilt and shame — without compensatory behaviours

ARFID — avoidant/restrictive food intake disorder, characterised by extreme food selectivity not driven by weight concerns

The Pakistani Context

In Pakistan, a few specific factors compound the challenge:

- Body comments are culturally normalised — from family, friends, and society at large
- Diet culture is pervasive but rarely named as such
- The "ideal" female body has specific cultural connotations that create particular pressures
- Many families do not recognise the signs and assume the person is "just dieting"
- There are very few eating disorder specialists available

Warning Signs

- Dramatic restriction of food intake or avoiding meals
- Frequent trips to the bathroom after eating
- Rituals around food — cutting food into small pieces, eating in a specific order, excessive calorie counting
- Distress about body weight that seems disproportionate
- Physical symptoms — hair loss, feeling cold, dizziness, dental erosion

What Treatment Looks Like

CBT-Enhanced (CBT-E), developed specifically for eating disorders, is the most evidence-based outpatient treatment. It addresses the specific thought patterns and behaviours that maintain the disorder.

Recovery is possible. But it requires specialised support — and it is never too late, or too early, to reach out.