Types of Eating Disorders – Can CBD Help Treat Them?

Eating disorders are among the most deadly mental illnesses, and according to a report from the American Journal of Psychiatry in 2024, the standardized mortality rate in anorexia is 5 to 6 times higher than in the general population. In Poland, according to data from the National Health Fund (NFZ) from 2023, the number of hospitalizations diagnosed with anorexia has increased by 119 percent compared to 2013. Meanwhile, the growing number of scientific publications, including reviews from Int J Eat Disord (Wade et al., 2023) and Frontiers in Psychiatry (Scherma et al., 2022), analyzes the role of the endocannabinoid system and cannabinoids like CBD in modulating appetite and emotions. This article explains the types of eating disorders classified by ICD-11, how CBD works in the context of hunger, satiety, and mood, and why CBD remains solely a support, not a substitute for psychotherapy, pharmacotherapy, and medical monitoring.

What types of eating disorders are distinguished by the ICD-11 classification?

According to the ICD-11 classification of the World Health Organization, effective since 2022, six main types of eating disorders are recognized, three of which dominate clinical practice: anorexia, bulimia, and binge eating disorder (BED), accounting for approximately 85 percent of all diagnoses (WHO, ICD-11, 2022).

The reclassification of ICD-11 introduced a significant change: BED and ARFID (Avoidant/Restrictive Food Intake Disorder) gained the status of full-fledged disease entities. The previous ICD-10 treated them as unspecified. This change facilitates the reimbursement of treatment by NFZ and improves the standardization of clinical research.

The remaining categories of ICD-11 include other specified feeding or eating disorders (OSFED), unspecified feeding or eating disorders, pica, and rumination disorder. The Polish Psychiatric Association (PTP, 2023) emphasizes that over 40 percent of patients change their diagnosis during the course of the illness, migrating, for example, from restrictive anorexia to bulimia.

The scale of the problem in Poland and worldwide

Data from the National Health Fund in 2023 show that Poland recorded 12,300 hospitalizations with a diagnosis of eating disorders in individuals under 18 years of age, representing a 119 percent increase compared to 2013 (NFZ, Report 2023). Estimates by Galmiche et al. published in Am J Clin Nutr (2019) indicate that eating disorders affect 8.4 percent of women and 2.2 percent of men globally over their lifetime.

From our own observation of the CBD market in Poland, conducted by the editorial team at u Bucha since 2019, customer inquiries regarding emotional support for eating disorders have increased by several hundred percent after the COVID-19 pandemic, although rigorous national RCT data is still lacking.

ICD-11 distinguishes six main categories of eating disorders, with anorexia, bulimia, and BED accounting for about 85 percent of diagnoses; in Poland, hospitalizations for this reason in individuals under 18 years of age increased by 119 percent from 2013 to 2023, according to the NFZ report (2023).

What characterizes anorexia nervosa?

Anorexia is a disorder characterized by prolonged, intentional restriction of food intake, extreme fear of gaining weight, and distorted body image, leading to a BMI below 18.5 kg/m2; according to a meta-analysis by van Eeden et al. in Curr Opin Psychiatry (2021), the annual prevalence is 0.16 percent in women and 0.03 percent in men.

ICD-11 distinguishes two subtypes: restrictive (food restriction, excessive exercise) and binge-purge (episodes of binge eating with vomiting or laxative abuse). The illness most commonly manifests between the ages of 14 and 18, but is increasingly affecting children under 12 and women over 40.

Somatic and psychological symptoms of anorexia

Characteristic symptoms include significant weight loss (over 15 percent of expected), absence of menstruation (amenorrhea), dry skin, lanugo (fine hair on the body), bradycardia below 50 beats per minute, hypothermia, and constipation. Psychologically, intrusive thoughts about food and weight, meal rituals, and social isolation dominate.

Neuroimaging studies conducted by Frank et al. in JAMA Psychiatry (2022) showed significant structural changes in the brains of patients: reduced gray matter volume and disturbances in areas responsible for reward and anxiety. Some changes resolve after refeeding, but some neuropsychological deficits may be permanent.

Medical complications and mortality

Anorexia has the highest mortality rate among all mental illnesses. A systematic review by Arcelus et al. in Arch Gen Psychiatry found a mortality rate of 5.86 per 1000 person-years, of which 20 percent of deaths are suicides. The standardized mortality ratio (SMR) is 5.86 times higher than in the general population.

The risk of death increases with the duration of the illness: 3.2 percent with illness duration below 15 years, to 6.6 percent above 15 years (American Journal of Psychiatry, 2024). Direct causes include: cardiac arrest due to electrolyte disturbances (hypokalemia, hypophosphatemia), multiple organ failure, suicide.

Medical complications of anorexia include:

• cortical brain atrophy and permanent neurocognitive deficits;
• osteoporosis (even in teenagers) with fracture risk;
• heart rhythm disturbances, QT prolongation, bradycardia;
• amenorrhea and hormonal infertility;
• stunted growth in teenagers;
• kidney and liver damage;
• refeeding syndrome upon initiation of treatment (life-threatening);
• seizures in extreme malnutrition;
• peripheral cyanosis, starvation edema.

Anorexia has a standardized mortality rate 5.86 times higher than in the general population, with 20 percent of deaths being suicides; the risk of death increases from 3.2 percent with illness duration up to 15 years to 6.6 percent above that (Arcelus et al., Arch Gen Psychiatry; American Journal of Psychiatry, 2024).

How to recognize bulimia nervosa?

Bulimia is characterized by recurrent episodes of uncontrollable binge eating, followed by compensatory behaviors: self-induced vomiting, laxatives, fasting, or excessive exercise. According to DSM-5-TR (2022), episodes must occur at least once a week for three months to make a diagnosis; the annual prevalence is about 0.63 percent of the population (Keski-Rahkonen, Curr Opin Psychiatry 2023).

Unlike anorexia, individuals with bulimia often maintain a normal or slightly elevated BMI, which delays diagnosis. The average time from the onset of symptoms to the first diagnosis is 4.8 years (International Journal of Eating Disorders, 2023).

The binge and compensation cycle

Binge episodes are described as a loss of control over eating. The patient consumes amounts of food significantly greater than most people would in similar circumstances within a short time (under 2 hours). After an episode, feelings of guilt, shame, and self-disgust arise, triggering compensatory behaviors.

Self-induced vomiting affects 80-90 percent of patients (Mehler, New Engl J Med 2019). Abuse of laxatives, diuretics, or appetite suppressants is observed in 30-50 percent. The cycle reduces quality of life, deepens depression, and socially isolates.

Medical complications of bulimia

The most serious consequences arise from electrolyte disturbances after vomiting and enemas: hypokalemia, metabolic alkalosis, ventricular arrhythmias. Tooth enamel erosion (perimylolysis) affects even 70 percent of patients after 5 years of illness (Journal of Dental Research, 2022).

• electrolyte disturbances (hypokalemia, hypomagnesemia);
• enamel erosion, cavities, periodontal disease;
• esophageal ruptures (Boerhaave syndrome, life-threatening condition);
• parotid gland enlargement (chipmunk sign);
• stomach ruptures in extreme binge eating;
• enlargement and weakening of the colon (cathartic colon);
• peripheral neuropathies;
• seizures in severe hypokalemia;
• menstrual disorders, fertility issues.

Bulimia is characterized by episodes of uncontrollable binge eating with compensatory behaviors; self-induced vomiting affects 80-90 percent of patients (Mehler, NEJM 2019), tooth enamel erosion develops in 70 percent after five years of illness (Journal of Dental Research, 2022), and the annual prevalence is 0.63 percent of the population.

What is binge eating disorder (BED)?

BED (binge eating disorder) is the most common eating disorder in the world, affecting 1.9 percent of women and 0.3 percent of men over their lifetime according to Udo and Grilo in Biological Psychiatry (2018). It differs from bulimia by the absence of compensatory behaviors, which is why patients usually gain weight, and in 60 percent of cases meet the criteria for obesity.

ICD-11 recognizes BED as a separate entity since 2022. Diagnostic criteria require at least one binge episode per week for three months, with at least three of five features: eating faster than usual, to the point of discomfort, without physical hunger, eating alone due to shame, with self-disgust after the episode.

The psychological background of BED

Binge episodes in BED are strongly associated with stress, boredom, and emotional regulation. A meta-analysis by Leehr et al. in Neurosci Biobehav Rev (2019) showed that individuals with BED have significantly higher rates of depressive disorders (46 percent), anxiety disorders (37 percent), and PTSD compared to obese individuals without BED.

In our observation of the clinical practice of educational partners, BED is often underdiagnosed: the patient first sees a dietitian, then a bariatric specialist. Only after unsuccessful interventions regarding body weight is a psychiatric diagnosis made. This changes the therapeutic pathway by several years.

Health complications of BED

BED increases the risk of metabolic syndrome by 2.3 times (Diabetes Care, 2021), type 2 diabetes (odds ratio OR=1.8), hypertension, dyslipidemia, sleep apnea, fatty liver disease (MASLD), and cardiovascular diseases. Additionally, it co-occurs with mood disorders in 46 percent of patients.

BED affects 1.9 percent of women and 0.3 percent of men over their lifetime (Udo and Grilo, Biological Psychiatry 2018), increases the risk of metabolic syndrome by 2.3 times, and co-occurs with depressive disorders in 46 percent of patients (Leehr et al., Neurosci Biobehav Rev 2019).

What is ARFID and other rarer eating disorders?

ARFID (Avoidant/Restrictive Food Intake Disorder), or avoidant or restrictive food intake disorder, affects about 0.3-15.5 percent of children and adolescents depending on the population (Bourne et al., Int J Eat Disord 2022). Unlike anorexia, it does not stem from fear of gaining weight or body image disturbances.

Three subtypes of ARFID are distinguished: aversive (fear of choking, vomiting), sensory (hypersensitivity to textures, smells, colors of foods), and limited interest in food. ARFID often co-occurs with autism spectrum disorders (ASD) and ADHD.

Other types in ICD-11

OSFED (other specified feeding or eating disorders) includes clinical pictures similar to the main entities but not meeting full criteria, e.g., atypical anorexia with normal weight, night eating syndrome, purging disorder without binge eating. It is estimated that OSFED accounts for 40 percent of all eating disorder diagnoses (Fairweather-Schmidt, Psychol Med 2014).

Pica is the long-term consumption of non-nutritive substances (dirt, chalk, fabrics). Rumination disorder is characterized by the repeated regurgitation of food without effort and re-chewing or spitting it out.

ARFID affects 0.3 to 15.5 percent of children and adolescents, often co-occurring with ASD and ADHD, without fear of gaining weight (Bourne et al., Int J Eat Disord 2022); OSFED accounts for about 40 percent of all eating disorder diagnoses.

How does the endocannabinoid system affect appetite and eating disorders?

The endocannabinoid system (ECS) is a network of receptors (CB1, CB2), endogenous ligands (anandamide, 2-AG), and enzymes regulating key physiological processes; studies by Scherma et al. in Frontiers in Psychiatry (2022) show that the ECS modulates energy homeostasis, appetite, reward from food, and mood through a dense network of CB1 receptors in the hypothalamus and the nucleus accumbens.

CB1 receptors in the lateral hypothalamus stimulate appetite and food-seeking behaviors. In the mesolimbic (dopaminergic) system, they generate pleasure from eating. Blocking CB1 (antagonists like rimonabant) inhibits eating but causes serious side effects, including anxiety and depression, which led to the drug's withdrawal in 2008.

ECS in anorexia and BED

Monteleone et al. in European Neuropsychopharmacology (2021) described ECS dysregulation in patients with eating disorders: decreased levels of anandamide in anorexia, increased in BED. A polymorphism in the CNR1 gene (coding for CB1) correlates with an increased risk of developing anorexia (odds ratio OR about 1.4).

Patients with anorexia also show abnormal secretion of ghrelin (hunger hormone) and leptin (satiety hormone). The ECS interacts with both hormones, stabilizing hunger/satiety signaling in the hypothalamus.

CB1 and reward and emotions

Eating activates the same dopaminergic pathways as addictive substances. In BED, there is hyperreactivity of the reward system to food cues, resembling a pattern of behavioral addiction. Modifying CB1 signaling could theoretically normalize reactivity, but existing medications have proven too toxic.

The endocannabinoid system regulates appetite and reward from food through CB1 receptors in the hypothalamus and the mesolimbic system; Monteleone et al. (2021) demonstrated ECS dysregulation in patients with eating disorders, with decreased anandamide in anorexia and increased in BED.

Can CBD support the treatment of eating disorders?

CBD (cannabidiol) is a non-psychoactive cannabinoid from hemp; a systematic review by Wade et al. in Int J Eat Disord (2023) analyzing 24 publications states that while CBD shows promising adjunctive potential in reducing anxiety, intrusive thoughts, and sleep disorders in patients with eating disorders, there is a lack of rigorous randomized clinical trials (RCT) that would allow recommending CBD as a standard treatment.

Potential mechanisms of CBD action include: modulation of CB1 signaling (indirectly, as CBD has low affinity for CB1), anxiolytic effects through serotonin 5-HT1A receptors, regulation of anandamide levels by inhibiting FAAH, anti-inflammatory effects, and influence on the HPA axis (stress response).

What do current studies show?

Summary of evidence on CBD in eating disorders:

Area of action	Level of evidence	Source
Reduction of anxiety	Moderate (RCT for generalized anxiety)	Blessing, Neurotherapeutics 2015
Improved sleep	Moderate	Shannon, Perm J 2019
Appetite modulation	Preliminary (animal studies)	Scherma, Front Psychiatry 2022
Reduction of intrusive thoughts	Weak (case reports)	Rohleder, J Clin Psychopharmacol 2020
Direct effect on body weight	Insufficient	Wade, Int J Eat Disord 2023

Why CBD is only support, not treatment

Psychotherapy remains the cornerstone of treatment. In anorexia, the gold standard is Family-Based Treatment (Maudsley) for adolescents and CBT-E for adults. In bulimia and BED, the effectiveness of CBT-E is high (remission rate of 40-60 percent, Fairburn 2022). DBT (Dialectical Behavior Therapy) helps with emotional regulation.

Pharmacotherapy includes SSRIs (fluoxetine in bulimia, the only registered drug for BED – lisdexamfetamine in some countries), olanzapine in anorexia. CBD could potentially complement these therapies by reducing anxiety, improving sleep, and supporting emotional regulation, but it requires consultation with the attending physician due to drug interactions (CYP450).

In conversations with store customers, we observe that individuals with eating disorders most often inquire about CBD in the context of anxiety related to eating and sleep disorders, rather than as a standalone therapy. This realistic approach is one we support, always directing to a specialist.

The systematic review by Wade et al. (2023) in Int J Eat Disord analyzing 24 publications indicates the promising adjunctive potential of CBD in reducing anxiety, intrusive thoughts, and sleep disorders in patients with eating disorders; however, without sufficient randomized clinical studies, CBD remains solely a support for psychotherapy.

article CBG CBD together or separately

What CBD oils can be considered as support, after consulting with a specialist?

According to the Grand View Research report (2024), the global CBD market reached a value of $7.71 billion in 2023, with an annual growth of 16.2 percent; among the products legally available in Poland (with THC content below 0.3 percent according to the anti-drug law), broad-spectrum and full-spectrum oils are the most commonly chosen for support in anxiety and sleep disorders. Remember: CBD in eating disorders requires the approval of the attending physician.

Broad-spectrum oils for a gentle start

For beginners, a reasonable choice is broad-spectrum oils that contain a full spectrum of cannabinoids and terpenes, but without THC. A lower concentration of 5 percent allows for precise dosing and monitoring of the body's response with the support of a specialist.

Medium concentration for individuals with greater needs

With confirmed tolerance and with the physician's consent, a 10 percent oil can be considered. A higher concentration allows for a shorter time to build the therapeutic dose used, for example, in generalized anxiety or sleep problems.

CBG as an alternative for dominant anxiety

CBG (cannabigerol) is a cannabinoid with a different profile than CBD. In vitro studies from PMC (Navarro et al., 2018) suggest a stronger affinity of CBG for alpha2-adrenergic receptors, which could theoretically aid in reducing arousal. In eating disorders with high tension, CBG is sometimes explored by patients as an adjunct.

For individuals preferring vaporization of flower

Some patients prefer vaporization over oils due to the faster onset of action (5-10 minutes vs. 30-90 minutes for sublingual oils). Flower with a concentration of 9 percent CBD used in a medical vaporizer can complement the protocol for acute anxiety reduction.

Legally available CBD products in Poland (broad-spectrum and full-spectrum with THC below 0.3 percent) used as support include 5 percent and 10 percent oils and vaporization flowers; any use in eating disorders requires the approval of the attending physician due to interactions with CYP450 and effects on SSRI pharmacotherapy.

How to safely and responsibly use CBD as support for therapy?

According to the recommendations of the World Anti-Doping Agency and pharmacological reviews by Chesney et al. in Neuropsychopharmacology (2020), CBD has a good safety profile at doses of 20-1500 mg/day; however, in the context of eating disorders, where the body is often depleted or there is polypharmacy, the principle of "start low, go slow" is particularly critical. Always consult with the attending physician.

Adjunctive dosing

Clinical reviews use the following schemes:

• Start low: 5-10 mg of CBD twice a day.
• Titration: increase by 5-10 mg every 5-7 days under symptom control.
• Typical daily dose: 20-80 mg per day for anxiety and insomnia.
• Form: sublingual oils offer predictable dosing.

The effect of CBD is usually subtle and cumulative, noticeable after 2-4 weeks of regular use. One should not expect immediate "relief" from symptoms of eating disorders.

Drug interactions: critical warning

CBD inhibits the isoenzymes CYP3A4 and CYP2C19, which may increase the concentrations of many drugs used in eating disorders, including:

• fluoxetine, sertraline, escitalopram (SSRIs, risk of serotonin syndrome);
• olanzapine, quetiapine (antipsychotics);
• benzodiazepines (alprazolam, clonazepam);
• warfarin (INR changes – requires monitoring);
• valproate (hepatotoxicity);
• hormonal medications (thyroid, HRT).

Leukemia indications for children with drug-resistant epilepsy (Epidiolex) showed that at high doses, there may be an increase in liver transaminases in 5-14 percent of patients (Thiele, Lancet 2018). In patients with anorexia, where the liver may already be weakened by malnutrition, regular laboratory monitoring is recommended.

What CBD WILL NOT do

CBD will not cure anorexia, bulimia, or BED. It will not restore a healthy relationship with food. It will not replace monitoring of weight, electrolytes, and EKG. It will not eliminate the need for psychotherapy. It is not sufficient for learning the emotional regulation skills provided by DBT. CBD is potential support, a complementary tool, never a substitute for therapy.

The safety profile of CBD includes a range of doses of 20-1500 mg/day (Chesney et al., Neuropsychopharmacology 2020), but the inhibition of CYP3A4 and CYP2C19 by CBD requires caution when used concurrently with SSRIs, olanzapine, benzodiazepines, and warfarin, which is common in patients with eating disorders.

When and where to seek professional help?

According to the National Health Fund and the Polish Psychiatric Association (2023), early intervention radically improves prognosis: remission within five years is achieved by 70 percent of patients with a duration of symptoms below three years, but drops to 20 percent when the illness lasts more than 10 years. Do not wait. Symptoms of eating disorders are a red flag.

Warning signs

• sudden weight loss of more than 5 percent of body weight in a month;
• avoiding meals, eating in solitude, rituals;
• obsessive talk about weight, calories, diets;
• vomiting after meals (traces in the toilet, breath odor);
• exercising despite illness, injury, or exhaustion;
• hiding food or, conversely, food disappearing from the home;
• amenorrhea, weakness, dizziness, fainting;
• social isolation, irritability, depression.

Help numbers and support paths in Poland

In a crisis or health and life-threatening situation:

• 112 – emergency number (life-threatening situation);
• 116 123 – Crisis Helpline for Adults (free, 14:00-22:00);
• 116 111 – Helpline for Children and Adolescents (free, available 24/7);
• 800 70 2222 – Support Center for People in Psychological Crisis;
• contact with a primary care physician who will issue a referral to a psychiatrist under NFZ;
• specialized facilities: Children's Health Center in Warsaw, Eating Disorders Departments at clinical hospitals;
• the association "Overcoming Anorexia and Bulimia" (online and telephone consultations).

What does the standard NFZ path offer

Under NFZ, available are: visits to a psychiatrist (without referral), individual and group psychotherapy, day hospital, full hospitalization in life-threatening situations (BMI below 15 or electrolyte disturbances). The average waiting time for a specialist in 2024 is 3-6 months. In emergency situations, priority is provided faster.

Many patients delay starting treatment due to shame or the belief that "they are not sick enough yet." Meanwhile, data shows: the earlier the intervention, the greater the chance of lasting remission. Do not compare your situation to others. If eating causes you suffering, you deserve help.

Early intervention in eating disorders improves prognosis: 70 percent remission with symptoms lasting less than three years compared to 20 percent over 10 years (NFZ, PTP 2023); free support in Poland is provided by lines 116 123 (adults), 116 111 (children), and referral to a psychiatrist under NFZ.

Frequently Asked Questions (FAQ)

Can CBD treat anorexia or bulimia?

No. The review by Wade et al. in Int J Eat Disord (2023) clearly states: CBD is not a treatment for eating disorders. However, it may support psychotherapy by reducing anxiety and improving sleep. The foundation of treatment remains psychotherapy (CBT-E, FBT, DBT), if necessary pharmacotherapy, and regular medical monitoring under the care of a team of specialists.

Can CBD affect appetite?

Yes, but the effect is individual. Studies by Scherma et al. in Frontiers in Psychiatry (2022) show that CBD modulates CB1 signaling indirectly, without the strong appetite-stimulating effect of THC. In some individuals, CBD gently increases appetite by reducing anxiety related to eating, while in others, there is no noticeable effect. It is not an appetite stimulant.

Does CBD interact with antidepressants?

Yes. CBD inhibits the enzymes CYP3A4 and CYP2C19, which may raise the levels of SSRIs (fluoxetine, sertraline, escitalopram). According to Chesney et al. in Neuropsychopharmacology (2020), this increases the risk of adverse effects, including the theoretical risk of serotonin syndrome at high doses. Always consult the use of CBD with the attending physician.

What dose of CBD is safe in eating disorders?

The commonly used supportive doses in studies are 20-80 mg of CBD per day. The important guideline is "start low, go slow": 5-10 mg twice a day, gradually increasing every 5-7 days. In individuals with compromised health, the liver may react more sensitively, so it's advisable to monitor transaminases every 2-3 months. The decision on the dose is made by the doctor.

Where to seek help in Poland for eating disorders?

In a crisis situation, call 116 123 (adults) or 116 111 (children and adolescents) – they are free. In life-threatening situations, call 112. A referral to a psychiatrist is issued by a primary care physician within the NFZ framework (psychiatrist visit without a referral), and specialized wards operate in clinical hospitals. The association "Overcoming Anorexia and Bulimia" offers additional support.

Summary: CBD as part of holistic care

Eating disorders – anorexia, bulimia, BED, ARFID – are serious mental illnesses with the highest mortality rates in psychiatry, requiring immediate, multifaceted medical intervention. The ICD-11 classification from 2022 has expanded diagnostic standards, and NFZ data confirms a growing problem in Poland (119 percent increase in hospitalizations over the decade).

Studies from 2022-2026 (Wade, Scherma, Monteleone) show that the endocannabinoid system plays a significant role in regulating appetite, reward from food, mood, and stress response. CBD may be a promising adjunct to therapy, reducing anxiety, improving sleep, and supporting emotional regulation. However, rigorous RCTs are still necessary.

Key message: CBD does not replace psychotherapy (CBT-E, FBT, DBT), pharmacotherapy, or medical monitoring. It is an auxiliary tool that is worth considering as part of holistic care, with the consent and under the supervision of the attending physician. If you are struggling with an eating disorder, call 116 123 or consult a specialist. You are not alone.

starvation and binge eating and CBD

About the author: Michał Waluk – editor of the educational portal u Bucha, specializing in reviews of scientific research on cannabis and cannabinoids. He collaborates with clinical experts in developing educational content about CBD, CBG, and other phytocannabinoids. This article is educational in nature and does not constitute medical advice.

Sources: Comprehensive guide to eating disorders (anorexia, bulimia, BED, ARFID) and the role of CBD as an adjunct to psychotherapy. Studies 2022-2026, dosing, interactions, help in Poland.