Aziz Ahmed Soomro, M.B.B.S., M.D.

Child, Adolescent and Adult Psychiatrist

Mental Disorders

Eating disorders are characterized by abnormal eating habits taken to extremes. The most common eating disorders are anorexia nervosa and bulimia nervosa. Several variations on the disorders can also be encountered and are known as “eating disorders not specified” (EDNOS).

Eating disorders can develop at any stage in life, though are most common in adolescence and young adulthood. Though men and boys can develop eating disorders as well, anorexia and bulimia are most common in women and girls. An estimated 5 to 15 percent of those affected by eating disorders are male, though men may go untreated due to a stigma of eating disorders being primarily ‘female’ illnesses.

The causes of anorexia and bulimia are varied and rarely a single factor can be pinpointed in a particular person suffering from either of these illnesses. Poor self-image generated by social pressure by peers and the media are commonly cited and studied factors. Self-destructive views on eating and self-image may have been learned as a child, even unintentionally taught by the parents. Lesions on particular parts of the brain have been shown to have a link in those who develop an eating disorder. Some studies also show that eating disorders may be genetic.


Anorexia is the pursuit of unhealthy thinness through the use of extreme dieting, excessive exercising, or vomiting. A fear of gaining weight and a distortion of one’s own body image overrides the body’s need for food, resulting in disastrous consequences to the body. The long term effects of anorexia can devastate the body as malnourishment and a myriad of other effects set in: electrolyte imbalance, depression, thinning of the bones (osteopenia/osteoporosis), and cardiac arrest. Substance abuse and eventual suicide is also common, and people with anorexia are ten times more likely to die as a result of their illness.

Symptoms of Anorexia

There are several possible signs of anorexia despite severe weight loss. However, if you suspect that you or a friend or family member may have anorexia, a psychiatric diagnosis must be made, as anorexia may either be comorbid, or coexistent, with another disorder, or similar symptoms may be due to a different illness altogether.

  • Obvious, dramatic weight loss
  • Brittle hair and nails
  • Yellowed skin
  • Severe constipation
  • Drop in body temperature
  • Constantly feeling cold
  • Continual fatigue or lethargy
  • Becoming withdrawn and secretive, especially concerning eating
  • Preoccupation with calories and fat content, despite rarely appearing to eat


Bulimia is characterized by a fear of gaining weight and obsessions with body image. The difference between anorexia and bulimia lies in the way the fear of gaining weight manifests itself. Bulimics may appear to be at a normal weight range, but have recurring episodes of excessive overeating, also known as binge eating, immediately followed by self-induced vomiting or purging. These episodes are highly secretive and despite causing feelings of shame and self-loathing, often occur several times a week.

Electrolyte (body salts) imbalances as well as kidney problems can set in over time. Other problems are created by the effect of the gastric acid frequently attacking the teeth and the lining of the mouth and esophagus. A variety of other psychiatric comorbidities can also develop, among them depression, low self-esteem and substance abuse.

Symptoms of Bulimia

As with anorexia, if you suspect that you or a friend or family member may have bulimia, make an appointment with a psychiatrist today to get an accurate medical diagnosis and a treatment plan. The presence of an eating disorder may be visible to friends and family, but discerning the underlying reasons and less obvious symptoms and coexisting disorders may only be possible for a psychiatrist.

  • Lacerations and cuts to the inside of the mouth and throat
  • Chronically sore throat 
  • Sensitive or decaying teeth
  • Swollen glands in the neck, under the jaw, and in the mouth
  • Chronic gastric reflux
  • Calluses or scars on the back of the hands due to accidental biting during the gag reflex

Eating Disorder Treatment

If you are looking for help in overcoming your eating disorder, you’ve already taken the most important step in realizing that there is a problem and you can get the help and support you need. If you know a friend or family member who may have an eating disorder, talk to psychiatrist to help you devise a strategy.

Treatment options for both anorexia and bulimia are very similar, but each must be tailored to the patient to address the individual issues that may be behind the illness. Also, because eating disorders often occur with other psychiatric disorders, such as depression or anxiety, the treatment must factor in those symptoms and deal with them, or risk relapse later on.

Treatments for Anorexia
The primary treatment for anorexia is psychotherapy, such as cognitive behavioral therapy (CBT), to help change the circle of thoughts that led to anorexia. Family therapy, as well as other types of interpersonal therapies, are also useful in selected cases.

The first stage of anorexia treatment is helping the person seeking help slowly get back to a weight that isn’t causing immediate harm to their body. Next, the psychiatrist will help is treat other present disorders that might prevent the return to a healthy state of mind. Anorexia therapy focuses on changing the negative thought patterns about self-image and weight that led to anorexia.

Treatments for Bulimia

Cognitive behavioral therapy (CBT) is an effective treatment for bulimia, and may also be combined with other types of interpersonal therapy. Some antidepressants have shown promise in treating bulimia in some cases. However, medication alone is not a cure for bulimia, and only therapy can help reduce the cycle of negative thoughts and self-image and thus, the chances of relapse. Recent research may suggest a role for transcranial magnetic stimulation (TMS) for the treatment of bulimia.


Insomnia is often defined as the inability to fall asleep, or difficulty staying asleep. Insomnia can be a symptom of another disorder (secondary insomnia), a disorder of its own (primary insomnia), or be seen independent of another presented disorder (co-morbid). There are over 80 defined sleep disorders and insomnia is one of the most common. One in ten adults suffer from chronic insomnia, though children and adolescents can suffer from sleeping problems as well.
Insomnia in any of its forms can result in impairment during the day, chronic fatigue, and higher levels of stress and irritability. Lack of sleep can cause drowsiness interfering with driving as well as difficulty in operating machinery.

Causes of Insomnia
Poor sleep quality can be attributed to several factors, depending on the type of insomnia. Commonly used substances, such as caffeine, tobacco, and alcohol may be the cause. Out of the medical causes for insomnia, chronic pain and sleep apnea (difficulty breathing at night), are the most common.
Secondary insomnia can also be attributed to psychiatric conditions, such as depression, anxiety or PTSD. Certain medicines taken for various disorders may cause insomnia as a side effect. Primary insomnia, being independent of another disorder, can be caused by a number of issues, such as stress or lifestyle changes.

Signs and Symptoms of Chronic and Acute Insomnia
The difference between chronic insomnia and acute insomnia is the amount of time the symptoms are in effect. If symptoms are present 3 nights or more per week, chronic insomnia may be diagnosed. Any less than that may be acute insomnia.

Symptoms of insomnia include:

  • Trouble falling sleep
  • Sleeping for short periods
  • Waking several times at the night
  • Unable to sleep for most of the night
  • Waking up too early
  • Unusually light sleeping
  • Waking up tired

Therapies and Treatments for Insomnia
While it may be difficult to cure insomnia, simple lifestyle changes, such as giving up coffee or alcohol can help. Herbal treatments for insomnia such as chamomile or valerian are available but mostly non efficient. Over the counter sleep aids and sleep pills work for some insomniacs, but also carry the risk of dependence, as well as possible interference with any other medications you may be taking. Melatonin produces insignificant benefits for primary insomnia and none for secondary insomnia. Meditation, yoga and Tai Chi are among the most effective complementary and alternative medicine means to improve insomnia symptoms. Cognitive Behavioral Therapy (CBT) helps target the thoughts and actions that are disrupting the normal sleep patterns. Many insomnia cases are treated with medication, though this may not be the best route for everyone. Medications come with the risk of dependence and possible withdrawal.

Posttraumatic stress disorder is the onset of a specific set of symptoms in response to an extreme traumatic event in one’s life. It is gender-independent, affecting both men and women of all ages. The causes of post traumatic stress disorder, as well as the events leading to it, are just as varied. PTSD in children and adults can result from trauma during childhood, such as children in abusive homes. Victims of rape, assault, or abuse can develop PTSD due to their traumatic experiences. Social workers, emergency service workers, members of the military, and many others’ occupations also expose them to such traumatic events.

How to Recognize PTSD:
The signs of post-traumatic stress disorder must continue for more than 30 days for a PTSD diagnosis. If these symptoms last less time, than they may rather be signs of acute stress disorder. The length of time after the traumatic event before these symptoms onset do not negate the possibility for PTSD, or make the emotions or experiences any less valid. The duration of post traumatic stress disorder’s symptoms likewise do not invalidate the seriousness of the illness, or the events experienced. DSM-IV defines acute post-traumatic stress disorder as lasting less than three months, chronic post-traumatic stress disorder as lasting three months or more, and delayed-onset post-traumatic stress disorder as when symptoms of PTSD occur six months or more after the trauma.

Symptoms of post traumatic stress disorder include:

  • Persistent preoccupation with the traumatic experience affecting daily life
  • Dissociation – emotional numbness, a perceived disconnection between cognitive thought and the body or emotional state
  • Increased arousal – such as hypervigilance, insomnia, difficulty staying asleep, or anger issues
  • Flashbacks – recurring dreams revolving around the traumatic experience, flashback memories, intense reaction to any reminder of the trauma experienced
  • Depression – feelings of hopelessness, low self-esteem, and difficulties in previously established relationships

Treatment Options for PTSD
There are several post traumatic stress disorder therapies and medications available. However, there is no single recovery plan to deal with reactions to trauma, nor is there any one-time cure to “get over” PTSD. A preliminary appointment with our clinic can help work out individual PTSD therapy options. Medication to help regulate the symptoms of posttraumatic stress disorder is available, as well as psychotherapy, Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT).

Dr Aziz Soomro Logo

we want to hear from you