Fear of Hunger: A Novel Eating Disorder Presentation in a 19-Year-Old Female from Gaza under Siege - A Case Study
M. Abu-SlaihIntroduction
Eating disorders (EDs) in conflict-affected populations remain under-researched, with most literature focused on refugees outside active conflict zones. Current systems like DSM-5-TR and ICD-11 exclude eating disturbances caused by food scarcity, creating a diagnostic gap for cases arising from siege or famine. This case describes a trauma-related eating disturbance driven by fear of hunger and moral distress, falling outside.
Objectives
To describe a unique restrictive eating disorder in a young woman living under siege in Gaza. The case highlights how extreme food insecurity and collective trauma can manifest as a distinct syndrome rooted in fear of starvation and survival guilt—rather than body-image distortion (as in AN) or sensory avoidance (as in ARFID). A secondary aim is to call for expanding diagnostic frameworks to include such trauma-related, context-bound disturbances.
Methods
A 19-year-old female in Gaza was followed remotely during the 2023–2025 siege via online consultations and messages. Management included trauma-informed supportive psychotherapy and psychoeducation. Assessment relied on detailed interviews with the patient and her family and continuous monitoring of behavioral, cognitive, and physical changes.
Results
The patient showed severe food restriction, ~10–12 kg weight loss, and behaviors like hiding or rationing food. Motivation stemmed not from body-image concerns but from intense fear of food depletion and guilt about eating while others starved. She expressed thoughts such as “If I eat now, there won’t be enough later,” and “It’s wrong to feel full when others are hungry.” No body-image distortion, weight-gain fear, or sensory aversion was observed. The pattern didn’t meet AN or ARFID criteria, as it reflected a realistic reaction to food scarcity. Treatment focused on validating her fears, addressing moral injury, and restoring structured eating, leading to partial nutritional and anxiety improvement, though core fears persisted.
Conclusions
This case suggests a potential new diagnostic entity, Famine-Related Food Avoidance —a trauma-based eating disturbance distinct from known EDs. It exposes a major gap in DSM-5 and ICD-11, which fail to classify such psychologically devastating yet contextually understandable responses to imposed starvation. These presentations warrant clinical recognition and trauma-informed criteria that reflect the profound impact of siege and conflict on eating behavior and mental health.
Disclosure of Interest
None Declared