Exorexia: Rare Pre/Post-Surgical Eating Disorder

Exorexia is a rare, informal term describing severe voluntary food restriction before and/or after surgery to achieve weight loss unattainable through conventional dieting.

Clinical Context

• Not in DSM-5 or ICD-11.
• Overlaps with: Anorexia nervosa, Avoidant/Restrictive Food Intake Disorder (ARFID), Body Dysmorphic Disorder, Orthorexia.
• Motivation: Perceived surgical "failure" if weight not lost; body image distortion; control.

Risks

• Pre-op: Malnutrition → poor wound healing, infection, anesthesia risk.
• Post-op: Dehiscence, electrolyte imbalance, delayed recovery, dumping syndrome exacerbation.
• Psychological: Entrenches disordered eating; may trigger full AN.

Management

• Pre-surgical psych eval (standard for bariatrics).
• Nutritional optimization pre/post-op.
• CBT-E, DBT for eating pathology.
• Multidisciplinary bariatric team follow-up.

Surgery is a tool, not a cure for eating pathology. Mental health integration is essential.