18th May 2021
Question: If someone has eating disorder then what is the ruling on fasting. If they eat during fasting, then is it both Qadha and Kaffarah or just Qadha?
الجواب حامداً و مصلياً
In the name of Allāh, the Most Gracious, the Most Merciful
Answer
The question about eating disorder in relation to fasting depends on the nature as well as the severity of the disorder itself. Experts generally categorise eating disorder under mental health condition, a condition where a person uses food to cope with certain feelings and anxiety about their physical shape either by overeating or abstaining from eating altogether. This anxiety is caused by a number of reasons for instance, a family history of eating disorder but mostly worried about either being overweight or too slim, low self-esteem or obsessed with looks and perfectionism.[1]
Experts broadly categorise eating disorder into three main types;
- Anorexia nervosa – the individual trying to keep their weight as low as possible by eating very minimal, avoid eating and over exercising. This can potentially result in self-harm by losing a lot of weight.
- Bulimia – A person losing control over their eating habit by eating in large portions. Such individuals eat in excessive amounts and yet take drastic actions of purging food either by vomiting or using laxatives to control their weight.
- Binge – This is more or less similar to bulimia except that rather than trying to lose weight they gorge themselves in eating until they feel uncomfortably satiated. By binging, they end up gaining a lot of weight and end up feeling ashamed and depressed thereafter.[2]
Most eating disorder patients excessively worry about their physical appearance and avoid socialising with others. Many as a result end up falling into severe depression or anxiety disorder because of this. The most common symptoms experts diagnose include having strict yet unusual habits around food routine, eating alone or secretly (feeling uncomfortable eating around others), depression and self-guilt.[3] Ramadhān fast could potentially trigger anorexia patients with high risk of relapse by avoiding eating and may either skip iftar or suhur or eat very little. Those with bulimia or binge eating disorder, fasting may cause them to binging food during iftar or suhur time resulting in losing control over their eating. There have been reported cases where binge eating has led many to becoming diabetic. Eating disorder patients are referred to special therapists who can help them manage their diet through CBT (cognitive behaviour therapy) treatment combined with a strict diet program and anti-depressant tablets if necessary. If it is a Muslim therapist then they can hopefully guide Muslim patients through their Ramadhān fast.[4] Managing ones eating disorder is sometimes possible and sometimes not depending on the individual’s ability and the duration of the suffering. Hence if fasting is not a problem for them, then they should fast whilst following the guided diet program of a reliable Muslim practitioner. If they struggle to fast then the following issues must be considered in order to be exempted from fasting from the Sharī῾ah perspective.
Firstly, whether the dispensation given to an ill person can apply to a mentally ill person with eating disorder or not and secondly, whilst fasting if the sudden urge of eating kicks in due to the overwhelming pressure necessitates both Qadha and Kaffarah or just Qadha. Regarding the first point, classical Hanafi jurists when discussing rulings on illness usually refer to the physical illness. Illness as the Hanafi jurists explain implies to bodily dysfunction or any change to one’s condition taking it out from its normal functional state )due to some acute pain(.[5] The general ruling is that if an ill person by fasting fears perishing or loss of limb or fasting would burden their health to the extent that it will either severely deteriorate them or delay in recovery because of the acute pain based on their personal experience or the advice of a (preferably) Muslim doctor then they are exempted from fasting.[6] Likewise a healthy person who fears that by fasting, they will most likely fall ill based on previous experience is also exempted from fasting according to the most authoritative position.[7] They are required to postpone their fasts as Qadha to a later date upon recovery but if they did fast and end up breaking it due to an illness then only Qadha is necessary but no Kaffarah. The condition is that the illness should be acutely enough where fasting is harmful to their health. Suffering from a minor illness where fasting is not detrimental to their health does not exempt them from fasting. [8]
Mental health unlike all other illnesses is internal that only a professionally trained doctor can diagnose. Certain forms of depressions can affect one’s physical health and even result in self-harm. The objective of the Sharī῾ah is to repel harm and not to burden its followers beyond their natural capacity. One aspect of illness the jurists discuss is the deficiency of the mind (نُقْصَانُ عَقْلٍ) like suffering a severe headache to the degree that weakens one’s actions.[9] Though mental condition is not the same as having a headache, it implies that the Sharī῾ah does consider internal illnesses as a valid excuse to not to fast especially if it weakens their health that affects their daily functioning. The underlying principle therefore is that if a specific mental condition is such that fasting deteriorates or weakens their health or takes them out of their normal functional state affecting their daily chores and activities, would fall under the category of an ill person who is excused from fasting until recovery.
Once this is clear then anorexia that weakens the body by losing a lot of weight combined with anxiety disorder is a form of harm to themselves. If fasting will most likely deteriorate their health and exacerbate their mental condition, then the concession of illness would apply to them which means that they can be excused from fasting by eating throughout the day to regain weight and recover. Those with bulimia and binge eating disorder then it all depends on the degree of harm they suffer physically and mentally as for them it is a about controlling their eating habit and eliminating the anxiety of their physical appearance. This now leads on to the second point of Qadha and Kaffarah. An anorexia patient as described above can be excused if fasting is harmful to them and make up for them as Qadha later on with no Kaffarah. Those with bulimia and binge eating disorder, then if they develop certain illnesses where fasting becomes harmful to their health or mentally overwhelmed to the degree that they become dysfunctional, lose control and unable to do their daily chores then they can be excused and make up for their fasts as Qadha later on upon recovery and if they break it then only Qadha is necessary, no Kaffarah. However, if with the help and the guidance of a Muslim practitioner’s therapeutic treatment and diet program, they can fast throughout Ramadhān without a problem, exercise control over their eating habit and able to cope with their anxiety then they must fast. If they intentionally break it then both Qadha and Kaffarah would be necessary.
[Allãh Knows Best]
Written and researched by (Mufti) Abdul Waheed
Answer Attested by Shaykh Mufti Saiful Islam
JKN Fatawa Department
[1] Over view of Eating Disorder, NHS website; https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/ [accessed May 2021]
[2] Over view of Eating Disorder, NHS website; https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/ [accessed May 2021]
[3] Over view of Eating Disorder, NHS website; https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/ [accessed May 2021]
[4] Dr Vicki Mountford, How to manage your eating disorder during Ramadan. https://www.maudsleyhealth.com/blogs/how-to-manage-your-eating-disorder-during-ramadan/ [accessed May 2021], Over view of Eating Disorder, NHS website; https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/ [accessed May 2021] also see, Hala Abu Taha, FASTING DURING RAMADAN AND EATING DISORDERS: A COMBINATION THAT SHOULD BE AVOIDED. https://www.meeda.me/blog/fasting-during-ramadan-and-eating-disorders-a-combination-that-should-be-avoided/ [accessed May 2021]
[5] Ahmad Ibn Muammad Ibn Isma’il, Hashiyah Tahtawi, Kitab Sawm p. 684
فصل في العوارض
فيجوز “لمن خاف” وهو مريض “زيادة المرض” بكم أو كيف لو صام والمرض معنى يوجب تغير الطبيعة إلى الفساد
“والمرض معنى الخ” قال في القاموس المرض ظلام الطبيعة واضطرابها بعد صفائها واعتدالها اهـ ويقال في اسم الفاعل مارض ومرض ومريض
Zuhayli, Fiqhul Islami wa adillatihu, Kitab Sawm, vol 2 p. 567
المبحث السادس – الأعذار المبيحة للفطر
المرض: معنى يوجب تغير الطبيعة إلى الفساد،
[6] Durrul Mukhtār wa hashiyah Ibn Ābideen Shāmi, Kitābus Sawm, vol 3 p. 403-404
فَصْلٌ فِي الْعَوَارِضِ الْمُبِيحَةِ لِعَدَمِ الصَّوْمِ
(أَوْ مَرِيضٍ خَافَ الزِّيَادَةَ) لِمَرَضِهِ وَصَحِيحٍ خَافَ الْمَرَضَ، وَخَادِمَةٍ خَافَتْ الضَّعْفَ بِغَلَبَةِ الظَّنِّ بِأَمَارَةٍ أَوْ تَجْرِبَةٍ أَوْ بِأَخْبَارِ طَبِيبٍ حَاذِقٍ مُسْلِمٍ مَسْتُورٍ وَأَفَادَ فِي النَّهْرَ تَبَعًا لِلْبَحْرِ جَوَازَ التَّطْبِيبَ بِالْكَافِرِ فِيمَا لَيْسَ فِيهِ إبْطَالُ عِبَادَةٍ.
(قَوْلُهُ خَافَ الزِّيَادَةَ) أَوْ إبْطَاءَ الْبُرْءِ أَوْ فَسَادَ عُضْوٍ بِحَرٍّ أَوْ وَجَعَ الْعَيْنِ أَوْ جِرَاحَةً أَوْ صُدَاعًا أَوْ غَيْرَهُ، وَمِثْلُهُ مَا إذَا كَانَ يُمَرِّضُ الْمَرْضَى
(قَوْلُهُ بِغَلَبَةِ الظَّنِّ) تُنَازِعُهُ خَافَ الَّذِي فِي الْمَتْنِ وَخَافَ وَخَافَتْ اللَّتَانِ فِي الشَّرْحِ ط (قَوْلُهُ بِأَمَارَةٍ) أَيْ عَلَامَةٍ (قَوْلُهُ أَوْ تَجْرِبَةٍ) وَلَوْ كَانَتْ مِنْ غَيْرِ الْمَرِيضِ عِنْدَ اتِّحَادِ الْمَرَضِ ط عَنْ أَبِي السُّعُودِ (قَوْلُهُ حَاذِقٍ) أَيْ لَهُ مَعْرِفَةٌ تَامَّةٌ فِي الطِّبِّ،
Fatawa Hindiyyah, Kitābus Sawm, vol 1, p. 227
[الْبَابُ الْخَامِسُ فِي الْأَعْذَارِ الَّتِي تُبِيحُ الْإِفْطَارَ]
(وَمِنْهَا الْمَرَضُ) الْمَرِيضُ إذَا خَافَ عَلَى نَفْسِهِ التَّلَفَ أَوْ ذَهَابَ عُضْوٍ يُفْطِرُ بِالْإِجْمَاعِ، وَإِنْ خَافَ زِيَادَةَ الْعِلَّةِ وَامْتِدَادَهَا فَكَذَلِكَ عِنْدَنَا، وَعَلَيْهِ الْقَضَاءُ إذَا أَفْطَرَ كَذَا فِي الْمُحِيطِ. ثُمَّ مَعْرِفَةُ ذَلِكَ بِاجْتِهَادِ الْمَرِيضِ وَالِاجْتِهَادُ غَيْرُ مُجَرَّدِ الْوَهْمِ بَلْ هُوَ غَلَبَةُ ظَنٍّ عَنْ أَمَارَةٍ أَوْ تَجْرِبَةٍ أَوْ بِإِخْبَارِ طَبِيبٍ مُسْلِمٍ غَيْرِ ظَاهِرِ الْفِسْقِ كَذَا فِي فَتْحِ الْقَدِيرِ.
Ibn Humām, Fathul Qadeer, Kitāb Sawm, vol 2 p. 350
وَجْهُ قَوْلِنَا أَنَّ قَوْله تَعَالَى {فَمَنْ كَانَ مِنْكُمْ مَرِيضًا أَوْ عَلَى سَفَرٍ فَعِدَّةٌ مِنْ أَيَّامٍ أُخَرَ} [البقرة: 184] يُبِيحُ الْفِطْرَ لِكُلِّ مَرِيضٍ، لَكِنَّ الْقَطْعَ بِأَنَّ شَرْعِيَّةَ الْفِطْرِ لَهُ إنَّمَا هُوَ لِدَفْعِ الْحَرَجِ، وَتَحَقُّقُ الْحَرَجِ مَنُوطٌ بِزِيَادَةِ الْمَرَضِ أَوْ إبْطَاءِ الْبُرْءِ أَوْ فَسَادِ عُضْوٍ، ثُمَّ مَعْرِفَةُ ذَلِكَ بِاجْتِهَادِ الْمَرِيضِ، وَالِاجْتِهَادُ غَيْرُ مُجَرَّدِ الْوَهْمِ، بَلْ هُوَ غَلَبَةُ الظَّنِّ عَنْ أَمَارَةٍ أَوْ تَجْرِبَةٍ أَوْ بِإِخْبَارِ طَبِيبٍ مُسْلِمٍ غَيْرِ ظَاهِرِ الْفِسْقِ،
[7] Fatawa Hindiyyah, Kitābus Sawm, vol 1, p. 227
وَالصَّحِيحُ الَّذِي يَخْشَى أَنْ يَمْرَضَ بِالصَّوْمِ فَهُوَ كَالْمَرِيضِ هَكَذَا فِي التَّبْيِينِ وَلَوْ كَانَ لَهُ نَوْبَةُ الْحُمَّى فَأَكَلَ قَبْلَ أَنْ تَظْهَرَ الْحُمَّى لَا بَأْسَ بِهِ كَذَا فِي فَتْحِ الْقَدِيرِ
Ahmad Ibn Muammad Ibn Isma’il, Hashiyah Tahtawi, Kitab Sawm p. 684
فصل في العوارض
أفاد أن الصحيح الذي غلب على ظنه المرض بصومه ليس له أن يفطر وأفاد السيد أن في ذلك خلافا فالزيلعي على إباحة الفطر له ولعلامة مسكين على عدمه وقد تبع فيه صاحب الذخيرة وجرى على إباحة الفطر في الدر وذكر في القهستاني أن الممرض ملحق بالمريض قوله
It is only according to the Shafi’ee and Hanbali fiqh that a healthy person must fast until they end up falling ill.
Zuhayli, Fiqhul Islami wa adillatihu, Kitab Sawm, vol 2 p. 567
المبحث السادس – الأعذار المبيحة للفطر
والصحيح الذي يخاف المرض أوالضعف بغلبة الظن بأمارة أو تجربة أو بإخبار طبيب حاذق مسلم مستور العدالة، كالمريض عند الحنفية. والصحيح الذي يظن الهلاك أو الأذى الشديد كالمريض عند المالكية.
وليس الصحيح كالمريض عند الشافعية والحنابلة.
[8] Kasān, Badā’i Sanāi, Kitāb Sawm, vol 2 p. 97
[فَصْلٌ حُكْمُ فَسَادِ الصَّوْمِ]
وَقَدْ بَيَّنَّا أَنَّهُ لَيْسَ الْمُرَادُ عَيْنَ الْمَرَضِ، فَإِنَّ الْمَرِيضَ الَّذِي لَا يَضُرُّهُ الصَّوْمُ لَيْسَ لَهُ أَنْ يُفْطِرَ فَكَانَ ذِكْرُ الْمَرَضِ كِنَايَةً عَنْ أَمْرٍ يَضُرُّ الصَّوْمُ مَعَهُ.
Zuhayli, Fiqhul Islami wa adillatihu, Kitab Sawm, vol 2 p. 567
وضابط المرض المبيح الفطر: هوالذي يشق معه الصوم مشقة شديدة أو يخاف الهلاك منه إن صام، أو يخاف بالصوم زيادة المرض أو بطء البرء أي تأخره فإن لم يتضرر الصائم بالصوم كمن به جرب أو وجع ضرس أو إصبع أو دمل ونحوه، لم يبح له الفطر.
[9] Ibn Humām, Fathul Qadeer, Kitāb Sawm, vol 2 p. 350
أَوْ نُقْصَانُ الْعَقْلِ، كَالْأَمَةِ إذَا ضَعُفَتْ عَنْ الْعَمَلِ وَخَشِيَتْ الْهَلَاكَ بِالصَّوْمِ، وَكَذَا الَّذِي ذَهَبَ بِهِ مُتَوَكِّلُ السُّلْطَانِ إلَى الْعِمَارَةِ فِي الْأَيَّامِ الْحَارَّةِ، وَالْعَمَلُ الْحَثِيثُ إذَا خُشِيَ الْهَلَاكُ أَوْ نُقْصَانُ الْعَقْلِ