An eating disorder is characterised by behaviours surrounding food intake that can lead to a negative change in physical or psycho-social health. Food is a central part of our lives as it is the fuel our bodies need to maintain our survival. When people are under stress, their appetite and the way they view food can be affected. They may lose interest in eating, eat more than usual or crave certain types of food. Very often this will pass when their lives return to normal and the difficulties are resolved.
However, for some people, food can become an overwhelming concern which continues to dominate their lives. They may develop eating habits that become damaging to their physical and psychological health. They may try to control their intake of food by avoiding eating or they may find it difficult to stop eating even when they are full. Some people use potentially harmful ways to try to lose weight such as making themselves vomit, using laxatives or over exercising. When someone’s eating behaviour and attitudes to eating become affected to this extent, they may have what is known as an eating disorder. Eating disorders often have a significant impact on someone's life. They can affect health and well-being, work, social life, family and relationships.
An eating disorder is a serious mental illness that can affect individuals of all ethnic backgrounds, ages and genders. Anorexia Nervosa and Bulimia Nervosa are ten times more common in females than males, although the number of males presenting with an eating disorder is on the rise. Eating disorders occur more often in people who have been overweight in childhood.
Eating disorders can develop for a variety of reasons including:
· Body dissatisfaction, low self esteem, distorted body image (over/under estimation of body size).
· Perfectionism, anxiety, depression.
· Societal, professional, recreational pressures to fit a certain body type.
· Family history of an eating disorder, stress, lack of social supports, isolation.
· Attachment and relationship difficulties.
There are three main categories of eating disorder: Anorexia Nervosa, Bulimia Nervosa and a more general category which includes Binge-Eating Disorder. Although they differ in some ways, they also share common features and sufferers can move from one diagnosis to another over time. Additional categories of eating disorders include ARFID (Avoidant Restrictive Food Intake Disorder) and OSFED (Other Specified Feeding or Eating Disorder).
Anorexia Nervosa - The most predominant symptom of Anorexia Nervosa is losing a lot of weight rapidly or remaining at a weight that is much lower than healthy and recommended for their age, height and build. As well as deliberately skipping meals, restricting amount of intake, or avoiding foods they see as ‘bad’ they may overly exercise, misuse diuretics/laxatives or make themselves sick.
Binge-Eating Disorder – This involves eating unusually large quantities of food over a very short period. These ‘binges’ can be planned in advance, and are typically done in isolation. They are usually very distressing for the person and lead to them feeling ashamed of this behaviour. People are often very disconnected during a binge, and sometimes can find it hard to remember what they ate.
Bulimia Nervosa – Also known as bulimia leads to people getting caught in a cycle of over eating huge amounts of food (binging) followed by purging to compensate. Purging can be done by taking laxatives, vomiting, fasting for long periods of time, or excessively exercising. Binge eating episodes can be brought on by stress, anger, or anxiety and are often very distressing for the individual.
Avoidant/Restrictive Food Intake Disorder – Also known as ARFID, it is characterised by avoidance of certain foods, limiting their intake, or both. ARFID is never characterised by concerns over weight or shape. It leads to a disturbance in eating or feeding due to a sensitivity to a characteristic of the food (texture, taste, smell, temperature etc). It can also come from a negative experience after eating a certain food such as a stomach pain, vomiting or choking, which then leads the person to avoid the food in the future.
Other Specified Feeding or Eating Disorder – OSFED is an umbrella term for individuals who can experience any of the symptoms described in the previous illnesses, but do not fit the criteria for that illness. They can sometimes experience these symptoms for a limited amount of time, but it can also be a long term condition.
· Deliberately skipping meals, restricting amount of intake, or avoiding foods you see as ‘bad’
· Avoiding social situations that involve food
· Excessively worrying about your weight or shape
· Exercising too much
· Changes in food such as being anxious, withdrawn, depressed
· Developing very strict habits or rituals around food
· Vomiting or taking laxatives after food
· Feeling cold, dizzy or tired
· Heart racing, feeling faint or fainting
· New problems with digestion such as bloating, constipation or diarrhoea
· Tingling, pains or numbness in arms and legs
· Weight being very high or low for their age, height and build
· Not getting a period or other delays in puberty
If you think you might have an eating disorder, it is important that you speak to your doctor or another practitioner at your GP Practice.
If you discover that you have an eating disorder but you are not sure if you are ready to change this, it is still an important first step to ask at your GP Practice about monitoring of your health. Eating disorders can have a very detrimental effect on you physical and mental health. Your doctor might monitor things like your weight and blood pressure and they may do some blood tests as well as other investigations, depending on the symptoms and behaviours associated with the eating disorder.
Your GP may decide that you need additional support with your eating disorder, depending on the severity of your symptoms. They can refer you to a specialist, such as a psychologist, dietitian, psychiatrist, or a multidisciplinary team comprising of various specialities. The route to recovery is different for everyone, and these specialists will help tailor your treatment to you. Treatment can comprise of frequent physical monitoring, guided self help, and individual talking therapy.
If you suspect that your child has an eating disorder or has recently been diagnosed with one, keeping open lines of communication can aid their recovery. If you have concerns around your child’s eating you can discuss this with their healthcare provider. This may be difficult as it is hard for your child to process they have a problem. They may become withdrawn, anxious, depressed and easily irritated. They might even come across as angry as they are trying to process their emotions. Try not to feel hurt if they do not open up straight away. More advice can be found here
· Sudden and dramatic weight loss.
· Avoiding social outings involving food.
· Isolating, changes in mood and behaviour.
· Excessive or obsessive exercising.
· Wearing loose or baggy clothes to hide their body.
· Lying about their weight, or when they have eaten.
· Eating a lot of food very fast.
· Frequently going to the bathroom right after a meal.
· New behaviours around food, such as cutting it up very small, using specific cutlery or crockery.
A good first step in seeking help with an eating disorder after speaking to your GP is to find out as much information as possible. A number of useful eating disorders websites, books and self help guides can be found below.
(FEAST) Families Empowered and Supporting Treatment of Eating Disorders
Eating Disorders and Autism
Eating disorder management app - Rise Up + Recover
Get self help website
Books on recovery from ED :