Recognising Eating Disorders

Do I have an eating disorder?

If you have problem with eating and your eating behaviour, or your attitudes about food and weight are taking pleasure out of your life you may have an eating disorder. People with eating disorders typically worry a lot about their weight and about the food they are eating (or trying not to eat). You probably have an eating disorder if some of the following is happening:

Excessive concern and preoccupation about calories or fears of weight gain.
Eating habits that you know in your heart are abnormal.
There is a lot of shame and guilt around eating.
You don’t think you are too thin but other people are worried about you.
You vomit to avoid gaining weight or use laxatives.
Your weight is fluctuating a lot.
There are a lot of foods you strictly avoid to control your weight, and you feel like a terrible person if you eat any of these foods.
You have unmanageable cravings for certain types of food that you think you should not be eating.
Exercise is something you are driven to do; you would feel fat or like a bad person if you missed an exercise routine.
You are depressed and irritable.
You pretend that you have eaten to get people off your back.

Which eating disorder?

There are 3 types of CLINICAL eating disorder. At their root, all of them are concerned with control of weight and shape. Anorexia Nervosa, Bulimia Nervosa and anything else which are known as FEDNEC (Feeding & Eating Disorders Not Elsewhere Classified). This includes Compulsive Eating, and types of anorexia or bulimia which are not severe. There is a less familiar eating disorder called The Night Eating Syndrome and one named Orthorexia, which is thought to be similar to anorexia. People with Orthorexia are obsessed with healthy eating plans such as food allergy plans – but this masks a bad relationship with food. Children may suffer from problems with eating, which are not related to control of weight.

There are problems with diagnosis for the following reasons:

There are degrees of severity for all of these conditions. These days many people especially women are concerned about their eating habits and it is hard to know when someone “tips over” from normal eating, develops problem eating, then falls into a real eating disorder that may have serious medical and emotional consequences. The behaviours associated with real eating disorders include binge eating, starving to the point of emaciation, purging,(vomiting or taking laxatives for weight control), excessive exercising, chewing food and spitting it out, and obsessive dieting
People don’t come definition-shaped, for example one man’s binge is another man’s good meal. People have different ways of expressing their relationship with food

The bottom line is, if eating “rules your life” you will probably need some kind of help with your Disordered-eating. Your disordered eating should be seen merely as a period of time in your life when, for whatever reason, this is the way you are coping and your eating has become in distress.

Anorexia Nervosa

When someone has lost a lot of weight through food restriction and often also excessive exercising. Sometimes the decision to lose weight has been purposeful and sometimes it just “happens by accident” as when a person starts restricting certain types of food such as meat or fats or carbohydrate because of health concerns. A young girl or boy who decides to become vegetarian may be on the way toward anorexia. Typically, there is great fear about weight gain, this fear appears to increase the thinner the person becomes.
Anorexics typically consider that weight loss is a good thing, and most consider that they are” fat”, even when they are skeletal. Many will deny that they have a problem, despite the concern of other people, even when they are dangerously thin. A profound fear of weight gain manifests itself as a phobia of eating, which helps keep the illness going. There are other psychological benefits of starvation, which kick in as the illness continues. These benefits, such as feeling special, feeling competent, being different, gaining attention, not having to participate in normal life, not having to “grow up”, not even feeling authentic feelings; all of these help keep the anorexic trapped in his or her illness, and overrides their wish to recover.
Some anorexics “binge eat” although the amounts eaten are small. If they vomit or take laxatives we can say that they have the bulimic subtype of anorexia nervosa. Anorexia is largely a young-female condition although men suffer too and so do children as young as 5, and older or elderly women. These are the “hidden sufferers” who don’t often get the help or attention they may need.

About 1 in 3 anorexics recover (this may take some time) and about 1 in 3 start overeating and may have long term problems with food control. The death rate is unacceptably high with between 1 in 5 dying early as a result mostly of starvation effects or suicide.

Bulimia Nervosa

Typically are normal in weight or even overweight and they regularly use laxatives or they vomit in order to avoid gaining weight usually as a result of overeating or binge eating. As with anorexia, weight gain is greatly feared although the bulimic is not usually afraid of being at a normal body weight, even if they are desperate to lose some weight. It is hard to define a binge because to some people one bar of chocolate can feel like a tragedy and binge events can vary very much from person to person or even for the same person over time.

Bulimics may try hard to restrain their eating, or even starve in between bouts of overeating to try and lose weight, or they try to stave off eating in case one bite brings loss of control. Some, but not all, have chaotic eating patterns, binge eating and purging very frequently. Purging is not an effective way of getting rid of all calories eaten which is why many people with bulimia eventually gain weight.

Bulimia has an addictive feel because it becomes a way of regulating emotions and helping people cope with life. This is why people can be bulimic for many years unless an eating disorder specialist properly treats them, using a form of therapy called CBT. They are often able to conceal their behaviour, even from people who live with them. After all, it feels shameful to confess their problems, even to a doctor. The side effects of bulimia however are very harmful and can lead to illness and even death.

Binge Eating Disorder (BED)

The third main type of eating disorder. Also described as “compulsive eating” it is arguably the most common eating disorder. We believe that almost half of all overweight people who seek help for their weight problem suffer from this disorder to a greater or lesser extent. Weight loss in itself however will not cure the problem.

Compulsive eating can feel like bulimia nervosa except that sufferers do not vomit or take laxatives to control their weight. They have a sense of overeating, which feels out of control. It feels as if they are taken over by someone else. Binge eaters may feel as if they have no willpower where food is concerned and they may eat in secret, guilty and miserable about their behaviour. Because of their eating habits they are always struggling to avoid gaining weight, often without success. They may go from one diet to another in the quest for weight loss and eating control.

People with BED may binge, eat small amounts continuously, or pick at food from time to time. Although the medical profession takes this disorder less seriously than anorexia or bulimia, it can ruin both health and someone’s quality of life. As one person put it: “Food is ruling my life. I wish I could just take it or leave it, but it’s never enough”.

Why and How?

There is no simple explanation as to why people develop eating disorders and there has been a lot of research into the causes. We know that we cannot simply blame the culture, fashion magazines, family relationships, early traumatic experiences, or abuse or buried psychological problems like depression or anxiety.

Eating disorders arise from a combination of personal, family, physical or genetic factors as well as life experiences that may cause someone to be both emotionally vulnerable AND sensitive about their weight and shape. DIETING has a role to play in the development of an eating disorder, in fact in most sufferers the eating disorder grew out of dieting behaviour. Research suggests that people who are neurodivergent are 10 times more likely to develop an eating disorder.

It is hard to “tease out” the relative contribution of many of these factors. You may often hear it said that the root of eating disorders is low self esteem and certainly for people with eating disorders, their weight plays a very important role in their opinions about themselves prior to the onset of an eating problem. People who do not develop eating problems may be concerned about their weight but there are other domains in life that influence their self-esteem; these act as a protective buffer. Eating disorders are coping behaviours, which provide the person with an outlet for displacement of feelings, which really relate to other areas of life being out of control.

Looking at people who have eating disorders, we note several things in common:

Feelings of powerlessness, or worthlessness
They are terribly sensitive to imagined rejection or abandonment
Most have poor assertion skills and find it hard to manage relationships healthfully
They may have perfectionist attitudes, and find it hard to measure up to their own high standards for themselves, but would not necessarily apply those standards to other people
They are not good emotional problem-solvers, and tend to avoid life’s difficult situations
Find it hard to say “no” or ask for what they want in life, may be “people pleasers” or go out of their way to be nice, may have moments of aggression when things get on top of them
They may lack confidence in managing relationships in a way that serves their needs rather than those of other people

There is increasing evidence that early intervention for all types of eating distress is essential for successful, effective and full recovery.