What is an eating disorder?
At Nourish. Nurture. Thrive. we support individuals who are distressed by their body image, their sense of self, and the way they engage with food, exercise, or other behaviours to cope. At its core, an eating disorder is often disordered eating together with an intense focus on weight, shape, and body image. Eating disorders can range from mildly disordered eating habits and a gnawing sense of discomfort with one’s body, to a severe mental illness with serious physical and sometimes fatal complications.
Eating disorders are often widely misunderstood and trivialised as a superficial lifestyle choice and a condition that is limited to adolescent girls. In actual fact, eating disorders pervade sociocultural and socioeconomic boundaries, and affect females and males across the lifespan.
Other factors can increase vulnerability to the development of an eating disorder, including life transitions (such as concluding school, pregnancy, menopause), engagement in certain sports, life stressors, other physical health conditions (such as diabetes and polycystic ovary syndrome), and other mental illnesses.
About one in 20 Australians suffers from an eating disorder and this rate is increasing.
What is disordered eating?
In a culture fixated with diets, celebrities, social media and reality TV shows, it can feel disorienting, if not impossible, to locate a psychologically balanced and healthy way of eating, exercising, and “being” in our skin.
Disordered eating can present in a range of guises, but is usually typified by fixed, or inflexible eating patterns, which lead to distress if they cannot be maintained. Disordered eating may include:
- Restrictive dieting (fasting, skipping meals, chronic restricted intake, or cutting out food groups such as carbohydrates, fat, or sugar)
- Binge eating (feeling “out-of-control” while eating and eating large amounts of food within a relatively short period of time)
- Compensating for dietary intake (for example, excessive exercise, using diet pills, laxatives, vomiting, etc.)
- Using steroids or other supplements to enhance athletic performance and alter one’s physical appearance
Types of eating disorders:
We have included a brief outline of diagnosable eating disorders, according to the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the most commonly used guide world-wide to diagnose mental illnesses). However, it is important to remember that everyone is unique, and illnesses often don’t fit neatly into these categories, but rather exist on a spectrum of severity or sit between diagnoses.
Individuals with Anorexia Nervosa are usually at a low weight considered unhealthy for their body shape and size. They may use extreme measures to lose weight, such as restricting their dietary intake, exercising compulsively, or vomiting, for example. People with Anorexia Nervosa are often terrified of gaining weight and preoccupied by fears around their body shape, weight, and diet. Despite being underweight, the illness prevents people from seeing their body accurately, and often overrides their emotions, behaviour, and thinking. Anorexia Nervosa has very serious medical consequences, compromising brain functioning, bone growth, and major organs.
Individuals with Bulimia Nervosa typically find themselves trapped in a cycle of binge eating (eating with a sense of being out-of-control in a relatively short period of time) and then trying to compensate for their binge through purging (for example, vomiting, laxative use, or excessive exercise). People with Bulimia Nervosa often associate self-worth with their shape and weight, and suffer feelings of shame and self-loathing. Bulimia Nervosa is commonly a hidden illness, as weight fluctuations may not be obvious, and the emotional consequences often lead individuals to hide their behaviours and concerns. However, this condition can have severe health consequences, including increased risk of heart failure, gastrointestinal complications, weakened bones, and infertility issues.
Binge Eating Disorder:
Individuals with Binge Eating Disorder experience compulsive episodes of binge eating (feeling a lack of control over their eating behaviour). People with Binge Eating Disorder suffer from emotions such as guilt and shame, and for this reason the illness is often secretive and isolating. People with this condition feel an immense amount of distress as a result of their binge episodes. There are significant health issues related to Binge Eating Disorder, including osteoarthritis, kidney problems, and increased risk of other chronic illnesses, such as diabetes and heart disease.
Avoidant/Restrictive Food Intake Disorder (ARFID):
Individuals with Avoidant/Restrictive Food Intake Disorder experience disordered eating which has significant consequences, such as significant weight loss, nutritional deficiency, interference with psychosocial functioning (e.g. being able to participate with peers at school, etc.) or leads to a dependence on enteral feeding (such as tube feeding) or supplements. This condition is characterised by the fact that the person experiencing ARFID does not experience any disturbance in their body image.
Individuals with Pica persistently eat substances which are neither food, nor do they provide any nutritional value. The consumption of these substances cannot be solely attributed to social or cultural norms, or mental or physical illnesses.
Individuals with Rumination Disorder experience chronic regurgitation, re-chewing, re-swallowing, or occasionally vomiting of previously eaten foods.
Other Specified Feeding or Eating Disorder/Unspecified Feeding or Eating Disorder (OSFED/UFED):
This category describes disordered eating which causes distress and impacts on an individual’s life in a significant way (eg. socially, occupationally, etc.) but does not meet the full criteria for other diagnoses.
However, it is important to note that a diagnosis of OSFED or UFED does not necessarily mean that the symptoms are less severe or concerning. An example of an OSFED diagnosis is Atypical Anorexia Nervosa, where all criteria for AN are met, with the exception of an individual’s weight being within or above the normal range, despite significant weight loss. This commonly occurs when there has been a substantial weight loss from a higher BMI, and the physical complications and risk issues can be just as severe as for those with AN. Furthermore, diagnoses of OSFED or UFED may be given initially when disordered eating symptoms first emerge. There is then a high risk of the symptoms developing further into a more pervasive and enduring eating disorder presentation.
When to seek help:
Eating disorders are, by their very nature, secretive and shame-inducing. Acknowledging an eating disorder in yourself, or identifying one in someone you care about, can be incredibly difficult.
There can be signs of an eating disorder, when you know what to look out for. These are not limited to, but may include:
- Dieting behaviour (e.g. restricting food groups, skipping meals)
- Eating in isolation or avoiding meals with people
- Binge eating behaviours, such as hoarding food, or food disappearing from the cupboard or fridge
- Patterns of visiting the bathroom during or shortly after meals
- Excessive exercising (e.g. exercising even if sick or injured, becoming highly distressed if prevented from exercising)
- Changes in food preferences (e.g. becoming a vegetarian, preoccupation with “healthy eating”, or rejecting foods that were once enjoyed)
The National Eating Disorders Collaboration has great resources, including how to spot the physical, psychological, and behavioural signs of an eating disorder: http://www.nedc.com.au/recognise-the-warning-signs
Eating disorders are somewhat unique, because they encompass both serious psychological and severe physical health concerns. The sooner you access support for an eating disorder, the better the chances of recovery for you or your loved one. Choosing to seek help is a really significant step toward recovery.
How to support someone with an eating disorder:
Eating disorders are vicious. They do their best to overpower the sufferer and anyone else that gets in their way, including family and loved ones. Parents and carers can find themselves overwhelmed and exhausted by a disease that seems to take over the person they know. It can feel nearly impossible to remain calm, patient, empathic and firm in the face of a disease that appears contradictory to common sense or our most basic survival instincts. At times it may seem as if the sufferer does not want to get better, has become someone you don’t recognise, or someone you feel you can no longer trust.
The Eating Disorders Victoria website provides some excellent information for families, carers and friends on how to help support a person with an eating disorder. http://www.eatingdisorders.org.au/
We also recommend:
- Become informed and educated about the illness
- Encourage the person to seek professional help
- Try to remain calm and patient when communicating. The use of empathy, honesty and openness can go a long way when sharing your concerns.
- Be actively involved in treatment (if appropriate, i.e. for parents/partners)
- Look after yourself as much as possible.
- Try to separate the person from the eating disorder.
- Remain hopeful that recovery is possible.