Defining Eating Disorders «
26th February 2019
In honour of #eatingdisordersawarenessweek, I’m opening up the conversation all about eating disorders, breaking the stigma and talking all about how important it is to embrace a healthy relationship with food!
In clinic I can work with you 1-2-1 to support you on your journey when facing disordered eating.
Food is as much a reflection of our psychology as it is our personal habits. So, what our mind is feeling, we ultimately need to understand how this can shape and influence our food choices, too.
I’m going to walk you through some of the basic facts when it comes to eating disorders, covering what they are, who they affect, as well as what to do when facing a suspected eating disorder.
What is An Eating Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), eating disorders can be defined as:
“Serious and complex conditions of abnormal eating attitudes and behaviours that have important consequences for the physical and mental health of affected individuals” (DSM IV, 1994).
An eating disorder might involve:
- Limiting the amount of food being eaten
- Eating very large quantities of food at once
- Getting rid of food eaten through purging, laxative misuse, fasting or excessively exercising
- A combination of the above behaviours
Eating disorders are complex mental illnesses with no one single cause.
*DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) published DSM-5 in 2013, culminating a 14-year revision process. For more information, go to www. DSM5.org.
Types of Eating Disorders
There are many different types of eating disorders, which includes:
- Anorexia Nervosa – a serious mental illness where people are of low weight, due to limiting their energy intake. As well as restricting calorie intake, an anorexic may also excessively exercise to burn off the food eaten. Sufferers with anorexia often suffer with a distorted body image of themselves, seeing themselves as much larger than they really are. They often experience a deep fear of gaining weight and challenge the idea that they may need to gain weight.
- Bulimia Nervosa – people with bulimia are caught in a cycle of eating large quantities of food (bingeing), and then trying to compensate for the overeating by vomiting, taking laxatives, fasting, or excessively exercising (called purging). Bingeing often involves not feeling in control of how much is being eaten and a sense of ‘disconnectedness’ from what is happening.
- Binge Eating Disorder – people with binge eating disorder experience a loss of control and eat large quantities of food on a regular basis. Binge eating normally takes place in private, and sufferers often report feelings of guilt and disgust at their lack of control during and after binge eating. Unlike those with bulimia, people with binge eating disorder do not regularly use purging methods following a binge.
- Orthorexia – a term recently coined in the last 10 years, orthorexia is categorised as an unhealthy obsession for eating healthy and ‘pure’ food. Foods are often eliminated in an attempt to lead the healthiest lifestyle possible, but the list of ‘allowed’ foods soon becomes less and less, as the sufferer uses healthy or ‘clean’ foods to deal with their negative thoughts and feelings in a bid to feel in control. Someone with orthorexia may feel extremely anxious or guilty if they eat anything they feel is unhealthy.
- EDNOS – this may refer to Eating Disorders Not Otherwise Specified (EDNOS), which means that the person’s eating disorder does not exactly match the criteria of symptoms that a specialist will check to diagnose with anorexia, bulimia or binge eating disorder.
- Disordered Eating and Other Eating Disorders – for instance, emotional overeating, rumination disorder or pica.
It can also be possible that people can move between diagnoses in the case that their symptoms change. There is a lot of overlap that occurs between different eating disorders, and it is important to diagnose them so that the most appropriate treatment can be given.
Who is Affected by Eating Disorders?
In the UK alone, it is estimated that eating disorders currently affect approximately 1.25 million people (Beat Eating Disorders UK, 2019).
Most people think that eating disorders only affect young women and adolescents, but it is imperative that we break this stereotype!
Eating Disorder Definition – “Serious and complex conditions of abnormal eating attitudes and behaviours that have important consequences for the physical and mental health of affected individuals” (DSM IV, 1994)
Eating disorders can in fact affect men or women, from a young age to those who are much older.
Whilst young women are considered much more likely to develop an eating disorder (statistics show that 1 in 100 females aged 15 to 30 are affected by anorexia nervosa), there is no gender or age limit on disordered eating (Beat Eating Disorders UK, 2019).
Yes it’s true – eating disorders don’t discriminate!
And whilst eating disorders have historically been associated with straight, young white females, they can be experienced by people from all demographics, no matter what age, gender, ethnicity or cultural background. They can affect all kinds of bodies, regardless of size, meaning that you cannot always tell if somebody has an eating disorder.
Misconceptions about who eating disorders affect has huge ramifications and can lead to fewer diagnoses for those who do not fit the common stereotype. It has even been reported that men have been discouraged from coming forward about their eating disorders, due to the social stigma attached to males seeking psychological support.
This is important to highlight, since it is estimated by the National Institute of Health and Care Excellence that 11% of those with an eating disorder are male (NICE, 2017).
What Causes an Eating Disorder?
Eating disorders are highly complex.
They are not caused by one single factor. Rather, they arise from a combination of long-standing behavioural, biological, psychological, social, environmental and emotional factors.
Examples of biological factors include:
- Irregular hormones
- Genetics (research on eating disorders and genetics is still in its infancy, but it is known that genetics does indeed play a role).
- Nutrient deficiencies
Examples of psychological factors include:
- Negative body image
- Poor self-esteem
Examples of environmental factors include:
- Family and childhood traumas (e.g. sexual abuse, severe trauma or grief)
- Exposure to media or professions that promote being thin as the ‘ideal’, such as fashion magazines or modelling careers.
- Aesthetically-oriented sports that place emphasis on maintaining a lean physique (e.g. ballet, gymnastics, rowing, diving)
- Peer-pressure amongst friends or colleagues
- Stressful life events
I think I have an Eating Disorder: What Should I Do?
Step 1- If you first suspect that you may be suffering with an eating disorder, the first step is to make an appointment with your GP right away.
Step 2 – The next step is to tell somebody close to you, who you can trust. Opening up to loved ones around you is so important if you are facing an eating disorder.
Step 3 – Once you’ve made your GP appointment, see if your trusted friend or relative can accompany you on your visit to the doctor’s. It’s important to have a support system in place, so a friendly face can be a huge help.
Step 4 – Whilst you’re there, give the GP as much information as you can about what you are experiencing. Bear in mind that you may experience some misunderstandings such as:
- “What you’re experiencing hasn’t gone on long enough”
- “Your weight doesn’t suggest you need referral”
- “This may be a phase, come back if it happens again”
Regardless of symptom duration, BMI or weight, you are within your rights to request to see another GP if you have not been taken seriously or referred to see an eating disorder specialist. The sooner a referral is made, the better and quicker the chances are of recovery.
If you would like more information on what to do if you are seeking eating disorder treatment (for yourself or a loved one), a UK charity for eating disorders, Beat, have created a downloadable booklet for support before your first GP visit. You can find it by clicking here.
Additionally, you can find eating disorder specialists privately via the National Centre for Eating Disorders (NCFED). Browse through their counsellor database here.
Why Is it So Important to Seek Help with an Eating Disorder?
Eating disorders can be incredibly serious and in some cases, may be fatal.
Anorexia nervosa has been shown to have the highest mortality rate of all mental illnesses (Beat Eating Disorders UK, 2019)
Despite the seemingly glum outlook, eating disorders are treatable and it is indeed possible to make a full recovery.
Additionally, it is important to seek help with an eating disorder to ensure that you are not being deprived of key nutrients which could lead to malnutrition or anaemia. Further problems include digestion and fertility issues, hormonal imbalances and poor bone health.
Signs & Symptoms of Eating Disorders
Common signs and symptoms of someone who may be experiencing an eating disorder include:
- Chronic dieting despite being hazardously underweight
- Exhibiting a continued fixation with food and obsessing over the caloric content of meals.
- Avoiding social functions or situations that involve food or eating
- Depression and a general withdrawal from life
- Engaging in unhealthy eating patterns, such as hiding food, eating alone, or cutting food into tiny pieces to appear as though more of the dish has been eaten.
This list in not exhaustive and of course, the many different types of eating disorder can vary in terms of signs and symptoms, which is why it is important to speak with a specialist about the symptoms you are experiencing to guide tailored treatment protocols.
Understanding Your Relationship with Food
Emotional eating can affect any of us. There isn’t one person who does not have a relationship with food. We all relate to food in some way or another; be it social, cultural, emotional, and of course, for survival.
We can eat for comfort, or as a way to provide some temporary distraction from something that is bothering us.
In those who suffer with an eating disorder, your relationship with food can be completely knocked out of balance, and sometimes this is hard for you to spot.
We all experience emotions, and everyone is to some degree an emotional eater. The problem occurs when our emotions rule our eating patterns. They can be fuelled mostly by negative emotions such as anger, anxiety, depression, negativity, boredom, guilt and shame.
The trick is to tap into what you’re feeling and frequently check in with yourself and your emotions. Once you’ve gained some awareness of your thoughts, you are better able to understand what’s driving your eating behaviours.
My Experience Working with Clients
Whenever I’ve spoken with clients who suffer with a poor relationship with food, I tell them that the sooner we can identify what the underlying problem is, the quicker we can devise some practical strategies to deal with their disordered eating.
Underlying factors often include:
- Poor Body Image:
The importance of working on body image is so essential for improving any disordered patterns of eating. Poor body image is having a particularly negative view of yourself and your body, and so work must be done on this in order to support healing and recovery. I’ll be writing some upcoming articles on this very topic so keep a lookout in the next couple of months.
- Low Self-esteem:
How you perceive yourself is so important if you suffer with an eating disorder. Having low confidence or self-esteem can permeate into our food choices, as we may over or undereat based on our beliefs and values of ourselves.
I see social media play a large role in people’s self-esteem, be it the comparison of celebrity bodies or alternatively those of friends or peers.
- Stress, Anxiety and Difficult Emotions
Many of us use food to deal with our emotions, particularly those negative emotions like stress and anxiety. Food can seem like the easiest way to deal with our life problems because of the way certain foods can influence our hormones and the neurotransmitters in our brain (e.g. sugary foods can give us an instant boost and make us feel happy and energetic, but then sooner or later we will dip and experience those blood sugar crashes and low mood).
Dealing with those emotions sensibly and challenging any negative thoughts are huge factors that can help people to re-establish a healthy relationship with food.
I hope this guide has helped to provide some valuable insights into eating disorders and how you can best move forward if you (or a loved one) is suffering.
I am currently advancing my clinical training to become a Master Practitioner in Eating Disorders & Obesity with the National Centre for Eating Disorders as this is an invested passion of mine that I would like to support my clients with further.
If you would in the meantime like to see me for a clinical consultation, please send me an enquiry by clicking here.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. 4thedn. Washington DC: APA.
Beat Eating Disorders UK. (2019). Eating Disorders. Available at: https://www.beateatingdisorders.org.uk/how-many-people-eating-disorder-uk (Accessed: 26 February 2019).
National Institute of Health and Care Excellence (NICE). (2017). Eating Disorders: Recognition and Treatment. Available at: https://www.nice.org.uk/guidance/ng69/ifp/chapter/Eating-disorders-the-care-you-should-expect (Accessed: 26 February 2019).
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