For my first article, I wanted to give you a (very) brief introduction to eating disorders. Eating disorders are too big and complex to discuss in one go, so I will be following this article up with others that do go into more depth. Do you have any specific questions about eating disorders? Send them to me and I'll include the answers in future articles.
What is an eating disorder?
We'll start at the begining. What is an eating disorder? There isn't actually a clear answer to this question because no one has been able to write a definition that has been universally accepted. This is partly down to the complex nature of all mental health problems and partly down to the fact that eating disorders are known as being comorbid. Being comorbid means that eating disorders typically exist alongside other mental health conditions, such as depression or anxiety. Because the individual with an eating disorder will also be experiencing symptoms of other mental health conditions, and because the symptoms interact with each other, it makes it very difficult to define where one condition stops and another starts.
The NHS defines eating disorders as ‘…when you have an unhealthy attitude to food, which can take over your life and make you ill.’ (www.nhs.uk)
Beat, the UK’s leading eating disorder charity, defines eating disorders as '...serious mental illnesses that involve disordered eating behaviour.’ (www.beateatingdisorders.org.uk)
My personal view is that eating disorders are severe and complex mental illnesses that often start as coping mechanisms to help us deal with other problems that we're living with, such as low self-esteem, anxiety, or as a response to a traumatic event. Eating disorders are characterised by having an unhealthy relationship with food, such as restricting what or how much you eat, uncontrollably overeating, or eating things with no nutritional value, or that are harmful.
There are an estimated 1.25 million people living with an eating disorder in the UK and an additional 5 million people who are directly affected by eating disorders (www.beateatingdisorders.org.uk). Even more people will be living with disordered eating, which is again characterised by a problematic relationship with food or eating patterns. That is far, far too many people! Which is part of the reason why I specialised in eating disorders, I want to help as many people to recover as I can.
What eating disorders are not
Now, there is a lot of misunderstanding about eating disorders. I've seen the harm that these misunderstandings can do to someone who is living with an eating disorder so I want to challenge some of them.
First, no one chooses to have an eating disorder. That sentence is so important that I'm going to tell you again: no one chooses to have an eating disorder. Eating disorders develop as a response to a mixture of genetic, environmental, social, cultural and psychological factors. Eating disorders are not phases or attempts to get attention; they are serious illnesses and need to be treated as such.
Second, eating disorders are not just about being thin. We're all familiar with the stereotypical image of a teenage girl skipping lunch because she wants to slim. Although an excessive fear of being overweight is a part of anorexia and bulimia, there are also core underlying problems such as low self-esteem, extreme perfectionism, or a feeling of being out of control to name just a few. I'm not saying that it's impossible, but I have NEVER met anyone with an eating disorder where there wasn't at least one underlying problem.
Third, eating disorders are not restricted to teenage girls. Anyone – and I mean anyone – can develop an eating disorder. Anyone of any gender, age, race, culture, or class can develop an eating disorder. Some groups are more likely to develop eating disorders, such as young females, but that doesn’t mean that someone else, such as a middle-aged man, cannot develop or be living with an eating disorder. 25% of eating disorder diagnoses go to men and there is every reason to believe that eating disorder rates amongst men are far higher than that. We know that men are less likely to seek professional support for their mental health in general. We also know that, unfortunately and inexcusably, there are quite a lot of doctors who don't associate eating disorders with men and so opportunities to diagnose and support sufferers are missed.
Symptoms of eating disorders
As with all mental illnesses, there is no right or wrong way to be ill with an eating disorder. The symptoms are varied, complex, and can come and go. While there are some commonalities, the symptoms of eating disorders will be different for everyone. For example, if you have a diagnosis of anorexia nervosa, you may experience all or some of the symptoms that are required for a clinical diagnosis. The symptoms that you do experience will vary in intensity and severity across time.
There is an added difficulty that because eating disorders are comorbid with other mental health problems, you may be experiencing symptoms of two or more problems at any one time. For instance, you may experience the symptoms of bulimia nervosa as well as experiencing the psychological and physical symptoms of anxiety.
Below is a list of some common symptoms of eating disorders (please be aware that I have not separated these symptoms according to types of eating disorder and they are in no particular order):
- Having strict habits or rules to do with food and eating
- Experiencing changes in your mood
- Being very concerned about your weight and appearance
- Eating very little food
- Feeling out of control and eating too much food
- Making yourself sick, or taking laxatives after eating
- Exercising excessively to burn calories
- Avoiding socialising if food will be involved
- Always feeling cold, tired or dizzy
- Your weight is very high or low for someone of your age and height
- Having problems with your digestion
- (For females) your periods becoming irregular or stopping entirely
Your symptoms do not have to be severe for you to ask for help. If you recognise that you have any of the symptoms above, I urge you to speak to a professional.
Types of Eating Disorder
There are many different types of eating disorders; below are the most common.
Anorexia is known as a restrictive eating disorder because sufferers will feel powerful urges to restrict the number of calories that they consume. Restricting food intake may be accompanied by what is known a purging behaviour, such as deliberately being sick, using laxatives, or exercising too much, to purge the calories that have been consumed.
Avoidant / Restrictive Food Intake Disorder (ARFID)
Someone living with ARFID will restrict or avoid certain types of food, the amount that they eat, or both. There are several reasons why someone may limit what they eat with ARFID, but weight loss is not usually one of them. Restrictive behaviour may be due to being very sensitive to taste, smell or texture, or it may develop following a traumatic incident such as choking.
People who have bulimia experience cycles of binging (overeating food while feeling out of control) and then compensate by purging. It’s not uncommon for someone with bulimia to maintain an average weight, which means that the eating disorder can be easier to hide. Maintaining an average weight does not make bulimia any less serious than other eating disorders.
Binge Eating Disorder (BED)
BED is where people regularly feel out of control and eat large quantities of food very quickly, leading them to feel uncomfortably full which is often accompanied by feelings of shame or guilt. Binges will usually happen in private and they can be spontaneous or may be more ritualised (buying special foods, bingeing at a particular time or in a specific place).
Orthorexia is not a formally recognised eating disorder, but it is becoming more common. Orthorexia is an obsessional compulsion to only eat “healthy” foods which is so extreme that it becomes damaging to the person’s health and well-being. There is some debate as to whether orthorexia is an eating disorder in its own right, a subtype of another eating disorder, or a form of OCD. It's important to differentiate between a desire to eat healthy foods, and an obsessional compulsion to only eat "healthy" food. As orthorexia becomes more severe, the list of allowed "healthy" food will often decrease, depriving the individual of all the nutrients that their body needs.
Other Specified Feeding or Eating Disorder (OSFED)
OSFED is a diagnosis that is given to someone when they are suffering from an eating disorder, but their symptoms do not exactly match the diagnostic criteria for one of the other eating disorders. It's not uncommon for someone to believe that if they are diagnosed with OSFED then they do not have a "proper" or "full" eating disorder and are therefore not sick. That simply isn't the case. OSFED is no less serious than any other eating disorder and the risks are just as great. Because eating disorder symptoms vary so much and diagnostic criteria are so strict, OSFED is one of the most common eating disorder diagnoses given in the UK.
What should I do if I think that I have an eating disorder?
If you are concerned that you have an eating disorder, PLEASE go and talk to your GP as soon as possible. The earlier treatment is started, the higher the chances of making a full recovery. Your GP may be able to refer you to your local mental health team for assessment and specialist support.
If your GP is unable or unwilling to refer you to the mental health team, or the mental health team are unable to support you, there are still plenty of options for you to get help. Remember, counselling can be an effective treatment for eating disorders. I work with individuals who are experiencing an eating disorder as well as family members of sufferers. Please contact me if you want to discuss having counselling.