Understanding Restriction

Understanding Restriction in Eating Disorders: Causes, Effects, and Recovery

This is the first blog in our Understanding Eating Disorder Symptoms series.

Eating disorder symptoms are rarely present in just one diagnosis. Some symptoms, like restriction, can be found in all bar two eating disorders. Others, like purging, are found in fewer eating disorders.

This crossover of symptoms can lead to some confusion. Which eating disorder do I have? Do I even have an eating disorder if I don’t do this specific behaviour? I think I restrict, but I don’t count calories, so am I really restricting? This series of blogs aims to help you truly understand the different symptoms of eating disorders, what they mean, and what you can do about them.

Restriction is perhaps the most well-known behaviour that can be present in an eating disorder. It sounds simple enough: someone is not eating enough. But what does this actually mean in reality?

What Does Restriction Look Like?

Restriction can take many forms, including:

Limiting Calories: Eating significantly less than your body needs to function properly. You might count calories and aim to be below the number of calories you have burnt that day, or you may have an upper-calorie limit, also known as a calorie cap, which you do not go over regardless of how much physical activity you have done.
Eliminating Food Groups: Cutting out foods like carbohydrates or fats because you believe that they’ll make you fat or because you believe them to be unhealthy.
Skipping Meals or Snacks: Regularly missing meals or snacks because you want to reduce the overall number of calories consumed that day.
Avoiding Social Situations: Skipping social events that involve food, such as eating out with family or friends.
Only Eating Safe Foods: Only eating certain foods you feel okay eating. This is often driven by wanting to avoid feeling ill, or because you believe that these particular foods are healthy enough to avoid or limit weight gain.
Only Eating at Certain Times: Often referred to as fasting, you allow yourself to eat during specific windows or when you have to finish eating a certain amount of time before an activity. This is commonly seen in anorexia, where you may have a rule that you need to finish eating well in advance of sleeping in case the food you are digesting is stored as fat. It is also common in ARFID, where you might need a certain amount of time between eating and activities to make sure that you’re not going to be sick.

Which Eating Disorders Can Restriction Be a Part Of?

Restriction is one of the most common eating disorder behaviours, but it’s not present in all eating disorders. The eating disorders it can be a part of are:

Anorexia: Restriction is always present in anorexia.
Avoidant/Restrictive Food Intake Disorder (ARFID): As its name suggests, like anorexia, ARFID always involves some level of restriction. This can be a quantity restriction but is most commonly about cutting out foods for various reasons. This can be due to wanting to avoid feeling or being sick or because some textures, tastes or smells make the food inedible to us.
Binge Eating Disorder (BED): Although many people view BED as a purely overeating disorder, it often involves periods of restriction. The cycle that you can be caught in is that you binge, often in the evening, and feel ashamed and disgusted with yourself. You strive to “do better” tomorrow, so you wake up and have a “healthy” breakfast and lunch. Unfortunately, these “healthy” decisions are often too much and too quick, so you’re actually restricting and creating an energy deficit that builds across the day. Sooner or later, your brain will activate its defence mechanisms and force you to eat, which often becomes a binge and triggers the binge-restrict cycle to repeat.
Orthorexia: Like anorexia and ARFID, restriction is always present in orthorexia. If you have orthorexia, you may still eat enough calories, but the desire to eat only “healthy” foods can lead to more foods and, eventually, food groups being cut out of your diet.

There is a common misconception that people with Bulimia also restrict, but this isn’t the case. If you have bulimia, you tend to eat enough food and food groups most of the time but have periods where you binge and then compensate for the binge through purging. If you’re also restricting, you actually have Anorexia Nervosa subtype 2, also known as Anorexia Binge/Purge.

Why Might You Restrict?

There are so many reasons why people restrict their food. Some reasons are emotional, some psychological and some physical. Common triggers include:

Reducing Anxiety: This is particularly common in Anorexia, Binge Eating Disorder (BED), Avoidant/Restrictive Food Intake Disorder (ARFID) and Orthorexia. There are loads of reasons why you might feel anxious eating food. One of the most common ones is a fear of weight gain, often seen in anorexia. Disgust at how we see our body is common in BED. Anxiety that food might make us ill or unhealthy is frequently seen in ARFID and Orthorexia. Another reason that’s commonly seen in ARFID is finding different textures, tastes or smells too unpleasant to cope with.
Perfectionism: Perfectionism is shared across all eating disorders, but particularly anorexia and orthorexia. It is linked with the fear of weight gain and incorporates beliefs that we need to eat the ‘right’ foods to make or keep our body looking how it “should” look in anorexia or functioning at its best in the case of orthorexia.
Body Dysmorphic Disorder (BDD), often known as Body Dysmorphia, is Common in anorexia, but it can be present in other eating disorders and on its own without an eating disorder. Body dysmorphia is where we see our body differently from how it is or focus on perceived flaws. You may truly believe that your body is larger than it actually is—the intense emotions around this lead to restriction to lose weight.
Emotional Coping: Sometimes restriction is a way to avoid anxiety about weight or fear of being ill. You may also use restriction to numb your emotions. We’ve seen this in clients who have experienced trauma or grief. The emotions are so overwhelming that they cannot cope. Restricting food reduces the brain’s ability to feel certain emotions, making life far more bearable.

The Physical and Mental Effects of Restriction

Restricting the food you eat can have many different effects on the body. Some come on quite quickly and are relatively harmless, although still very unpleasant. Others can have long-term implications for your health and potentially lead to death. Some of the effects that you might experience are:

Fatigue: If you restrict your intake enough for your body fat to drop below the level your body is happy with, your brain will start to reduce your metabolism. This will make you feel more lethargic and weak as your body tries to save as much energy as possible.
Dizziness: Another common symptom, this can be caused by low blood sugar or low blood pressure, particularly if you’re also restricting your fluid intake. Although common, dizziness can be really dangerous. We’ve known more than one client fall and hit their head on something.
Irritability and Anxiety: Your brain wants to keep you alive. Starvation is not very compatible with life – at some point, you will die if you don’t get enough nutrients. This can lead to irritability and anxiety as your brain triggers different defence mechanisms that are designed to encourage you to look for food and, once found, guard it for yourself.
Obsessive or Compulsive Thoughts: Linked to the increase in anxiety, your brain can become more rigid in its thinking. This is because thinking takes a lot of energy and your brain is trying to save energy. One of the easiest ways to do that is to rely on habits and routines.
Low Mood and Depression: Your mood is likely to drop considerably as you restrict. This is partly due to your brain not wanting to spend precious energy on emotions (sorry, but feeling happy isn’t necessary for survival) and partly as a response to increasing isolation and not having the energy to engage in activities you enjoy.
Social Withdrawal: Food is a key part of all cultures across the globe. Restricting what, when or how much we eat can lead to us avoiding socialising with family and friends.
Digestive Problems: Constipation, despite a lack of food, is incredibly common. Digesting food takes an awful lot of energy, so to preserve energy, your body slows down digestion, leading to constipation. This can be incredibly physically uncomfortable, reinforcing the desire to restrict. Typically, the digestive system will speed up and return to normal when you increase how much you’re eating. Sometimes, we need some help with prescribed laxatives or enemas.

In the long term, restriction can lead to:

Severe Nutritional Deficiencies: Damaging bones and organs can be very severe and dangerous and potentially lead to death. You might be diagnosed with osteopenia, where your bones start becoming weaker. This can then develop into osteoporosis, where your bones are considerably weaker than they should be, and you’re at a much higher risk of fractures. Severe nutritional deficiencies can also lead to organ damage and failure. We most often see this in the kidneys or liver first, often followed by the heart. If this is caught early enough, the damage may be reversible, but, unfortunately, there are times when the damage is not reversible and needs to be medically treated.
Hormonal Imbalances: The most common example of this is amenorrhea, which is where someone with female reproductive organs experiences their periods becoming irregular or stopping. This usually gets better when you increase your nutritional intake, but this isn’t guaranteed. It’s not unknown for people who have restricted their food to find it hard to conceive a baby or to enter an early menopause

Seeking Help and Recovery from Restriction

It can be challenging to reduce and stop restriction, as the psychological and emotional mechanisms that drive it can be powerful.

Not only that, but it can also be dangerous to increase how much food you’re eating too quickly. Refeeding syndrome can be triggered when our bodies aren’t able to adjust to the increase in the amount or variety of food quickly enough. This can lead to imbalances like low phosphorus, potassium, and magnesium levels. If not carefully managed with medical supervision, the imbalances can result in complications such as heart failure, seizures, and respiratory issues. We want to make it absolutely clear that refeeding syndrome is very rare. Still, it’s a potential and serious risk which underlies the importance of having professional support and medical monitoring when you start eating more.

Because of the physical, psychological, and emotional impact and risk of restriction, we always recommend talking to your GP and getting professional support to help with recovery. Clinics such as ours can support you through recovery while working with your GP or other doctors to keep you as physically healthy as possible.

Conclusion

Restriction can feel like a way to gain control, but its toll on the body and mind can be severe. Understanding the dangers and seeking help as quickly as possible through your GP and an eating disorder specialist clinic can help you break free from the cycle of restriction and move towards a healthier, more balanced life.

If you or someone you care about is struggling with restriction or other eating disorder behaviours, don’t hesitate to reach out to us. Support is available, and recovery is possible.