An Introduction to Eating Disorders

What are Eating Disorders?

Eating disorders are serious mental illnesses affecting people of all ages, genders, ethnicities and backgrounds. People with eating disorders use disordered eating behaviour as a way to cope with difficult situations or feelings. This behaviour can include restricting the amount of food eaten, eating very large quantities of food at once, purging food eaten through unhealthy means (e.g. making themselves sick, misusing laxatives, fasting, excessive exercise, or more recently, misusing weight loss injections), or a combination of these behaviours.

It’s important to remember that, very often, eating disorders are not all about food itself, but about feelings. The way the person treats food may make them feel more able to cope, or may make them feel in control, though they might not be aware of the purpose that this behaviour is serving. An eating disorder is never the fault of the person experiencing it, and anyone who has an eating disorder deserves fast, compassionate support to help them get better.

How Common are Eating Disorders and What Causes Them?

Anorexia nervosa: most common age is 15-25 years and the prevalence in that age group is 0.5-1%.

Eating disorders can affect anyone but they are more common in Caucasian women.

It is likely that the causation of eating disorders is complex with biological, social and psychological factors contributing. The biopsychosocial model studies various risk factors including:

biological -genetics, individual predispositions
psychological -personality traits such as perfectionism, cognitive rigidity (black and white thinking and thinking that rules are absolute)
social –from specific triggers like a traumatic event, to developmental exposure (especially as they usually occur in puberty), something psychologically challenging (for example friendship groups, rejection by friends or social media driving the focus on body shape and appearance and picking up unhealthy ideas)

There is also a link between Autism and Eating Disorders.

What types of Eating Disorder are there?

Anorexia Nervosa
Bulimia Nervosa (associated with binge eating and purging by vomiting)
Binge Eating Disorder
Avoidance/Restrictive Food Intake Disorder (ARFID)- this is particularly common among people with Autism where certain foods aren’t eaten due to their appearance, smell, texture or due to a fear of choking or vomiting rather than underlying body image disturbance.
Other Specified Food and Eating Disorders (OFSED) incl RED-S

Anorexia Nervosa in More Detail:

Characterised by extremely restricted eating, extreme thinness (emaciation), relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, and an intense fear of gaining weight.
They may develop rules around what they can or cannot eat and become very controlled about food preparation (what, where and who by).
These behaviours can be compounded by laxative misuse, manipulation of medication or excessive exercise.
Patients often don’t recognise how poorly they are and go to great lengths to reduce their intake, as well as hide their weight loss and thinness from friends and family (disguising or hiding food, being secretive, throwing food away, wearing baggy clothes)
Anorexia nervosa can have serious physical effects on the body such as causing periods to stop, reduced muscle mass, osteoporosis, gut issues and death.7

Weight and shape may be a big factor in someone with anorexia’s sense of self-worth. This can lead to them checking their body regularly and weighing themselves, or avoiding scales and mirrors. People with anorexia may have a distorted image of themselves, meaning that they see themselves as bigger than they really are. This is known as ‘body dysmorphia’. They may also experience a deep fear of gaining weight.

Binge Eating Disorder

Binge eating disorder has behaviours that become driven in ways that appear similar to an addiction. The sufferer will binge-eat vast quantities of food in one sitting, often several times a week and usually in secret. They hide the evidence and subsequently feel immense shame, regret, and low self esteem. It can be associated with other conditions such as anxiety and depression and have a profound impact on day to day life such as relationships, work, social events, exercise etc.

Recognise:

If someone is developing anorexia, often changes in behaviour are noticeable before changes to physical appearance. Signs include:

Saying they have eaten earlier or will eat later, or that they have eaten more than they have
Not being truthful about how much weight they have lost
Strict dieting and avoiding food they think is fattening
Counting the calories in food excessively
Eating only low-calorie food, or otherwise limiting the type of food they will eat
Missing meals (fasting)
Avoiding eating with other people
Hiding food
Cutting food into tiny pieces to make it less obvious they have eaten little or to make food easier to swallow
Eating very slowly
Taking appetite suppressants, such as slimming or diet pills
Obsessive and/or rigid behaviour, particularly around food
Irritability
Excessive exercising – this might involve exercising when not physically well enough to do so, or feeling guilty or anxious about not exercising
Vomiting or misusing laxatives (purging)
Social withdrawal and isolation
Wearing baggy clothing to hide their body, due to self-consciousness or to make weight loss less noticeable

You might notice changes behaviour as well before physical symptoms become obvious. Psychological signs include:

Fear of fatness or pursuit of thinness
Excessive focus on body weight
Distorted perception of body shape or weight – for example, thinking they are much larger than they are
Underestimating or denying the seriousness of the problem, or believing there isn’t a problem at all (this is common even after diagnosis)
Spending a lot or most of their time thinking about food
Anxiety, particularly about eating in front of other people
Low confidence and self-esteem
Difficulty concentrating
Perfectionism and setting very high standards for themselves
Other mental illnesses, such as depression, anxiety, or obsessive-compulsive disorder (OCD)

Eating Disorders, especially AN, affects all the body’s organs, including the brain and muscle tissue. Aside from weight loss, Physical signs include:

Irregular periods, or periods stopping altogether
Difficulty sleeping and tiredness
Feeling dizzy
Stomach pains
Constipation
Bloating
Feeling cold
Growth of soft, fine hair all over your body (called lanugo)
Hair loss

In addition, there is a social consequence- we use food and meals in society to drive us as families and friends together so you may notice people not wanting to socialise or eat out or in front of others.

Identify:

**There is strong evidence that the earlier help is sought, the better the prognosis.**

Where to go to for Help:

This can be tricky as people often don’t recognise that they have an eating disorder themselves and can often be ambivalent about seeking help.

See your GP. They can initiate physical and psychological support and signpost you/your loved one, to specialist services.

You will then have specific and strategic guidance and support from the specialist clinician once under their care such as: family support groups, dietician input, regular psychologist reviews which is family focused, CBT and physical health monitoring.

For Parents:

Family support and engagement is essential to aid and maintain recovery. Parents will be supported to try to take responsibility as early and effectively as possible without the child feeling like they’ve lost control. There might be shame and uncertainty around change which is why this support is crucial. Above all, try to stay calm and COMMUNICATE to help the family member/child feel in control. If you do things behind the family member’s back, you may lose their trust, which is paramount.

BEAT: this fantastic charity is an amazing resource for information and support:

The UK's Eating Disorder Charity - Beat

beateatingdisorders.org.uk

Dr Annabel Bucher is a GP with an extended role in Eating Disorders. She has worked in General Practice in the NHS for nearly 20 years, caring for patients in her local community of North Essex. In recent years, Dr Bucher has developed a special interest area of eating disorders where she helps treat the medical impact of these disorders upon her patients.

Children’s Mental Health
Parenting