The term “eating disorders” refers to a range of mental health conditions where disordered eating patterns cause a range of psychological and physical symptoms.
Eating disorders occur for many reasons and are greatly influenced by beliefs around self image, and misdirected attempts to use diet to moderate distress.
Eating disorders affect about 4-16% of the population over 15 years of age, and all individuals with disordered eating patterns are at risk and should be offered treatment. In Australia 1.2 million are living with an eating disorder: 83,000 have anorexia; 120,000 have bulimia; 1 million have a binge eating disorder.
Eating disorders have one of the highest mortality rates of any mental illness. Males do experience eating disorders as well, but often have a different experience and may focus instead on performance issues around exercise, and often they do not present for treatment for many years.
Types of Eating Disorders
There are several categories of eating disorders in our current DSM-5:
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder
- Other Specified Feeding and Eating Disorder
- Unspecified Feeding or Eating Disorder
- Avoidant/Restrictive Food Intake Disorder
- Rumination Disorder
Most people (55%+) who experience an eating disorder will also have other mental health conditions such as depression, anxiety, trauma, personality vulnerabilities, body dysmorphia and some may misuse substances.
Research has found no specific causes for eating disorders, but instead there is an array of environmental factors that cause an individual to feel distressed. The eating disorder develops in response to managing distress through a focus and obsession around food, and behavioural changes in the way those with an eating disorder eat or manage food, and how they think about food.
Those with eating disorders will require a treating team that also helps to rule out other common misdiagnoses such as IBS, food intolerances, abdominal pain, hormonal disorders, candidiasis, allergies and chronic fatigue.
There are a number of risk factors that may lead to a person becoming vulnerable to eating disorders. These include:
- a family history of eating disorders or psychiatric illness;
- family dieting;
- family ideals around appearance;
- low self-esteem, perfectionist personality, obsessive tendencies;
- traumatic childhood experiences;
- severe guilt or shame, inability to tolerate emotions;
- low social confidence;
- poor body image;
- major life events;
- peer pressure;
- and career choices where eating or body image is core to success and media influences.
As you can see there are so many factors that can create an environment for an eating disorder to develop, and usually those with eating disorders will have many factors that influenced the condition starting.
What can Protect/Help Those with Eating Disorders to Recover?
There are also many factors that help.
Having the ability to communicate assertively, positive self-esteem, feeling supported in peer and family relationships, self-direction, self-awareness, motivation to change, cognitive flexibility, the desire for independence and hope for the future are all helpful factors that can positively influence recovery.
When does Dieting become an Eating Disorder?
Eating disorders should be considered when an eating behaviour becomes clinically significant, interfering with the individual’s ability to function normally in work, social or psychological wellbeing. It is also important to consider the cultural or social or lifespan stages with regards to what is “normal”.
About 75% of teenagers are unhappy with their appearance and 50% are dieting. Dieting is the single biggest factor that can lead to an eating disorder.
Dieting behaviours can often lead to fasting, use of diet pills, laxatives, crash diets, over-exercising and less commonly, vomiting. It is the repetitive engagement of these behaviours that leads to disordered eating. Take note that it is fasting for “weight loss” that is the issue, which is different to cultural or faith-based fasting where groups engage in reduced eating together.
Family may be concerned about their child or teenager having an eating disorder, but it can be difficult as young people may hide the behaviours, and sometimes it may only be when they look thin, pale or have a low energy that others can identify that something might not be right.
What are the Recommendations for Treatment?
Early intervention, assessment and treatment should be offered at the earliest opportunity. Ideally the sooner treatment commences the better the prognosis.
Severe weight loss makes engagement with therapy and treatment difficult and will often cause a referral for a hospital admission. Treatment will involve a team including the GP (primary coordinator of all health services), Dietitian (educate and plan food intake), Psychiatrist (Diagnosis, Therapy and Medication management especially for complex histories), Mental Health Clinician (delivery of therapy such as IPT, CBT or DBT for the conditions referred).
Ideally it is helpful for those with weight disturbances, fear of gaining weight, dieting or eating abnormalities to self-refer to review what is healthy or not, and even if a label or disorder is not diagnosed the likelihood of preventing an eating disorder is higher if someone intervenes early.
The Importance of Early Intervention
Often those with eating disorders will present to healthcare professionals with an array of other complaints that are not easily identified as disordered eating patterns. Remember, early intervention can prevent an eating disorder.
Common ways of describing symptoms of an eating disorder include:
- Gastrointestinal problems such as diarrhoea, nausea or constipation;
- Hormonal issues such as cessation of menstruation or fertility issues, irregular periods;
- Exercising despite having a sports injury;
- Feeling run down all the time;
- Feeling cold due to low blood pressure and may even have irregular pulse;
- Food allergies or restrictive diet due to self-diagnosed food sensitivities;
- Poor recovery from usual health conditions such as viruses, injuries;
- Distorted self image;
- History of a mental condition that requires restricting food;
- Secret management of food in the way that food is hidden, avoided, or social eating avoided to avoid detection.
Eating Disorders in Children
In younger children the usual key symptom is marked malnutrition or starvation, which is different to adults. Children may have body image issues or may have different symptoms from adults, and rather than having a focus on food they may avoid foods or become so fussy that a normal diet cannot be maintained.
- Encourage healthy eating and healthy physical activity;
- Positive body image;
- Enjoy family meals;
- Families to talk less about weight;
- Don’t assume overweight teens have experienced weight mistreatment.
What about Obesity?
Making long term changes in health eating behaviours is very important. Making people feel ashamed, or anything that decreases self-esteem around body image can predispose individuals to seeking maladaptive eating behaviours to manage weight.
If you or a loved one are concerned about disordered eating, please book me in for an appointment or a free emotional health checkup.
Author: Vivian Jarrett, MAAPI, MAPS, MAICD, B Psych (Hons), GCert (ResCom).
Vivian Jarrett is no longer taking bookings.
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