Eating disorders

Anorexia is a restrictive eating disorder in which a person’s mind does not allow them to eat freely and in accordance with their body’s needs. It is stereotypically depicted as a very thin, emaciated female refusing to eat, however this is an extreme and a sensationalised story. In most cases, anorexia does not look like this.

Some common characteristics of anorexia include:

• Intense fear of gaining weight
• Excessive and/ or compulsive exercise (including lower-level movement compulsions)
• Fear of ‘losing control’ around food
• Strong feelings of guilt or shame when eating or in relation to specific foods that society may deem to be ‘unhealthy’
• Inability to be spontaneous, especially when food is involved
• Hyperfocus on food
• Constant thoughts about eating – for instance a person might finish one eating occasion and be instantly thinking about the next. This is what is referred to as ‘mental hunger’
• Desire to feed other people but often with an inability to eat the same food themselves – for some this might look like a sudden interest in baking or cooking
• Constant exhaustion that cannot be resolved by sleeping
• Rapid or sudden changes in a person’s weight
• Laxative abuse
• Loss of menstrual period for some however others may never lose their period. This doesn’t determine severity in any way
• Hiding food or hoarding food
• Low bone density – after an extended period of restriction, loss of bine density can lead to osteoporosis or osteopenia

It is so important to note that food restriction does not always amount to weight loss.

A serious and life-threatening eating disorder characterised by events of binge-eating followed by attempts to reduce or avoid weight gain, referred to as ‘compensatory behaviours’

People with bulimia are typically considered to be in a ‘normal’ weight range – that is; their BMI falls within what is typically considered to be ‘healthy’.

Some examples of compensatory behaviours include:

• Excessive or compulsive exercise
• Using and misusing laxatives
• Vomiting after eating
• Restriction of food intake
• Misuse of water pills (diuretics)

It is important to note that the fact that a person’s weight is not considered to be concerningly low does not mean that they are not unwell or that they are not at risk of serious medical complications. When food intake is restricted, a person is at risk of experiencing the physical complications of malnutrition regardless of the size of their body. Especially if a person is engaging in purging behaviours or excessive exercise behaviours, the effects on the body can be even more significant.

Binge Eating Disorder, is a serious mental health condition where a person engages in recurrent periods of bingeing.

In a binge, a person consumes an amount of food that would typically be considered large in one sitting, usually over a very short period of time.

There is a difference between bingeing (loss of control and inhibition around food – eating to combat or soothe an emotion, fear, or even boredom) and overeating (eating past fullness, something that we might tend to do if we are enjoying ourselves at a celebration)

Orthorexia  is characterised by an obsessive preoccupation with ‘clean eating’ or following a ‘healthy’ diet.

Orthorexia often looks very similar to other eating disorders – especially anorexia nervosa – and often co-exists.

Note: Orthorexia is not yet classified as a formal eating disorder diagnosis.

Avoidant restrictive food intake disorder (ARFID) is often misunderstood as being ‘picky eating’, unfortunately it is far more complicated than this and it is by no means what is typical childhood ‘fussiness’.

People with ARFID have challenges relating to the taste, texture, smell, colour, and unfamiliarity of certain foods. They typically have an aversion to food, with no real interest in it or in eating, which can lead to nutritional intake, which is inadequate or heavily limited, thus resulting in similar physical complications as those seen in anorexia nervosa. For this reason, it can be incredibly difficult to differentiate.

Pica mainly affects people who are pregnant and children. It is a feeding disorder characterised by the persistent eating of non-food substances or objects that are not normally intended to be consumed – such as ashes, dirt, clay, or even flaking paint.  

The main medical risks posed by pica are dependent on the substance that the person is consuming – but may include lead poisoning, intestinal damage, damage to teeth, infections, bowel problems, stomach pain, and blood in the stool.

For children, it is normal and expected that they will put things in their mouths that are not intended for consumption. Perhaps they put objects in their mouth, bite their fingernails, or chew on hair and toys. However, pica is more a compulsive need to consume non-food items

It can be very difficult to detect – especially as many people will hide these behaviours – and often is not done so until medical complications arise.

Other Specified Feeding and Eating Disorder (OSFED) typically refer to eating disorders that display similar symptoms to other identified eating disorders that do not necessarily meet the conditions for diagnosis. It is used to denote that an eating disorder is present and that it is causing intense distress or challenges in a person’s life.

A feeding condition in which a person repeatedly regurgitates undigested food or partially digested food. They spit up food, and then either re-swallow it or spits it out. This regurgitation is a reflex – it is not intentional or purposeful.

It is important to note that a person with rumination disorder is not spitting up food because they feel nauseous or unwell.

Diabulimia is not recognised formally in the DSM-5.

It is a life-threatening condition where a person living with type-1 diabetes intentionally give themselves less insulin (or stop taking it altogether) with the intention of deliberate weight loss.

FACT – eating disorders can affect anyone, regardless of gender, ethnicity, sexual orientation, social class, religion… or any other demographic.

Fact – whilst anorexia has the highest mortality rate out of any psychiatric condition, all eating disorders can be incredibly life threatening, regardless of a person’s weight

Fact – you cannot tell is someone has anorexia merely by looking at them. The depiction of anorexia that is showcased in the media is only one of its many presentations, and is certainly not the most common.

Fact – in most cases, people with anorexia do eat. In a lot of cases, they might even eat more (by volume) than what people without eating disorders do, and in order to recover from a restrictive eating disorder like anorexia they most certainly need to eat more than people without an eating disorder. The amount of food a person does eat or doesn’t eat does not mean that they are ‘better’.

It is not uncommon for people with eating disorders to either mainly eat in front of an ‘audience’ or to mainly eat alone.

People with eating disorders are not immune to starvation, and even in the very rare case that a person is refusing oral intake entirely, they still require nutrition (which would most likely be given in a clinical setting through a nasogastric feed).

Fact – most people with eating disorders actually quite like food, in fact very often they are incredibly obsessed with it and centre it in any way possible. It is not uncommon for people with eating disorders to have a constant desire to feed others, to watch cooking shows, to look through cookbooks etc. It is – generally – not so much about not liking food as it is about not liking the way it makes them feel. Fear around food is typically because of the nutritional content and the ways this may change a person’s body or lead to a perceived lack of control as opposed to the actual act of eating.

The exception to this is Avoidant Restrictive Food Intake Disorder (ARFID), in which a person usually has very little interest in food and may fear eating not because of the nutritional content, but because of a fear of choking, vomiting, or being harmed.

Fact – eating disorders affect people of any and all genders and gender identities.

Fact – an eating disorder is not at all a choice. Eating disorders typically have an initial trigger of weight loss, which we know can happen for a number of reasons, after which genetics, environmental factors, personality type, stressors and an endless list of factors have far more of a role in its development and maintenance than choice ever had or will have.

For more myths and facts, see Eating Disorders: Myths and Facts written by Lived Experience advocate Rachael Burns.

Family based therapy is a common treatment used for young people with an eating disorder who still live at home with their family.

It is based on the fundamental premises that:

1. Nobody is to blame for the development of the eating disorder (unlike in family focused therapy )
2. It externalises the eating disorder as a separate being
3. The young person does not have to consent to treatment
4. Hospitalisation is a short-term solution
5. The cause of the illness does not matter.

Cognitive Behavioural Therapy (CBT) is a type of psychotherapy (talk therapy) that encourages people to change their thoughts, feelings and behaviours. CBT is typically conducted one-on-one and will involve talking to a psychologist. It is important to note that for adolescents, this process will involve the family.

Dialectical Behavioural therapy (also called DBT) is a type of psychotherapy that provides a structured approach to building practical life skills.

DBT is usually delivered through a combination of group work, individual work, and homework.

Radically Open Dialectical Behavioural Therapy (RO-DBT) is just that – ‘radical’. It is a stream of DBT specially tailored for individuals who experience intense over-control and who may be resistant to many more traditional treatments.

Responsive feeding therapy is considered an effective treatment for Avoidant Restrictive Food Intake Disorder (ARFID) amongst young children, in which carers create a pleasant and distraction-free space around meals. They model a healthy relationship with food and aim to create a safe environment around foods.

Acceptance and Commitment Therapy (ACT) is a type of therapy that uses proven methods to help people make changes to their behaviour. It combines acceptance and mindfulness, being aware of the present moment, with commitment and behaviour change techniques.

ACT for eating disorders focuses around helping people to accept and sit with uncomfortable feelings whilst committing to behaviours that are in line with their life goals and values.

Exposure and response prevention therapy allow a person to gradually face their fears in a safe and controlled environment, allowing them to rewire neural pathways associated with fear, danger and avoidance.

A key part of recovery from most eating disorders is nutritional restoration, and in all eating disorders it can be incredibly beneficial to work with a dietitian to create a customised meal plan in line with what a person needs to adequately nourish their body.