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Eating disorders

Overview

An eating disorder is a mental health condition where a person has developed an unhealthy preoccupation with food or their body weight or shape. This preoccupation is causing them to go to extremes with their eating behaviours, at times to the point of starvation and overexercising to lose weight or prevent weight gain. If left untreated, the eating disorder will harm their mental, emotional and physical well-being. It can also put them at risk of death.

Keep in mind, though, that only a medical professional can diagnose an eating disorder and not everyone who’s unhappy with their body appearance will develop an eating disorder.

In Australia alone, there are approximately 4 in every 100 people with eating disorders at any given time. That’s about 1 million people.

Here’s a quick break down by type:

  • 3% have anorexia nervosa
  • 12% have bulimia nervosa
  • 47% have binge eating disorder
  • 38% have other eating disorders

Plus, 63% are female and 37% male, with females more likely to experience all types of eating disorders than males, with the exception of binge eating disorder where the prevalence is almost equal. It’s suspected the actual number of males with eating disorders may be much higher as males are more likely to be overlooked or misdiagnosed.

Research suggests transgender people are more likely than cisgender people to be diagnosed with an eating disorder or to engage in disordered eating.

Overall, it’s estimated that 9% of the Australian population will experience disordered eating during their lifetime.

Eating disorders are treatable, so the best step is to talk to a GP or a mental health professional who will help determine whether the person has an eating disorder.

What’s it like having an eating disorder?

While it’s natural for all of us to worry a little about our body appearance and eating habits, a person with an eating disorder might judge their self-worth largely on their body appearance, shape and weight. They usually feel ashamed and guilty about this preoccupation, but they’re doing it because they feel and see themselves as overweight and physically unattractive.

Once they’ve developed this mental health condition, it can be very hard for them to recover without professional support. They often try their hardest to stop on their own, refuse to talk about what’s happening out of fear their family and friends will judge them, and often don’t seek help because they don’t know how to find people who will genuinely understand and support them without judgement. It can be a huge battle for them.

While in some people the disorder doesn’t last long, it can become a long-term problem in others and cause them to experience other mental, emotional and physical health issues that put them at risk of death. It usually affects their relationships and everything they do in life. So the sooner they seek help, the sooner they can recover.

The three most common eating disorders

The three most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. They can occur at any age, race, gender, sexual orientation and social status. Looking in, it can be hard to tell whether someone has an eating disorder because their weight and appearance might fluctuate close to ‘normal’ or ‘average’.

Anorexia nervosa

A person with anorexia nervosa is obsessed with being thin. They use their body shape and weight as their main criteria for self-worth. They refuse to eat because they think they’re ‘fat’, even when they’re already at a healthy weight.

Something has caused them to develop an intense fear of gaining or regaining weight, and they’re using extreme compensatory behaviours to lose weight and control their body weight. These behaviours typically include fasting, dieting, vomiting, using diet pills, taking laxatives, exercising excessively, and constantly worrying about calories, fats and carbs.

Bulimia nervosa

A person with bulimia nervosa goes through periods where they don’t eat, followed by binge eating (eating an unusual amount of food), followed by compensating behaviours such as purging or exercising. They fast, binge eat, purge, fast, binge eat, purge.

The binge eating happens because they feel unable to stop eating. They purge by throwing up or by misusing laxatives, and it’s also common for them to exercise excessively to avoid gaining weight. They might also use water pills, laxatives and diet pills to control their weight.

Binge eating disorder

A person with binge eating disorder eats past the point of feeling full (often painfully full). This might sound like overeating, but it’s not the same thing. Overeating is eating more than your body needs (e.g., miscalculating your portions). Binge eating disorder typically occurs in response to psychological distress, and the person might feel temporarily comforted by the food. They too feel unable to stop eating once full. They’re binging at least once a week, even when not hungry, and have been doing it for three months or more.

Unlike people with bulimia nervosa, those with binge eating disorder don’t use compensatory behaviours such as purging and exercising, which is why many tend to be overweight or obese. Still, they often feel guilty, upset, disgusted or ashamed for having binged. Hence, they might mask their symptoms.

Signs and symptoms

The following are just some of the signs and symptoms that suggest a person might have an eating disorder and should seek help.

Common symptoms of anorexia nervosa

  • Denies feeling hungry
  • Displaying an intense obsession with food
  • Saying they feel unworthy or hopeless
  • Drastically losing weight
  • Not naturally gaining weight if they’re a child/teenager
  • Experiencing abdominal pain
  • Feeling dizzy, faint or always feeling cold
  • Focused on trying to achieve the perfect body
  • Wearing baggy clothes that disguise their body shape
  • Wearing thick layers even on hot days
  • Makes excuses to avoid meals

Common symptoms of bulimia nervosa

  • Frequently fasting
  • Extremely concerned about their body weight or shape
  • Drastically losing or gaining weight
  • Discoloured teeth caused by vomiting
  • Swollen cheeks or jaws
  • Taking frequent trips to the bathroom after eating
  • Calluses on their knuckles from self-induce vomiting
  • Feeling bloated or dehydrated
  • Feeling guilty and anxious about eating

Common symptoms of binge eating

  • Drastically losing weight
  • Wearing baggy clothes that disguise their body shape
  • Wearing thick layers even on hot days
  • Evidence of eating in hiding
  • Evidence of hoarding food (e.g., in their bedroom)
  • Feeling guilty and anxious about eating

Causes of eating disorders

An eating disorder often develops as a way to cope with psychological and emotional distress. The factors that contribute to the eating disorder vary from person to person and are typically biopsychosocial, meaning a mix of biological (genetic and biochemical), psychological (personality and mental health), familial (such as modelling eating behaviours) and social (including cultural norms about food and appearance) factors in a person’s life. The causes are therefore different for each person.

The following are just some of the factors that may increase a person’s risk of developing an eating disorder:

  • They have low self-esteem and don’t feel worthy
  • They’re suffering from depression
  • They’re always over-valuating their appearance
  • They have difficulties with distress tolerance and emotional regulation
  • They’re always told to hide their emotions
  • They’re excessively concerned with what other people think
  • Their family members have eating disorders or other mental illnesses
  • There’s a maladaptive family attitude to food and body weight
  • They’ve experienced physical, psychological or sexual abuse
  • They’ve been neglected and must self-parent
  • Their parents are overweight or have larger bodies
  • They’re always being judged on their eating, body weight or body shape
  • Their partner or closest friends are engaging in chronic dieting
  • They must stay slim for work or recreation purposes (e.g., modeling, ballet, influencer)

How are eating disorders diagnosed?

Self-diagnosis

People with eating disorders often turn to Google and social media Internet for guidance and support. They also often use online questionnaires and quizzes to self-screen or self-test. These tests can include diagnostic questions similar to those a qualified mental health professional would ask during a consultation.

But even if the person recognises that they might have an eating disorder, they will most likely need an assessment and treatment from a mental health professional. That’s because the self-testing tool and advice will never be as accurate as a 1-on-1 assessment with mental health professional and the treatments that would be tailored for them to address their existing health issues and prevent even worse conditions. The healing process can only begin with the most appropriate professional treatments. It’s always advisable that a person who suspects that they have an eating disorder seeks a professional assessment from a GP or mental health professional.

Professional diagnosis

Medical professionals use strict criteria to diagnose eating disorders. Just because a person is showing the signs and symptoms of eating disorders doesn’t necessarily mean they have an eating disorder.

The diagnosis for eating disorders usually starts with a GP. The GP will examine the person and talk to them to get an understanding of their mental, emotional and physical health, what they may be going through, and to identify any warning signs and symptoms.

The GP will do this through the following steps:

  • Doing a full physical examination of the person, including their teeth for signs of decay
  • Asking questions to evaluate the person’s health, including their medical history, emotional health, mental health, physical health and their wellbeing
  • Asking questions about the person’s attitude towards food
  • Asking about their eating habits and their lifestyle
  • Ordering blood tests because eating disorders can damage the body and vital organs
  • Order x-rays and other scans if they suspect damages to the person’s bones and other organs

The GP might then refer the person to a mental health professional for a psychological evaluation and diagnosis. Both the GP and mental health professional might ask the person to complete a questionnaire or self-assessment.

How are eating disorders treated?

While there’s no known definitive way to prevent eating disorders, there are ways to treat them. There’s also no one-size-fits-all treatment since everyone is different. The best thing would be for the person to work with a combination of health professionals, including a GP, psychologist and dietitian, and perhaps joining a therapy group for people going through similar journeys.

With the right support, people with eating disorders can and do recover.

Common treatments for eating disorders include:

If a person is malnourished or very thin or underweight, and experiencing issues such as dizziness and fainting, they may be admitted to hospital for immediate care and treatment. This is usually through the general hospital.

More on hospital admission

The person can talk to a mental health professional such as a psychologist, psychiatrist or other mental health therapist or counsellor. One of the methods the professional might use is called cognitive behavioural therapy (CBT). This method is the leading evidence-based treatment for eating disorders because it helps the person identify and change their thoughts, attitudes, feelings and behaviours associated with their eating disorder. The person might do weekly weighing and keeping a diary of their regular eating, as such laying a new foundation for other changes.

Find professional support

Through health professionals and other sources, a person diagnosed with an eating disorder can develop new healthy habits and learn to self-love. Education is essential to change thoughts, attitudes, feelings and behaviours associated with eating. It should cover nutrition and following a regular healthy eating habit and ways to avoid binging, fasting, dieting, purging and overexercising. It should also help address related issues such as low self-esteem and the preoccupation with their appearance.

Find more resources

Not to be confused with family therapy where the family is ‘blamed’ for the person’s eating disorder. Family-based treatment is where the trained professional leverages the person’s relationship with their family to help them recover from their disorder. This approach is especially common when the person with the eating disorder is a child, adolescent or a young adult living at home. As the parents love them, they’re onboard to support them on their recovery journey. So they become part of their support team.

There’s no specific medication for treating eating disorders. However, a health professional may prescribe medicines to treat symptoms related to the eating disorder. This is done in conjunction with other treatment approaches. For example, it’s common for a person with an eating disorder to suffer from depression and anxiety. Their GP might prescribe antidepressants to help reduce their symptoms while they also see a dietitian to learn how to maintain a regular eating habit.

How to choose a GP

Stepped care is an evidence-based, stepped approach to offering services and supports to someone with a mental health condition. It recognises that when someone is on their recovery journey, they would need access to different types and levels of interventions—from the least to the most intensive—to match their current needs. In this care, this will ensure the person with the eating disorder gets the most appropriate services for their mental health needs at any given time.

Find professional support

While an eating disorder isn’t a lifestyle choice, a person with an eating disorder might benefit from a lifestyle change that supports their recovery journey. This change could be incorporating activities that are not food related (such as yoga, meditation, art therapy and taking up sports) to help them start to feel better and happier. Focusing on food without professional guidance from a mental health professional or dietitian might not be a good idea, so we recommend seeking help to work on a trackable meal plan.

Find a dietitian(Opens in a new tab)

Help & Support

The best way to help anyone with a suspected mental health condition is to support them. Love them, listen to them, be genuinely interested in what they have to say, keep an open mind to get a full understanding of what they’re going through, and, most importantly, acknowledge it and believe them when they say they’re struggling and that they’ve tried to overcome their eating disorder.

It can be extremely hard for the person to talk about their eating disorder and why they do what they do. They’re probably worried that they’d be judged, making it harder for them to open up. So offer them a safe space to talk about it.

Sometimes a person won’t even know they have an eating disorder. It might be confusing for them and those trying to help. Either way, remember we’re not expected to have all the strategies and solutions for them. That’s the role of mental health professionals.

Perhaps suggest the person books an appointment with a GP. Saying something like this could help:

“How about we go see a GP just to make sure you’re OK? Because I’m worried about you. I can come with you and stay outside while you talk to the GP. You don’t need to tell me anything you’ve discussed… unless you want to.”

Because maybe they feel more comfortable talking to someone they don’t know. And that’s OK too. Just be there when they’re ready to talk.

Next Steps

A GP, clinical psychologist or a dietitian is the best place to start the discussion about eating disorders. They have the training and experience to help someone who is struggling. They can also refer them to the appropriate services and therapies to get them on the right track with their eating.

Find a GP or other health professinal

Websites

Butterfly - Support for eating disorders
Butterfly Foundation
Offers support for eating disorders and body image issues. Options include calling their National Helpline on 1800 33 4673, chatting online, joining a support group, or reaching out via email Visit site(Opens in a new tab)
Find professional help for eating disorders
Butterfly Foundation: Find a Professional
The directory lists a range of practitioners and services that can be helpful, although a GP is also a good place to start if you’re unsure. Visit site(Opens in a new tab)
Eating Disorders Families Australia
Eating Disorders Families Australia
Offers support, mentoring, advice and community to help people with eating disorders on their recovery journey Visit site(Opens in a new tab)
Inside Out Eating Disorders
Inside Out Institute for Eating Disorders
Australia’s national eating disorder research and clinical excellence institute. Visit site(Opens in a new tab)
Eating Disorders Victoria
Eating Disorders Victoria
Offers guidance and support to help Victorians understand and recover from eating disorders. At every stage, from discovery to recovery. Visit site(Opens in a new tab)
National Eating Disorders Collaboration
National Eating Disorders Collaboration
A one-stop portal designed to make eating disorder information more accessible for everyone. This website is an initiative of the federal Department of Health and Ageing. The resources are designed through a collab of people and organisations who have an expertise or interest in eating disorders. Visit site(Opens in a new tab)
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