The NHS definition of addiction is: ‘Not having control over doing, taking or using something…
I happened to write this article on mental health day, and I wondered how many of us even thought about eating disorders despite it having the second highest mortality rate of all psychiatric disorders. 1 10,200 deaths each year are the direct result of an eating disorder—that’s one death every 52 minutes (ANAD, 2021).
I am yet to find someone who is completely satisfied with their body…Today’s society is so focussed on looks and appearance; there are social pressures of thinness, diet culture, beauty standards … these are a daily struggle for most people who would go at lengths to change how they look in order to conform with these standards despite putting their health at risk. These social pressures can have an impact on someone who may have been predisposed to developing an eating disorder.
What are eating Disorders?
They are life-threatening problems that can affect anyone irrespective of their socio-economic status, gender, race and background. Eating disorders most often start in adolescence and young adulthood, although there are cases that occur in childhood or later adulthood. In the midst of Covid-19 the number of people experiencing them increased rapidly in the UK with hospitalisation almost doubling. It is believed that 1.25 million people in the UK suffer from eating disorders and around 25% of those affected are male (BEAT, 2021).
Eating disorders are illnesses that are characterised by severe disturbance in eating behaviours, thoughts and emotions. People with these issues are preoccupied with food, weight, and shape and this causes them significant distress. There are different types of eating disorders, they include Anorexia, Bulimia, Binge Eating Disorder and OSFED, previously EDNOS, ARFID, Pica, and Rumination Disorder. Eating disorders often occur with other mental disorders such as anxiety, depression, OCD, substance abuse, Autism and Borderline Personality Disorder/EUPD.
How can you tell if someone has an eating disorder?
You cannot tell if someone has an eating disorder by just how they look. Eating disorders are complex and can present in different ways. Some people with eating disorders restrict their eating and follow a strict diet, others overeat and try to control weight gain through purging by vomiting, over-exercising, fasting or using laxatives or diet pills. Some people use some of these methods to cope with emotions or to stay in control of their lives.
Causes of Eating Disorders
As in many illnesses, there are no clear-cut causes of eating disorders. There could be genetic or biological causes, and/or psychological and emotional factors. There are also risk factors like family history, other mental health problems, dieting and stress.
- Life transitions and/or trauma
They can range from life transitions that cause anxiety to stressful/traumatic events.For instance, for young people transitioning to a secondary school, going to university, or starting a new job, can be experienced as extremely overwhelming and may lead to uncontrollable anxiety. Other distressing events like loss of a loved one, sexual assault, domestic violence, conflictual relationships can lead to extremely negative emotions. In such cases an individual may feel loss of control and may use food restriction or managing their weight to have some form of control. They feel like this is the only aspect of their life that they can have control over.
- Personality traits
There are other personality or temperamental factors that may be associated with eating disorders. These include perfectionism, poor body image, low self-esteem, negative view of self and feelings of inadequacy. Individuals may use food to manage how they feel about themselves either by under eating or overeating or using other compensatory measures like over exercising and vomiting.
- Careers and hobbies
There are other careers and sporting activities such as dance, athletics, horse riding, modelling, wrestling, for instance that may require a certain look which are known to have predisposed some individuals who may have been vulnerable to developing eating disorders.
How to manage eating disorders
Eating disorders are complex and may require joint working of professionals. People with eating disorders often delay in getting help, however research has shown that early intervention is essential before the disordered patterns of eating becomeentrenched. Treatment includes psychotherapy and nutritional support. In some cases, medication to alleviate anxiety, depression and other related disorders maybe needed. Other forms of therapy like yoga, meditation have been found to help with relaxation and stress management.
How different eating disorders may present
- Anorexia Nervosa: characterized by self-starvation and weight loss resulting in low weight for height and age. There is intense fear of weight gain or becoming fat although underweight and a distorted perception or disturbed view of how one looks. Some people with anorexia may bingeintermittently and purge and others restrict and exercise excessively.
- Bulimia Nervosa: people with bulimia tend to alternate restricting their food and bingeing on ‘forbidden’ foods. Bingeing entails eating a large amount of food rapidly in a short space of time accompanied by a feeling of loss of control. After a binge there are feelings of guilt and regret which triggers ‘compensatory’ behaviours such as vomiting, over-exercising, taking laxatives or diet pills.
- Binge Eating Disorder: like bulimia, those who struggle with this disorder binge on large quantities of food, but they do not compensate.
- Otherwise Specified Feeding and Eating Disorder (OSFED, previously EDNOS) These are characterised by eating difficulties that do not meet the full criteria of the disorders listed above. The reason may experience a few of the symptoms of some or all disorders.
- Avoidant/Restrictive Food Intake Disorder (ARFID): commonly called picky eating, it involves a disturbance in eating that leads to persistent failure to meet nutritional needs. Unlike anorexia, arfid does not have excessive concerns about weight or shape.
- Pica: Pica is an eating disorder in which a person repeatedly eats things that are not food and with no nutritional value like charcoal, chalk, soap. There is no food aversion in this condition.
- Rumination Disorder: condition in which a person keeps bringing up food from the stomach into the mouth (regurgitation) and rechewing the food or spitting it out.
What to do to support someone who has an eating disorder
Don’t blame yourself or them
Ask them what support they would like
Learn a bit more about eating disorders so you can offer better support
Avoid talking about dieting and weight, be mindful of your own relationship with food.
Where to seek help for eating disorders
Article written by: Ellen Mothoa, Clinical Psychologist at Bramham Therapy Newbury (specialising in eating disorders)