What are eating disorders?
Eating disorders are often described as an outward expression of internal emotional pain and confusion. Obsessive thoughts about, and the behaviour associated with, food are maladaptive means of dealing with emotional distress which cannot be expressed in any other satisfactory way. The emotional distress is often to do with a negative perception of self, a feeling of being unable to change "bad" things about oneself: food is used as an inappropriate way of taking control.
Perhaps due to cultural ideas of what constitutes perfection, people often feel a strong desire to be thinner than their bodies naturally tend to be - "when I am thin everything will be alright". They confuse who they are with what they look like. As a result they change their eating patterns and may as a consequence be at risk of developing an eating disorder.
An eating disorder involves a distorted pattern of thinking about food and size/weight: there is a preoccupation and obsession with food, as well as an issue of control or lack of control around food and its consumption.
There are several recognised eating disorders which can be described as follows:
Anorexia
Anorexic people starve themselves with the aim of losing weight to a point which others would consider to be very thin (although the sufferer is unlikely to perceive themselves as such). The longer the condition continues, the more difficult it can be to tackle, and in severe cases can necessitate hospitalisation and can even prove fatal. Sufferers are typically in their teens or twenties and most are women, although around 10% are male. The following are symptoms:
• Distorted perceptions of one's weight, size and shape
• Behaviour which results in a marked weight loss
• A morbid fear of gaining weight or becoming fat
• Excessive exercising (while starving)
• Cessation of periods in women.
Bulimia
Bulimic people may well maintain their normal weight. The condition is characterised by:
• Bouts of eating followed by purging
• Distorted perception of own weight, size and shape
• A powerful urge to overeat, leading to binge eating and a resultant feeling of being out of control
• Compensatory behaviour such as self-induced vomiting; misuse of laxatives, diuretics or other medication; fasting; or excessive exercise
• A morbid fear of gaining weight or becoming fat.
Compulsive eating
• Recurrent episodes of binge eating and consequent feeling of being out of control
• Marked distress about binge eating and the attempts to control it
• During a binge may: eat more quickly than normal; eat until uncomfortably over-full; eat large amounts when not hungry; tend to "graze" rather than eat meals; eat alone in secret; feel disgusted and guilty with oneself.
Food deprivation
• Weight-loss accomplished primarily through extreme dieting, fasting or excessive exercise
Non-specified
Other, but related difficulties with food include:
• Anorexic behaviour though still menstruating
• Anorexic behaviour where, despite significant weight loss, current weight is still normal
• Someone of normal weight inducing vomiting or purging after small amounts of food
• Chewing and spitting food rather than swallowing
What characterises eating disorders?
Apart from the characteristics described above, there are other fairly common features which are often present. Some are more likely to be recognised by friends rather than the person with the problem.
• Preoccupation with thoughts of food so that diet and food become the central focus of one's life
• A reliance on behaviour associated with food to deal with difficult emotions, stresses and tasks
• A desire for control over at least one aspect of one's life
• Perfectionism
• Low self-esteem from failing to meet expectations, which is then reinforced by the behaviour associated with the eating disorder, resulting in more self-disgust, shame and guilt, leading to lowered self-esteem
• Distorted thinking – “when I am thin I will be able to cope with anything”
• Secondary disorders caused by the behaviour such as dental and digestive system damage, depression
• More women than men are affected
• Sometimes, difficulty in adapting to being adult and to being sexual.
How to help yourself
The earlier help is sought the easier it is likely to be to change, but people do get over even very serious difficulties in time. The suggestions below may sound rather simplistic - in practice it usually helps considerably to talk about these with someone who is trained - and it may take some persistence!
• Acknowledge that the problem exists!
• Rather than just trying to tackle the unhelpful behaviours connected with food, try to identify what the eating disorder is disguising or helping you avoid - for example, are there difficulties in relationships, or within the family, or events in your past that have hurt you and changed how you feel about yourself?
• Challenge the distorted thinking! Although you may still think of yourself as overweight, at least allow yourself to recognise that others may see you quite differently, or even that they may be disinterested in your weight and just see you for who you are.
• Develop a pattern of eating that suits you and keeps you healthy. This isn't the same as saying develop a rigid routine of eating that cannot be varied! Maintaining a generally balanced diet is important, but allowing yourself to party (and break the rules') is also OK sometimes!
• Accept your body, i.e. respect your body regardless of it's current shape or size; set realistic expectations for changing it; recognise and understand its strengths and limitations. Recognise, too, that your body is not the same as your identity - confidence and personal contentment can be present however you look!
• Don't keep it a secret any longer - and it is unfair to expect a friend to keep secrets for you! Rather, seek support in dealing with the disorder from a professional helper or a self-help group.
Causes
All eating disorders are influenced by body image. Dissatisfaction with the body as a whole, or particular parts can lead to an eating disorder. It can also maintain the disorder as the person attempts to reach the desired body shape and size, which is frequently unattainable. Sufferers usually display signs of denial consciously or unconsciously refusing to admit there is a problem. Denial is a powerful obstacle to treatment and will discourage the sufferer from looking for help.
There is no specific reason for the development of an eating disorder. Different eating disorders are due to a variety of factors:
• Anorexia and bulimia: evidence of reduced serotonin activity in the brain
• Anorexia: genetic vulnerability, family history of an eating disorder or obsessive compulsive disorder (OCD)
• Bulimia can be triggered by food restriction in childhood
• Binge eating disorder and bulimia can be triggered by ‘normal’ dieting.
Characteristics of both substance abuse and eating disorders:
• They are chronic diseases
• They are characterised by denial, secretiveness, rituals and obsessive/compulsive behaviour, pre-occupation with a substance (e.g. drugs, food)
• They may be life-threatening
• Sufferers may move from one disorder to another.
Physical risks
• Anorexia: Low body weight and in extreme cases emaciation, low vitamin and mineral levels leading to electrolyte imbalance which in turn leads to muscle cramps, slow brain function and heart problems; osteoporosis, anemia, loss of hair, developing a covering of fine body hair, gastric problems, faintness, constipation, oedema (fluid retention), vulnerability to cold and infection, in females menstruation (periods) stops and the sufferer risks fertility loss.
• Bulimia nervosa: Fertility problems, gastro-intestinal disorders, tooth decay, esophagitis, fatigue, salivary gland enlargement, brittle nails and dry hair, dizziness/fainting, muscle cramps and weakness, electrolyte imbalance. Some sufferers of bulimia nervosa shop-lift, self-harm and suffer from kleptomania.
• Binge eating: Reduced sense of feeling full which leads to further eating, obesity and cardiovascular problems.
Eating disorders and addiction
Research indicates that addiction to drugs or alcohol and eating disorders often co-exist. A study in the US found that 30 – 50% of individuals with bulimia and 12 – 18% of those with anorexia are dependent on alcohol or illegal drugs, compared to nine percent of the general population. It also found that 35% of alcohol and drug users have eating disorders, compared to three percent of the general population.
Eating disorders and substance abuse are both long-term illnesses which require intensive therapy to treat. Both involve an obsessive craving and a preoccupation with a substance (food or drugs), both have mood-altering effects, both are compulsive, often secretive and the sufferer will be in denial that there is a problem and continue with the compulsive behaviour despite the negative consequences on their health and in their lives.
It is important that where there is a co-existing eating disorder in a person who is chemically dependent that the sufferer is treated within a personalised programme of individual therapy, group therapy and family therapy for both conditions. If not there is an increased risk of relapse after treatment.
