Eating Disorders

See also: Dealing with Concerns About Your Teenager

Eating disorders are mental health conditions. People with these conditions control their food intake in some way, usually to help them cope with other feelings, issues or situations. These disorders manifest as unhealthy eating behaviours such as eating too much or too little, or worrying about weight or body shape. It is possible to develop an eating disorder at any age. However, these disorders most often start during adolescence. Contrary to popular opinion, they also affect both men and women.

It is challenging to recognise an eating disorder, either in yourself or in a close friend or relative. However, once recognised, they can be treated, and most people recover. This page provides information and advice for people experiencing eating disorders and their friends and family.

Types of Eating Disorder

The three best known eating disorders are anorexia nervosa, bulimia (or bulimia nervosa) and binge eating disorder.

  • People with anorexia nervosa try to control their weight by eating too little, taking a lot of exercise, or both.

  • People with bulimia eat more than they want, and then take action such as making themselves sick, or taking laxatives, as a way to avoid putting on weight.

  • People with binge eating disorder eat large amounts of food until they feel uncomfortable.

Anyone with disordered eating but whose symptoms do not fit exactly with one of these three conditions is likely to be diagnosed as having another specified feeding or eating disorder’.

This is apparently the most common diagnosis when it comes to eating disorders. Examples of conditions that fall into this category include low-frequency bulimia (bulimia, but in episodes that happen less often than is ‘normal’), purging to control weight, but not as part of binge eating or bulimia, and night-eating syndrome (eating at night, either during wakeful periods or after the evening meal).

Eating disorders and body image issues

People with many eating disorders often also experience body image problems, especially body image disturbance. This is a psychological condition where your perception of your body is not consistent with reality. There is more about this in our page on Positive Body Image.

One other condition worth mentioning here is avoidant or restrictive food intake disorder (ARFID).

This is where people avoid particular foods, limit their intake of food or both. This condition is not usually about controlling weight or body shape, or about a problematic body image. Instead, it tends to arise because of negative feelings about the taste or texture of certain foods, or in response to a negative experience such as choking on a particular food. It may also happen because the person concerned simply does not feel particularly hungry. ARFID often starts earlier in childhood than many other eating disorders.

More than just picky eating!

ARFID is not just picky eating—a phase that many children go through at some point.

Children (and adults) with ARFID do not grow and develop normally, because they are not taking in enough calories to support their normal body function.

As a basic rule of thumb, you don’t need to worry about a picky eater provided they appear to be developing and growing normally. If that’s the case, keep your fingers crossed that this is a phase, and will pass—but keep watching to be sure it doesn’t get more extreme.

Causes of Eating Disorders

It is not really clear why people develop eating disorders. ARFID is often the easiest to link to a previous event or events. There are also some factors that make developing an eating disorder more likely, including:

  • Someone in your family has previously developed an eating disorder;

  • You have a history of depression or drug or alcohol misuse;

  • You have experienced negative comments being made about your eating habits, size, weight or shape;

  • You are worried that you need to stay slim, perhaps because you feel pressure to do so from your job or hobbies (for example, dancers often come under pressure to stay slim, and body shape is also important for athletes);

  • You have been sexually abused; or

  • You have one of a range of other mental health and well-being issues, such as anxiety, low self-esteem, an obsessive personality or perfectionism.

It’s not an absolute

Being affected by or having experienced one or more of these factors does not mean that you will develop an eating disorder. It just means that you are more likely to do so.

Signs and Symptoms of Eating Disorders

There are a number of signs or symptoms that may indicate that you have an eating disorder.

Many of these are what we might call ‘social’ signs. These include:

  • People around you are worried that you have an unhealthy relationship with food. This is not an absolute, but it is often a warning sign;

  • You spend a lot of time worrying about your weight and/or the shape of your body, or about your food intake;

  • You avoid socialising when food is involved. For example, you won’t go out with friends or family for a meal;

  • You eat very little food;

  • You use laxatives or make yourself sick after eating, especially if you think you have eaten ‘too much’;

  • You exercise a lot—some would say too much;

  • You have very strict habits or routines around food. For example, you will only eat at certain times, or restrict your intake of certain foods to particular days or times, and you will never break these rules.

You may also notice changes in your mood. Many people with eating disorders become more withdrawn, or feel anxious or depressed.

There are also some physical signs and symptoms of an eating disorder. These are associated with changes to your body caused by not eating enough, or not taking in enough nutrients. They include:

  • Feeling cold, tired or dizzy, all of which are signs that your body is not functioning normally;

  • Pain, tingling or numbness in your arms and legs, which are signs of poor circulation;

  • Feeling faint, or your heart beating much too fast;

  • Problems with your digestion, such as bloating or constipation;

  • Having a very low or high body weight for your age and height (and for more about this, you may like to check our page on Body Mass Index); and

  • Not having periods (if you are a girl).

Warning Signs for Other People

Signs that someone you know may have an eating disorder include behavioural and physical changes such as:

  • Losing a lot of weight;
  • Lying about weight loss or food intake (for example, “I ate at my friend’s house, you don’t need to feed me” when you know that their friend’s family is going out for a meal later);
  • Eating a surprising amount of food very quickly;
  • Going to the bathroom a lot after eating;
  • Exercising excessively;
  • Avoiding eating with other people;
  • Cutting food up into small pieces or eating very slowly; and
  • Wearing looser or baggier clothes so that you cannot see their body shape.

Treating Eating Disorders

If you think that you or someone you know may have an eating disorder, it is important to seek help (or encourage them to do so).

WARNING! Don’t delay seeking help!

Eating disorders, especially anorexia nervosa, are extremely serious conditions. Anorexia has a very high death rate compared with other mental health problems. There are two reasons for this:

  1. People with anorexia are effectively starving themselves. They therefore experience problems associated with starvation, including their bodily functions shutting down.
  2. People with anorexia are far more likely than most other people to consider suicide.

It is therefore very important to seek help if you are concerned about someone having an eating disorder—even if that feels like you are breaking their trust.

This will apply to both friends and relatives. Relatives and parents in particular may find it helpful to look at our page on Communicating with Teenagers, to help to establish a conversation.

The first person to contact should probably be your general practitioner, who can refer you on to specialist services. Unfortunately, there are often waiting lists for these services, which can lead to people ending up in crisis, and having to be hospitalised. However, once people start to get treatment, they often go on to make a good recovery—although it is important to be clear that they may always have a tendency towards developing eating problems.

Treatments vary with the precise eating disorder, but include regular physical health and weight checks, talking therapies, group therapy, individual therapy, and/or guided self-help programmes.Some medications may also be helpful, including anti-depressants, anti-anxiety medications and mood stabilisers.

A Final Thought

Eating disorders are challenging for both the individual concerned, and their family and friends.

They can affect relationships, and make it harder to communicate. They can also be extremely dangerous if untreated. However, with the right help, most people make a good recovery—and this is more likely if treatment starts earlier.