Eating disorders: not just a food issue
It is estimated that approximately 68,000 New Zealanders will develop an eating disorder sometime in their life time. The Eating Disorder Foundation of Australia believes up to 5% of all Australians have an eating disorder.
Eating disorders are most commonly experienced by females (90%) with the average age of onset being 17 years, although the age of people getting anorexia is falling with cases being diagnosed in girls as young as 8 – 10 years. Bulimia usually affects women in their late teens and 20’s.
Approximately 60% fully recover, 20% will partially recover and 20% will never recover. Typically, recovery from bulimia is faster and has higher success rates than people with anorexia. Amongst 15-24yr old females, anorexia and bulimia are the third most common chronic illnesses after asthma and obesity.
Leaving eating disorders untreated can have serious consequences. Physical problems associated with anorexia, for instance, include anemia, constipation, osteoporosis, even damage to the heart and brain. Research has found that individuals with anorexia have a mortality rate 18 times higher than peers who don’t have eating disorders. Bulimia can result in a sore throat, worn-away tooth enamel, acid reflux, and heart attacks. People with binge eating disorder may develop high blood pressure, cardiovascular disease, diabetes, and other problems associated with obesity.
It is important to understand the nature of eating disorders as an eating disorder is not a lifestyle choice – it is a serious mental illness which requires intervention and treatment. Myths that eating disorders are just about being thin, are caused by the family environment or fashion models, are a rich girls problem or that they can’t even be beaten, are untrue. So what are eating disorders all about?
An eating disorder is a disorder of:
- feelings and emotions
- thinking (or thought processes)
- values and lifestyle
At the core of nearly every eating disorder is that food is misused to try and resolve emotional problems. When a person is unable to face their feelings, define problems, and resolve them effectively, he or she may become susceptible to the onset of an eating disorder.
An eating disorder has no single cause
A combination of factors are thought to play a role in the development of an eating disorder with no one factor operating in isolation.
Recent scientific research has shown is that people are born with an inherited predisposition toward developing an eating disorder – a gene responsible for addiction. This addiction can appear in different forms: alcohol and/or drug addiction, food addiction, nicotine etc. That’s why many eating disorder sufferers, especially bulimics, also suffer from addictions to other substances.
However, not all people who inherit an addiction gene suffer from an eating disorder or other addictions. The presence of additional factors are required to trigger the onset of an eating disorder.
A number of personality traits have been identified as precursors to a person developing an eating disorder. They are likely to be:
- Perfectionists – always striving to be the best at whatever he or she does.
- Kind and caring
- Very sensitive to other people’s opinions with a need to please others.
- Very self conscious and will attach too much importance to weight, body image and fitness.
- Self critical
- Suffering from low self-esteem
- Easily addicted and/or obsessed with things.
- Lacking effective problem-solving skills.
- Fearful or ambivalent about growing up or developing sexually – including changes to the body during puberty.
As well as the genetic link and/or a predisposition to an eating disorder, most often there is a trigger which sets the eating disorder in motion. The trigger can often happen at a time of transition, shock or loss where increased demands are made on the young person who is already unsure of their ability to meet perceived expectations. Even a happy event can lead to disorders because of the stressful impact of the event on an individual’s new role and body image. Such triggers might include:
- a life change such as moving house, starting a new school, beginning a new job, starting a new relationship.
- bullying and teasing
- the death or serious illness of someone close
- family problems such as divorce and family disharmony
- a break-up of an important personal relationship
- experiencing abuse such as rape or incest.
Essentially, a trigger is a situation that a person is struggling to deal with.
Types of eating disorders
Anorexia nervosa is characterised by a severe restriction of the amount of food eaten, resulting in dramatic weight loss. Additionally, excessive exercise, purging (forced vomiting), laxatives, enemas and diuretics can be used to decrease weight.
A person with anorexia will display considerable anxiety around food. This can manifest itself by the person skipping meals, refusal to eat previously eaten food types and being secretive about eating, or even by serious conflict at meal times. From the perspective of the anorexia sufferer – food is the enemy and must be avoided at all costs.
Bulimia Nervosa is characterised by binge eating (often high calorie foods) in a short period of time, then purging. Commonly, the person is unable to stop eating once started until the sense of fullness is extreme. In order to prevent weight gain most will try and rid their bodies of the food they have just eaten by vomiting. Other methods include the use of laxatives, diuretics and occasionally enemas. Fasting or restricting food intake for a day or several days and/or exercising excessively can also be methods used to control their weight.
Binge Eating Disorder – Compulsive Overeating
Like people with bulimia, those with binge eating disorder experience frequent episodes of out-of-control eating. The difference is that binge eaters don’t purge their bodies of excess food.
Eating Disorders Not Otherwise Specified (EDNOS)
Many eating disorders do not fall within the strict clinical definitions of anorexia or bulimia but can still be extremely serious for the person and their family. A significant number of individuals with eating disorders fit into this category. For example, individuals who are severely restricting their food intake but have yet to cross the weight loss threshold necessary to be diagnosed as anorexic; individuals who regularly purge but do not binge eat, and individuals who meet criteria for bulimia nervosa, but binge eat less than twice weekly, etc. Being diagnosed as having an “Eating Disorder not Otherwise Specified” does not mean that there is any less danger or that the suffering is any less.
It may be more difficult getting the help you require for someone with an EDNOS but their illness should not be downplayed or left untreated.
Is it an eating disorder?
Distinguishing between normal teenage behaviour with food fads and temporary diets, and the beginnings of an eating disorder can often be very difficult – the signs and symptoms are not always obvious. People with an eating disorder will often go to great lengths to disguise their disordered eating behaviours and physical appearance (if there is significant weight loss), or other physical problems.
A person with an eating disorder is typically irrational and they may be difficult to live with. Even this clue may be overlooked as moody, irrational behaviour is often put down to being just a normal teenage phase.
If challenged about food the response is likely to be an aggressive and confrontational denial – everyone else has a problem, not them. It is not unusual to have inappropriate, obstinate and controlling behaviour. Anxiety attacks and depressive episodes that result in the person isolating themselves from family and friends can become common occurrences.
It is important to seek help
It is important to remember is that Anorexia, Bulimia, Compulsive Overeating and other unspecified Eating Disorders, or any combination of them, are all very serious psychological illnesses. They all have their physical dangers and complications.
Research has found that the sooner help is sought and appropriate treatment given, the faster the rate of recovery.
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