What is disordered eating?
Food plays an important role in our lives, and our eating habits do change occasionally. The idea that someone with disordered eating will either be overweight or underweight is a misconception. Disordered eating is not always related to weight. Anyone can experience disordered eating, regardless of age, gender, weight or background.
If disordered eating persists for a long time, it may be a warning sign of an eating disorder. Fighting eating disorders is not easy, but it is most important to understand that the problem of eating disorders is not just about eating habits, but more about struggling with painful experiences and negative emotions in life. There is often a hidden burden behind an eating disorder, whereby an individual attempts to control their diet to distract and avoid an ongoing problem.
What is the difference between disordered eating and eating disorder?
- Disordered eating is having difficulties adjusting eating habits
- An eating disorder is a medical diagnosis. During the diagnosis process, a medical professional will overview an individual’s eating pattern, and measure weight, BMI and/or perform bloodwork to determine whether someone has an eating disorder.
Eating Disorders and Other Mental Health Issues
Many individuals with eating disorders also have other mental health problems. Some common problems include:
- Obsessive-compulsive disorder
- Phobias of certain foods
- Self-esteem and body image issues
- Self-harm (eating problems may present as a form of self-harm)
- Body dysmorphic disorder
How many types of eating disorders are there?
The followings are the four most common eating disorders:
Binge Eating Disorder
Other Specified Feeding and Eating Disorder (OSFED)
1. Bulimia Nervosa:
Bulimia is one of the most common eating disorders. If someone has a bulimia diagnosis, they may eat large amounts of food at once because of negative emotions. After binge eating, they may feel guilty or ashamed and purge (throw up) the food they ate. Someone who is struggling with bulimia nervosa may experience a cycle of binge eating and purging.
Individuals with bulimia nervosa might experience/feel:
- shame and guilt
- hatred towards their body
- that they are fat
- scared of being found out by family and friends
- depressed or anxious
- lonely, especially if no one knows about their diagnosis
- very low, sad and upset
- quick or sudden changes in mood
- stuck in a cycle of feeling out of control and trying to regain it
- numb, whereby feelings are blocked out by bingeing or purging
Individuals with bulimia nervosa might:
eat lots of food in one go (binge)
experience daily cycles of eating, guilt, purging, feeling hungry/eating again
binge on foods that they think are bad/unhealthy
starve oneself in between binges
eat in secret
crave only certain types of food
try to get rid of food by making themself sick, using laxatives or exercising a lot
Ways in which the body may be affected:
stay relatively the same weight, or experience frequent weight changes
be dehydrated, which can cause bad skin
have irregular periods (or none at all)
harm teeth and get a sore throat from stomach acid due to purging
if using laxatives, one might develop irritable bowel syndrome (IBS), a stretched colon, constipation or heart disease
2. Anorexia Nervosa
Individuals with anorexia often limit themselves to the portion size they eat, which prevents them from getting enough energy and nutrients to support healthy functioning of the body. Many individuals may think that anorexia is mainly related to slimming and dieting. But in fact, anorexia is often associated with low self-esteem and a negative self-image.
Subtypes of anorexia nervosa:
An individual with the restricting subtype of anorexia nervosa severely restricts energy intake, and weight loss occurs primarily through dieting, fasting and/or excessive exercise. Recurrent episodes of binge eating or purging behavior (e.g., self-induced vomiting, misuse of laxatives) have been observed in the past three months.
An individual with this subtype of anorexia nervosa severely restricts energy intake and has also engaged in recurrent episodes of binge eating or purging behavior in the past three months.
Someone with anorexia nervosa might feel:
unable to think about anything other than food
like they have to be perfect or that they will never good enough
lonely, especially if no one knows about their eating problems
a need for control
that they are hiding things from their family and friends
that losing weight is not enough
frightened of putting on weight
tired and not interested in things they normally enjoy
depressed or suicidal
angry if someone challenges them about their weight or food intake
a sense of achievement from denying themself food and/or over-exercising.
Someone with anorexia nervosa might:
reduce their food intake or completely stop eating
spend a lot of time calculating calories of food that they eat
hide food or secretly throw it away
avoid 'dangerous' foods, like those with high amounts of calories or fat
read recipe books and cook meals for others, without eating personally eating them
use drugs that claim to reduce their appetite or speed up digestion
exercise a lot with strict rules
develop very structured eating times
make up rules about food (e.g.: listing 'good' and 'bad' types or only eating food with certain colors)
How might the body be affected:
weigh less than you normally would or should, based on age and height
lose weight rapidly
become physically underdeveloped, especially if anorexia starts before puberty
feel very cold and weak
move around more slowly than normal
have irregular periods or none at all
lose hair or start to have very thin hair
develop fine fuzzy hair on your arms and face
lose interest in sex, or unable to have or enjoy sex
experience difficulty in concentration
develop fragile bones
3. Binge Eating Disorder
Individuals with binge eating disorder may feel a lack of control and eat large amounts of food in a relatively short period of time. Overeating often causes feelings of guilt and shame. With binge eating disorder, someone may rely too much on the emotional comfort of food or use food to escape from the emotions that they do not want to face.
Symptoms of binge eating:
- Frequent overeating
An individual experiences repeated binge eating eat large amounts of food in a short period of time (usually less than two hours). According to diagnostic criteria, binge eating episodes occur at least once a week for three months. During an episode, individuals can feel a lack of control over their eating and may not be able to stop even if they want to.
- Eating habits
An individual who binge eats usually has a range of identifiable eating habits. These may include eating quickly, eating when the body isn't hungry, and continuing to eat even when feeling full or sick.
- Feelings about food
It is very common for individuals with binge eating disorder to have feelings of guilt and shame. During periods of binge eating, they often feel guilty or ashamed about how much and how they eat. Overeating usually occurs during times of stress, anger, boredom, loneliness, or distress. At times like these, binge eating is used as a way to cope or distract from emotions. After overeating, they may experience guilt, shame, disgust, and depression.
- Behavior towards food
Due to their feelings about food, individuals with binge eating disorder tend to be very secretive about their eating habits and choose to eat alone.
Someone with binge eating disorder might feel:
- out of control
- as if they cannot stop eating
- ashamed of how much they eat
- lonely and empty
- very low, even worthless
- unhappy about their body
- stressed and anxious
Someone with binge eating disorder might:
- eat large amounts all at once (bingeing)
- eat without really thinking about it, especially when doing other things
- often eat unhealthy food
- eat for comfort when they feel stressed, upset, bored or unhappy
- eat until they feel uncomfortably full or sick
- hide how much they are eating
- find dieting hard whenever they try it
How might the body be affected:
- weight gain
- feeling sick
- shortness of breath
- sugar highs and lows (having bursts of energy then feeling very tried afterwards)
- develop health problems, such as acid reflux and irritable bowel syndrome (IBS)
- develop problems linked to being overweight (e.g.: type 2 diabetes, high blood pressure, or joint and muscle pain)
4.Other Specified Feeding and Eating Disorder (OSFED)
An individual with OSFED does not meet the criteria to be diagnosed with another eating disorder; however, they may be presenting with many symptoms of other eating disorders. OSFED is often associated with complex medical and psychiatric complications.
What Causes Eating Disorders?
Regardless of background, age and gender, anyone may experience an eating disorder. Although bulimia and anorexia are more common in women, many men also suffer from eating disorders. Because eating disorders are generally seen as a problem for young women, many male patients are afraid of seeking help, which makes the condition worse. There is no single cause of eating disorders and eating disorder problems can involve multiple causes. In general, stressful events, trauma, anxiety and depression are some common triggers for eating disorders.
These events may include:
- physical, psychological and/or sexual abuse
- the death of a loved one or some serious family problems such as parental divorce
- stress at school or at work (such as having exams or being bullied, long-term high intensity work)
- major life changes (e.g., puberty, new school or job, new living arrangements)
- personality (e.g., perfectionism, addictive/obsessive behavior, lack of confidence)
- societal and cultural pressures (e.g., physical insecurities)
How to effectively manage eating disorders?
On a personal level
1. Understanding Eating Disorders
Individuals often believe that only young women experience dietary problems, but it may occur for males or older women. Anyone may experience eating disorders.
2. Thinking about recovery
Recovery means different things to different individuals. It can take a long time for goals to be achieved. Recovery may take years rather than weeks and months and may be accompanied by instances of relapse - but it's possible to recover, even if it takes a long time.
3. Share with Individuals you trust
Family and friends may not fully understand the situation, but most of them are happy and willing to help. Don't be afraid, take the time to speak with others when ready. Ensure that channels of communication remain open so that support remains readily available.
4. Seek support/ resources
Individuals who experience eating disorders often feel ashamed and feel that no one understands their feelings and experiences. Some of them may eat alone, so that individuals around them may not know their situations, which makes them feel that they are fighting alone. Therefore, it is beneficial for them to communicate with others who have had a similar experience such as attending group therapy and support groups.
There are many resources in the community dedicated to supporting individuals with eating disorders. Individuals who experience eating disorders can participate in support groups to reduce the feeling of loneliness through mutual understanding and sharing with others who have similar experiences and feelings. They can also use crisis lines for help, which allows for anonymity for those who do not want to disclose their personal information. In addition, some websites and forums also provide online resources. However, they should be careful about internet safety and choose their resources carefully.
5. Practice mindfulness and relaxation techniques
Mindfulness is a therapeutic technique that focuses on the sensations in the body, the feelings in the mind, and the immediate environment. When taking the time to slow down and observe, it will be easier to understand reactions and emotions. Relaxation techniques such as meditation and yoga may also help in this regard. In the process of relaxation, one can calm their mind and visualize thoughts from new perspectives.
6. Look after yourself
Overcoming an eating disorder can be a long road, and it can be an important part of life. Changing how you feel, behave and think is not something that can achieved overnight. Being patient and making changes slowly is the key to recovery. The first step in overcoming an eating disorder doesn’t have to be related to eating. Ensuring that they are kind to themself in order to gain self-confidence and appreciate is an important first step. Sometimes it may feel like progress has been lost or that a relapse has occurred, and this can be discouraging. But it is important to accept that this is part of the process and to routinely acknowledge what has already been achieved.
Treatments for eating disorders
1. Seek help from medical professional
Medical professionals will assess situations to see if an eating disorder is presenting.
Although a general practitioner (GP) or family doctor may not have experience in treating eating disorders, they can provide referrals to agencies that specialize in supporting eating disorders. These agencies can provide counselling or psychotherapy, group counseling, or other professional support services. For example, a nutritionist can help set up a diet that is nutritious and helps stabilize weight.
2. Counselling/ Psychotherapy
Working with a counselor can help manage the underlying issues that may cause an eating disorder. They will utilize different therapeutic techniques. For example: helping manage past life experiences, or to explore relationships with family members and close friends in order to identify the causes of eating disorders.
Group and family therapy is yet another option, which is also a great way for family to better understand individual situations and learn how to provide support along the road to recovery.
Cognitive Behavioural Therapy (CBT)
CBT is a type of speech therapy. It helps with understanding how thoughts and emotions affect behavior in order to construct positive changes. CBT can help with understanding emotions behind the symptoms (e.g., restricting food intake) that someone is experiencing and how they can change the pattern accordingly.
Doctors can also prescribe medications to help individuals overcome eating disorders. However, there is no medication specifically for treating eating disorders. Doctors may prescribe antidepressants or other mental health medication to treat other symptoms with eating disorders such as depression and anxiety.
4. Admission to a clinic or hospital
If an eating disorder becomes severe, admission to a clinic or hospital for treatment may be required. Medical professionals will determine the next course of action based on a variety of factors, including (but not limited to): weight changes, the effectiveness of other treatments, and the impact of living environment.
Outpatients can stay at home on weekends and weeknights. Admitted patients will need to stay in the hospital for the duration of treatment, and the length of stay will depend on the progress of recovery.
Patients admitted to the hospital will receive a series of support from medical staff, including:
- Occupational therapists
- Social workers
- Family and Relationship Therapists
- Nurse specialists
Family and friends
If a family member or a friend has an eating disorder, there are several ways to help:
- Maintain open channels for communication
- Listen patiently and try not to make assumptions
- Understand that individuals with eating disorders don't necessarily realize that they have an eating disorder as a problem; they may see their eating habits as an outlet for anger, loss, powerlessness, self-loathing, and guilt.
- Don't rush into persuading them to change their behaviours
- Encourage them to seek professional support, such as counsellor or doctor. If they are concerned about asking for help, you can offer to help them with it.
- Help them find useful information and resources