Awareness weeks are used to bring attention to important issues, causes or events. They help people learn, reflect and contribute a greater understanding of these issues. Eating Disorders Awareness Week is an important date in the calendar to encourage people to spot the signs and reach out to a friend or loved one making an enormous difference to their life.
WHAT IS AN EATING DISORDER?
An eating disorder is a clinically diagnosed mental health condition characterised by severe disturbances in eating behaviours, thoughts and emotions related to food, weight, and body image. Eating disorders are not a choice and they can significantly impact a person’s physical health, emotional well-being, and daily life, in some cases they can be life-threatening. With treatment, people can recover.
Many people are aware of Anorexia Nervosa and Bulimia Nervosa. Anorexia is the restriction of food intake, intense fear of weight gain and distorted body image whereas bulimia is a pattern of binge eating followed by purging (vomiting, laxatives, excessive exercise). In 2013 two other eating disorders were officially recognised as a distinct eating disorder. Binge Eating Disorder (BED) which is the recurrent binge eating without purging, often leading to distress and guilt and Avoidant/Restrictive Food Intake Disorder (ARFID) which displays as limited food intake due to sensory issues, lack of interest, or fear of consequences like choking.
Today, in the UK, over 1.25m people live with an eating disorder, that’s 1 in 50 people. Anyone can develop this mental condition. Let’s look at the signs and symptoms of each of the four eating disorders mentioned above.
1) ANOREXIA NERVOSA
Signs and Symptoms | Health Consequences |
Extremely restricted eating | Anaemia – low iron |
Intense & excessive exercise | Bone thinning, fractures and breaks |
Thinness & extreme thinness (emaciation) | Amenorrhea - absence of periods in females |
Relentless pursuit of thinness | Muscle wasting, weakness |
Unwillingness to maintain weight | Lethargy and feeling cold |
Intense fear of gaining weight | Low blood pressure, fainting |
Distorted body image | Poor bowel health, constipation |
Anosognosia – denial of seriousness of low body weight | Damage to heart structure and function, slow breathing and pulse |
Lying about food intake | Delayed puberty |
Avoiding social events | Infertility |
Wearing oversized clothes | Brain damage |
Low self-esteem | Multiple organ failure |
Obsession over food or diet | Death |
Anorexia nervosa can be fatal. It has an extremely high death rate compared with other mental disorders. People with anorexia nervosa are at risk of dying from medical complications associated with starvation. Suicide is a leading cause of death for people diagnosed with anorexia nervosa.
2) BULIMIA NERVOSA
Signs and Symptoms | Health Consequences |
Disappearing after meals | Low blood pressure |
Self-induced vomiting | Chronically inflamed and sore throat |
Skipping meals or eating small amounts at regular mealtimes | Worn tooth enamel, increasingly sensitive and decaying teeth |
Cur or calloused knuckles from self-induced vomiting | Swollen salivary glands in neck and jaw area causing ‘Bulimia face’ |
Fasting | Acid reflux disorder, indigestion and heartburn |
Hoarding food | Pancreatitis |
Exercising excessively | Electrolyte imbalance |
Misuse of laxative, falsely believing they will cause weight loss | Irregular periods, missed periods or fertility problems. |
Lack of control - over eating during an episode | Gum disease and painful sores in corners of mouth |
Withdraw from friends and social activities | Hair skin and nail problems |
| Constipation, diarrhoea and IBS |
Approximately 1% of individuals with bulimia nervosa will struggle for their lifetime. Increasing awareness of symptoms, causes, and interventions of bulimia nervosa can result in a meaningful reduction of this prevalence.
3) BINGE-EATING DISORDER
Signs and Symptoms | Health Consequences |
Eating unusually large amounts of food in short amount of time, for e.g. within 2hrs | Weight gain, leading to obesity and it’s adverse ill -health |
Eating very fast during binge episodes | Digestive distress – bloating, nausea, constipation and acid reflux |
Eating even when full or not at all hungry | Insomnia due to physical discomfort and psychological distress |
Eating until uncomfortably full | Type 2 diabetes |
Eating alone or in secret | High blood pressure |
Feeling distressed, ashamed, or guilty about eating | High cholesterol |
Dieting frequently, possibly without weight loss | Breathing issues, asthma, sleep apnoea |
Sense of loss of control over what, when and how much to eat | Gallstones, gallbladder disease |
Elevated levels of distress about weight, shape and eating | Hormonal dysregulation affecting appetite, hunger and fullness cues |
The main difference between bulimia and binge eating disorder is that bulimia is characterized by purging after a binge, while people with binge eating disorder do not purge.
4) AVOIDANCE RESTRICTIVE FOOD INTAKE DISORDER (ARFID)
Signs and Symptoms | Health Consequences |
Severe restriction of types or amounts of food eaten | Unhealthy weight loss |
Lack of appetite or interest in food | Malnutrition |
Dramatic weight loss | Changes to physical growth which are averse to good health |
Upset stomach, abdominal pain, or other gastro issue with no known cause | Functional impairments associated with academic performance, work and relationships |
Limited range of preferred foods that becomes even more limited | Developmental delays |
Anxiety when presented with new or feared foods | Co-occurring anxiety disorders |
Avoidance of certain foods due to texture, colour, smell or taste | Gastroparesis – delayed stomach emptying, causing excessive fullness, bloating and early satiety |
Difficulty chewing foods | Gastro distress such as constipation and bloating |
Consuming extremely small portions |
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Dependence on supplements or external feeding tubes |
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Frequent vomiting or gagging after exposure to certain foods |
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Unlike cases of anorexia and bulimia, ARFID does not typically involve poor body image, a drive to be thin, or a displeasure with external appearance. However, inadequate nutrition and caloric intake, especially among children, can seriously delay growth or prevent normal weight gain.
ARFID frequently occurs with other conditions, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorders (OCD).
Mental and Emotional Effects of Living with an Eating Disorder
Aside from the physical damage eating disorders having on your body, it's also linked to mental health problems. Some of the issues include:
Anxiety
Depression
Low self-esteem
Irritability
Moodiness
Self-harm (such as cutting)
Obsessive-compulsive behaviours
Guilt, shame, or embarrassment
Self-hatred
Social isolation
Drug or alcohol abuse
Suicidal thoughts or actions.
HOW TO HELP
It is best to address and tackle disordered eating behaviour as early as possible. It may seem challenging, but keep in mind you are doing the best thing for your loved one, and for yourself. There are no right or wrong ways to start this discussion as every situation and person is different, however there are some points to consider.
1. Be prepared
Before initiating a conversation, make sure you feel prepared. Understanding the signs and symptoms of eating disorders can help. Be aware that having this conversation may not go the way you hope, or it may open up other issues. Make sure you feel ready for these outcomes.
Choose a time when you are both feeling calm and are unlikely to have any distractions. Pick a safe and comfortable place, and try to avoid raising it before, during or immediately after a meal.
2. Communicate
Be calm, honest and open about your concerns for the person.
Before speaking to the person, it is important to think about what you would like to say to maximise the chances of a positive conversation. Use your knowledge of the person to decide the best way and time to approach them. You may find it helpful to role play your conversation with another person, or role play your approach in your own mind.
Assure the person you are talking about it because of your genuine care and concern, rather than coming across as making accusations or judgements.
Use ‘I’ statements rather than ‘You’ statements as the latter can lead to the person feeling attacked. For example, you could say, ‘I am concerned for you because I have noticed you’re not so happy at the moment’ rather than ‘you aren’t happy at the moment’.
3. Offer information
Your family member or friend may not be ready to take in what you are saying at the time, but they might be ready to look at a fact sheet, brochure or list of services in their own time. You can download a fact sheet from the Hub of Hope HERE.
4. Avoid using labelling or judgmental language
Focus on the person’s behavioural changes rather than their weight, food consumption or physical appearance. For example, you might decide not to use the words ‘eating disorder’ but to talk more generally about moods, behaviour, isolation and your concerns about them.
5. How they might respond
Be prepared for their emotional reaction, which may be one of anger, denial or relief:
Anger – the person may feel angry at their privacy has been threatened, that they have not been able to deal with the eating disorder on their own or that they are embarrassed or ashamed.
Denial – the person may deny there is a problem because they feel guilty or ashamed. The person may also feel protective about their eating disorder, especially if it serves a purpose for them, such as a coping mechanism or a sense of control in their life. Alternatively, the person may be confused and shocked because they have not yet identified themselves as having an eating disorder.
Relief – the person may feel relieved that someone has noticed and offered them support or help. If the person is truly endangering his or her life by their eating habits, family and friends may need to insist that professional help is sought.
6. Seek help
Encourage the person to seek professional help. The first port of call will usually be a GP, as they are best placed to provide a diagnosis. Reassure them that you are there to help and support them and they are not alone in their situation. Encourage them to seek support from the people in their life who love them, such as friends, family or parents. Encourage the person to think about the benefits of a life without an eating disorder.
Where to go for help on the web:
NHS https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/
PODCASTS:
The Eating Disorder Recovery Podcast. Dr. Janean Anderson
Just Eat Normally: Eating Disorder Recovery. Rachel Evans
Food Psych Podcast with Christy Harrison
Written by Alice, Health & Wellbeing Coach.
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