How would you rate your relationship with food and your body image? Would you say it is a healthy one? What feelings and emotions would you associate with it? Happiness? Satisfaction? No feelings? Guilt, or shame? Do you feel like you need to starve for the rest of day after eating something "naughty" or go and "run it off"?
Having an unhealthy relationship with food and body image can lead to eating disorders. From Monday 1st March is Eating Disorders Awareness Week and I'd like to bring your attention to the three most common eating disorders, the causes, symptoms and some resources available for those seeking help.
What are eating disorders?
According to the NHS website "An eating disorder is when you have an unhealthy attitude to food, which can take over your life and make you ill".
NICE shared the following statement in its 2017 clinical guideline on eating disorders: "Eating disorders are defined by the negative beliefs and behaviours they cause people to have about themselves and their eating, body shape and weight."
Eating disorders are serious mental illnesses that can have severe psychological, physical and social consequences. Eating disorders might appear to be about food, weight, negative body image or low self-esteem. Some may use eating disorders as a way of dealing with emotional and stress-related issues, as a coping mechanism. They can be viewed as lying on a spectrum with self-harm.
People with eating disorders can very often suffer with other mental health issues such as anxiety, depression, substance misuse or OCD. They are also at increased risk of suicide.
Eating Disorders - who can be affected?
Eating disorders can affect anyone, however research shows that they most commonly affect young women aged 13 to 17 years old.
"The number of hospital admissions with a diagnosis related to eating disorders in England has doubled since 2010. In 2017/18 there were 16,547 admissions where an eating disorder was recorded as either a primary or secondary diagnosis. 91% of those admitted were female". (1)
Just like any other mental health issues this doesn't only affect the individual but also those around them, their family and friends. It is difficult to watch loved ones go through these potentially life-threatening disorders. Being supportive, educating yourself on eating disorders, listening without judgement and offering to go along to see a professional is great help.
Types of Eating Disorders and their characteristics
Anorexia nervosa
People who have anorexia either don't eat enough food or exercise too much (or both) to keep their weight low. This can lead to some serious, life-threatening health problems because they start to starve. They often view themselves as fat even when they are underweight.
Physical signs:
Severe weight loss
Well below average weight
Menstrual dysfunction (irregular or a complete loss of menstrual periods)
Fertility problems
Bone thinning, fractures and other injuries, and even premature osteoporosis
Gastro-intestinal problems
Electrolyte imbalance
Kidney and bowel disorders
Growth of downy hair on face, arms and legs (body's strategy to protecting itself against heat loss associated with extreme thinness)
Feeling cold
Restless, sleeping very little
Dry/yellow skin
Psychological signs:
Obsessive about food, dieting and being thin
Claiming to be fat when thin
Obsessive fear of weight gain
Low self-esteem
Depression and anxiety
Perfectionism
High need for approval
Social withdrawal
Behavioural signs:
Eating very little
Relentless exercise
Great interest in calorie, carbohydrate and/or fat content in food
Anxiety and arguments about food
Avoiding eating in company of other people
Lying about eating meals
Obsessive weighing
Rituals around eating
Bulimia nervosa
People who have bulimia go through periods where they eat excessive amounts of food (binge eating) and then purge - make themselves vomit, use laxatives or do excessive exercise, or a combination, to try to stop themselves gaining weight.
Physical signs:
Tooth decay, enamel erosion
Stomach and oesophagus (commonly known as the food pipe) pain
Puffy face due to swollen salivary glands
Normal weight or extreme weight fluctuations
Abrasion on knuckles from self-induced vomiting
Menstrual irregularities
Muscle cramps/weakness
Frequently dehydrated
Dark circles under eyes
Psychological signs:
Low self-esteem and self-control
Impulsive
Depression and anxiety
Preoccupied with food and eating
Body dissatisfaction
Obsessed with body image, appearance and body weight
Overly concerned with being slim
Behavioural signs:
Out of control binging
Eating to numb feelings/provide comfort
Guilt, shame, withdrawal, and self-deprecation after binging
Frequent weighing
Disappearing after meals to get rid of food
Secretive eating
Purging - vomiting, laxative abuse
Binge eating disorder
Binge eating disorder involves regularly eating large portions of food all at once until you feel uncomfortably full, and then often upset or guilty. Binges are often planned in advance and the person may buy "special" binge foods.
Physical signs:
Increase in weight
High blood pressure and cholesterol levels
Heart disease
Type II diabetes
Fatigue
Joint pain
Gallbladder disease
Sleep apnea
Psychological signs:
Low self-esteem
An obsessive personality
Perfectionism
Depression and/or anxiety
Overly concerned with being slim, particularly if you also feel pressure from society or your job (for example ballet dancers, jockeys, models or athletes)
Behavioural signs:
Eating much more rapidly than normal
Eating when not feeling physically hungry
Eating alone/hiding the binges because of feelings of shame
Feeling disgusted, depressed or very guilty after binging
Source of the picture: Beat (Twitter, 2017)
What NOT to say to someone suffering or recovering from an eating disorder
If you know someone who might be suffering from an eating disorder it is important to know that certain language that you use could be triggering, even if your intentions are good. Here are some examples from 'Beat':
1. "But... you're eating well, so you're doing better, right?"
2. "So are you still... you know... do you still have an eating disorder?"
3. "I just work out every day to not feel bad about my body"
4. "I wish I was as devoted and strong as you are, I could finally lose a couple of pounds!"
5. "But people don't like it when you're skin and bones"
6. "But you're not actually that thin..?"
Where to seek help
It is advised to avoid direct confrontation about sufferers eating behaviours or physical symptoms because they may feel embarrassed and their self-esteem threatened and they are likely to deny that they have a problem. If they admit to having an eating problem you can propose that they see a counsellor. This can be done via NHS with a GP's referral.
Various forms of specialist help are available, such as trained counsellors from self-help organisations (see resources below). For more serious and life-threatening cases, private eating disorders clinics can provide the required help, or, with a GP's referral, treatment within a multi-disciplinary team of trained psychiatrists, endocrinologists, gastroenterologists and other medical specialists.
Helpful resources:
ABC (Anorexia & Bulimia Care) - a UK eating disorders organisation
Phone: 0300 011 1213 (Helpline)
Email: support@anorexiabulimiacare.org.uk
Website: www.anorexiabulimiacare.org.uk
Phone: 0345 634 1414 (Helpline, for anyone over 18)
Phone: 0345 634 7650 (Youthline, for anyone under 25)
Email: help@b-eat.co.uk (18 or over) or fyp@b-eat.co.uk (25 or under)
Website: www.b-eat.co.uk
MGEDT (Men Get Eating Disorders Too!) - national charity raising awareness of eating disorders in men
Email: sam@mengetedstoo.co.uk
Website: www.mengetedstoo.co.uk
References:
"Eating Disorders Awareness Week - Debate Pack, Number CDP 2019/0055, 26 February 2019, By Dr Sarah Barber Tom Powell Carl Baker Nikki Sutherland
NHS UK
MHFA England
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