Eating Disorders

Eating Disorders are a range of complex conditions relating to persistent eating habits and behaviours that impact negatively on an individual’s health, emotional wellbeing and capacity to function in everyday life. They relate to a disordered relationship with food and ongoing severe concern or distress about body shape or weight. Eating disturbances may include inadequate or excessive food intake, either of which can, not only ultimately damage a person’s well-being, but which if persistent or untreated, can be life-threatening or carry long-term health risks.

Eating Disorders can affect both females and males and they can often co-exist with other conditions such as anxiety disorders, depression or substance abuse.

Eating disorders are treatable however the symptoms and consequences, if not addressed, can be detrimental or even deadly. Research has shown for example, that Anorexia Nervosa has the highest mortality rate of any psychiatric disorder (Arcelus, Mitchel, Wales & Nelson, 2011). It is a life threatening disorder due to the the effects extreme weight loss and starvation have on the body and the brain. Repeated vomiting, associated with Bulimia, can cause esophageal damage, electrolyte imbalance can damage the heart and significant dental damage can develop as stomach acids erode tooth enamel. Binge eating can cause long-term health issues such as obesity, diabetes, high blood pressure and heart disease .

Understanding Eating Disorders

The reasons behind the development of Eating Disorders can differ but are thought to include a combination of environmental, social and cultural factors and can also involve some element of genetic disposition.

Some examples of causes are:
• Trauma – childhood or family including childhood sexual abuse
• Media and cultural pressure – reinforcement of the thinness culture and idealisation of thin people as stereotypes
• Peer pressure – from friends, co-workers or social groups
• Professions that promote or idealise thinness and weight loss such as modelling or ballet
• Hormonal factors
• Negative body image
• Poor self esteem

Cultural attitudes have a significant effect on how we view our bodies and what is considered to be ‘perfect’ or ‘desirable’. Some aspects of current culture glorify thin women, and elsewhere there is a focus on BMI (Body Mass Index), and on ‘desirable’ levels of muscle mass. These can contribute to a disordered relationship with food, eating and exercise as we strive to achieve what has been put forward as ‘healthy’ or optimal. This can also make us dissatisfied with our own bodies and body shapes. For example a culture which values thinness or a particular body shape and can make those who don’t meet these supposed criteria feel undesirable or unworthy. Food and eating issues can therefore become an expression of ourself and our self-worth.

Other reasons for individuals to develop Eating Disorders and deprive themselves of food and nourishment, eat to excess, binge eat or exercise excessively are out of feelings of anxiety, inadequacy, poor self-esteem, pressure to achieve, or the desire to please others who are important to them.

People with eating disorders can often be highly sensitive and overly concerned with meeting the expectations of others. Eating Disorders can sometimes commence in teenage and adolescent years when identity is becoming a key issue and the opinion of peers is of huge importance.

Signs and Symptoms of Eating Disorders

The reasons behind the development of Eating Disorders can differ but are thought to include a combination of environmental, social and cultural factors and can also involve some element of genetic disposition.

Some of the more general signs that can signal the onset or presence of an Eating Disorders include:
• Preoccupation with eating, food, body shape and weight as well as sensitivity to comments around these
• Rapid weight loss or frequent weight changes
• Avoidance of social occasions, family and friends -withdrawing and becoming isolated
• Anxiety, irritability around mealtimes
• Calorie counting, avoidance of food groups, fasting
• Dissatisfaction around body image
• Depression and anxiety
• Low self esteem

Cultural attitudes have a significant effect on how we view our bodies and what is considered to be ‘perfect’ or ‘desirable’. Some aspects of current culture glorify thin women, and elsewhere there is a focus on BMI (Body Mass Index), and on ‘desirable’ levels of muscle mass. These can contribute to a disordered relationship with food, eating and exercise as we strive to achieve what has been put forward as ‘healthy’ or optimal. This can also make us dissatisfied with our own bodies and body shapes. For example a culture which values thinness or a particular body shape and can make those who don’t meet these supposed criteria feel undesirable or unworthy. Food and eating issues can therefore become an expression of ourself and our self-worth.

Other reasons for individuals to develop Eating Disorders and deprive themselves of food and nourishment, eat to excess, binge eat or exercise excessively are out of feelings of anxiety, inadequacy, poor self-esteem, pressure to achieve, or the desire to please others who are important to them.

People with eating disorders can often be highly sensitive and overly concerned with meeting the expectations of others. Eating Disorders can sometimes commence in teenage and adolescent years when identity is becoming a key issue and the opinion of peers is of huge importance.

Types of Eating Disorders

Anorexia Nervosa is characterised by extreme, restricted food intake that eventually causes dangerously low body weight. This intentional starvation can lead to malnutrition as well as other severe health risks. Those suffering from Anorexia Nervosa will have an intense fear of gaining weight even though they are already underweight. Also, they will be unable to accurately perceive their own physical appearance – this self perception of their own body will have become distorted and they will have ongoing obsessive thoughts about food and weight.

Two subgroups of Anorexia Nervosa have been identified:

Restricting: which includes restricting food intake, calorie intake, or other restrictions around food.

Purging: involves a compensatory mechanism as a result of severe feeling of guilt following eating and can take the form of self-induced vomiting, intense exercising and use of laxatives, for example.

Both types involve an irrational fear of weight gain and abnormal or dysfunctional eating patterns.

Some of the warning signs of Anorexia Nervosa are:
• Chronic dieting despite being underweight
• Ongoing fasting, calorie counting, avoidance of food groups such as fats or carbohydrates
• Failure to maintain a normal body weight for age and height
• Rituals around food, eg eating very slowly, cutting food into tiny pieces
• Eating in private or avoidance of meals in the company of others
• Secrecy around eating and food. Claiming to have eaten in order to avoid mealtimes
• Misuse of laxatives, diuretics, appetite suppressants
• Compulsive exercising, even in bad weather or when unwell or injured
• Feeling cold without reason
• Fine hair appearing on the body (as the body attempts to keep warm)
• Lethargy, low energy
• Loss of menstrual cycle

Risks associated with Anorexia Nervosa
Anorexia Nervosa is a serious disorder where the risks and potential consequences extend across both the social and physical aspects of life.
For an Anorexia sufferer obsessed with food and weight, friendships and relationships decline in importance as their focus is elsewhere.
For reasons including lack of energy and motivation there is a loss of interest in normal life and activities.
These in turn create isolation and loneliness..

There is potential for serious physical harm and this can include functioning of major organs in the body, including the heart.

Some of these risk are:
• Heart disease – the most common cause of death in Anorexics due to muscle wastage
• Damage to the skeletal system especially where Anorexia occurs before bones are fully developed
• Loss of bone calcium (osteopenia)
• Loss of bone density (osteoporosis)
• Infertility due to compromising of the hormonal system
• Electrolyte and other chemical imbalances
• Gastrointestinal issues
• Dental harm as a result of stomach acids eroding tooth enamel

Bulimia is characterised by binging, which is ingesting an abnormally large quantity of food in a short period of time. It is often followed by purging what has been eaten in order to avoid gaining weight. Purging is the name given to the inappropriate compensatory behaviours of trying to undo or get rid of food consumed while binging. Methods of purging can include forced vomiting, use of laxatives and diuretics or extreme exercising all driven by an attempt to avoid gaining weight from what has been eaten. With Bulimia, the bingeing can create a feeling of loss of control, followed by guilt or self loathing with purging reflective of frantic efforts to undo both the feelings and the effects of binge eating.

Some of the warning signs and symptoms of Bulimia are:
• Fluctuations in weight
• Habitually leaving the table or going to the bathroom immediately after
  eating
• Deterioration in condition of teeth from self-induced vomiting
• Swelling in the cheeks (swollen salivary glands)
• Sores around the mouth or calluses or marks on knuckles (from self-induced
  vomiting).
• Hoarseness in voice
• Broken blood vessels in the eyes
• Having a smell of vomit

By comparison with Anorexia Nervosa the physical effects of Bulimia may not be as obvious however there are still serious consequences such as:

Some of the warning signs and symptoms of Bulimia are:
• Cardiovascular issues
• Electrolyte and other chemical imbalances
• Gastrointestinal issues
• Loss of bone calcium (osteopenia)
• Loss of bone density (osteoporosis)

One of the most common and detrimental side effects of Bulimia however is dental damage as through the repeated act of self-induced vomiting teeth are subjected to continuous and seriously erosive stomach acid.

Rhis in turn creates further problems such as:
• Increased risk of cavities
• Painful or bleeding gums
• Soft palate damage
• Hoarseness in voice
• Chronic sore throat
• Oesophageal damage
• Cardiovascular issues

Binge Eating Disorder is characterised by the consumption of unusually large amounts of food and feeling a loss of control and an inability to stop eating. Those suffering from Binge Eating Disorder may binge eat even when not hungry and continue to eat long after they are full. They may feel extremely distressed during or after eating but still feel powerless to stop. During a binge, eating may take place so quickly that food is barely being registered as being eaten and is often not even tasted.

With Binge Eating Disorder there are no compensatory behaviours or attempts to ‘make up’ for overeating and many people with this disorder are overweight or obese. Binge eating can form a cycle in that the eating is comforting for a very brief period and eases or ‘stuffs down’ unpleasant emotions like anxiety, stress or depression. However, it is often followed by feeling of regret, guilt and self-loathing. Weight gain and obesity associated with this type of overeating can compound negative feelings about appearance and the self, and food continues to be used to cope and in an attempt to feel better.

Some of the signs and symptoms of Binge Eating disorder are:
• Hiding or stockpiling food to eat later
• Eating continuously throughout the day with no planned mealtimes
• Rapidly eating large amounts of food
• Eating normally among others but gorging when alone
• Feeling numb while eating
• Unable to feel sated or satisfied no matter how much food consumed
• Using food as a source of comfort to relieve boredom or stress or deal with
  depression

Risks Associated with Binge Eating Disorder

Some of the risk associated with Binge Eating Disorder are:
• Type 2 Diabetes
• Cardiovascular disorders
• Insomnia or sleep apnea
• Gastrointestinal disorders

Treatment for and Recovery from Eating Disorders

People can and do recover from Eating Disorders.

When considering the treatment and recovery from an Eating Disorder it is important to remember that although behaviours are centred on food, they are not primarily about food. Eating Disorders are about how an individual sees themselves and how their self worth is, for them, connected to their physical appearance. Their self image has become distorted and their eating behaviour has then also become disordered in an attempt to correct this.

True happiness and self esteem come from loving oneself and the road to recovery is about taking steps towards self acceptance and learning to listen to one’s own feelings and to one’s own body.

The first step on this road is if for a person to acknowledge that they have a problem and that what they are doing to themselves is destructive. This may be difficult as they may have feelings of shame, guilt, self-disgust, fear, or feel helpless to either continue with the behaviours or let go of them which may also be terrifying. Behaviours around Eating Disorders can be very embedded and although they are a destructive coping mechanism they will have played a significant role in person’s life in helping them feel or safe or in control when faced with overwhelming anxiety or distress.

Effective treatment for Eating Disorders includes a number of aspects – physical, behavioral, emotional and psychological. Recovery is about learning healthier ways to cope with difficult feelings, developing a better relationship with food and nourishment for the body and also importantly involves recovering a sense of oneself which includes self acceptance and self love. A high level of personal commitment as well as appropriate treatment is needed in the recovery process.

Some of the aspects of treatment and recovery from Eating Disorders are:
• Understanding how self-image impacts eating behaviours
• Helping to understand and address self-image issues
• Understanding how self-image can become distorted
• Medical Care and attending to physical health issues
• Attention to nutrition for physical health

Due to the complexity of these conditions, treatment of Eating Disorders can sometimes involve a broad team of specialised professionals including GP’s, specialised support groups or organisations as well as counselling and psychotherapy.

Counselling and psychotherapy can be of significant help in the treatment of and recovery from Eating Disorders.

Therapy can help an individual:
• To address traumatic events that may have occurred in the past or have become linked to distortions in self image
• To reconnect with who they are beyond eating habits and body image
• To learn healthier ways of expressing emotions, and dealing with difficult and uncomfortable feelings
• To develop and maintain healthier relationships
• To cultivate a sense of self including the individuality of oneself and learn self acceptance and self love
• To develop healthier eating habits grounded in nourishment and nutrition and care of the body

Evidence has shown that early identification and treatment can greatly reduce the duration of severity of Eating Disorders and therefore it is important to seek professional help as soon as possible.

To Find a Therapist to help with Eating Disorders click here:
Other sources of support for Eating Disorders in Ireland include GP’s and some of the following organisations:

HSE – National Clinical Programme for Eating Disorders
Bodywhys – the national eating disorder association of Ireland.
The Rutland Centre – Based in Dublin.
Eating Disorder Centre Cork – Based in Cork and offering specialist out patient treatment.
Lucena Clinic Services – providing mental health services for children and adolescents.
St Patrick’s Hospital – Services in outpatient, day patient or inpatient settings.
St John of God Hospital – Based in Dublin offering both inpatient and outpatient services.