Concerned about your child, a friend or a family member’s disordered eating behaviours? Health Psychologist Kelly Gall discusses how to identify disordered eating behaviours, when to seek assistance and how psychologists can help.
What is Disordered Eating?
Disordered eating occurs when an individual’s eating, exercise or concerns regarding their weight or shape become physically or emotionally unhealthy. It may manifest in a range of negative thoughts and feelings about food or weight and shape management including:
- obsessing about dieting goals or caloric intake;
- feeling out of control of their eating (regardless of the amount of food consumed);
- being very anxious about eating or fearful of foods (where no allergy or intolerance exists);
- having a very rigid fixation on eating “healthily” that causes distress or impairs their functioning;
- being very fearful or anxious of putting on weight;
- feeling guilty after eating;
- eating to manage distress.
Disordered eating also presents in unhealthy behaviours, such as:
- restrictive dietary practices such as very low caloric diets, or eating very limited types of foods;
- frequent or compulsive bingeing;
- purging through vomiting or laxative use;
- eating in secret;
- eating compulsively.
Disordered eating can cause problems for the individual including distress, impaired physical health, or limiting their social functioning. A person experiencing disordered eating may or may not experience a full-blown eating disorder. However, some disordered eating such as feeling out of control of when, what or how much is eaten, is distressing in and of itself. Disordered eating also places people at higher risk of meeting eating disorder diagnoses in the future.
So what is an Eating Disorder?
Mental health and behavioural disorder diagnoses are made when people meet a specific combination of symptoms within defined timeframes. Eating Disorders are characterised by specific combinations of disordered eating, and its effects (such as weight loss) that have occurred within recent months.
The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5) recognises four specific eating disorders:
1. Anorexia Nervosa (AN)
Anorexia is associated with an individual deliberately consuming fewer calories than their body requires to maintain a minimum healthy body weight; intense fear of gaining weight or becoming fat; and distorted impressions regarding their body weight or shape. Some people experiencing this condition will also engage in bingeing and/or purging behaviours. Anorexia Nervosa is a very serious health condition with wide-ranging and often severe impacts on the body, which can be life-threatening.
2. Bulimia Nervosa (BN)
Bulimia involves episodes of eating unmistakeably large amounts combined, while feeling out of control of this eating, with behaviours intended to offset the extra intake of calories. These “compensatory behaviours” include vomiting or laxative use, use of other medications, fasting and excessive exercise. People with Bulimia Nervosa are generally very concerned about their weight and shape. The weight management behaviours in Bulimia Nervosa can cause a variety of physical problems.
3. Binge Eating Disorder (BED)
Like Bulimia Nervosa, Binge Eating Disorder involves episodes of binge eating while feeling out of control. However, “compensatory behaviours” are not present. The bingeing that occurs in this disorder results in the individual feeling embarrassed or disgusted with themselves at the time and upset, depressed or guilty afterwards.
4. Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant/Restrictive Food Intake Disorder tends to first occur in infancy and early childhood. Children exhibit food and eating aversions that result in them having nutritional deficiencies, failing to meet weight or growth targets, or other impairments in their functioning. The aversions can be caused by a variety of reasons, but these kids are not just “picky eaters”.
Two further non-specific categories of Eating Disorders exist for symptoms and behaviour that do not clearly align them with one of the four specific disorders.
With the exception of ARFID, Eating Disorders often begin in adolescence or early adulthood. While Binge Eating Disorder can first occur later in adulthood, often these individuals have experienced binge eating or loss-of-control eating (where the person experiences occasions where they feel out of control of their eating but may not eat large amounts) as children or adolescents. Anorexia Nervosa and Bulimia Nervosa are more common in girls, however up to 40% of those with Binge Eating disorder are male.
Childhood and adolescence is an incredibly important period of emotional, social and physical development. Eating Disorders impact significantly on physical health in ways far beyond a person’s weight such as through hormonal regulation, impaired growth, brain and cognitive functioning. Eating Disorders are not pleasant and people experiencing them are distressed. Early intervention in disordered eating and Eating Disorders reduces the impact that these conditions have on peoples’ lives and tends to improve treatment outcomes.
What about Orthorexia?
The term “Orthorexia” refers to a person engaged in rigid beliefs and behaviours centred around eating “healthy”, to the extent that it actually serves to diminishes their health or wellbeing – or creates a fear response to foods believed to be unhealthy. It is not intended to refer to those who choose to eat healthily, and experience no detrimental effects.
Although Orthorexia does not currently constitute a formal diagnosis, it can lead people to develop restrictive and unhealthy dietary practices, and for food to become an unreasonably large focus of their lives. Othorexia can lead to nutritional deficits and interfere with a person’s ability to fully engage in and enjoy social experiences.
What causes disordered eating and Eating Disorders?
Biological, psychological and social factors all contribute to the development of disordered eating and the specific Eating Disorders. These factors can vary considerably between individuals.
It is important to remember that even where someone’s eating problems seemed to have stemmed from their deliberate decisions and behaviours, Eating Disorders themselves are not a choice.
Treatment for Eating Disorders
Psychological treatments are regarded as “first-line” or recommended for BN and BED, and are also suitable for “Orthorexia” and disordered eating generally.
Cognitive Behavioural Therapies are effective and can be used to tackle the thoughts and emotions underlying the eating behaviours, manage distress and create healthier attitudes towards food, eating, body image, and to bolster self-esteem. Cognitive Behavioural Treatments also seek to replace the disordered behaviours with healthy eating, and allow the individual to exert greater control over the amounts they consume. Some symptoms, such as feeling out of control, are targeted by cognitive, emotional and behavioural strategies used simultaneously.
Treatments for AN are best conducted in in-patient, or day patient settings by a multidisciplinary team incorporating doctors, dieticians and psychologists and psychiatrists. Psychological treatments will commonly involve other family members or partners in addition to the patient themselves. If you, a friend, or a loved one appears to be experiencing or developing AN it is very important to seek help via your GP.
Given the impacts on their development, your GP should be your first point of call for children experiencing ARFID.
When to Seek Help
Early intervention is most effective; you need not wait for formal diagnosis. If your relationship with eating or your body is causing you distress then it is worth getting treated.
However, should you meet the criteria for an Eating Disorder then you may qualify for Medicare support of up to ten of your sessions of counselling each year if your GP raises a Mental Health Care Plan. This can make your treatment more affordable and also will enable your Doctor to support your care and monitor your physical health. Should you attend a psychologist first, and they identify that you have an Eating Disorder, they will recommend that you engage with your GP for these reasons.
The length of treatment required will vary substantially from individual to individual and will depend on the amount and severity of symptoms, and the depth of the issues that triggered these behaviours in the first place. Eating Disorders are likely to take longer to treat than less complicated disordered eating. Your psychologist will devise and discuss a treatment plan with you that takes these factors into consideration.
Supporting your Loved One
Seeking treatment will usually be very difficult for people experiencing disordered eating or an Eating Disorder. Those who view their behaviours as important in maintaining their desired weight or shape, or integral to their sense of identity, may actively resist treatment. However, getting assistance as early as possible is very important.
In the early days one of the best things you can do is to get informed – the National Eating Disorders Collaboration and the Butterfly Foundation websites contain more information on Eating Disorders, the warning signs that you can look for, and ways that you can support your loved one. It can also be helpful to speak with your doctor or psychologist about your concerns and to get support for yourself.
Author: Kelly Gall, BSc (Hons), M Psych (Health), M Clin Psych, MAPS, MCHP.
Kelly Gall is an endorsed Health Psychologist and is currently undergoing further training in Clinical Psychology. Using the biopsychosocial model, Kelly develops tailored, holistic treatment plans that incorporate psychological, physical and social strategies aimed at empowering her clients to improve their psychological and physical health as well as their overall quality of life. Find out more on her website, Healthy Inside and Out.
To make an appointment with Health Psychologist Kelly Gall, please call (07) 3067 9129 or you can book online today.
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