Understanding exactly what are Eating Disorders.
An eating disorder is a serious mental illness characterised by extreme concerns about weight, body shape, eating and/or body image. These concerns lead to disordered and unhealthy patterns of behaviour, including restricting food intake, fasting, counting calories, vomiting, misuse of laxatives, and excessive or driven exercise. These behaviours can greatly affect a person’s physical, psychological and social functioning.
According to the National Eating Disorders Collaboration (NEDC), approximately 9% of the Australian population suffer from an eating disorder. Eating disorders affect men and women of all ages, of all socio-economic backgrounds, and of all shapes and sizes. Eating disorders are not lifestyle choices, or a “diet gone too far”. They are a serious mental illness that has the highest mortality rate (from medical complications and suicide) of any psychiatric disorder. They can also lead to serious physical and emotional consequences. They are not “phases” that people snap out of and recovery requires treatment and support.
With early appropriate treatment, dedication and hard work, recovery is possible. The sooner you get help, the greater the chance of a full recovery.
Five of the more common types of eating disorders recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are:
- Bulimia Nervosa,
- Anorexia Nervosa,
- Other Specified Feeding and Eating Disorder (OSFED),
- Binge Eating Disorder and
- Avoidant/Restrictive Food Intake Disorder (ARFID).
Bulimia Nervosa (BN) is characterised by recurrent episodes of binge eating, followed by compensatory behaviours.
- Binge eating involves eating a very large amount of food within a short period of time, and feeling out of control or unable to stop.
- Compensatory behaviours are ways of attempting to control weight or shape. This includes vomiting, misusing laxatives or diuretics, fasting, excessive exercise, or misusing over the counter or prescription medications for the purpose of weight control.
Because of the large amount of food consumed in a binge, and the relative ineffectiveness of most compensatory behaviours, weight may fluctuate, but many people with bulimia nervosa remain within the healthy weight range or may even gain weight. People who suffer from Bulimia Nervosa often get caught up in an out of control cycle of binge eating and attempting to compensate.
This can lead to feelings of guilt, shame and embarrassment, as well as preoccupation with eating, body image and fear of weight gain. For this reason, individuals often keep their eating and compensatory behaviours very secretive, and therefore the disorder can go undetected by friends and family.
Anorexia Nervosa (AN) is characterised by persistent restricted intake leading to significantly low body weight. This is accompanied by an intense fear of weight gain, or, persistent behaviour that interferes with necessary weight gain. For a person with Anorexia Nervosa, self-worth is often very much caught up with weight, body shape or control over eating. Individuals also often experience a distorted view of their body, believing that they are overweight when in fact they are dangerously underweight.
There are two subtypes of Anorexia Nervosa.
- Restricting subtype refers to individuals who severely restrict the amount and type of food they eat. They may also engage in other weight control behaviours such as excessive exercise.
- Binge/purge subtype also involves extreme restriction, but this is accompanied by episodes of binge eating and compensatory purging.
Other Specified Feeding and Eating Disorder
A person with OSFED presents with some of the symptoms of other eating disorders (Anorexia Nervosa , Bulimia Nervosa or Binge Eating Disorder), but does not quite meet the full criteria. OSFED is no less serious than other eating disorders and is the most commonly diagnosed eating disorder amongst adolescents and adults.
Binge Eating Disorder
Binge eating disorder is characterised by regular episodes of binge eating. Unlike Bulimia Nervosa, someone suffering from Binge Eating Disorder will not engage in compensatory behaviours (such as vomiting, laxatives, fasting etc.). Individuals with Binge Eating Disorder will often eat alone or in secret because of feelings of shame and guilt about their eating behaviours. Many people with binge eating disorder are overweight or obese.
Avoidant/Restrictive Food Intake Disorder
An ARFID diagnosis describes a disorder where an individual struggles to obtain adequate nutrition, in the absence of the fear of weight gain &/or preoccupation with weight and shape that characterises AN, BN or OSFED.
Feeding or eating disturbances such as lack of interest in food or lack of appetite, aversion to certain textures, or feared consequences of eating (not weight/shape based) lead to weight loss and difficulty maintained a healthy weight.
Eating Disorders: What are the Risks?
Eating disorders are serious mental illnesses that are associated with poor physical and psychological health and reduced quality of life. When eating disorders go untreated, they can be associated with serious, even life-threatening health complications. It is important that any individual with an eating disorder remains aware of the potential health risks.
It is strongly recommend that all individuals with an eating disorder regularly consult with a medical practitioner, to monitor and manage potential health risks and avoid more serious and irreversible changes.
One very concerning medical risk of having an eating disorder is heart problems. Heart problems may cause a person to: tire easily, feel light-headed and faint, be sensitive to the cold, have an irregular heartbeat, or experience chest pains. These heart problems are very serious and in extreme cases may lead to sudden death.
When a person rapidly loses weight, the size and strength of their heart substantially decreases. As a result, their heart is not able to pump blood around their body as efficiently as it should. This can lead to feeling light-headed and dizzy when standing up suddenly from a sitting or lying position. It is only with gradual renourishment that a person’s heart can return to its normal size and strength and therefore begin to pump more efficiently.
Nevertheless, given the seriousness of these heart problems, it is essential that your heart functioning is monitored regularly by your GP.
Electrolytes, or salts in the body such as potassium and sodium, help our muscles work properly. Since your heart is a muscle, electrolytes maintain its regular beat. Frequent vomiting or the use of laxatives or diuretics can cause fluid loss, which may lead to fluctuations in the body’s electrolytes, and as a result cause an irregular heart beat and possible heart attack.
To reduce the likelihood of problems associated with an imbalance of electrolytes, it is important that you have the levels of electrolytes in your blood checked by your GP regularly. Your GP may prescribe you with potassium or other supplements to help maintain a stable level of electrolytes.
Research shows that loss of bone density and bone mineral deficiencies are common in individuals with eating disorders (especially anorexia nervosa), and that damage can occur early in the course of an eating disorder. If damage or insufficient growth occurs during adolescence, an individual may not achieve their optimal bone density, increasing the risk of developing osteoporosis. The main cause of osteoporosis is malnutrition and low weight.
Many hormonal changes occur when a body has insufficient reserves of fat and muscles. These include changes to sex hormones (testosterone and oestrogen) as well as high levels of cortisol, low levels of Insulin-like Growth Factor 1 (IGF-1) and Leptin – both are hormones critical to our body functioning. Changes in these hormones can slow bone development and even cause bone loss.
If osteoporosis develops, bones become fragile and are likely to break from the slightest injury or fall. Bone fractures, chronic pain, disability, and loss of stature (height) may also occur. Although we cannot reverse damage to bone health, the only way to prevent further bone damage is by treating eating disorders early and reversing malnutrition. A well-balanced diet rich in calcium and vitamin D and vitamin K is important for building and maintaining bone strength. A person would also need to work towards maintaining a healthy body weight and normalising body composition (particularly fat) to maintain bone health. Excessive exercise will deplete calcium resources.
If you, or someone close to you has signs of an eating disorder, it is important to see your GP and discuss seeking help immediately.
Author: Merryl Gee, BSocWk, AMHSW, MAASW, MACSW, MANZMHA, MPACFA.
Merryl Gee is a psychotherapist working from a strengths-based, person-centred framework. With over 30 years’ experience, she has a particular interest people who have experienced trauma such as sexual assault or childhood sexual abuse.
To make an appointment with Brisbane Psychotherapist Merryl Gee try Online Booking. Alternatively, you can call M1 Psychology Loganholme on (07) 3067 9129 or Vision Psychology Wishart on (07) 3088 5422 .