“Disordered eating,” sometimes called chaotic eating, is common in our culture. It can range in severity from mild to extreme. At the milder end are irregular eating patterns, such as skipped meals, or yo-yo dieting. But at the extreme end are medically defined eating disorders that can become life-threatening.
Eating disorders are hard on both physical and mental health. They can disrupt family life, friendships, and everyday life. Eating disorders almost never disappear without professional help. The earlier help is obtained, the easier recovery will be.
If thoughts about food, eating and body image start making you feel bad, it’s time to get some help. The sooner, the better.
Eating disorders are complex conditions that can start at a young age. There are four medically defined types of eating disorders: anorexia nervosa, bulimia nervosa, binge eating and other specified feeding and eating disorder(OSFED)
- Between 1% and 2% of adolescents and young adults have an eating disorder.
- Most of those affected are female.
- Anorexia usually starts in puberty, while bulimia tends to develop a few years later.
- Eating disorders often develop gradually and may grow out of cycles of dieting.
There’s no single cause of eating disorders, but some people are more likely than others to experience them. Personal risk factors include:
- feelings of low self-esteem or self-worth
- feeling a general lack of control, feeling powerless
- a need for perfection
- difficult family relationships
- a history of abuse or trauma.
Eating disorders are more about issues of control and self-worth than about food. The ability to control food intake and the body itself become tightly connected to feelings of self-worth.
Eating disorders may mask other problems. They may start as a way of coping with personal issues, but in time they create more problems than they solve. It’s common for persons with eating disorders to have other mental health problems such as depression, anxiety or substance abuse issues.
People with eating disorders seldom see that they have a problem, which is a barrier to getting the help they need. At the same time, persons with eating disorders can experience shame and guilt and may try to hide their food-related activities. This can make it difficult for friends or loved ones to know there’s a problem.
Eating disorders are dangerous and do not go away by themselves.
Types of eating disorders
Anorexia nervosa usually starts at puberty and 90% to 95% of those with anorexia are female. Within 10 years of its onset, 10% of people with anorexia will die from the illness and its complications, including suicide.
Anorexia amounts to self-starvation and includes:
- the need to be very thin along with a fear of being fat
- a preoccupation with weight and body image
- a distorted body image; feeling overweight no matter how thin
- obsession with food
- Sense of low self-esteem and feelings of self-worth that are closely tied to body image.
Outward signs can include:
- eating very little, sometimes to the point of starvation
- limiting the types of foods consumed, becoming more restrictive over time
- over-exercising, spending more and more time working out
- using diet pills and laxatives
- denial of hunger
- obvious ongoing weight loss that cannot be reasonably explained
- making frequent comments about feeling fat or overweight
- avoiding situations that involve food, so avoiding mealtimes or social occasions.
As the disorder progresses, health impacts can include:
- slowed heart rate and low blood pressure
- lethargy, muscle weakness, risk of fainting
- signs of starvation such as hair loss, lack of menstrual periods, skin changes, yellowing of the palms or soles of the feet
- growth of downy hair all over the body to keep the body warm
- reduced bone density
- irritability, depression, difficulty concentrating
- increased risk of heart failure[BT1] .
For someone with anorexia, weight is controlled by severely limiting the amount eaten. A person with bulimia nervosa eats, but follows it with purging. More common than anorexia, bulimia can involve:
- an ongoing cycle of uncontrollable binge-eating followed by purging – that is, getting the food out of the body – in an effort to erase the effects of the food binge
- forced vomiting and overuse of laxatives, diuretics and diet pills
- over-exercising, fasting and dieting
- extreme concern about weight, though body weight may remain normal, or “yo-yo” up and down
- self-esteem tied to body image.
Signs of bulimia can include:
- obsessive exercising
- physical effects from frequent vomiting such as swollen cheeks or jaw, discoloured teeth, or hardened, thickened skin on the back of hands
- evidence of purging, such as frequent trips to the washroom after meals, packaging from laxatives or diuretics in the trash, or signs (smell, traces) of vomit or diarrhea
- lack of energy
- rapidly disappearing food supplies or empty packaging from a lot of snack products
- frequent weight checks
- reduction of normal activities, including withdrawal from social activities, as the bulimic activities become an intense, consuming interest.
Health impacts of bulimia can include:
- bowel disturbances, constipation
- inflamed esophagus, possible ruptures
- tooth decay and staining
- heart trouble
- electrolyte imbalance[BT2]
The fact that a person with bulimia may be a “normal” weight can help to hide the disorder from others. But, like anorexia, bulimia is a very serious medical condition that requires professional help.
Binge Eating Disorder
Binge eating involves:
- frequent episodes of overeating, often in secret, often of junk food
- feeling a loss of control during the binge
- feelings of guilt, shame or disgust about bingeing.
This disorder does not include the purging seen in bulimia, but it can involve cycles of dieting or fasting. Outward signs may include:
- weight gain
- eating alone.
Health impacts of bingeing can include:
- high blood pressure
- joint pain and distress (from carrying extra weight)
- heart disease.
Other Specified Feeding and Eating Disorder (OSFED)
Some eating behaviours that cause a great deal of distress do not fit neatly into one of the three main types of eating disorder. OSFED is the diagnosis used in these cases.
What intervention is available?
Eating disorders are complicated. Intervention will include help from a combination of medical, psychological and nutrition experts, along with help from the family. The basic goals of intervention are to restore health, reach and maintain a healthier weight, normalize eating habits, and feel better psychologically and physically.
Intervention may include:
- individual or group counselling[BT3]
- family-based therapy (FBT)
- medications, sometimes
- hospitalization, if necessary.