Eating Disorders
Over 1.6 million people in the UK are estimated to be directly affected by eating disorders. This is likely to be an underestimate as we know there is a huge level of unmet need in the community. This shows just how common eating disorders are.
It is a common misconception that eating disorders are caused by the media. While it is a contributing factor, it is not the sole cause. People are normally predisposed to eating disorders without the media influence.
I am not going to write the generic crap about Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder, but I will be discussing those in this post, as well as a lesser known eating disorder called Orthorexia Nervosa. Before I start discussing these, I want to eliminate the myth that eating disorders have a specific look or body type. This is completely untrue, and actually most people struggling with eating disorders are at a healthy weight. On top of this, many people at a healthy weight struggling with a restrictive eating disorder feel they are “not sick enough” or “thin enough” to ask for help and this is further influenced because of the misconception that eating disorders are a certain body type. About 40% of people referred to eating disorder clinics are classified ‘Eating Disorder Not Otherwise Specified’ with symptoms that don’t fit neatly into either the anorexia or bulimia classifications. This myth isn’t just limited to restrictive eating disorders. Being overweight is not exclusive to Binge Eating Disorder. I want to clarify that eating disorders are MENTAL HEALTH ILLNESSES. While there are physical implications, they are not physical conditions.
The most commonly heard of eating disorders are Anorexia Nervosa and Bulimia Nervosa. Anorexia is a restrictive disorder, meaning that a person will restrict their food intake, count calories and have fear foods which they will avoid. Rituals and habits such as only smelling food or chewing and spitting food are not uncommon. Bulimia is an eating disorder where a person will binge and purge, meaning they may eat a lot of calories in one sitting, then purge the food. Purging can be done either by induced vomiting, using laxatives and over exercising. At the same time, it is not uncommon for people with Bulimia to restrict their food, as well as people with Anorexia to purge. It is not unusual for the two disorders to cross over. However, the disorder that has the most prevalent symptoms will be the diagnosis. For example:
A male restricts his food intake, counts calories and avoids certain foods. He is underweight with a low BMI. After eating he takes part in induced vomiting. However, his symptoms don’t signal towards Bulimia because of the absence of regular binge eating. His diagnosis is Anorexia Nervosa.
Binge Eating Disorder
From the National Centre For Eating Disorders:
Binge and compulsive overeating is where someone feels compelled to eat when they are not hungry and who cannot stop when they have had enough. It affects more people than both anorexia and bulimia. We know that 1 in 2 people who seek help for their weight problem eats compulsively. Put another way, about 12 million people in the UK suffer from compulsive overeating to some extent.
Binge Eating Disorder symptoms include:
- Eating faster than usual
- Eating large amounts of food in a short space of time
- Eating beyond feeling full
- Eating in secret due to embarrassment
- Feeling guilty after bingeing
- Compensating for overeating by dieting or restricting food
Orthorexia Nervosa
Orthorexia Nervosa is currently not a recognised eating disorder in the Diagnostic and Statistic Manual, also known as the DSM (USA) or the International Classification of Diseases (UK). The term and disorder was coined by American physician Steven Bratman. He proposed Orthorexia as an eating disorder characterised by an obsession with healthy (or “pure”) foods. Many may see this as a diet. However, the difference between Orthorexia and a diet is how much a person is affected by the illness. For example, someone on a diet may be strict or feel guilty for treating themselves. Someone with Orthorexia may suffer social isolation, anxiety, depression, malnutrition or even death. Orthorexia can also lead to Anorexia Nervosa or Bulimia Nervosa. The person suffering will not allow themselves to eat anything other than is deemed “healthy” or “pure”. For example, a person may only eat certain types of fruit and have a huge fear over other types of fruit.
In 2016, formal criteria were formed in the peer-reviewed journal Eating Behaviors by authors Dr Thom Dunn of the University of Northern Colorado, and Steven Bratman. The criteria is as follows:
Criterion A. Obsessive focus on "healthy" eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue, but this is conceptualized as an aspect of ideal health rather than as the primary goal. As evidenced by the following:
- Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health. (Footnotes to this criteria add: Dietary practices may include use of concentrated "food supplements." Exercise performance and/or fit body image may be regarded as an aspect or indicator of health.)
- Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame.
- Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe "cleanses" (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy food.
- Malnutrition, severe weight loss or other medical complications from restricted diet
- Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet
- Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined "healthy" eating behavior.
One thing I would like to address is the myth that eating disorders are all about thinness and weight loss. This is just a symptom, not the entire disorder. Many sufferers have impaired thinking and beliefs, such as losing weight will make them happy or successful, though the opposite is true. As the disorder grows, many people usually become extremely depressed and highly anxious. Megan Jayne Crabbe, author of Body Positive Power and also known as @bodyposipanda on Instagram wrote:
'I refuse to keep chasing that empty promise of happiness granted through restriction and self hatred. I'll take my happiness right now. We are all so worthy of it, exactly as we are.'
Recovery
While there is no “cure” for eating disorders, treatment/management of the disorder and recovery is possible. However, recovery requires a lot of hard work from the sufferer and the intervention team and can take a lot of years. Also, it is very common for someone recovering from one eating disorder to develop a different type of eating disorder, e.g. a person recovering from Anorexia may develop Binge Eating Disorder. Recovery usually includes Cognitive Behavioural Therapy to challenge negative thoughts and cycles that the person might be stuck in. It can also include a dietitian to help the person gain more nutrients in a healthy way and to stick to a balanced diet plan. A lot of the work comes from the sufferer themselves, including challenging themselves by slowly introducing fear foods into their diet, or to try and lessen their purging.
Many people today find inspiration for their recovery through the Body Positive Community, which is a growing movement on Instagram and blogs. A few of the most well known Body Positive bloggers are:
- Megan Jayne Crabbe- @bodyposipanda
- Milly Smith – @selfloveclubb
Recovered from an eating disorder, and with 186,000 followers Milly is empowering women all over the world. She is currently battling cervical cancer at the moment and raising awareness of living with both a physical illness and a mental illness. - Grace Victory- @gracefvictory
With 131 followers on Instagram, Grace is a cancer fighter and mental health advocate, trying to eliminate fatophobia and showing the world that size doesn’t equate to worth. - Any BODY- @any.body.co
This Instagram consists of two Australian models and best friends, Georgia Mae and Kate Wasley. Through their Any BODY account, they promote loving all bodies no matter of size, self love and positivity.
EATING DISORDER HELP
If you or someone you know is struggling with disordered eating or obsessions, no matter what their weight or size, it is extremely important to get help. There are plenty of ways to do this- a trip to the GP who can refer you to mental health services or your Care Coordinator if you’re already in mental health services. There are also charities that give therapy, such as one to one or group therapy.