We all make food choices such as becoming vegetarian or eating more healthily. But sometimes a change in eating habits can be a problem, particularly if food is being used to cope with painful experiences or feelings. An eating disorder occurs when there are serious disturbances in eating behaviour, such as extreme reduction of food intake or severe overeating, as well as distress about body shape or weight.

Eating disorders are not due to a failure of will or behaviour, they are illnesses which develop due to maladaptive eating patterns spiralling out of control.  Eating disorders frequently develop during adolescence or early adulthood,  but their onset can occur during childhood or later in adulthood.  Eating disorders frequently occur with other psychiatric disorders such as depression,  substance misuse, and anxiety disorders.  The disorders can lead to a wide range of physical health complications, including serious heart conditions and kidney failure which can be fatal

This fact sheet covers:

• What types of eating disorder are there and what are the symptoms?
• What causes eating disorders?
• What are the treatments for eating disorders?
• How can I help someone with an eating disorder?

Anyone can develop an eating disorder regardless of age, sex, cultural or racial background. Females are more likely than males to develop an eating disorder but it is thought that eating disorders in males are greatly under diagnosed and should be acknowledged as a growing issue. According to ‘beat’, the eating disorder charity, at least 10% of people diagnosed with an eating disorder are male.

What types of eating disorder are there and what are the symptoms? 

• There are a number of eating disorders, and this factsheet covers the following:
• Anorexia nervosa Bulimia nervosa
• Other eating disorders and eating problems

Anorexia nervosa 

Anorexia more commonly starts in the teenage years. About 1 in 250 teenage girls and young women and 1 in 2000 teenage boys and young men have anorexia. This is a disorder which makes eating very distressing and people with anorexia often have a distorted perception of how they look. They are likely to think they are overweight even when they have become dangerously thin.

Unusual eating habits develop in order to avoid eating properly, such as avoiding food and meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. They may deny hunger, make excuses to avoid eating, will often hide food they claim to have eaten. People with anorexia may repeatedly check their body weight, and many try other ways of controlling their weight, such as intense and compulsive exercise, or getting rid of what they have eaten by vomiting and abuse of laxatives, enemas or diuretics. Girls with anorexia often stop getting their period.3

Signs of anorexia nervosa

• Visible self starvation
• Obsession with weight and appearance
• Obsession with calories and fat content of food
• Obsessive exercise
• Keeping lists of food or a ‘food diary’
• Self-defeating statements after food consumption.
• Low self-esteem. Feeling worthless, putting self down as being “too stupid” or “too fat” and
  saying they don’t matter.
• Need for acceptance and approval of others.
• Unusual food rituals or habits such a cutting up food very small, shifting it around on plate,
  not swallowing food, hiding food
• Reading books and visiting websites about weight loss methods

Physical effects often improve when someone recovers, but there is a risk of long-term damage such as osteoporosis. It may be useful to talk to your doctor about any steps you can take to reduce your risk of developing long-term problems.

Bulimia nervosa 

Studies suggest that 8 in every 100 women will develop bulimia at some point in their lives but the condition frequently begins in the late teens.4 Men can also develop bulimia but it is less common than in women. Bulimia can develop where people have had anorexia in the past.

Bulimia nervosa translates as ‘nervous hunger of an ox’,5 but it is actually a hunger which is an emotional need not satisfied by food. After binge eating to fill the emotional or hunger gap, there is a state of panic to get rid of the eaten food. This will be done by vomiting and/or taking laxatives, by starving or working off the calories by exercising excessively. This is often referred to as ‘purging’.

People with bulimia often perform the behaviours secretly, feeling disgusted and ashamed when they binge, yet relieved once they purge. They are often fascinated by food, sometimes buy magazines and cook- books to read recipes, and enjoy discussing dieting issues. They may regularly engage in stringent diet plans and exercise.

Signs of bulimia nervosa 

• Uncontrollable urges to eat vast amounts of food
• Obsession with food or feeling out of control around food
• Anxiety and depression; low self esteem, shame and guilt
• Distorted perception of body weight and shape
• Bingeing and vomiting
• Regular stomach upsets/ lots of time spent in bathroom
• Disappearing into toilet straight after meals to vomit
• Avoiding eating in front of others
• Excessive use of laxatives, diuretics or enemas
• Periods of fasting, moods swings
• Excessive exercise
• Secrecy and reluctance to socialise
• Shoplifting for food/ overspending on food
• Food disappearing or being hoarded

Effects of bulimia nervosa on the body

• Frequent weight changes
• Sore throat, tooth decay and bad breath caused by vomiting
• Swollen salivary glands
• Poor skin condition and possible hair loss
• Irregular periods
• Lethargy and tiredness, mineral imbalances in body
• Increased risk of heart problems, increased hair growth on face and body
• Damage to bowel, puffiness of face and fingers
• Kidney disease, intestinal damage

Other eating disorders

Not all symptoms will apply to all people for the eating disorders in this factsheet, there will be variations. For example, a diagnosis may be made of a ‘partial syndrome’ which might suggest that a person has an eating disorder but does not meet all the diagnostic criteria e.g. a woman may have anorexia but still has periods.
An eating problem might be specific to a certain eating behaviour, such as chewing and spitting food without swallowing, or swallowing food and then regurgitating it. Some people eat items such as tissues to fill up on without calorie intake.
Where someone has elements of an eating disorder, or has symptoms that do not normally fall within the diagnosis of one of the main eating disorders, they are said to have an ‘atypical eating disorder’ or an ‘eating disorder not otherwise specified’ (EDNOS)

Binge eating disorder (BED)

People with binge-eating disorder experience frequent episodes of out-of- control eating, eating large quantities of food in a short period of time uncontrollably, with the same binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating disorder do not purge their bodies of excess calories. This can mean many people with this condition are overweight for their age and height.

People may binge as a way to cope with difficult emotions such as unhappiness, guilt or low self-esteem and to cope with daily stresses and problems in their lives. Because people with binge-eating disorder are often overweight they are at risk of a heart attack, high blood pressure and cholesterol, kidney disease and/or failure, arthritis and bone deterioration, stroke and diabetes.

Compulsive overeating

People with compulsive overeating have an “addiction” to food, using food and eating as coping strategies similar to people with binge eating disorder. People suffering with this disorder are often overweight, so at a greater risk of a heart attack, high blood pressure and cholesterol, kidney disease and/or failure, arthritis and bone deterioration, stroke and diabetes.

Signs of binge eating disorder and compulsive eating

• Fear of not being able to control eating, and of not being able to stop eating
• Fear of eating around others
• Believing that life will be better if they lose weight
• Putting self down with comments after eating
• Blame their failure in social and professional life on weight
• Depression/ mood swings
• Fatigue
• Using a variety of popular diet plans
• Hiding food in strange places to eat later
• Vague or secretive eating patterns

Effects of binge eating disorder and compulsive eating on the body

• Getting out of breath after light activity
• Excessive sweating
• High blood pressure and/or cholesterol
• Leg and joint pain
• Weight gain
• Decreased mobility due to weight gain
• Loss of sexual desire or promiscuous sexual activity
• Insomnia
• Poor sleeping habits

Other eating problems

Other conditions can also cause unusual eating patterns or behaviour, but are not classified as eating disorders.

Prader Willi syndrome

This is actually a genetic, rather than emotional, disorder which results in excessive eating from early childhood. This may lead to tantrums and learning difficulties and children may not grow full height for their age.

Pica

This is a disorder where people eat items which contain no nutritional value including dirt, plastic, pencil erasers, faeces, paper, coal, chalk and wood. Pica most commonly affects children or people with developmental disabilities. Depending on the substance eaten, this behaviour could be dangerous and lead to poisoning.

1. What causes eating disorders?

Like with all psychiatric illnesses, there is no single factor that causes someone to develop an eating disorder. A person’s experiences, personality and genetic make-up may all play a part in the development of an illness. Factors can include a person’s culture, family life, things that have happened to them or that they have seen, feelings that they need to act on impulse or that they need to achieve perfection and physical or genetic factors.

Some people believe that eating disorders are a direct result of the pressure from media and fashion to be thin. Whilst this kind of pressure can play a part in dieting behaviours, there are clearly more complicated issues that cause only some people to lose control of their eating behaviours and suffer distress.

For people with anorexia nervosa, their obsession with weight loss may be due to the belief that their value as a person depends on their weight and body shape. This can lead to an intense fear of being overweight and eating that most people do not experience, even when dieting. Anorexia nervosa stems from some emotional need, which could be lack of stability in current relationships, anxiety about growing up or experiencing body change, or trying to cope with something traumatic such as sexual abuse. Anorexia can develop even if a person has a very supportive family, partner or friends, so it’s important to remember that it is no one’s fault.

Bulimia nervosa may develop because a person needs an emotional release for a range of issues, such as experiencing physical, emotional or sexual abuse, or difficult family or other relationships. It might be that there isn’t an obvious reason but a person still needs an emotional outlet. Bulimia and other eating disorders are clearly destructive coping strategies, and someone suffering in this way needs support to recover.

2. What are the treatments for eating disorders?

Early treatment is very important, but this is not always possible when someone refuses to see a doctor.  When someone with an eating disorder gets to a level of acceptance of their situation where they want to change, treatment will aim to restore regular and healthy eating patterns, and deal with psychological and emotional issues. Teaching individuals new coping strategies is often part of therapy plans. Your first step is usually through your GP, who can begin the referral process onto specialists and treatments as needed.

There are a number of different types of treatments for eating disorders, and people may be offered a combination of these:

• For those at a very low weight, the first stage will focus on getting weight put on, before therapy begins. This may be done as an in- patient at a hospital or specialist facility
• Talking therapies are often an important part of eating disorder treatments and may include; counselling, cognitive behaviour therapy (CBT), interpersonal therapy (IPT), group therapy, and family therapy. The most suitable treatment for an individual depends on their age, weight and situation
• Family support to help a family address any issues which may have led to the eating disorder and to support the family as a whole
• In some cases medication may be prescribed, such as antidepressants, but medication should not be the only treatment for eating disorders

This can be very distressing for people with anorexia as feeling in control is such an important need for them. Hospitalisation should only ever be part of a wider approach which addresses reasons for the disorder developing in the first place.

According to the Royal College of Psychiatrists, more than half of people with anorexia recover after being ill for an average period of 5-6 years.  Some of the most severe cases of anorexia may be fatal, though this rate is much lower if a person stays in touch with medical care. As long as the heart and other organs are not damaged, the other complications caused by starvation will improve slowly when the person is eating again.

3. How can I help someone with an eating disorder?

If you are worried about someone, you can try talking to them about what you have noticed. Perhaps they will be willing to see a doctor to speak about their feelings and habits. A supportive environment can help a person recover, so ask the person how you can help. Many people with an eating disorder will deny that anything is wrong if someone tries to confront them about the issue. If they are determined not to talk about it, you could suggest that they at least read a little about eating disorders to help them recognise their own situation. They may even be relieved that it is a recognised condition for which there is support and treatment.

If someone is vomiting regularly, this can be very bad for their teeth. They should not brush their teeth after vomiting. Instead, they should use a non-acidic mouthwash and should avoid acidic food and drinks, such as ‘fizzy drinks’.