People often think about ED as Dieting. Whereas Dieting is often for the improving the health of the body by losing a bit of weight slowly, ED is an illness when a person tries to feel better about their life through food / lack of food. It can be caused by many factors – depression, stress, lack of self-esteem, pressure from friends/media, trauma etc.
What is Anorexia Nervosa?
Anorexia Nervosa is a serious eating disorder and mental health condition whereby the individual tries to keep their weight as low as possible by strictly controlling and limiting what they eat. They have an intense fear of gaining weight and feel compelled to continuously lose weight despite being underweight. Excessive exercise often accompanies anorexia nervosa as well. They might also develop an obsession with food and diet and may therefore excessively count calories in food even if they do not intend to eat it. Some people binge eat and then try to get rid of the food by vomiting or use of laxatives. There may be many causes of anorexia but scientists suggest that the condition results from biological, psychological and environmental factors. An individual may believe that they are fat/overweight, they may have a strong fear of being fat and they may have an overwhelming desire to be thin.
Signs and Symptoms
- A person with anorexia nervosa will lose a lot of weight deliberately for example, by eating as little as possible, vomiting, over exercising and abuse of laxatives.
- A person with anorexia nervosa will want their weight to be as low as possible.
- They will be terrified of gaining weight.
- After eating they may try to get rid of food from their body.
- They may use any available opportunity to burn calories.
- They may abuse laxatives or diuretics to make food leave the body as quickly as possible.
- People who suffer from Anorexia Nervosa usually do not lose their appetite and so they would still feel hungry. However they may tell lies about what they have eaten, give excuses for not eating, find it difficult to think about anything other than food, pretend they have eaten, tell lies about how much weight they have lost and so on.
- A person with anorexia nervosa may strictly diet, count calories excessively, avoid food which they believe is fattening, miss meals, avoid eating with other people, take appetite suppressants and cut food into small pieces (so that it looks like they have eaten more than they actually have).
- They may drink fluids which contain caffeine so that they can get a low-calorie burst of energy.
- They may hide how thin they are by wearing baggy clothing.
- A person who suffers from anorexia nervosa may believe that people will value them more as a person if they are thinner.
- They will see their exercise weight loss as a positive thing.
- They may have a distorted body image, for example they think that they are fat when they are not.
- They may have low self-esteem and self-confidence.
- Their school work or job performance may decline.
- They may find it difficult to concentrate.
- They might lose interest in activities that they previously enjoyed.
- They may grow lots of fine hair on their body, especially their face.
- Their pubic hair may become thin.
- Their heartbeat may become slower/irregular.
- They may have pain in their abdomen and feel bloated or constipated.
- They may feel the cold more and have a lower body temperature.
- They may feel light-headed, dizzy or weak.
- They may feel tired.
- They may notice a difference in their sleep patterns.
- They may suffer from hypotension (low blood pressure).
- They may suffer from swelling in the face, hands or feet (oedema).
- In children, puberty and growth spurts may be delayed.
- In women, periods may stop (amenorrhea).
Experts believe that anorexia nervosa is caused by a combination of psychological, environmental and biological factors. It is also believed that some people have distinct personality traits which make them more likely to suffer from anorexia nervosa.
Environmental factors including living in a culture where being thin is promoted and this can be emphasised through the media. This causes the person to develop a destructive cycle of excessive dieting and weight loss. Teenagers in particular may feel stressed and pressured into looking good during puberty which can trigger anorexia. Stressful life events such as the death of a loved one, abuse, difficult family relationships and so on could also trigger anorexia nervosa as restricting food may make a person feel more in control of their life.
Psychological factors include poor reaction to stress, tendency towards depression and anxiety, perfectionism (setting strict goals), obsession and compulsion (not necessarily OCD), feeling scared/doubtful about the future.
Extreme dieting can disrupt the normal functions of the brain which may make anorexia symptoms worse. Malnutrition can disrupt the balance of hormones in the body which could disrupt the normal functioning of the brain.
The doctor will assess the patients eating habits and weight and they may ask questions such as how the individual feels about their weight, if the individual believes that they are overweight even if others think that they are thin, if the individual makes themselves vomit, if the individual (woman) still has periods and if not, how long the periods have stopped for.
The doctor is not trying to catch you out, they are simply trying to ascertain the seriousness of your symptoms so that they are better able to help you out. It is important to answer the questions honestly. They will not judge you.
They may check the individuals weight which is usually about 15% below average for their height, age and sex. They may also calculate your Body Mass Index (the normal BMI for adults is 20 – 25 but people with anorexia may have a BMI below 17.5).
The doctor may also check your pulse and blood pressure and may take a blood test to diagnose anorexia nervosa. They will test the level of fluids in the blood and the level of minerals such as potassium.
If your GP believes that you have anorexia nervosa, they may refer you to a specialist for a detailed assessment however sometimes the GP may carry out the detailed assessment themselves.
Before you treatment begins there will be an overall assessment of your health (either by your GP or another healthcare professional) checking your health/medical needs, social needs, how severe your condition is and so on.
Where you are treated depends on the seriousness of your condition but it could be as an outpatient (most commonly), as a day patient/in a day unit, or as an inpatient in hospital (if your weight loss and symptoms are severe).
The treatment usually includes psychological treatment (speaking to a counsellor or therapist) and advice on eating/nutrition. These treatments work better when combined. Your physical health will be monitored closely e.g. your weight will be checked regularly and you may have regular health checks. If you take laxatives/diuretics you will be advised to reduce them gradually so that your body can adjust to the changes. You may also be given advice about dental hygeine to help prevent stomach acid damaging the enamel on teeth caused by vomiting. You will also be advised on how to gain weight safely. Your body will not be used to normal amounts of food so you are likely to gradually increase the amount of food intake over time.
What is Bulimia Nervosa?
People with bulimia try to control their weight by binge eating (eating a very large amount of high-calorie food over a short period of time without necessarily being hungry or needing it) and then purging (getting rid of food from the body) through the misuse of laxatives and vomiting. People with bulimia will also have an overwhelming fear of gaining weight/becoming fat and will therefore be very critical of their own weight. People with bulimia purge to maintain a chosen weight and purging will usually be done in secret. Bulimics purge because they feel guilty about binge eating however binge eating is compulsive and they feel that they cannot control it.
Signs and Symptoms
- Binge eating will occur regularly, not just once or twice
- Binge eating may be spontaneous or planned
- Feeling physically bloated after binging
- Feeling unattractive after binging
- A powerful fear of gaining weight
- Guilt and regret about binging
- Purging (self-induced vomiting, misusing laxatives, diuretics and diet pills, over-exercising, extreme dieting and/or periods of starvation and taking illegal drugs)
- Many sufferers may also suffer from low self-esteem
- Belief that they are overweight when they are in fact underweight or normal weight for their height/age/sex
- May set strict rules about dieting, eating and exercising
- If they fail to keep to these rules, they may binge on the things that they have denied themselves. This will often result in guilt which results in purging.
- You may also notice a regular change in weight in sufferers of Bulimia
- Obsessed with food and eating
- Spending too much money on food
- Episodes of over-eating and episodes of starvation
- You may notice scarred knuckles from forcing fingers down throat to vomit
- Sufferers of Bulimia may also suffer from anxiety and depression
- Some sufferers of Bulimia isolate themselves from others
There is no straight forward answer however professionals believe that Bulimia is caused by an overwhelming fear of gaining weight alongside other complex emotions which contribute to the problem including stress, depression, OCD, anxiety, personality disorders, post-traumatic stress disorder and low self-esteem. Binging and purging may be a way to deal with the emotions.
Social pressure to look thin through the media and fashion industry is another possible cause of Bulimia.
Hormonal changes during puberty can make a person more aware of their appearance and they may often compare themselves to others and become affected by eating disorders such as Bulimia. If they feel that they have no control over their lives, they may try to control it through binging and purging.
If someone has suffered from Bulimia within the family, it is believed that this may make it more likely for others in the family to suffer from Bulimia through genetics.
Though it may be a difficult and long process, it is possible to recover from bulimia but the first step towards treatment is recognising the problem and having a genuine desire to recover. This may involve big changes in lifestyle and circumstances. Treatment will involve psychological support/treatments to help sufferers of bulimia re-establish a healthy attitude towards food and eating and to help sufferers with potential underlying causes which contribute to their eating disorder such as anxiety, OCD and so on.
Psychological treatments include Cognitive Behaviour Therapy (CBT) which involves looking at your emotions and learning to think differently about food, eating and problems/concerns. Sufferers may also be asked to keep a food diary to help determine what triggers episodes of binge eating. Another psychological treatment which may be available is Interpersonal Therapy which involves meeting with a therapist to discuss ones condition but the focus is on their personal relationships rather than their relationship with food. If it is believed that the loss of a loved one or a big change in one’s life is the cause/trigger of Bulimia, they are more likely to have Interpersonal Therapy. The most common therapy, however, is CBT.
Selective Serotonin Reuptake Inhibitors (SSRIs/antidepressants) may be used to help treat bulimia as this can also help with possible underlying conditions such as depression, anxiety and social phobia.
Hospital treatment is rare for Bulimia unless the sufferer has serious health complications and their life is at risk. The overall aims of treatment in order for the sufferer to recover is to change their eating habits, change their attitudes about food and to gain weight safely if necessary.
It is important to start treatment as early as possible because the longer someone has bulimia, the harder it is to re-learn healthy eating habits.
Binge Eating Disorder
What is Binge Eating Disorder?
This is an eating disorder where a person feels compelled to overeat on a regular basis; they will eat a very large amount of high-calorie food over a short period of time without necessarily being hungry or needing it. Binges are often planned and they will go on a food shop specifically for their binge-eating episode. However, binge eating will usually take place in private and the person feels that they have no control over their eating. They will often feel guilty or disgusted after binge eating. They may also be suffering from other conditions such as depression and anxiety. Binge eating can cause these to develop through guilty/self-loathing but can also be the underlying cause of binge eating.
Signs and Symptoms
- Binge eating is associated with obesity, where someone is very overweight with a Body Mass Index (BMI) of 30 or over. Obesity is a serious health problem because it can lead to other serious conditions such as high blood pressure, high cholesterol, type 2 diabetes, heart disease and asthma which can shorten life expectancy by six or seven years
- Unlike with sufferers of bulimia, sufferers of Binge Eating Disorder do not purge themselves to control weight
- Sufferers may have a number of physical effects due to fluctuating blood sugar levels, including sugar craving, stomach pains, intolerance to heat and cold, headache
- Sufferers may feel trapped in a cycle of binging, guilt, restraint and binging
- They are unable to understand why they cannot control their body’s sugar cravings
- They blame themselves for their weakness
- They often suffer from low self-esteem, depression and anxiety which is both a cause and effect of Binge Eating Disorder
Speak to your doctor about your eating habits and look for three or more of the following:
- Eating faster while binging - Eating until uncomfortably full - Eating when not hungry - Eating alone/secretly as a result of embarrassment about amount of food you are consuming - Feelings of disgust, guilty or shame after binging
There will be a self-help programme as an important part of treatment and it will look at ways you can break the binge eating cycle to tackle the eating disorder. There will also be psychological therapy including CBT to work out new ways of thinking about situations, food and feelings; psychotherapy to help understand your strengths/weaknesses and why you feel anxious; and adapted dialectal behaviour therapy (DBT) where you discuss all aspects of your eating disorder with a therapist. SSRIs/antidepressants may be prescribed to help reduce binge eating as depression and anxiety may be an underlying cause (as well as a result) of the eating disorder. There will also be a focus on losing weight healthily but the psychological issues need to be dealt with first if weight loss is to be successful/long-lasting.
Eating Disorder not Otherwise Specified (EDNOS)
Eating Disorders are very complex and in some cases, an individual may not meet the full diagnostic signs of Anorexia Nervosa or Bulimia Nervosa. Many people with eating disorders are therefore diagnosed with EDNOS. Examples of signs that a doctor uses to diagnose EDNOS:
- Meets all the criteria of Anorexia Nervosa except has regular menses
- Meets all the criteria of Anorexia Nervosa except despite significant weight loss, the individuals weight is still normal
- Meets all the criteria of Bulimia Nervosa except binges occurr less than twice a week or for a duration of less than three months
- An individual of normal body weight who regularly engages in inappropriate compensatory behaviour behaviour after eating small amounts of food
- An individual who repeatedly chews and spits out, but does not swallow, large amounts of food
EDNOS is usually much more difficult to diagnose and often unsuspected by other people because patients are not severely under/overweight.
Who suffers from Eating Disorders?
According to the NHS, around 1 in 250 women and 1 in 2000 men will experience Anorexia Nervosa at some point and the condition usually develops around the age of 16 or 17. Bulimia Nervosa is five times more common than Anorexia Nervosa and 90% of people with bulimia are female. Bulimia usually develops around the age of 18 or 19. Binge Eating Disorder affects males and females equally and usually appears later in life, between the ages of 30 and 40.
Supporting someone with an ED
People with eating disorders often don’t seek help through fear and they may hide their condition for years. They might find it difficult to admit that they have a problem or talk about their symptoms. The most important steps towards diagnosis and treatment is recognising that they have a problem and wanting to get better. Support and encouragement from people close to them is important.
Avoid telling somebody with an eating disorder that they're too thin, need to eat more, should go on a diet and so on because these often make the person suffering from the eating disorder feel worse which could worsen their condition and make them less likely to seek help.
Where to get help
If you are suffering from or believe that you are suffering from an eating disorder, please speak to someone you trust and perhaps ask them to go with you to visit your GP. If you do not feel able to tell someone you trust, there are many other places you can contact for support (see below for more details), including Nightline, Samaritans and B-eat.
Sources of support/advice:
You might also find other threads relevant:
- Samaritans – Samaritans have experience in supporting people with depression and with body image concerns. You can contact them any time (day or night) for support. If you feel unable to contact them on the phone, you could email them, write them a letter, text them or visit your local branch for support.
- Nightline - If you feel unable to speak to them on the phone or skype, you can email them or speak to them through instant messaging. They will listen to you and help you feel supported.
- B-eat – You can seek information about eating disorders on this website. Additionally, you might like to seek support by contacting the helpline, visiting the Adult & Youth Live Chat Service, visiting the message board or watch inspirational videos about beating eating disorders.
- Pale Reflections – This is an Eating Disorder support community which provides detailed information about eating disorders, seeking support for eating disorders and helping others who suffer from an eating disorder.
- Something Fishy
- Eating Disorder Association UK
- Purple Chocolate Forum
- A video you might like to watch
- An inspiring recovery video
Type(s) of treatment is up to the patient’s choice and the usefulness of treatment often depends on the individual. However, bear in mind that patients with ED are often afraid to ask for help / do not feel they deserve help. If you suspect your friends/family members are suffering from ED, it’s important to show concern and support, and to keep watch over them. Hope this would help clarify a few things about ED’s.
AND a VERY good book - Conquering Anorexia - Clare Lindsay. Although the author was Anorexic, it is also a very inspirational book for Bulimia & EDNOS. Reading the first page already struck me almost to tears because of the resemblance of our thoughts and feelings, and I would highly recommend it to those suffering from ED's as well as those who want to understand ED's.
The BEST BOOK I've read so far though is Wasted - Marya Hornbacher. It's another autobiography, and she was both bulimic and anorexic and I can identify with it so much. It explores many issues about eating disorders and I can identify so much with it. It is really worth reading. And for those without ED or want to understand it - it's a great read too.
Bulimia/Anorexia: The Binge Purge Cycle and Self-Starvation - Marlene Boskind-White, William C. White. This is the only self-help book which I've enjoyed reading about eating disorders, and it focuses more on Bulimarexia / Bulimia Nervosa more than Anorexia Nervosa. Highly recommend it.
Christopher Fairburn's Overcoming Binge-Eating. It's a 2-part book, the first covering things like diagnostic criteria, examples, statistics, symptoms, yada yada (very interesting). The book is focussed on bulimia nervosa and binge-eating disorder primarily. The second part is a self-help manual based around CBT. It's useful for family or friends to read as it really helps to explain what is going on and how best they can provide support.
- One-on-one therapy
- Support groups
- Cognitive Behavioural Therapy
- Medical / hospital treatment (for severe cases)
- Friends and family support network
One Members Experiences of Eating Disorders
I'm posting this because I want to let those who are suffering from the same problems know that it's not the end of the world. It is, on the contrary, the beginning of a new start.
I'll try to keep this brief so you won't get bored and I won't let myself drone on. I've been suffering from depression since longer than I know - mainly due to family problems - my parents have a very poor relationship. My depression grew, and in April 2003, it brought about my eating disorders. I went on a cycle: binge-bulemia-binge-anorexia-binge-anorexia-bulemia-binge. I lost at least 17 lbs in less than 2 weeks in my 1st anorexia, and the 2nd time only lasted for a week before I turned bulemic again, (that was brought about by my friend's suicide). I gained almost 25 lbs from Sept to Jan, and my mom finally found out. She confronted me, I refused to talk to her. I felt ashamed, and I wanted her to just go away and leave me alone. I thought she would have yelled at me for my bad attitude, but she was surprisingly patient and finally convinced me to see a shrink.
I started my treatment and medication. I also started realising the worsening of my mom's depression, which I've been suspecting for 2 years. She also found out about her - breast & uterus lumps, back/hip/neck-bone problems. Acknowledging my problems also got me to try understand depression & ED's. I finally begged her to see a shrink. She refused to believe she's depressed - partly because all her siblings and my cousins have developed depression (2 have schizophrenia). It took 2 months of endless begging to get her to see a shrink, by then it was May.
She also started reading up on depression and ED's, and we got closer than ever. When she breaks down, I become her "mother". When she cries, I try not to cry in front of her so she won't cry even more. One time she said, "When you return from uni, I'll probably be in a mental institute." I broke down the next day, and couldn't stop crying.
Despite all this, we've developed this trust that has never existed before. One night I didn't feel like eating, but she didn't force me to eat / make any negative comments. Instead, she just said, "It's OK then." Later, she lent me the book she bought on ED full of case studies which made me cry. I cried because I empathised them. I also cried because I finally realise why my mom has been so much more understanding lately. She's going through her depression, yet she still tries to understand my problems to help me. I regretted being so selfish in the past because I have always taken her for granted. I never appreciated her for her efforts and I felt so bad about it.
Ironically, it took our depressions to pull us together. But it also made me realise that although the path of recovery is long and difficult, it is not something to be afraid of, but to embrace. Cliche but true, because it means that everyday I'm getting better. I've had moments when I fell off-track and binged, and I was tempted to give up. But then I see my mom and I know that I should. Every morning when I take my medication, it reminds me that I've not given up, and I love and thank my mom more than anyone else.
So please, learn from my mistakes. For those without eating disorders, please don't take anyone for granted. And those in my shoes, please don't be scared to acknowledge your problem and receive treatment. It's not easy, but don't give up, because by stepping out of the dark and getting help, you've made the biggest step to a brand new start.