A whistle stop tour of eating disorders

If you’ve never had an eating disorder or experienced a loved one struggling, then you may feel mystified, as to what can stop a person wanting to eat. Eating is surely a fundamental, biological need. Why would someone deny themselves a basic survival for existence?

You may also wonder if it’s all about vanity or achieving a certain aesthetic. But then feel perplexed to notice that someone with an eating disorder has shockingly low levels of self-worth and will hide their body accordingly.

Skeletal bodies and emaciation may be your perception of an eating disorder. And, if someone has anorexia, then the physical change in the body is usually marked and obviously visible. Anorexia nervosa is the eating disorder that you will hear about in the media, as there are more often casualties to this illness, this being the mental health condition with the highest mortality rate.

Anorexia, however, is the tip of the growing iceberg of eating disorders and many people suffering from these conditions are normal weight or overweight, still experiencing a daily preoccupation and distress around food, but symptoms being hidden. 

Historically, you were often wrongly deemed ‘not ill enough’ for treatment, unless your weight was descending to alarming levels. Thankfully, the tide is turning and eating disorders are being recognised in people of all different shapes and sizes. Early intervention is vital for all eating disorders and can prevent a mental health chapter, turning into a lifelong struggle with food.

A psychological coping strategy

So why would someone choose not-to-eat or self-induce vomiting or punishing exercise for hours on end? 

An eating disorder is a psychological coping strategy. Not one that is chosen with conscious thought, but one that can firmly embed in someone’s psyche and then limit motivation to change.  So gentle encouragement to eat more from well-meaning loved ones will be likely met with huge ambivalence and fear, likened to taking away, what has become a life-raft in a turbulent river. 

The drive to control weight brings a fleeting boost to self-esteem when targets are achieved and met. The preoccupation with food can be a welcome escape from difficult emotions and a distraction from the ups and downs of life. 

An eating disorder can be a cry for help when communication through words feels impossible or someone feels unheard. 

When life is out of control, then controlling food can bring comfort, simplicity and predictability that other life areas cannot offer. It’s no surprise that NHS referrals for eating disorders have skyrocketed during the pandemic.

Five main eating disorders

Let’s take a closer look at the main eating disorders.

Anorexia nervosa

Anorexia nervosa involves intense restriction of food through calorie counting, omitting food groups or simply not eating enough. It can be disguised through the veil of clean eating and being ‘healthy’, when underneath lurks a terrible fear of weight gain, which can be extremely difficult to admit to. 

People with anorexia can purge through vomiting or laxatives and this then becomes know as purging-subtype.

Loss of periods is common in females and loss of sex drive is common across all genders. 

The impact of starvation on the body is momentous and someone with anorexia nervosa will experience physical and mental complications, which will interfere with living.  Poor concentration, isolation, tiredness, feeling cold and a constant, gnawing and obsession with food predominate.

Most people with anorexia can be treated in a community setting, whereas some will require an inpatient approach with much more intensive support.  Successful treatment involves a motivational approach to engage the sufferer in the process of change. Families can be integral in helping with this with their support.

Bulimia nervosa

Bulimia nervosa involves alternating periods of restrictive eating and binge eating when there is a significant loss of control around food. 

A binge involves eating a considerable amount of food, often several thousand calories in one sitting. Food is eaten rapidly and in secret.

A binge can fleetingly be enjoyable and almost euphoric, but quickly the shame and self-loathing descend, and someone will purge the food by vomiting, taking laxatives or compulsively exercising. Cycles can be relentless and extremely distressing. 

Bulimia can be dangerous with electrolytes becoming imbalanced and impacting heart function. Teeth are eroded by stomach acid through purging, and cheeks can become puffy as salivary glands work overtime to neutralise stomach acid. People with bulimia can be any shape or size and the illness is often hidden from others.

Binge eating disorder

Binge eating disorder shares the same restriction and then binge eating behaviour seen in bulimia, without the purging element. It causes extreme distress and physical and emotional discomfort.

People with binge eating disorder often gain significant weight from bingeing. They can feel incredibly isolated and alone, when told by society, to simply eat less and move more, with the illness lingering like a shameful shadow in the background. 

There may always be another diet looming on the horizon, seen as ‘the solution’ to all problems. Ultimately, this ignores the psychological coping element, and someone can be perpetually stuck in a relentless diet/binge cycle.

OSFED (Otherwise Specified Feeding or Eating Disorder)

Commonly, people with cross diagnoses or who do not fit neatly in a category. In this case, someone has OSFED. They may purge but not binge eat or symptoms may not meet eating disorder diagnoses. Anyone with OSFED should take this condition seriously and seek treatment as such.

OSFED includes atypical anorexia nervosa (an equally valid and troubling condition) involving the symptoms and behaviours of anorexia, whilst outward weight remains in what is deemed a healthy range.

If you are naturally more muscular, tall or larger boned, then the government's weight recommendations through BMI can be unhelpful and overlooking of a possible eating disorder.  Sadly, people may be unwittingly praised for their weight loss by those around them when they are suffering in silence from anorexia.

ARFID (Avoidant Restrictive Food Intake Disorder)

ARFID also warrants a mention but requires another article for discussion. ARFID involves issues with eating not motivated by a desire to change weight, but rather an aversion to taste, texture, sight of food, being a sensory-based food aversion, and/or a loss of appetite or interest in food and/or a fear of eating due to abdominal pain or vomiting.

In summary, eating disorders are complex, psychological illness. The criterion of being low weight will only capture a minority of sufferers, and eating disorders affect people of all shapes and sizes.

Do seek help early if you recognise that you are struggling with an eating disorder, as early intervention supports positive recovery outcomes.

For a comprehensive overview of the eating disorders, do visit BEAT. 

This article was written by Harriet Frew.