Registered Psychologist, Perth, Western Australia
What are eating disorders and disordered eating?
Eating disorders and disordered eating involve problems around eating behaviour, attitudes and beliefs about body shape and weight, and unhealthy weight management. There are many symptoms that are common to eating disorders which include;
- Dieting
- Food avoidance
- Binge eating
- Excessive exercise
- Eating rituals (i.e. cutting food into very small pieces, only eating at certain times of the day, weighing food)
- Skipping meals
- Fear of fatness
- Distorted body image
- Preoccupation with food
- Preoccupation with body weight
- Talking and thinking frequently about food, body image and weight
- Avoiding social situations that involve food or wanting to eat alone
- Playing with food rather than eating it
- Going to the bathroom straight after meals
- Self-acceptance and self-esteem overly based on body image and weight
- Wearing loose fitting clothing to hide weight loss
- Unbalanced eating (such as restricting major food groups i.e. carbohydrates)
- Obesity
Sometimes people with eating disorders engage in what is known as ‘compensatory behaviour’. This is behaviour that compensates for overeating and can include;
- Extreme dieting
- Fasting
- Use of laxative
- Use of diuretics
- Self-induced vomiting
- Excessive exercise
These behaviour traits become a problem for people when they begin to affect physical health, mental health, work performance, academic achievement or engagement in social activities.
Types of eating disorders
In individuals with Anorexia Nervosa you may see the following;
- Failure or refusal to maintain a normal body weight
- Intense fear of weight gain and body fat
- Distorted body image
- Self-esteem based on thinness
- Overly restricted diet or binging and purging
- Absence of menstrual cycle
In individuals with Bulimia Nervosa you may see the following;
- Binge eating and compensatory behaviour (vomiting, laxative use, excessive exercise etc.)
- Self-esteem overly based on body image
- Feelings of loss of control over eating
Individual with Binge Eating Disorder may display the following;
- Regular periods of binge eating
- Eating rapidly
- Eating when not hungry
- Eating alone
- No compensatory behaviour (vomiting, laxative use, excessive exercise etc.)
- Feelings of guilt or disgust after binging
However there are a large number of people who do not meet the strict criteria for the above eating disorders who can be considered to have Eating Disorders Not Otherwise Specified (EDNOS) if the symptoms are still having a significant impact on their quality of life. These people may display the some of the following symptoms;
- Binge eating
- Dieting and food control
- Excessive exercise and other compensatory behaviour (vomiting, laxative use)
- Fears of weight gain
- Preoccupation with food, weight and body image
- Distorted body image
- Self-acceptance and self-esteem negatively influenced by body image and weight
What causes eating disorders?
There are many factors causing of eating disorders and there is no single consensus between researchers or clinicians as to what the cause is. The development of eating disorders may involve a combination of the following factors and examples;
- Cultural – the cultural ideal to be thin
- Social – problematic family relationships or friendships
- Family of origin issues – adolescents striving for autonomy from the family by controlling their food intake
- Personality/psychological – depression, anxiety, feelings of inadequacy or loneliness, dealing with painful emotions and gaining a sense of control, perfectionistic personality traits, low self-esteem, disturbances in identity development
- Neurochemical – there is some speculation about a chemical imbalance (serotonin)
- Genetics – genetic vulnerability (eating disorders can run in families)
- Transition periods across the life span
Eating disorders across the lifespan
Although eating disorders are typically thought to occur in adolescent girls, they also occur in children and adults not excluding boys and men. Eating disorders tend to develop in adolescence or young adulthood but they may also develop in young children, middle aged people and the elderly. In midlife and beyond they tend to be underdiagnosed.
Transition periods across the lifespan may trigger the onset or relapse of eating disorders. The transition period between childhood and adolescence, as well as between adolescence and adulthood place youngsters more at risk of developing an eating disorder.
Other developmental transitions or experiences that may trigger disordered eating include;
- The death of loved one
- Divorce or widowhood
- An empty nest (children moving away from home)
- Loss of youthfulness
- Pregnancy
- Menopause and physical signs of aging
- Marital difficulties
- Medical illness
It is important for parents to know that the fear of gaining weight and distortions in body perception may not be present in children.
Health, social and psychological aspects of eating disorders
Eating disorders and disordered eating can be very detrimental to a person’s health. This is one of the reasons it is important to seek help and have a doctor involved in your treatment. Physical health consequences may include;
- Arrested growth
- Fatigue
- Constipation and diarrhoea
- Susceptibility to fractures
- Delayed menarche and puberty
- Absence of menstrual cycle
- Hypotension
- Dry skin
- Hypothermia
- Electrolyte imbalances
- Hormonal imbalances
- Decreased bone density
- Compression fractures
- Osteoporosis
- Infertility
- Kidney failure
- Liver failure
- Cardiac arrhythmias (irregular heart beat)
- Dental problems
- Reproductive system damage
Many individuals who suffer with eating disorders and disordered eating also have other psychological and social difficulties. Sometimes these other issues start before an eating disorder develops and at other times they can be the result of eating disorders or something that maintains them. Often there will be a complex relationship between these issues and the eating disorder. Some of these issues include;
- Depression
- Anxiety disorders (Obsessive Compulsive Disorder, Obsessive Compulsive Personality Disorder, Social Phobia, Social Anxiety, Agoraphobia and Generalised Anxiety Disorder)
- Childhood sexual abuse or sexual assault
- Low self-esteem
- Perfectionism
- Avoidance of emotions
- Difficulty in recognising and controlling emotions
- Substance use disorders
- Personality disorders
- Self-harming and suicidal ideation
- Interpersonal dependency
- Non-assertive and permissive interpersonal style
- Avoidance of interpersonal conflict, competition and rivalry
- Struggles to fill the ‘perfect’ role in the family of origin
How counselling/psychotherapy can help?
Many people with eating disorders or disordered eating patterns do not seek help. However it is imperative that people struggling with these issues seek treatment sooner rather than later, especially in childhood and adolescence. The longer these difficulties are present the more entrenched the thoughts and behaviour becomes, the harder it is to make changes. The most effective treatment involves the support of a psychologist/counsellor/psychotherapist, a general practitioner, a dietician and possibly a psychiatrist. Visiting any of these professionals to discuss disordered eating is a good start.
Psychological treatment may address the issue directly (through addressing the symptoms) or may target the underlying causes of the eating disorder (addressing relationship issues etc). It can help in the following ways;
- Establishing healthy patterns of eating and exercise
- Identifying the thoughts and beliefs that cause or maintain disordered eating and challenging them
- Changing behaviour that maintains the eating disorder
- Identifying and addressing interpersonal difficulties
- Learning emotion regulation skills
- Gaining insight and addressing issues around role transitions, grief and loss, unresolved relationship issues
- Improving self-esteem and self-acceptance
- Problem-solving skills
- Developing coping strategies
- Improving relationship and communication skills
- Mindfulness skills (detaching from distressing emotions)
- Managing relationships
- Building autonomy
- Education around realistic weight expectations, healthy eating patterns etc
- Identity development
- Preventing relapse
If you are experiencing any difficulties with eating disorders or disordered eating and would like help with this please contact Sherry-Lee Smith on 042 135 1020 or via email on the contact page.
Sherry-Lee Smith
Registered Psychologist
Mt Lawley Counselling Centre
13 Alvan St
Mt Lawley WA 6050