Let’s talk about Eating Disorders

by Dr Priya Rajyaguru
eating disorder awareness

This week marks Eating Disorders Awareness Week (25th February- 3rd March 2019) an annual event hosted by the Eating Disorders charity, Beat.

Setting the record straight when it comes to eating disorders is important given just how much misinformation there is online and on social media specifically. Knowing what’s fact or fiction can be really difficult when faced with info-overload from a variety of sources on a daily, sometimes hourly, basis. 

To begin, have a go at this task. Say the words ‘eating disorder’ out aloud, and pay close attention to any images, thoughts or ideas your mind conjures up. A person with an eating problem. A person who is really thin. A person who is female. A person who is white. A person who is a perfectionist. A person who is obsessed with their weight. These are just a selection of ideas that over the years I have heard both in the clinic and presented via the media. While none of these statements are explicitly wrong, they do over-simplify an incredibly complex group of mental health disorders; and in doing so increase the risk of misunderstanding at both patient and professional level.

If you had a go at the task above, did any of those suggested ideas come to mind? If they did, you are not alone and it simply highlights a real problem when it comes to the way we talk about eating disorders in society. Such stereotypes carry an undertone suggesting eating disorders are not serious illnesses and that they always take the same form ie. white, middle-class women and girls. These stereotypes are dangerous, they discourage people from seeking help and make it less likely for family, friends, employers and healthcare professionals in some instances, to take them seriously. It can also mean it’s harder for a sufferer or loved one to spot the warning signs to seek help.

What are Eating Disorders?
Eating disorders are a group of serious mental illnesses. While there are certain demographic factors that increase the risk of different types of eating disorders, it’s extremely important to remember that anyone regardless of age, gender, ethnicity, sexual orientation, or background otherwise can develop one.

Some examples of eating disorders include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and Other Specified Feeding or Eating Disorder (OSFED).

While there are specific differences between each of these conditions, it’s useful to remember that all eating disorders involve an unhealthy attitude to food and a fixation on body weight and shape; which can take over a person’s life and make them very ill.  It’s also possible for a person’s symptoms and diagnosis to change over time, so that what might begin as Anorexia later becomes a clinical picture more consistent with a diagnosis of Bulimia.
As an aside, while being underweight is a clear sign of certain eating disorders like Anorexia, you don’t have to be underweight or overweight for that matter to be displaying the warning signs of an eating disorder.
 
What about Orthorexia?

You may have come across another term in relation to eating disorders especially on social media, Orthorexia Nervosa. Orthorexia refers to an unhealthy obsession with eating ‘pure’ food. What is considered ‘pure’ can vary from one person to the next and often individuals have an intense fixation on healthy eating, focusing on the quality and purity of food as opposed to the quantity only.

While Orthorexia remains unrecognised as an official clinical diagnosis, as with all other eating disorders it can be extremely disabling and dangerous for sufferers.

What causes Eating Disorders?
Eating disorders are complex conditions. We don’t know exactly why people are affected by them and there certainly isn’t one single reason. We normally think about a range of different factors that when combined might play a part including genetic, psychological, environmental, social and biological influences.
 
How common are eating disorders?

At this current time, we don’t know precisely how many people are affected in the UK or worldwide. Part of the reason for this is that while there has been some excellent research over the last few years, there still isn’t enough evidence to draw firm conclusions about prevalence (how common a condition is in the population). In addition, it’s widely thought that many people suffering with eating disorders don’t come to the attention of healthcare services, so research needs to think about nonclinical or community-based samples alongside those clinical ones.

To get some idea however the charity Beat has estimated that about 1.25 million people in the UK have an eating disorder (1). They do make it clear that this estimate is based on research from other countries (mainly European countries, the USA and Australia) and provide some information about how they arrived at this figure on their website (1).

Signs and Symptoms of an Eating Disorder

While some of the features are specific to particular eating disorder types, as a general rule it can be helpful to think about the following if you are concerned about yourself or a loved one.

Emotional and Behavioural 
  • Spending a lot of time worrying about your weight and your body shape
  • Being fixated on the idea of losing weight and controlling food intake
  • Being preoccupied with all things related to weight, food, fat, calories, dieting
  • Refusing to eat certain foods and becoming extremely distressed if confronted with having to
  • Having strict habits or rituals around food
  • Feeling uncomfortable eating around others
  • Going to the bathroom a lot after eating
  • Skipping meals or taking small portions at regular meals
  • Suddenly changing dietary intake in line with trends or fads e.g. veganism or cutting out dairy
  • Frequent weighing on the scales or checking in front of the mirror
  • Extreme mood swings
  • Exercising too much
  • Being secretive
  • Hiding the truth from loved ones and going to some effort to conceal the reality of the situation
Physical 
  • Feeling cold, tired or dizzy
  • Problems with your digestion
  • Extreme fluctuations in weight
  • Not getting or missing your period for women and girls

While there are lots of other potential symptoms and signs, if you notice any of the above it’s really important to seek help.

How to get help 
If you think you or your loved one may have an eating disorder, it’s really important you/they see the GP as soon as possible. Even if you aren’t sure, it can still be really useful to see the doctor who will be able to investigate things further.

If they think you may have an eating disorder then you will be referred to an age-appropriate eating disorder service. For under 18’s that will usually involve a referral to a CAMHS eating disorder team. For those older than 18 years, it will involve adult services.

Taking the first steps to access help can be really difficult and by their very nature eating disorders are secretive and stigmatised. Mental health professionals are well aware of this and the conflict it can cause in families regardless of age, sex, ethnicity or other demographic factors. When referred to an eating disorders team, they will talk to you and your family to ensure you receive the best quality of care.

References
(1) Beat Charity’s breakdown of their statistic on prevalence available here. 

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