Download What is an eating disorder?

Each year, eating disorders affect over 900,000 Australians. Of great concern is the mortality rate
for eating disorders, which is the highest of the psychiatric illnesses (over 20%), given its
physiological complications and link with suicide. 1900 Australians died last year as a result of an
eating disorder. They are also strongly associated with other distressing mental disorders such as
anxiety, depression, personality disorders and substance abuse issues. Also contributing to the high
mortality rate is the reluctance to seek help. Less than 30% of sufferers in the last year sought help
for their disorder.
In early March 2015, the Deloitte Access Economics report stated that eating disorders would cost
over $27 billion of taxpayer money over the next 10 years, while better intervention initiatives
would cost only $2.8 billion over this period.
It is not surprising, therefore, that one of the key actions from the Mental Health Commission’s 2015
strategic plan is to ensure adequate training is provided to all staff in mental health services in the
recognition, assessment, referral pathways and treatment of eating disorders. Another outcome
from the plan is to prioritise the development of community-based care models. Both of these
actions will promote earlier intervention and will help people to get more effective help in a timely
manner.
What is an eating disorder?
An eating disorder is a serious mental health illness which involves having an unhealthy preoccupation
with eating and/or exercise and body shape/weight. It is important to understand that an eating
disorder can be extremely dangerous, and should be acknowledged as distinctive from a diet, fad, or
attempt to seek attention.
There are a number of different types of eating disorders, the most common of which being: Anorexia
Nervosa; Bulimia Nervosa; and Binge Eating Disorder. These will be discussed in greater detail later in
the article.
How do I know if my child has an eating disorder?
There are a number of different behavioural, physical and psychological warning signs for parents to
watch out for. The Butterfly Foundation outlines the below warning signs for parents. If your child is
experiencing several of the below, it is important to seek help from a professional.
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Withdrawal from social events and activities that they used to enjoy
 A focus on diets, calories, health and particular foods. They might talk about wanting to be healthier
or fitter and become obsessive about checking the nutritional content of what they are eating.
 They might become irritable or anxious around dinner time. They may refuse to eat certain foods or
whole food groups.
 Complaints about the way they look, e.g. “I’m ugly” or “I’m fat”, or negative comments about their
abilities, e.g. “I’m hopeless”
 Frequent weight changes or rapid weight loss
 Change in clothing style such as wearing baggy or oversized clothing
Causes of Eating Disorders
There is no single cause of developing an eating disorder. However, the National Eating
Disorders Collaboration Australia has identified certain risk factors:
Genetic vulnerability
Some evidence has linked the inheritance of certain genes that relate to appetite, mood,
metabolism, food intake and reward-pleasure responses. However, the biological cause of eating
disorders is not clear cut, due to the fact that studies are conducted post development of an
eating disorder, which could have had an impact on the findings, therefore making it difficult to
establish a direct cause and effect relationship.
Psychological factors
Certain personality traits are known to be linked to the development of eating disorders,
particularly to that of Anorexia Nervosa ad Bulimia Nervosa::
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obsessive-compulsiveness
neuroticism
core low self-esteem
negative emotionality
perfectionism
harm avoidance
traits associated with avoidant personality disorder
However, again, the direct cause and effect relationship is difficult to identify due to the impact
that eating disorders have on the thoughts, emotions and behaviour of sufferers.
Socio-cultural influences
Those who take on the Western beauty ideal of the “perfect body” can be at risk of developing an
eating disorder. Images in the media show unattainable images of beautiful slim women, and
handsome muscled men, which encourage body dissatisfaction.
What can I do to help my child develop a healthy relationship with food, exercise and weight?
Parents play a key role in their child’s relationship with food and body image. Here are some tips for
parents from Kasey Edwards, best-selling author and expert in body image among young girls:
1. Never talk about body weight
Kasey advices never to talk about your own weight or your looks at all in a negative manner. When
others talk about weight in front of your children, do your best to neutralise it. This will help to
teach them that looks and weight are unrelated to self-worth.
2. Never talk about food in terms of calories or what’s fattening
Speak instead about the nutritional value of food.
3. Don’t ban certain foods
It is important not to classify foods into black and white categories of good and bad, as this is not the
case with most foods. Some processed foods are OK at times as they taste good and are part of
certain social rituals (e.g. birthday cake) but don’t contribute to making us fit and healthy and strong.
Classifying foods as “bad” can create closet eaters who sneak such “bad” food and eat it in secret.
4. Try limiting “rules” around food
Kasey suggests having only one rule such as “you must eat something of everything on your plate” to
ensure a wide variety of nutrients. She also doesn’t recommend forcing a child to eat if they do not
feel hungry as this encourages them to be in charge of their own appetite and avoids food wars or
dining table power struggles.
5. Focus on how bodies work rather than how they look
Celebrate the amazing things one can do with their body — such as running, jumping, skipping, and
rolling. This will help to teach them to value their body for what it can do instead of what it looks
like.
What about if my child gets diagnosed with an eating disorder?
The National Eating Disorders Collaboration of Australia Offers 7 tips for families and carers of those
suffering with an eating disorder:
1. Read up on eating disorders and learn as much as you can about how to treat them better.
This will also enable you to better understand their point of view and what they are going
through.
2. Remember who the person is – they are more than just their illness. Help them to regain
their sense of identity outside of the disorder.
3. Open the lines of communication. Ensure you express how you are feeling but avoid
judgement and negativity. Also encourage them to express their feelings openly and
honestly.
4. Try to stay positive in your own mind and about them. Talk about future plans and point out
their positive attributes and strengths to build their self-esteem.
5. Ensure you are engaging in self-care. Acknowledge that you have a tough role to play and
make time to relax and do things to restore your energy so you are in better shape to care
for your loved one.
6. Be patient and try to remember that recovery from an eating disorder is a slow process and
takes time and perseverance.
7. Get professional support for yourself and for your loved one. This will help ease the stress
that is associated with suffering from and caring for someone with an eating disorder.
What are my rights?
You have the right to medical treatment if you fear for the life of your child. The Australian
Government Department of Health states that health professionals are legally required to ensure
safety, as they have a 'duty of care'. For example, hospitalisation against someone’s will, which is
covered by the Mental Health Act.
Even if your child doesn’t want help, when a person with an eating disorder refuses treatment,
parents or carers may obtain a 'legal order' that allows them to take control temporarily over the
patient and make decisions on their behalf to authorise medical or psychiatric treatments. This is of
course used only for the purpose of saving a life when all other options fail.
In Australia, persons over the age of 14 can seek a confidential medical consultation. If your child is
younger than 14 then you will be included in all discussions about your child’s health. For those over
14, only that information which your child agrees to share can be shared by the health professional.
Types of Eating Disorders
The Mental Health Association of NSW outlines the following types of eating disorders, their
specific symptoms, and possible treatments:
Anorexia Nervosa
People who intentionally starve themselves suffer from an eating disorder called anorexia
nervosa. The disorder, which often begins in young people around the time of puberty,
involves extreme weight loss - at least 15% below the individual's normal body weight. Some
people with the disorder look emaciated but are convinced they are overweight. Sometimes
they must be hospitalised to prevent starvation. People with anorexia typically starve
themselves, even though they may experience severe hunger pains. One of the most
frightening aspects of the disorder is that people with anorexia continue to think they are
overweight even when they are bone-thin. For reasons not yet understood, they become
terrified of gaining any weight.
Food and weight become obsessions. For some, the compulsiveness shows up in strange
eating rituals or the refusal to eat in front of others. It is not uncommon for people with
anorexia to collect recipes and prepare gourmet feasts for family and friends, but not partake
in the meals themselves. They may adhere to strict exercise routines to keep off weight. Loss
of monthly menstrual periods is typical in women with the disorder. Men with anorexia often
become impotent.
Specific Symptoms of this Disorder
A person who suffers from this disorder is typically characterised by their refusal to maintain
a body weight, which is consistent with their build, age and height. The individual usually
experiences an intense and overwhelming fear of gaining weight or becoming fat. This fear is
regardless of the person's actual weight, and will often continue even when the person is near
death from starvation. It is related to a person's poor self-image, which is also a symptom of
this disorder. The individual suffering from this disorder believes that their body weight, shape
and size is directly related to how good they feel about themselves and their worth as a human
being. People with this disorder often deny the seriousness of their condition and cannot
objectively evaluate their own weight.
Physical Effects
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Chronic indigestion
Loss of motivation
Chemical imbalances
Severe sensitivity to the cold
Loss or thinning of hair
Skin and nail problems
Growth of fine body hair known as ‘lanugo’
Severe weight loss
Treatment
The treatment of this disorder is often difficult. This is because of the disorder's insidious
nature that wreaks havoc not only with the body, but just as seriously with the individual's
negative self-perception. Starvation is not an immediate concern of most individuals who
present with this disorder, but body weight and nutrition should be thoroughly evaluated at
the onset of therapy. A complete medical examination is usually warranted to evaluate the
person's health and medical status. Underweight individuals often suffer from medical
complications.
The first line treatment for people experiencing anorexia nervosa is a combination of a
structured eating plan with nutrition and psychotherapy.
Psychotherapy
Psychotherapy needs to focus on a number of issues after a therapeutic, trusting relationship
has been established. The most powerful issue is the obsession with body image, which is also
the most difficult to change.
Hospitalisation
Hospitalisation of anybody experiencing mental distress can often be a confusing and
emotionally wrought decision. Family members or significant others may need to intervene in
the person life to ensure they do not starve themselves to death. In these cases,
hospitalisation is not only necessary but also a prudent treatment intervention. Family
members should be aware that individuals who suffer from anorexia nervosa will often resist
treatment of any sort, especially hospitalisation. It is important, therefore, to come to an
agreement about the need for such a step and not be swayed by the person's pleas for seeking
alternative treatment options. Often these have already been tried with no success.
Medications
Some medications can be extremely helpful in treatment of a person who suffers from
anorexia nervosa. As always, the medication should be carefully monitored especially since
the person may be vomiting which may impact on the medication's effectiveness. A trusting
and honest relationship must be established between the physician and the individual or
medication compliance will almost certainly become an issue.
Anti-depressants (such as selective serotonin re-uptake inhibitors, e.g. Prozac or Zoloft) are
the usual drug treatment and may speed up the recovery process. Chlorpromazine may be
beneficial for those individuals suffering from severe obsessions and increased anxiety and
agitation.
Self-Help
Self-help support groups are an especially powerful and effective means of ensuring the
engagement in long-term treatment and decrease the rate of relapse to starving behaviours.
Individuals find they can share ideas and experiences with one another get objective feedback
about body image, and just gain increased social support. Many support groups exist within
communities throughout the world that are devoted to helping individuals with this disorder
share their common experiences and feelings.
Bulimia Nervosa
People with bulimia nervosa consume large amounts of food and then rid their bodies of the
excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising
obsessively. Some people use a combination of all these forms of purging. Because many
individuals with bulimia ‘binge and purge’ in secret and maintain normal or above normal
body weight, they can often successfully hide their problem from others for years.
Family, friends, and physicians may have difficulty detecting bulimia in someone they know.
Many individuals with the disorder remain at normal body weight or slightly above. Dieting
heavily between episodes of binging and purging is also common.
As with anorexia, bulimia often begins during adolescence. The condition occurs most often
in women but is also found in men. Many individuals with bulimia, ashamed of their strange
habits, do not seek help until they reach their thirties or forties. By this time, their eating
behaviour is deeply ingrained and more difficult to change.
Specific Symptoms of this Disorder
This disorder is characterised by recurrent episodes of binge eating, occurring at least twice a
month for a minimum of three months, which consists of:
Eating, in a discrete period of time (e.g., within any two-hour period), an amount of food that
is definitely larger than most people would eat during a similar period of time and under
similar circumstances. The food that is eaten is often the type which the person would usually
try to avoid – such as sweet or ‘junk’ food.
A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop
eating or control what or how much one is eating).
Individuals who suffer from this disorder often try to prevent themselves from gaining any
weight. This behaviour may include such things as self-induced vomiting; overusing laxatives,
diuretics, enemas, or other medications; refusing to eat (fasting); or excessive exercise. A
person's self-image is usually directly correlated with their weight, with a great deal of
attention focusing on how their body looks.
This disorder can only be diagnosed if it is not better accounted for by anorexia nervosa.
There are two major sub-types of disorders found within bulimia nervosa:
Purging Type: - The person regularly engages in self-induced vomiting or the misuse of
laxatives, diuretics, or enemas
Non-purging Type: - The person has used other inappropriate compensatory behaviours, such
as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the
misuse of laxatives, diuretics, or enemas
Physical Effects
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Chronic sore throat
Burning or rupturing of oesophagus
Cessation of menstruation
Strain on the body organs
Delay in puberty
Decreased bone mineral density
Swollen salivary glands
Erosion of dental enamel due to constant purging
Weight fluctuation
Treatment
A complete medical examination is usually warranted to evaluate the person's health and
medical status. Underweight or overweight individuals often suffer from medical
complications, especially if the person is using laxatives or vomiting as a method of controlling
their over-eating behaviours. Psychotherapies are most effective when it doesn't so much
focus on the actual eating behaviours, although they are important, but instead examines the
causes of those behaviours, such as poor self-perception and body image distortions.
Medication
Some medications can be extremely helpful for a person who suffers from bulimia. Medication
should be carefully monitored especially if the person may be vomiting or taking large
amounts of laxatives which may impact on the medication's use and effectiveness. A trusting
and honest relationship must be established between the physician and the individual or
mediation compliance will almost certainly become an issue.
Anti-depressants (selective serotonin re-uptake inhibitors such as Prozac or Zoloft) are the
usual drug treatment and may speed up the recovery process. Phenytoin and carbamazepine
may also help reduce the frequency of the binging behaviours.
Self-Help
Self-help support groups are an especially powerful and effective means of ensuring
engagement in long-term treatment and decrease the rate of relapse . Individuals find they
can share ideas and experiences, get objective feedback about body image, and gain increased
social support. Many support groups exist within communities throughout the world that are
devoted to helping individuals with this disorder share their common experiences and
feelings.
Compulsive Overeating Disorder
It seems that in our society, people with compulsive overeating are not taken seriously in spite
of the fact that they have a serious eating disorder. Our society tends to glorify thinness whilst
not tolerating people who are obese.. Overeating is characterized by episodes of gorging,
continuous eating and of weight gain. Please note, that there is a difference between
compulsive binging and the occasional overindulgence we can all enjoy once in awhile. The
weight of an individual suffering from compulsive overeating may vary from normal to severe
obesity. A sufferer may be over exercising or ‘compulsive exercising’ in an attempt just to burn
calories and lose weight. Often they will sneak away behind closed doors to exercise in privacy.
Where the average person can enjoy exercising for health benefits, the sufferer often does
not and seems to forget that exercising can be fun and enjoyable. By over exercising, the
sufferer seems to feel they are in control and they gain a sense of self-respect. Like anorexia
and bulimia, the sufferer is driven and fuelled by their fear of gaining more weight. It is easy
to see how many over eaters can later develop bulimia or anorexia. Eating disorders are the
preoccupation with body shape, food, thinness and control and it’s no surprise when in
today's world we all seem to want the perfect body and shape in which we can feel good and
accepted.
Binge Eating Disorder
Binge eating disorder probably affects millions and is the newest recognisable eating disorder
and perhaps even the most common. While people with bulimia are perfect examples of binge
eating, it is rare for people with binge eating disorders to purge (self-induced vomiting) or use
laxatives or diuretics. However, just because someone overeats does not mean they suffer
from binge eating disorder. Some victims of binge eating disorder may show behaviours or
have feelings such as:
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They eat faster than usual.
Eat in privacy (usually over guilt and embarrassment about how much food is being
consumed).
They often feel they cannot control how much they eat.
They will frequently eat when they are not hungry.
Episodes of eating large quantities of food.
Frequent feelings of disgust, self-hate or guilt after eating.
Most sufferers of binge eating are obese. This is slightly more common in females than males.
It is even more common in those who suffer from severe obesity. This disorder can be very
difficult for those who have it and many who attempt to try and control it usually fail. There
are times where victims may not attend social functions, school or even work so they stay in
privacy to binge eat. Many feel embarrassed and ashamed and conceal their problem from
others thus making them feel isolated and even depressed. Since so many binge eaters are
preoccupied about their body weight and size, they may avoid or be absent from family
gatherings or social functions. Close friends and family members of the sufferer are often
unaware of the disorder.
Eating Disorders Not Otherwise Specified
Sometimes a person can experience symptoms of an eating disorder but not meet the criteria
for a diagnosis of anorexia, bulimia or compulsive overeating. The fact that they do not meet
recognised criteria does not mean that a problem may not exist. Many people have disordered
eating patterns, such as being overly concerned with eating healthily, or having strict rituals
around eating. If left untreated, such eating patterns can develop into disorders.
Where to Get Help?
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Your local GP.
Community Health Centre (under ‘Community Health Centres’ in the White Pages).
School counsellor or teacher.
The Centre for Eating and Dieting Disorders: (02) 9515 5843 or www.cedd.org.au
Telephone Counselling Services eg. Lifeline 131 114, Salvo Careline 02 9331 6000, Kids
HelpLine 1800 551 800.
Many hospitals have Eating Disorder Units, contact them directly for details.
Mental Health Information Service 1300 794 991 (for services in your area).
The Butterfly Foundation on (02) 9412 4499 or www.thebutterflyfoundation.org.au
References
Eating disorders costing billions, report says. (n.d.). Retrieved April 21, 2015, from
http://www.sbs.com.au/news/article/2015/03/02/eating-disorders-costing-billions
Information and Resources. (n.d.). Retrieved April 21, 2015, from http://thebutterflyfoundation.org.au/facts-sheets/
Manocha, D. R. (n.d.). 5 Tips for Constructive Conversations with Your Child About Weight. Retrieved April 21,
2015, from http://www.generationnext.com.au/2015/03/5-tips-for-constructive-conversations-with-your-childabout-weight/
Mental Illness Factsheets - Mental Heath Association NSW. (n.d.). Retrieved April 21, 2015, from
http://www.mentalhealth.asn.au/our-resources/mental-illness-factsheets
The National Eating Disorders Collaboration http://www.nedc.com.au
http://www.arafmi.org/wp-content/uploads/2015/01/NSW-Mental-Health-Commission-Living-Well-A-StrategicPlan.pdf
http://www.eatingdisorders.org.au
Australian Government Department of Health
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-a-anorex-toc~mental-pubsa-anorex-2#hos\
http://www.dsm5.org/documents/eating%20disorders%20fact%20sheet.pdf