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Eating disorders

 

All of us need to eat for energy and to feel physically satisfied. When hungry our bodies usually tell us something is wrong so then we reach for a snack or make one of three meals a day. We can also enjoy food as part of meeting with friends or family. On some days of the year we may eat more such as over Christmas or another religious festival.

Food can be a complicated issue - disordered eating may be a symptom of psychological distress or an attempt to ‘fix’ a deep sense of unhappiness. When we under or overeat it may have an impact on body weight which can be the outward sign of a problem. However, not all eating disorders are visible.

There are certain eating disorders that are most recognised and treated within the health service. Even where someone doesn’t meet the criteria for them, or falls between the categories, there can still be significant eating distress which can hold the person back from having a full and healthy life.

Where you are taking your feelings out on food, or worrying without end about your body size, it is important to try to talk to someone about this before your eating does take over your life.

Anorexia

Anorexia is one type of eating disorder, which involves restricting what you eat. This may not mean you stop eating altogether, but you will be conscious of what food contains including seeing whole food groups as ‘unsafe’. Whatever you do eat may amount to very little compared to the diet of another person.

Doctors make a diagnosis of anorexia where someone has lost weight, (eg if their weight is 15 per cent lower than it should be for their age or height) and has a fear of becoming ‘fat’. Some people with anorexia may not be underweight yet, but were medically overweight originally and have lost too much weight too quickly through extreme diets – this situation is highly dangerous. Someone with anorexia or bulimia (see below) may use methods such as making themselves sick, taking laxatives or over exercising. All of these are risky. Someone with anorexia may find their periods stop. Due to lack of food it is possible to feel very cold even during the summer months. Mood can drop through poor diet which may result in depression. Ideas about body image and the need to eat become further from reality. Men can be affected by anorexia too, about 10 per cent of the total number of those with anorexia are men. While anorexia may begin when someone is in teenage years, it often also has an onset later on or starts when very young.

It is important to understand that most people going through anorexia haven’t entered onto this self destructive path from wanting to look like a model or celebrity. There are usually complex multiple causes such as life history, personality and sometimes an eating disorder already within the family. There can be a sense of ‘control’ through starvation, especially when life seems unpredictable and out of control. But food/anorexia ends up controlling the individual. Recovery can depend on how soon the issue is picked up and the support gained then. Many people with anorexia find it difficult to ask for help or may go through several attempts before reaching an acceptable weight where they can manage emotionally and physically, eating a healthy amount.

The treatment for anorexia depends on the person, or sometimes on the services available. Where someone has reached a very dangerously low weight, they may even need to go into hospital. If someone refuses treatment, they may be required to go into hospital without thier consent. This would be permissable under a section of the Mental Health Act where refusing treatment. The goal of programmes within inpatients units will be to regain weight before leaving the Unit and getting into a routine of eating meals. The treatment should also help someone to understand their feelings and behaviours. Most treatment is provided as an outpatient. This may include seeing a psychiatrist for assessment, meeting with a dietician, receiving psychological therapies, day care or doing some group work.

Anorexia is a very serious problem, even causing people to die due to complications – the effects of starvation or suicide. There can be long term effects such as bone thinning resulting in osteoporosis, damage to teeth and putting internal organs under strain.

Despite the low self esteem those with anorexia can feel, try to tell yourself that you are deserving of help. You need to go and see your GP first who may weigh you and ask questions about your eating and attitudes to food. Sometimes your GP may refer you to another service, one where they are skilled in eating disorders and can help you much further. Try to be as honest with your GP as you can, even when feeling unsure you want to change. Sometimes the effects of too little food and severe weight loss can play tricks on the mind or affect your motivation but you can still get support.

If you have anorexia you may want to look at the NICE guidelines about what help you can ask for.

The charity B-eat has a helpline you can call, message boards on their website and also local self help groups throughout the country. They also have a section of the website for young people.

B-eat helpline 0845 634 1414

B-eat youthline 0845 634 7650

There are also a number of other websites which provide information on recovery, treatment and research.

The Institute of Psychiatry carries our research into eating disorders. The Institute's website has useful information about eating disorders.

The Royal College of Psychiatrists' website has a section about eating disorders with leaflets that can be printed off.

My story

Read one person's personal account of living with anorexia.

Bulimia

While anorexia may cause someone to lose so much weight that other people start to notice, bulimia doesn’t always have the same impact. Some people may have anorexia and bulimia at different times. But for others with bulimia their weight will be within a normal range or just above this. This form of eating distress shows that weight isn’t always a good indicator that there is a problem, and that the thinking and habits around food can be dangerous even where it doesn’t show up. As with anorexia, someone with bulimia may feel very preoccupied with food and body size. The causes may be complex - there can be other problems someone may experience at times, such as self harming or acting on impulses.

Those with bulimia may have periods of ‘bingeing’ – taking in large amounts of food in an uncontrolled way before trying to ‘get rid’ of this, eg inducing vomit, using laxatives, starving or excessive exercise such as walking or using the gym. All of these methods can be damaging as part of this eating disorder. Purging (vomiting and taking laxatives) can disturb blood chemistry/electrolyte balance which can affect the heart. Being sick also erodes dental enamel so causing teeth loss or sensitivity. Using laxatives doesn’t result in getting rid of calories but instead you lose minerals, they can also have long term consequences on the body/bowel function. Sometimes it is an attempt to diet that causes the bingeing to happen as the body can’t cope with the lack of food, so this sets up a vicious cycle.

There is help there for bulimia

First of all you would need to go and see your GP, talk about the eating, feelings and anything you do after a binge. Your GP may refer you to an adult mental health or specialist service. The treatment for bulimia is often based on cognitive behavioural therapy, sometimes delivered as a computerised package, group or individual therapy, as well as support from health professionals. The NICE guidelines do cover the type of responses you should get when you ask for support with bulimia. There should be help to reduce and stop vomiting and use of diuretics or laxatives. If you also have anorexia you may be treated for this and if your weight has dropped too low for you to be safe or the impact of purging is putting your body at risk, you may need to attend hospital as an inpatient or a day patient. It is important to be honest about behaviour patterns as much as possible because of the physical dangers.

You will need to visit your GP regularly for blood tests and for monitoring. Regular dentist appointments are also important. Explain to the dentist, if you can, that you have an eating disorder.

The charity B-eat has a helpline you can call, message boards on their website and also local self help groups throughout the country. They also have a section of the website for young people.

B-eat helpline 0845 634 1414

B-eat youthline 0845 634 7650

The B-eat website has specific information about bulimia nervosa.

The BBC Headroom website has useful information and factsheets which you can download.

Binge eating disorder

Binge eating disorder is an eating disorder where someone may feel compelled to eat large amounts of food. Unlike bulimia, the person may not compensate/purge after these episodes of binge eating. This does mean that sometimes a person with binge eating disorder may gain weight or have problems associated with being overweight, but this is not always the case where they also diet. The eating problem can result in a sense of shame and the person may eat in private. It is important that binge eating disorder is identified by a GP and help offered. This may be within an eating disorders service which may offer group or individual therapy. The treatment may be similar to that provided to people with bulimia.

Compulsive overeating may be when food is eaten throughout the day - irrespective of hunger, time or need. There may be no sense of fullness that would usually stop someone eating, they may override this feeling and eating becomes a habitual way to cope with emotional distress. This again is a serious problem which can lead to problems around being overweight with the medical complications this can bring in the long term. You can use the b-eat helpline to ask for advice. Both binge eating disorder and compulsive overeating are more common with anorexia and bulimia. They cause great personal distress, change of food behaviour and physical problems.

The charity B-eat has a helpline you can call, message boards on their website and also local self help groups throughout the country. They also have a section of the website for young people.

B-eat helpline 0845 634 1414

B-eat youthline 0845 634 7650

The B-eat website has specific information about binge-eating disorder and complusive over eating.

The Something Fishy website is a website for people with eating disorders. It has useful information about binge-eating disorder.

There is also useful information on a website called 'the site'.

Someone may not experience only one form of eating disorder, it may in fact change over time, or even recur after times in ‘remission.’ Each eating disorder should be taken very seriously by the GP and other medical staff with a focus on understanding the psychology and behaviour patterns of the food problems, and how to manage or overcome them. The long term aim, although it takes time, is to eat on the basis of hunger, and enough to meet your body’s needs. This may mean three meals and two snacks or another programme worked out with a dietician or your doctor. Longer term, what is more important than food is the emotional side and making sure that you address what is really troubling you underneath the eating problem - where a coping mechanism has gone wrong and is telling you (and perhaps others) that you feel distress.

External resources

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