What are eating disorders?

An eating disorder is a condition which describes behaviour that focuses on an individual's abnormal relationship with food and is usually accompanied by a strong desire to change weight and body shape. Eating disorders can affect people of any age, but are most common among young women and usually start in the teen years to early twenties. However, they do affect men too and people can be vulnerable to developing an eating disorder at any age. Eating disorders are often a symptom of underlying distress and can become a coping strategy to help manage this. The causes of eating disorders are a complex interplay of genetics, the environment, life events and modern-day culture. People who develop eating disorders often have low-self esteem and perfectionist tendencies.

An interview with Hope Virgo, who is in recovery from anorexia, and eating-disorder specialist therapist Harriet Frew

What is anorexia?

Anorexia nervosa is an eating disorder, characterised by strong efforts to keep body weight as low as possible. While this is usually achieved by strictly limiting food intake, a person with anorexia may also use excessive exercise as a means of keeping body weight low. They may also use purging after eating using vomiting or laxatives (purging sub-type). Often people with anorexia suffer from low confidence and they may compare themselves ruthlessly with others. Losing weight and maintaining this can be used as a way to boost self-worth and can be seen as a positive achievement. Therefore, people may demonstrate low motivation to change and let go of the illness and have some ambivalence about getting help.

Not all people with anorexia are teenage girls. Anorexia among men is increasing and there are also more cases of mature women developing anorexia after changes in their life, such as childbirth, bereavement, and so on.

The most obvious physical sign of having anorexia is that he or she will weigh significantly less than they did before the illness started, but there are other significant physical symptoms also stemming from the weight loss:

lanugo (fine hair covering the body)
dizziness
poor quality hair and nails
osteoporosis
damage to the liver, kidneys, heart and digestive system
loss of periods (for women)

Someone with anorexia may also develop unusual behaviour to keep their eating disorder secret. Typical examples are:

avoiding eating in public
eating tiny amounts of very specific foods, rather than a normal range of food types
complaining of being full when they have hardly eaten at all
denying that they are less than a reasonable weight and need any help
finding the idea of gaining weight extremely disturbing

Anorexia may be treated using a variety of psychological therapies, including motivational enhancement therapy (MET); cognitive behavioural therapy (CBT), family therapy, cognitive analytic therapy (CAT), and psychodynamic therapy. These treatments work alongside diet plans to aid weight gain, and treatment of physical symptoms.

What is bulimia?

Bulimia is an eating disorder, in which people often strive to control or restrict their food intake in an attempt to manage weight. However, the strict control is often unsustainable and this is commonly followed by bingeing (eating quickly, large quantities of food in a discrete period of time, usually in secret). People with bulimia feel much shame and guilt for these eating episodes and then compensate for the bingeing through “purging” with vomiting or using laxatives, over-exercise or further food restriction. As with other eating disorders, bulimia can often be associated with self-harm and low self-esteem.

People with bulimia are often close to normal weight, though they typically have a distorted body image, and their weight may fluctuate regularly. Although, initially, bulimia is often driven by food restriction, it often becomes a way of coping with difficult emotions. Bingeing and purging can offer some distraction and dissociation giving relief. People with bulimia are usually more motivated to seek help as the bingeing and purging causes much distress.

People with bulimia will often try to hide their illness, but you may identify some of the following changes in their physical appearance:

vomiting
over-exercising
taking laxatives
visiting the toilet very soon after eating
complaining of tiredness
marks on hands from being pushed into throat to start gagging reflex
increased dental decay

Behaviour may not always be easy to pin down as it is often hidden from view (both the eating and purging), but these signs may be typical of someone with bulimia:

eating a large amount of food at one sitting
purging after bingeing
fasting
thinking and talking about food a great deal
extreme changes in mood
shame and embarrassment over loss of control over food

In the long-term bulimia can cause damage to the teeth and digestive system. Up to 8 per cent of women are estimated to have bulimia to some degree during their lives. Though a broad range of psychological therapies have been found to aid recovery, cognitive behavioural therapy (CBT) and family therapy are most frequently used.

What is Binge-Eating Disorder?

Binge eating disorder is more wide-spread than the other eating disorders and more evenly distributed between men and women, most of whom are mature adults. A binge involves eating quickly, large amounts of food in a short period of time and often in secret. This behaviour involves a great deal of shame and anguish. Typically, binge eaters might attempt to control their weight through dieting. Bingeing then occurs, at least initially, as a backlash to this. As with bulimia, binge-eating often becomes a way of managing difficult emotions as a coping strategy. People who binge or eat compulsively share many of the behaviours of bulimics, but their weight tends to go up and down.

People who struggle with binge-eating often have long-term family tensions and low self-esteem. A wide range of talking therapies (see above) are suitable for treating them.

General disordered eating

Often people do not fit neatly into one diagnostic eating disorder category with their symptoms, but still experience significant distress with eating and their body image. It is important to still seek out help in these circumstances.

Recently, orthorexia (not currently an official eating disorder) is an increasingly common condition. This is when people become obsessed with eating very healthy foods, so that it becomes linked to their self-worth and is also used to control their body shape.