EATING DISORDERS
WHAT IS AN EATING DISORDER?
An eating disorder is a medical diagnosis based on your eating patterns and medical tests on your weight, blood and body mass index (BMI). This page lists common eating disorders and other disordered eating diagnoses
Food is one of the many mediums through which our emotions and distress can be expressed, so you may have a very difficult relationship with food which impacts on your mental health, but doesn't fit into any of the current categories of diagnosis. It's also possible to experience more than one eating disorder, or to experience some symptoms from each disorder.
If your problems with eating aren't easy for your doctor to categorise, they might not give you a specific diagnosis. But even if you don't have a diagnosis, or prefer to think about your experiences in a non-medical way, you may find it helpful to understand some of the feelings and behaviours that can be associated with specific eating disorders.
Bulimia nervosa
If you experience bulimia, you may find that you eat large amounts of food in one go because you feel upset or worried (binging). You may then feel guilty or ashamed after binging and want to get rid of the food you have eaten (purging).
How you might feel
- ashamed and guilty
- that you hate your body or that you are fat
- scared of being found out by family and friends
- depressed or anxious
- lonely, especially if no one knows about your eating problems
- very low and upset
- like your mood changes quickly or suddenly
- like you're stuck in a cycle of feeling out of control and trying to get control back
- numb, like feelings are blocked out by bingeing or purging.
What you might do
- eat lots of food in one go (binge)
- go through cycles of eating, feeling guilty, purging, feeling hungry and eating again throughout the day
- eat foods that you think are bad for you when you binge
- starve yourself in between binges
- eat in secret
- crave certain types of food
- try to get rid of food you've eaten (purge) by making yourself sick, using laxatives or exercising excessively.
What might happen to your body
- you might stay roughly the same weight, or you might go from being overweight to underweight quite often
- you may be dehydrated, which can cause bad skin
- if you menstruate, your periods might become irregular or stop altogether
- if you make yourself sick, your stomach acid can harm your teeth and you can get a sore throat
- if you use laxatives, you could develop irritable bowel syndrome (IBS), stretched colon, constipation and heart disease.
Anorexia nervosa
If you get an anorexia diagnosis, this is because you are not eating enough food to get the energy you need to stay healthy. Sometimes people assume anorexia is just about slimming and dieting, but it is much more than this. At its core it is often connected to very low self-esteem, negative self-image and feelings of intense distress.
How you might feel
- like you can't think about anything other than food
- like you want to disappear
- that you have to be perfect
- like you are never good enough
- lonely, especially if no one knows about your eating problems
- that by eating you lose the control you feel you need
- that you are hiding things from your family and friends
- that you are fat and your weight loss isn't enough
- very frightened of putting on weight
- angry if someone challenges you
- tired and disinterested in things
- depressed or suicidal
- anxious
- a high or sense of achievement from denying yourself food or over-exercising
- panicky around meal times.
What you might do
- reduce your food intake or stop eating altogether
- count calories of all your food and spend a lot of time thinking about them
- hide food or secretly throw it away
- avoid foods that feel dangerous, like those with high amounts of calories or fat
- read recipe books and cook elaborate meals for people but not eat them yourself
- use drugs that say they reduce your appetite or speed up your digestion
- think about losing weight all the time
- exercise a lot and have strict rules about how much you need to do
- make rules about food, like listing 'good' and 'bad' foods or only eating things that are a certain colour
- develop very structured eating times
- check and weigh your body all the time.
What might happen to your body
- you might weigh less than you should or lose weight very fast
- you might become physically underdeveloped (in particular if anorexia starts before puberty)
- you may feel weak and move slowly
- you may feel very cold all the time
- if you menstruate, your periods might become irregular or stop altogether
- your hair might thin or fall out
- you might develop fine fuzzy hair on your arms and face (called 'lanugo')
- you might lose interest in sex or not be able to have or enjoy it
- you may find it hard to concentrate
- your bones may become fragile and you might develop problems like osteoporosis.
Binge eating disorder
If you have binge eating disorder you might feel that you can't stop yourself from eating, even if you want to. It is sometimes described as compulsive eating. If you experience binge eating disorder, you might rely on food to make you feel better or to hide difficult feelings.
How you might feel
- out of control and as if you can't stop eating
- embarrassed or ashamed
- lonely and empty
- very low, even worthless
- unhappy about your body
- stressed and anxious.
What you might do
- pick at food all day, eat large amounts all at once (bingeing)
- eat without really thinking about it, especially when you are doing other things
- regularly eat unhealthy food
- eat for comfort when you feel stressed, upset, bored or unhappy
- hide how much you are eating
- eat until you feel uncomfortably full or sick
- try to diet but find it hard.
What might happen to your body
- you might put on weight
- you might develop health problems associated with being overweight, such as diabetes, high blood pressure or joint
- and muscle pain
- you might experience breathlessness
- you might feel sick a lot
- you might experience sugar highs and crashes (having bursts of energy followed by feeling very tired)
- you might develop health problems such as acid reflux and irritable bowel syndrome (IBS).
Other specified feeding and eating disorder (OSFED)
OSFED is a diagnosis that is becoming more common. In the past you may have been given a diagnosis of eating disorder not otherwise specified (EDNOS) – but this isn't usually used any more.
If you are given a diagnosis of OSFED it means that you have an eating disorder but you don't meet all the criteria for a diagnosis of anorexia, bulimia or binge eating disorder. This doesn't mean that your eating disorder is less serious, it just means that it doesn't fit into current diagnostic categories. You might experience any of the behaviours, feelings and body changes associated with other eating disorders.
Getting a diagnosis of OSFED can help you access treatment and support.
Other diagnoses related to disordered eating
- Rumination disorder. If you have rumination disorder you will regularly regurgitate your food (but you do not have a physical health problem to explain it). You might re-chew, re-swallow or spit out the food you regurgitate.
- Pica. If you have pica, you will regularly eat things that are not food and have no nutritional value (for example chalk, metal or paint). This can potentially be very harmful.
- Avoidant/restrictive food intake disorder (ARFID). If you have ARFID you will feel a very strong need to avoid food in general or certain foods because of their smell, taste or texture. The idea of eating can fill you with anxiety. ARFID does not tend to be connected to issues with body image – it is an anxiety about the process of eating itself.
CAUSES OF EATING DISORDERS
There is no single cause of eating problems – most professionals think they come from a combination of environmental and biological factors. It might be hard to understand why it has become an issue for you, as the reasons may be complex and confusing.
Habits and traits
People with eating problems often share common traits which may make them more vulnerable, for example:
- perfectionism – wanting everything to be perfect and rarely being satisfied with what you have done
- being very critical of yourself
- being very competitive
- obsessive or compulsive behaviour
- a lack of confidence in expressing yourself.
Difficult life experiences
The beginning of eating problems can be linked to a stressful event or trauma. This can mean physical, emotional or sexual abuse, the death of someone close to you, divorce or serious family problems. Or it could be pressures at school or work such as facing exams or being bullied.
Eating problems often develop at the same time as you are going through major life changes such as puberty, going to a new school, working out your sexuality, or leaving home for the first time.
Family issues
Eating problems can be caused or made worse by childhood experiences. For example, if your parents were particularly strict, or home didn't feel like a safe or consistent place, you may have begun to use food as a way of gaining more control over your life. If they had very high expectations of you, you may have developed personality traits like perfectionism and self-criticism that can make you vulnerable to eating problems.
And if other people in your family were dieting, over-eating or experiencing an eating problem, this may have had an impact on you too.
Social pressure
Although social and cultural pressures probably don't cause eating problems, they can contribute to them and help to keep them going. Films, magazines, social media, adverts and peer pressure means that we are surrounded by messages about our body and (unachievable) ideas about how we should look.
You might not even be aware that it is happening, but you may find yourself comparing yourself with these unrealistic images and feeling bad about yourself as a result. This kind of social pressure can make you feel that you are not good enough, and can have an impact on your body image and self-esteem.
Physical and mental health problems
If you have physical or mental health problems, you may also develop eating problems. Having a physical health problem can make you feel powerless, so you may be using eating or exercise as a way of feeling in control.
Eating problems can begin because you experience a mental health problem such as depression, anxiety, bipolar disorder or body dysmorphic disorder. They can be linked to feelings of low self-esteem, worthlessness or powerlessness. Having an eating problem can also cause you to experience these kinds of mental health problems.
Biological and genetic factors
Research has shown that your genes may have an impact on whether you are vulnerable to developing an eating problem.
It has also been found that some people with eating problems seem to have different amounts of the brain chemicals that control hunger, appetite and digestion. For example:
- Having too much or too little of the brain chemical serotonin can affect your mood and appetite.
- Some people may be more sensitive to the hormones that control hunger and fullness. This could make them more likely to overeat or binge.
Triggers or 'at risk' times
Some things, although not the cause of your eating problem, could help to keep it going once it has developed. If you have had eating problems in the past, or you are coping with recovery at the moment, you might find it helpful to think about things that might make it more likely that your eating problems will come back – for example stressful situations or going on a diet. Some people call these 'triggers' or 'at risk' times.
RECOVERY AND SELF CARE
Living with – and recovering from – eating problems is really challenging. You have to think about food daily and live in your changing body. But there are lots of ways that you can help yourself cope with these challenges.
Here are some things you can do which could keep your eating disorder manageable:
- Keep a diary
- Be open with family or friends
- Build a support network with others who are going through the same or similar experiences.
- Relaxation
- Mindfulness
- Manage who you follow on social media.
- Try and distract yourself so your not constantly thinking of food.
TREATMENTS FOR EATING DISORDERS
Treatment can help you develop balanced and healthy eating patterns and help you face – and cope with – the underlying issues which may be causing your eating problem.
Talking to your doctor
Talking about your eating problems can be scary, but if you'd like treatment and support, the first step is usually to visit your doctor (GP). They should be able to refer you to more specialist services.
Online self-help programmes
If you are diagnosed with bulimia or binge eating disorder, or your eating problems have similar symptoms, you may be offered support through an online self-help programme at first. You should receive short support sessions alongside the programme. These may be face-to-face or over the phone. If you are finding it hard to complete, or don't find it helpful, ask your GP for more support.
Talking treatments
Accessing talking treatments
You can access talking treatments through the NHS. Your GP should be able to make a referral. There can be long waiting lists on the NHS, so you may also want to consider seeing a therapist privately – but be aware that private therapists usually charge for appointments.
Additional treatments for anorexia
These are some additional treatments which you may also be offered to treat anorexia:
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA).
- Specialist Supportive Clinical Management (SSCM). T
- Focal Psychodynamic Therapy (FPT).
Medication
There are no drugs specifically for eating disorders, but you may be offered medication to treat some underlying factors (such as depression or anxiety). The most common medication prescribed to people experiencing bulimia or binge eating disorders is a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs). If you have anorexia, you may be offered antidepressants or antipsychotics. Most people are offered these drugs alongside talking treatments – medication shouldn't be the only thing you're offered.
Being underweight can mean that drugs are absorbed more quickly into your bloodstream, which could make medication harmful or not as effective as it should be. Your doctor will decide whether to offer you medication, and you can decide whether you want to take it.
Admission to a clinic
You may need to go into hospital or to a clinic if your doctor or care team feel you are very unwell or underweight, if other kinds of treatment haven’t worked, or if your home environment is making it hard for you to stay well.
If you are an outpatient or day patient, you will go home most evenings and weekends. If you are an inpatient, you will stay in the hospital or clinic for most of your treatment. How long you are admitted for will depend on how much help you need to recover.
You will normally receive a range of support as an inpatient. The staff at the hospital or clinic could include:
- doctors
- dieticians
- psychotherapists
- occupational therapists
- social workers
- family and relationship therapists
- specialist nurses.
Treatment can include:
- talking therapies
- working in groups with other people experiencing eating problems
- medication
- refeeding.
Your weight and general health will be monitored. There may be guidance on buying, preparing and serving food, how to cope with stress and anxiety, how to be more assertive, and how to manage anger and communicate well.
What is ‘refeeding’?
Refeeding means being given food with the aim of bringing your weight up to a healthy level – it involves helping you to gain weight so that your energy levels and your physical health improve. You may be given specific foods because they have certain nutritional values or are particularly good at helping people gain weight.
How this works varies from one clinic to another. Some doctors may do this over a longer period of time, allowing you to gradually increase your weight, whereas others will want to help you back to a healthy weight as soon as possible.
This can be a distressing process, especially if you do not want to gain weight, and may be something you want to talk about with your doctor in more detail.
There are only a few NHS eating disorder clinics, so you may not always be able to access treatment close to where you live. This may mean going to a clinic further away, or it could mean going to a general mental health hospital. You can ask your GP or care team if you’d like to know more about specialist clinics.
There are also private treatment centres. Some may offer similar treatment to NHS clinics, while others will have a wider range of complementary and art therapies.
