Eating Disorders: the symptoms, the myths and the treatment
By Ellie Vincent
Disordered eating refers to a wide range of abnormal eating behaviours, such as restricting food intake, dieting or binge eating. These behaviours lie on a continuum and we will all find ourselves somewhere along this spectrum. Eating disorders, however, differ from disordered eating in terms of the frequency and severity of these behaviours. They are complex disorders which have a negative impact on an individual’s physical (e.g., malnutrition and fatigue) and mental health (e.g., self-esteem and mood). Therefore, eating disorders are serious mental illnesses that require specialist support, but they are treatable, and a full recovery is possible.
Some of the common symptoms of eating disorders are:
Preoccupation with weight, shape and body
Dissatisfaction with self and body
Strive for perfection
Purging (e.g., vomiting or using laxatives)
Constant body checking (e.g., measuring or weighing self)
Eating Disorder Categories
As previously mentioned, eating disorders fit along a spectrum of eating behaviours, therefore, there are several different categories of eating disorders. There are three main categories that many will be familiar with.
Anorexia Nervosa – characterised by constant intake restriction, intense fear of weight gain and a disturbance in perception of weight and shape. An individual with Anorexia will keep their weight as low as possible by restricting their intake and/or excessively exercising. Even though someone with Anorexia will be considerably underweight, starved and malnourished, they will still fear gaining weight and have a distorted view of their body – they may actually see themselves as overweight.
Bulimia Nervosa – characterised by episodes of binge eating (consuming abnormally large amounts of food in a relatively short period of time), which are associated with a sense of loss of control, guilt and shame. Binging episodes will be followed up compensatory behaviours to prevent weight gain, such as self-induced vomiting, fasting, over exercise and the misuse of laxatives. A person with Bulimia usually maintains an average weight for their height, which often makes it less recognisable than Anorexia. Similar to Anorexia, individuals with Bulimia will place a large emphasis on their body shape and weight when evaluating themselves.
Binge Eating Disorder – characterised by regular patterns of binge eating. Unlike Bulimia, an individual with Binge Eating Disorder will not use compensatory behaviours (e.g., self-induced vomiting) after binging. However, similarly, these binges will be associated with a loss of control, guilt and shame.
These three disorders are considered the most common categories of eating disorders, however there are additional eating difficulties which may not be as familiar as the above.
Other Specified Feeding or Eating Disorders (OSFED) – a person with OSFED may present with many symptoms of other eating disorders but their experiences will not fully meet the diagnostic criteria. For example, someone may present with all of the symptoms of Anorexia, including excessive restriction of food intake and intense fear of gaining weight, however they are not significantly underweight (known as Atypical Anorexia). This does not mean that their difficulties are less serious than other eating disorders but recognises that presentations of difficulties will differ from person to person.
Pica – a feeding disorder characterised by the consumption of non-nutritive, non-food substances, such as, chalk or paper.
Avoidant/Restrictive Food Intake Disorder – a feeding disturbance characterised by the avoidance of and/or restriction of certain foods. Reasoning behind this avoidance can be lack of interest in food, sensory characteristics (e.g., textures or smells) or a lack of interest in food.
Orthorexia – while not officially recognised in diagnostic manuals, Orthorexia is characterised by the need to eat healthy (or ‘pure’) foods. How foods are considered pure or impure will differ between each individual.
Eating Disorder Myths
In today’s society, most people will have some knowledge and understanding of eating disorders, especially the common categories outlined above. However, there are many myths or misconceptions that surround eating disorders, particularly in relation to the causes and who can develop an eating disorder. Below are some of these common myths and an explanation as to why these are not a true reflection of eating disorders.
Eating Disorders are a choice.
Often, people may think that eating disorders are just a ‘diet gone too far’ and that it is up to the individual to ‘get over it’. In fact, eating disorders are complex mental illnesses and there is no single cause. Research suggests that eating difficulties are caused by a combination of biological, psychological and social influences (such as the emphasis of thin body ideals portrayed in the media). Therefore, it is important to remember that eating disorders are not a choice, rather a complex mixture of internal and external factors, resulting in significant impairment and distress.
Eating disorders only affect young women.
A very common misconception of eating disorders is that they only affect women, in particular teenagers. While it is more likely that eating disorder develop in women between the ages of 12 and 20, anyone can develop an eating disorder at any time regardless of sex. Research has shown that there is an increase in the number of males that are seeking treatment for their eating difficulties. While it is unclear whether eating disorders are increasing in males or that more males are now seeking support, it highlights that the traditional stereotype of eating disorders being constrained to women is in fact a misconception.
‘I’m not ill enough for treatment’
One of the key barriers preventing people from seeking support for their eating difficulties is usually because they may feel that they are not ‘ill enough’ to get treatment. This is often because when people think of eating disorders, they usually think of someone drastically underweight. However, this is only typical for Anorexia and not the other eating disorder categories. It is important to remember that eating disorders are mental health illnesses and that physical symptoms (such as weight) are not more important than the mental health symptoms.
Eating Disorders are for life.
Eating disorders can cause serious harm to an individual, both physically and emotionally. The nature of eating disorders can also lead to feelings of hopelessness or that recovery will never come about. However, eating disorders are treatable and a full recovery is very possible. Getting support as early as possible has proven particularly helpful for recovery.
Over-eating is the same as binge eating.
While overeating and binge eating are conceptually similar, they are not the same. The key difference between these two behaviours surrounds the amount of food consumed and the control that someone has over this. Binge eating is eating until physically full and is objectively a large amount of food to eat in a short period of time. Individuals who experience binging episodes will feel that they have no control over this behaviour.
Recovery from eating disorders is very possible! According to the National Institute for Health and Care Excellence (NICE), the leading treatment for eating disorders is Enhance Cognitive Behavioural Therapy (CBT-E). Cognitive behavioural therapy (CBT) is used in the treatment of several mental health difficulties, focussing on the here and now to break cycles of unhelpful thinking using a range of coping strategies.
CBT-E is based on a model of eating disorders that is used to treat all eating disorders, focussing on the cognitive processes and beliefs that are involved in maintaining eating difficulties. CBT-E aims to change an individual’s core beliefs about themselves and food, as well as identifying potential triggers. This treatment is completely tailored to each individual’s unique experiences.
There are several stages to this treatment:
Understanding the client’s experiences and difficulties, providing insight and education into these concerns.
A detailed review of progress and identify any barriers to change.
Addressing and modifying processes that are maintaining eating difficulties.
Focus on maintaining the positive changes made and how to keep these going after therapy.
**If you or anyone else you know is exhibiting any of the above symptoms or behaviours, and could benefit from some support, one of our Therapists would be happy to provide a FREE 15 MINUTE CONSULTATION. This is a safe space to discuss your experiences in a confidential and non-judgemental environment and receive some advice and recommendations for support.
By Ellie Vincent, Junior Therapist in training.
BSc Psychology (Hons), MSc Clinical Psychology.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour research and therapy, 41(5), 509-528.
Fairburn, C. G., Cooper D Phil, Dip Psych, Z., Doll D Phil, H. A., O’Connor, M. E., Bohn D Phil, Dip Psych, K., Hawker, D. M., … & Palmer, R. L. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry, 166(3), 311-319.
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