Eating Disorders
Eating disorders are frequently misconceived as a “diet gone wrong”. In reality they involve extreme and unhealthy disturbances in eating behaviour such as the restriction of food intake and/or severe overeating. They can also involve compensatory behaviours such as over-exercising or self-induced vomiting which can lead to significant feelings of distress and over-evaluation of body weight and/or shape.
These disturbed eating behaviours can have a detrimental effect on an individual’s physical, mental and emotional health. For many individuals the eating disorder provides a coping strategy for difficult thoughts, feelings and experiences as well as a sense of control over their life which maintains the disorder. However despite this sense of control it is often the case that the individual has very little control and they are trapped under the controls of their disorder.
There are four main types of eating disorders that will all differ by behaviour however the psychopathology behind them is actually very similar
Bulimia Nervosa:
Bulimia is characterised by persistent episodes of binge eating followed by inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, fasting or excessive exercise. It is outlined in the guidelines that binge eating and inappropriate behaviours both occur at least once a week for three months to meet diagnostic criteria.
A binge eating episode is characterized by the following:
Eating within a discreet period of time (i.e.: 2 hour period) an amount of food which is considered larger than what most individuals would eat in a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode
Anorexia Nervosa:
Anorexia is characterised by the goal to lose weight through restriction of food intake, avoidance of specific food groups and compensatory behaviours such as purging and/or excessive exercise. Individuals will have a low body weight for their age, gender and physical health as well as a distorted body image and body dissatisfaction. Clients are often ambivalent about change and are unable to recognise the seriousness of their low body weight. Furthermore they are often preoccupied with their weight, shape and food and based their self-evaluation on this.
Binge Eating Disorder:
Binge eating can be characterised by eating rapidly large amounts of food with a sense of lack of control even when you are not hungry and until you’re uncomfortably full. This may be followed by short periods of restriction however; they do not often use the purging behaviors like those in bulimia. Binge eating episodes are often followed by intense feelings of guilt, shame, and self-loathing. Due to such strong feelings individuals become very isolated and socially withdrawn and typically experience co-morbid mental health disorders such as depression and anxiety as a result of this.
Those who have binge eating disorder are at significant risk of weight gain and subsequently high blood pressure, high cholesterol as well as other health complications such as Type 2 diabetes, Kidney disorders, stroke and heart attacks.
Otherwise Specified Feeding and Eating disorder:
This applies when symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational or other important areas of functioning but do not meet the full criteria for anorexia or bulimia nervosa.
Who is affected and why?
If we are to believe everything we read in the media we’ll assume that more women are affected by eating disorders than men. However this has significantly changed over recent years. We are starting to see a significant increase of referrals for men into services who are typically diagnosed with Anorexia or binge eating disorder.
It is unclear what leads to the onset of an eating disorder however it is likely that there are multiple factors that make an individual vulnerable. Such factors may include personality traits, stresses within the family and how these are managed or communicated; work or school pressures as well as media influences.
While there may be uncertainty around the cause of eating disorders, treatment focuses on the maintenance of the disorder in order to successfully overcome the difficulties.
Treatment for eating disorders:
Treatment for an eating disorder depends on the type of condition you have which was outlined in the NICE guidelines 2017. For young people with Anorexia or Bulimia the first line of treatment is Family based therapy. For other age groups and disorders Cognitive Behavioural Therapy Enhanced (CBT-e) is the recommended treatment.
Duration of the treatment varies depending on the cognitions, client’s engagement and motivation to change as well as the need for weight restoration, loss or maintenance.