Guide to Eating Disorders

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A Guide to Disordered Eating

What’s inside:



What are Eating Disorders and what do they look like?



Do I have an eating disorder? – A checklist for seeking help



How are eating disorders treated?

This document contains information and strategies that are meant to be helpful to persons experiencing symptoms of an eating disorder, it is not a substitute for the advice of a qualified mental health practitioner.

If you or someone that you know is experiencing symptoms of an eating disorder, please contact your family doctor or if in a crisis please call the National Eating Disorder Information Centre (1-866-633-4220), the

Crisis Line Association of BC (250-753-2495), or the Mental Health Support Line (310-6789).

Lifespan Development Group Inc. Psycho-Educational Materials ©

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What are Eating Disorders and what do they look like?

Eating Disorders can take a number of forms but the main common characteristic among them is that they involve disordered eating that in turn impacts negatively on an individual’s physical and mental health as well as their overall quality of life. A common misperception about Eating

Disorders is that they only affect young woman however research has shown that Eating Disorders can affect all kinds of people at different stages of their lives. Statistics tell us that four out of ten of us in our lifetime will either personally experience an eating disorder or will know someone who is. Incidences of men reporting an eating disorder is steadily on the rise. Eating disorders are among the most deadly mental disorders, with mortality rates at between 3.9-5.2% depending on the type of disorder.

Eating disorders are extremely complex and can emerge due to any number of reasons but research suggests that a number of common factors may contribute to development of an eating disorder:

 Psychological Factors that Can Contribute to Eating Disorders: o Low self-esteem o Feelings of inadequacy or lack of control in life o Depression, anxiety, anger, stress or loneliness

 Interpersonal Factors that Can Contribute to Eating Disorders: o Troubled personal relationships o Difficulty expressing emotions and feelings o History of being teased or ridiculed based on size or weight o History of physical or sexual abuse

 Social Factors that Can Contribute to Eating Disorders: o Cultural pressures that glorify “thinness” or muscularity and place value on obtaining the “perfect body” o Narrow definitions of beauty that include only women and men of specific body weights and shapes





3 o Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths o Stress related to racial, ethnic, size/weight-related or other forms of discrimination or prejudice

 Biological Factors that Can Contribute to Eating Disorders: o Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite, and digestion have been found to be unbalanced. The exact meaning and implications of these imbalances remain under investigation. o Eating disorders often run in families. Current research indicates that there are significant genetic contributions to eating disorders.

Several Forms of Eating Disorders exist. The most common of which as classified by the Diagnostic and Statistical Manual of Mental Disorders

(DSM-V) include: Anorexia Nervosa, Bulimia Nervosa, Binge Eating

Disorder (BED), and other specified feeding or eating disorder (OSFED).

 Anorexia Nervosa is probably the most widely known eating disorder. It is characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with activities in their lives. To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively.

Some people with anorexia binge and purge, similar to individuals with bulimia nervosa. Anorexia can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to





4 healthier eating habits and reverse some of anorexia's serious complications.

The physical signs and symptoms of anorexia nervosa are related to starvation, but the disorder also includes emotional and behaviour issues related to an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat. Further symptoms include:





Extreme weight loss

Thin appearance





Abnormal blood counts

Fatigue

 Insomnia





Dizziness or fainting

Bluish discoloration of the



 fingers

Hair that thins, breaks or falls out

Severely restricting food intake through dieting or fasting and may include excessive exercise

 Bingeing and self-induced vomiting to get rid of the food and may include use of laxatives, enemas, diet aids or



 herbal products

Lying about how much food has been eaten

Flat mood (lack of emotion)

 Social withdrawal

 Irritability

 Soft, downy hair covering the body





Absence of menstruation

Constipation

 Dry or yellowish skin





Intolerance of cold

Irregular heart rhythms

 Low blood pressure









Osteoporosis

Swelling of arms or legs

Preoccupation with food

Refusal to eat





Denial of hunger

Fear of gaining weight

 Lying about how much food has

 been eaten

Flat mood (lack of emotion)









Social withdrawal

Irritability

Depressed mood

Thoughts of suicide

 Reduced interest in sex

Anorexia, like other eating disorders, can take over your life.

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.





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If you're concerned that a loved one may have anorexia, watch for these possible red flags:





Skipping meals

Making excuses for not eating

 Eating only a few certain "safe" foods, usually those low in fat and calories





Adopting rigid meal or eating rituals, such as spitting food out after chewing

Cooking elaborate meals for others but refusing to eat

 Repeated weighing or measuring of themselves

 Frequent checking in the mirror for perceived flaws





Complaining about being fat

Not wanting to eat in public

 Calluses on the knuckles and eroded teeth if inducing vomiting

 Covering up in layers of clothing

 Bulimia Nervosa is generally characterised by excessive binge eating followed by purging or throwing up the contents of the binge in order to get rid of the calories. Additionally or alternatively, individuals with bulimia may engage in excessive exercise or other unhealthy weightloss behaviours or purge after eating only a small snack or a normal-size meal. Bulimia can be categorized in two ways however these behaviours can often overlap: o Purging bulimia. You regularly self-induce vomiting or misuse laxatives, diuretics or enemas after bingeing. o Nonpurging bulimia. You use other methods to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.

If you have bulimia, you're probably preoccupied with your weight and body shape. You may judge yourself severely and harshly for your self-perceived flaws. Because it's related to self-image — and not just about food — bulimia can be hard to overcome. But effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications.

Further symptoms to look out for include:





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 Being preoccupied with your body shape and weight

 Living in fear of gaining weight

 Feeling that you can't control your eating behaviour





Eating until the point of discomfort or pain

Eating much more food in a binge episode than in a normal meal or snack

 Forcing yourself to vomit or exercise too much to keep from

 gaining weight after bingeing

Misusing laxatives, diuretics or enemas after eating





Restricting calories or avoiding certain foods between binges

Using dietary supplements or herbal products excessively for weight loss

 Binge Eating Disorder (BED) is characterized by compulsive overeating in which people consume huge amounts of food while feeling out of control and powerless to stop. The symptoms of binge eating disorder usually begin in late adolescence or early adulthood, often after a major diet. A binge eating episode typically lasts around two hours, but some people binge on and off all day long. Binge eaters often eat even when they’re not hungry and continue eating long after they’re full. The key features of binge eating disorder are: frequent episodes of uncontrollable binge eating, feeling extremely distressed or upset and guilty during or after bingeing, and the absence of purging behaviours. Binge eating often leads to weight gain and obesity, which only reinforces compulsive eating. The worse a binge eater feels about themselves and their appearance, the more they use food to cope.

A list of further BED symptoms to watch out for is included below:

 Inability to stop eating or control what you’re eating







Rapidly eating large amounts of food

Eating even when you're full

Hiding or stockpiling food to

 eat later in secret

Eating normally around others,

 but gorging when you’re alone

Eating continuously throughout the day, with no planned

 mealtimes

Signs of damage due to

 Feeling stress or tension that is only relieved by eating





Embarrassment over how much you’re eating

Feeling numb while bingeing— like you’re not really there or

 you’re on auto-pilot.

Never feeling satisfied, no matter

 how much you eat

Feeling guilty, disgusted, or depressed after overeating

 Desperation to control weight and eating habits





7 vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath

 Fainting and dizziness as a result of dehydration

 Other Specified Feeding or Eating Disorder (OSFED) is the most common form of eating disorder and includes all of the eating disorders that do not meet the diagnostic requirements for any of the aforementioned disorders. This does not mean that a person with

OSFED does not have a serious condition. Often times a person presenting with OSFED may have an extremely complex condition that is composed of mix of components from each of the main disorders highlighted above. People with OSFED commonly present with extremely disturbed eating habits, and/or a distorted body image and/or overvaluation of shape and weight and/or an intense fear of gaining weight (if underweight).

 Weight loss, weight gain or

 weight fluctuations

Loss of or disturbance of menstrual periods in girls and women and decreased libido in

 men

Compromised immune system



(e.g. getting sick more often)

Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on

 knuckles, damage to teeth and bad breath

Fainting and dizziness as a result of dehydration

 Preoccupation with food and eating

 Preoccupation with body shape and weight (in men this can be a



 preoccupation with increasing muscle bulk)

Extreme body dissatisfaction

Having a distorted body image

(e.g. seeing themselves as overweight even if they are in a

 'Black and white’ thinking -

 rigid thoughts about food being

‘good’ or ‘bad’

Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)

 Evidence of binge eating (e.g.

 disappearance or hoarding of food)

Frequent trips to the bathroom





 during or shortly after meals which could be evidence of vomiting or laxative use

Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)

Eating at unusual times and/or after going to sleep at night

Changes in food preferences

(e.g. claiming to dislike foods previously enjoyed, sudden





8 healthy weight range for their age and height)

 Sensitivity to comments relating to food, weight, body shape or exercise

 Heightened anxiety and/or irritability around meal times preoccupation with ‘healthy eating’, or replacing meals with fluids)

 Depression, anxiety or irritability

 Low self-esteem and feelings of shame, self-loathing or guilt

Do I have an Eating Disorder? – a checklist for seeking help

If you experience disordered eating, it is likely that you will recognise some of the symptoms described below. If this case, it is advised that you speak to someone you trust and contact a medical professional for further help.

Please tick the boxes which regularly apply to you.

Do you feel pressured to be thin?

Do you feel you must be thin to be accepted by others?

Do you feel guilty about eating?

Do you have problems concentrating?

Do you often feel depressed and unhappy with body and/or self-image?

Do you feel the need to be perfect and the best in school, athletics and/or with weight control?

Do you feel that your weight is one of the few things in your life over which you have control?

Do you think about food almost all the time?

Do you diet excessively and/or abuse (over-use) laxatives, diet pills or diuretics?

Do you count all the calories in every single bite you eat?

Do you ever eat large amounts of food in a frenzy of hunger?

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )





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Do you feel out of control if you eat a large amount of food?

Do you feel you have become cut off from your family and friends?

Do you prefer eating by yourself?

( )

( )

( )

Do you ever self-induce vomiting after eating, particularly after a binge? ( )

Do you exercise for hours on end or beyond what others consider normal? ( )

Do you feel fat even if others tell you that you are thin?

Does your weight go up and down dramatically?

( )

( )

If you are a woman, have your menstrual periods stopped or become irregular? ( )

If you have ticked a number of the boxes you may be experiencing symptoms of an eating disorder. However don't be alarmed, there are things you can do to help. The following section includes information on how Eating Disorders are treated.

How are Eating Disorders treated?

The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counselling, coupled with careful attention to medical and nutritional needs. Some medications have been shown to be helpful. Ideally, whatever treatment is offered should be tailored to the individual; this will vary according to both the severity of the disorder and the patient’s individual problems, needs and strengths.

Recommended care is provided by multidisciplinary team including but not limited to a psychologist, psychiatrist, social worker, nutritionist, and/or primary care physician.

Care should be coordinated and provided by a health professional with expertise and experience in dealing with eating disorders.

Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal and





10 cultural forces that contribute to or maintain the eating disorder. Nutritional counselling is also necessary and should incorporate education about nutritional needs, as well as planning for and monitoring rational choices by the individual patient.

Many people with eating disorders respond to outpatient therapy, including individual, group or family therapy and medical management by their primary care provider. Support groups, nutrition counselling, and psychiatric medications administered under careful medical supervision have also proven helpful for some individuals. Family Based Treatment is a well-established method for families with minors.

The most common therapy for eating disorders is cognitive-behavioural therapy. This targets the unhealthy eating behaviours of the eating disorders and the unrealistic, negative thoughts that fuel them. One of the main goals is for you to become more self-aware of how you use food to deal with emotions. The therapist will help you recognize your emotional triggers and learn how to avoid or combat them. Cognitive-behavioural therapy for eating disorders also involves education about nutrition, healthy weight management, and relaxation techniques. Group psychotherapy has also been shown to be effective in the treatment of specific eating disorders.

More severe forms of eating disorders may require inpatient care. Inpatient care (including hospitalization and/or residential care in an eating disorders specialty unit or facility) is necessary when an eating disorder has led to physical problems that may be life threatening, or when an eating disorder is causing severe psychological or behavioural problems. Inpatient stays typically require a period of outpatient follow-up and aftercare to address underlying issues in the individual’s eating disorder.

Some Helpful Links

This website contains a wealth of information about eating disorder as well as some links to interesting articles regarding eating disorders:





11 http://www.eatingdisorderhope.com/recovery/self-help-tools-skills-tips

Some self-help types for overcoming an eating disorder: http://au.reachout.com/self-help-tips-for-eating-disorders

This website contains further information on eating disorders, how they are treated and some self-help information: http://www.helpguide.org/articles/eating-disorders/eating-disordertreatment-and-recovery.htm

This link contains a blog about encouraging a healthy body image: http://lifespandevelopment.ca/?p=1

Ms. Niamh Allen, M.A. B.Sc.





Guide to Eating Disorders

A Guide to Disordered Eating

What’s inside:

What are Eating Disorders and what do they look like?

Do I have an eating disorder? – A checklist for seeking help

How are eating disorders treated?

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Guide to Eating Disorders

A Guide to Disordered Eating

What’s inside:

What are Eating Disorders and what do they look like?

Do I have an eating disorder? – A checklist for seeking help

How are eating disorders treated?

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