Eating Disorders

Trying to understand what may lie behind eating disorders and what can be done to help a person suffering from one can be difficult. But below is a little information to help.

Anorexia Nervosa

One of the most important things to remember with this condition is that even when a full diagnosis has been given the person is still unaware that they have it. No matter how skinny an anorexic becomes, when they look in a mirror at themselves they still see an overweight person looking back at them.

So it's the ultimate in denial and it's very real for them. Because of this mind set, it can be exceptionally difficult to diagnose as the person doesn't ask for help as they are unaware of any thing wrong. The same goes for actual treatment as an anorexic sees treatment as someone trying to harm them. 

 The danger of anorexia is the fact that it is life threatening and often has a fatal outcome.
A fully diagnosed anorexic would be best placed under the care of their GP or in hospital or a clinic where 24 hour care can be maintained.

Some possible symptoms include a distorted body shape, obsessive thoughts about food, obsessive and compulsive behaviours and a continued state of striving for perfection. These behaviours all relate to a person's view of their self shape and size. In other words all consuming thoughts about body shape.

Emotions

• Low self esteem
• Depression
• Fear
• Mood swings.

Social

• Change in performance, for example, at work or school.
• Becomes withdrawn and isolated.
• Deterioration of relationships.

Physical symptoms

• Extreme weight loss/ Thinness.
• Pale complexion and sunken eyes.
• Feeling cold.
• Creaking joints.
• Headaches. 
• Constipation.

Behaviours

• Excessive exercise.
• Food restriction.
• When food is mentioned gets angry.
• Sensitive about body shape.

Bulimia Nervosa

This is a more recent concept and has only been around since the 1970's. Bulimia is defined by recurring episodes of binging which is usually done discretely. The person has a lack of control over eating and binges.  The criteria for a medical diagnosis would be two binges per week over three months plus the patients concern over their body shape or weight.  
Other clues include intervention by the person to prevent weight gain by;

• Taking laxatives.
• Dieting,
• Fasting.
• Vomiting.
• Exercise.

Bulimia however is difficult to diagnose as its symptoms are similar to Anorexia Nervosa and the behaviours are similar.

Physical symptoms include weakness, constipation, diarrhoea, chronic sore throat and excessive weight loss.

Behaviours

• Constant eating (secret hideaways of food)
• Not engaging in eating in company and or picking at food in company.
• Making excuses not socialising with friends, avoiding family meals and get togethers.
• Always saying ‘I have just eaten'!  

What can be some of the causes of eating disorders?

• Abuse.
• Role models.
• Learnt behaviour – values and habits.
• Peer pressure, conforming to other people's views.   

Some common factors of eating disorders.

• Drive for thinness.
• Fear of fatness.
• Concern for body shape / weight.

Eating disorders can be linked to anxiety; however sometimes a person is suffering from anxiety which is masking the real problem: the eating disorder, this can then lead to the eating disorder going unnoticed.

Below are some examples of what the implicit causes of eating disorders may be:

• A response to emotional stress. A person feels rejected = eating disorder.
• Society, which in turn leads a person to having to conform.
• Family expectations and pressure to do well.
• Learnt behaviours and unresolved conflicts = eating disorder
• Abuse which in turn leads to self hatred and a feeling of worthlessness and hopelessness.
• Sexuality/sex issues can lead to eating disorders
• Self punishment or a way to have control and punish others, for example family members.
• Power, control, anger.

At the hub of all of this there is often a lack of self esteem.

What can be done for eating disorders?

Empathetic, warm, caring and compassionate non-judgemental counselling is a good place to start. Latterly looking at thinking patterns and errors of thinking. Exploring options for change. Looking for connections between eating behaviours and beliefs.

• Goal setting increasing/decreasing food intake and exploring the feelings around this.
• Look at self rewards but not food related. Feeling well, etc
• Look for triggers what starts it off? 
• Challenging faulty thinking: If I don't eat I will be beautiful? Catastrophising: if I do eat I will get exceptionally fat. Looking for evidence: What is the evidence I have that if I don't eat I will be happy?

Is there a different way to look at this?  For example you may put on weight but will it make you fat?

Psychodynamics or going back in time can be helpful

• When was a time that you didn't binge?
• When did you start binging? What was going on in your life at that time?
• What was the first trigger? Relationship breakdown, rejection, abuse, bereavement or loss.
• What are current triggers: loneliness, bad day at work, debt, health?

 
To add to this, eating disorders often affects the young who do not seek help. And if they do seek help it's often in a non obvious way such as going to the doctors, then feeling embarrassed and not telling the doctor of their real concerns. Therefore there is a huge potential for a doctor to miss it altogether.

 For a more mature person binging, weight gain is not always recognised as a disorder. The signs go unnoticed and the pattern of binge = guilt = diet = binge = diet continue infinitum.

Not all weight gain or weight loss is eating disorders. Many of course are controlled for a healthy lifestyle and sometimes it can be a temporary reaction to a particular life event.

If you are concerned about yourself or another with regards to an eating anomaly seek help from a GP or NHS direct. Counselling of course can be beneficial and if necessary a counsellor will be able to refer a severe case on to the appropriate agency.

- James Harris, 2009