Eating Disorders

An eating disorder is characterized by destructive and obsessive thoughts about food and body weight. This includes people who limit the amount of food they eat (Anorexia nervosa), people who consume plenty of food in a very small time and then purge (Bulimia) or people who overeat often (Compulsive overeating).

Anorexia Nervosa

This is a potentially life-threatening eating disorder characterized by self-starvation, excessive weight loss and negative body image. While most common among females, about 10–15 % of individuals who suffer from anorexia are males.

There are several reasons behind the development of anorexia in an individual, and this may be attributed to a combination of environmental, social and cultural factors.

For some people, restricting their food and weight can be a way of controlling other area of their life that feel out of control. Their body image can come to define their sense of self worth. It can also be a way to express emotions that may feel too complex or frightening such as pain, stress or anxiety. A restrictive diet and excessive exercise can be a contributing factor to the onset of anorexia.

Diagnostic Criteria

The criteria for diagnosing anorexia are: 

  • Restricted energy intake: A person with anorexia is unable to maintain a normal and health weight. They could also have lost a considerable amount of weight in a short period of time
  • Fear of gaining weight: Even if they are underweight or malnourished, they still possess an intense fear of gaining weight of becoming overweight
  • Disturbed body image: A person with anorexia may view themselves as overweight when in reality they are dangerously underweight.

Signs & Symptoms of Anorexia Nervosa

These are some of the common behaviors you might notice in someone who has anorexia. 

Physical signs:

  • Rapid weight loss or frequeint weight changes
  • Disrupted menstrual cycle in girls and women and decreased libido in men
  • Fainting or dizziness
  • Feeling cold most of the time
  • Feeling bloated, constipated, or the development of intolerances to food
  • Feeling tired and not sleeping well
  • Lethargy and low energy
  • Facial changes
  • Fine hair appearing on face and body

Psychological signs:

  • Preoccupation with eating, food, body shape and weight
  • Feeling anxious and/or irritable around meal times
  • Intense fear of gaining weight
  • Depression and anxiety
  • Reduced capacity for thinking and increased difficulty concentrating
  • ‘Black and white’ thinking
  • Distorted body image
  • Low self-esteem and perfectionism
  • Increased sensitivity to comments relating to food, weight, body shape, exercise
  • Extreme body image dissatisfaction

Behavioral signs:

  • Dieting behavior
  • Deliberate misuse of laxatives, appetite suppressants, enemas and diuretics
  • Repetitive or obsessive behaviors relating to body shape and weight
  • Evidence of binge eating
  • Eating in private and avoiding meals with other people
  • Anti-social behavior
  • Secrecy around eating
  • Compulsive or excessive eating
  • Radical changes in food preferences
  • Obsessive rituals around food preparation and eating
  • Self harm, substance abuse or suicide attempts
  • It can be easy to confuse behaviors in the early stages of anorexia with a simple desire to “eat healthy”, “get in shape” or “just to lose a few pounds”. For people who are genetically at-risk for an eating disorder, this can quickly escalate into rapid weight loss and a full blown eating disorder.

The risks associated with Anorexia are severe and be life threatening. They include:

  • Anemia
  • Compromised immune system
  • Intestinal problems
  • Increased risk of infertility in men and women
  • Kidney failure
  • Osteoporosis
  • Heart problems
  • Death

Bulimia Nervosa

Bulimia nervosa is a serious disorder that involves a recurring pattern of binge eating followed by dangerous compensatory behaviors in effort to counteract of “undo” calories consumed during the binge.

What are compensatory behaviors?

These are used as a way of trying to control weight after binge-eating episodes. They include:

  • Vomiting
  • Misusing laxatives or diuretics
  • Fasting
  • Excessive exercise
  • Use of any drugs, illicit, prescription and/or ‘over the counter’ inappropriately for weight loss.

A person with Bulimia can become lost in a cycle of out-of-control eating and attempts to compensate which can lead to feelings of shame, guilt and disgust. These behaviors can become more compulsive and uncontrollable over time, and lead to an obsession with food, thoughts about eating (or not eating), weight loss, dieting and body image.

These behaviors are often concealed and people with Bulimia can go to great lengths to keep their eating and exercise habits secret. As a result, bulimia can often go undetected for a long period of time.

Many people with bulimia experience weight fluctuations and do not lose weight. They can remain in the normal weight range, be slightly underweight or may even gain weight.

Signs and symptoms of bulimia

The warning signs of bulimia can be physical, psychological and behavioral. It is possible for someone with bulimia to display a combination of these symptoms. 

Physical signs:

  • Frequent changes in weight (loss or gains)
  • Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
  • Feeling bloated, constipated or developing intolerance to food
  • Disturbance of menstrual cycle in girl
  • Fainting or dizziness
  • Feeling tired and not sleeping well

Psychological Signs:

  • Preoccupation with eating, food, body shape and weight
  • Sensitivity to comments relating to food, weight, body shape or exercise
  • Low self esteem and feelings of shame, self-loating or guilt, particularly after eating
  • Having a distorted body image
  • Obsession with food and need for control
  • Depression, anxiety or irritability
  • Extreme body dissatisfaction

Behavioral Signs:

  • Evidence of binge eating
  • Vomiting or using laxatives, enemas, appetite suppressants or diuretics
  • Eating in private and avoiding meals with other people
  • Anti social behavior, spending more and more time along
  • Repetitive or obsessive behaviors relating to body shape and weight
  • Secretive behavior around food
  • Compulsive or excessive exercising
  • Dieting behavior
  • Frequent trips to the bathroom during or shortly after meals which could be evidence of vomiting of laxative use
  • Erratic behavior
  • Self harm, substance abuse or suicide attempts

The risks associated with Bulimia are severe. People with Bulimia may experience:

  • Chronic sore throat, indigestion, heartburn and reflux
  • Inflammation and rupture of the esophagus and stomach from frequent vomiting
  • Stomach and intestinal ulcers
  • Chronic irregular bowel movements, constipation and/or diarrhoea due to deliberate misuse of laxative

Treatment for eating disorders

It is possible to recover from anorexia and bulimia, even if the individual has been living with the illness for many years. People with eating disorders can become entangled in a vicious cycle of (not) eating and exercising behaviors that can impact their ability to think clearly and make decisions.

Psychotherapy: Using Cognitive Behavioral Therapy as well as Interpersonal Psychotherapy, psychotherapy will help the individual re-examine and challenge existing thought and behavior patterns. It will look at the difficulties in the person;s life that are considered to be the basis of the disorder.

Nutrition: Our nutritionist will work closely with the psychotherapist to tailor a well-balanced eating plan. Education about nutritional values of food can be beneficial particularly when the person has lost track of what ‘normal eating’ is. This may be useful to help people identify their fears about food and the physical consequences of not eating well.

Mindfulness Based Therapy: This emphasizes the practice of mindful meditation, mindful eating and a range of other techniques in order to increase awareness and acceptance of eating behavior and the self. The aim of mindfulness is ‘letting go’ or disengaging with negative thoughts.

Group Therapy: This provides a supportive network of people who have similar issues to explore. This may address alternative coping strategies, underlying issues, ways to change behaviors, trigger to personal needs and long-term goals. Please check our calendar to find out when the next support group for eating disorders takes place.

Source: Eating Disorder, NEDC