Eating disorders explained
An introduction to eating disorders
Most people have a positive attitude towards food and eating, obtaining pleasure as well as nourishment from their meals, with food playing an important social role in most cultures. However, many people, both women and men, are critical of their bodies. In many areas of the world there is prejudice against overweight people and the general assumption is that shape is simply a matter of choice and losing weight a matter of self-control.
People with eating disorders have a hyper-critical view of themselves and develop a very different view of food which is so at odds with normal thinking that it is difficult for many of us to understand. Many people think that the problems can be reversed simply by eating normally again - this is not the case.
The incidence of eating disorders in this country is increasing every year. It is often thought that these are conditions that only affect teenage girls but actually many sufferers are people who are not in their teens, are living independently and may be married with children. In some the illness has persisted since their teens and in others it has arisen later in response to severe stress. About 10% of sufferers in the UK are male and a smaller percentage are children as young as 8 years old.
The two main eating disorders are Anorexia Nervosa and Bulimia Nervosa , which are closely interlinked in that people suffering from either condition share a dread of obesity and this is the central feature of both illnesses. This fear is characteristic of both conditions and has been described as "a morbid fear of fatness".
Anorexia nervosa
Anorexia literally means loss of appetite but, in fact, people with anorexia nervosa have a normal appetite and are often very hungry because of their dietary restrictions. This hunger is frightening for someone who is terrified of gaining weight and there is frequently much anxiety associated with food and mealtimes. In anorexia there is always substantial weight loss and in females, associated cessation of monthly periods.
Besides the restriction on food, other methods such as vomiting after eating, excessive exercising and the taking of laxatives may be employed as attempts at controlling weight.
As weight is lost, the person may lose normal perception of their body shape and develop a distorted body image in which they have a conviction that they are much larger than they really are. This can persist even beyond the time when normal weight is restored and may make it particularly difficult for patients to regain weight and to then maintain a normal weight. The distorted body image eventually returns to normal with the passage of time and the maintenance of normal weight.
Bulimia nervosa
In this condition there is the same desire for thinness and sufferers are usually constantly dieting, but at times will lose control of their rapid dieting and eat large quantities of food very rapidly, usually vomiting afterwards. Sometimes these binges are planned as a method of coping with stress. Many also take laxatives to try and eliminate food from their bodies as quickly as possible.
Their weight may stay within a normal range but will be subject to rapid swings, due to changing levels of fluid in the body brought about mainly by the vomiting. The erratic pattern of eating may cause irregular menstrual periods. Many bulimic patients become depressed and feel considerable shame and guilt about their behaviour.
The physical effects of starvation, binges, self-induced vomiting, laxative abuse and excessive exercising can be very serious and affect many different parts of the body. Occasionally, the depression associated with these conditions will lead to suicide.
What causes eating disorders
A lot of factors may play a part in the development of an eating disorder, and every situation is unique to that person.
Eating disorders usually start with normal dieting or may follow weight loss from another cause. The admiration and approval that this weight loss brings will encourage a vulnerable person to persist with further weight loss. Often the sense of being in control of something in their lives is a rewarding feeling. In addition, as the weight is lost, the mind focuses more and more on food, which may be a form of escape from other pressing problems.
However, not everyone who diets will be at risk of developing an eating disorder. It may be helpful to look at different aspects of the development of these illnesses.
The factors that encourage dieting affect everybody - the cultural and peer pressures to be thin, the fact that around one third of the female population is dieting at any one time - and when combined with PERSONAL VULNERABILITY they spell the potential for dieting to progress from normal to abnormal.
These personal factors include a tendency to perfectionism which is often associated with a feeling of "need to be in control of life", low self-esteem, perhaps arising from traumatic events in childhood, and childhood obesity (especially where teasing occurred).
PRECIPITATING FACTORS , which may trigger off the illness in someone who is already vulnerable, include the biological and psychological crises of puberty, personal losses and stresses such as broken relationships or important exams, and successful dieting with social reinforcement for weight loss.
There are also PERPETUATING FACTORS , which keep the illness going once they have become established. These include a lack of satisfaction with weight loss, body image distortion leading to marked fears of returning to a normal weight, and depression and anxiety resulting from semi-starvation which can dull motivation. Sometimes people become so familiar with the life imposed on them by their eating disorder that they come to fear the decisions and challenges involved in normal living.
How can you recognise an eating disorder?
Anorexia is not difficult for others to recognise, although it may be only later that the person concerned will accept the diagnosis. It will be obvious to others that dieting has continued long after a reasonable weight loss has occurred and that the person is becoming terribly thin. There will also be increasing restrictions on the types and quantity of food eaten, a tendency to prefer to eat alone and general irritability, disturbed sleep, complaints of feeling the cold and often an increase in general activity .
Bulimia nervosa may be more difficult to spot but sufferers themselves will know they have a problem and often feel trapped by it. They very often become depressed and feel disgusted with themselves. They often go to great lengths to hide their problem from others but sometimes people living with a bulimic will notice food is missing or that there is evidence of vomiting or of laxative abuse.
How can parents and friends help?
Firstly you should let the person concerned know that you are worried about them, being careful to avoid being critical of them. "Pull yourself together and eat properly" will not help at all, expressing that you are worried and asking the person concerned what is troubling them might. Let them know that you see their problem as an illness, not simply "bad behaviour". Encourage them to seek help or suggest that they talk to their doctor.
What is the next stage?
Once an eating disorder has become established it will be very difficult for the person concerned to make the changes necessary to overcome it alone. The first step will always be for the sufferer to recognise that there is a problem and that they need help. Often this does not occur until the illnesses have produced some physical effects other than the weight loss. Encouragement to seek the advice of a general practitioner is a good first step.
The GP may suggest referral on to a psychiatrist or psychologist. When a person is referred to a specialist it is often helpful and supportive for a close friend or relative to go with them, at least to their first appointment. Most people feel a sense of relief once they start talking to a professional person who understands their feelings.
What about treatment?
Treatment options can be discussed only after a thorough assessment of the symptoms and the underlying causes and the ways in which the person's life is affected by the illness. Some people can receive treatment as an outpatient, either being seen on their own, perhaps with members of their family at times, or by joining a group of other patients with similar problems. Outpatient group therapy can be particularly helpful for people suffering from bulimia.
Some centres will recommend day patient attendance to work more intensively on the illness; for some people inpatient treatment will be recommended.
The most important point is that the person concerned should be involved in decisions about treatment, especially where inpatient treatment is concerned. There should be no feeling of coercion, because sufferers need a sense of personal motivation to sustain them to face their worst fears and try to overcome them. Sometimes motivation will only develop after several outpatient sessions, when the full extent of the illnesses becomes apparent to the person concerned.
