Understanding Eating Disorders

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1 Barnet, Enfield and Haringey Mental Health NHS Trust Understanding Eating Disorders Information for patients and carers Page

2 What are eating disorders? Eating disorders affect the way you think, feel, and behave with food. Most people with an eating disorder eat too little or too much or use different unhealthy methods to get rid of calories as a way of gaining control, coping with unpleasant emotions and sometimes to punish themselves. Common features are constantly thinking about food, worrying about the calorie content of what you are eating and focusing too much on your weight and appearance. Rituals and obsessive habits concerning food are often present. Eating disorders are often associated with low self-esteem, feelings of shame and guilt. People affected often go to great lengths to hide their difficulties and sometimes deny that there is a problem. Types of Eating Disorders Anorexia nervosa, bulimia nervosa and binge eating disorder are the main eating disorders but often people have features of more than one of these and are diagnosed with EDNOS (Eating Disorder Not Otherwise Specified). People can present in different stages of life with different aspects of an eating disorder or go from one to another. Each of the main eating disorders is described below: Anorexia Nervosa - When you have Anorexia, you are determined to lose weight; even when you are underweight, you believe you are never thin enough. You will be very strict with what you eat and may exercise compulsively or purge. Bulimia Nervosa - When you have Bulimia, you have intense cravings for food, and secretly binge eat and then make yourself vomit or use laxatives to avoid gaining weight. You might alternate this with dieting but you are likely to stay at a normal weight. Binge eating disorder - When you have a binge eating disorder, you constantly have the impulse to overeat. This is linked with feelings of shame and blame, but you don't vomit or use laxitives to get rid of the calories. This often then leads to you being overweight. Page 2

3 Who experiences eating disorders? Anyone can develop an eating disorder, regardless of their age, sex or cultural background. Young women aged 15 to 25 are most likely to develop an eating disorder. Eating disorders are also getting more common in boys and men. Less commonly, an eating disorder can also start in childhood or in later life. For some people it is lifelong. Eating disorders are more common in jobs which demand a low body weight (or low body fat). These include body building, wrestling, dancing, swimming, and athletics. What are the symptoms of eating disorders? Anorexia Nervosa: Constant worry about your body or weight Eating less and less even when you are very thin Obsession with calories, food and nutrition Exercising more and more to burn off calories Smoking more or chewing gum to keep your weight down Loss of interest in social life and sex In girls or women - monthly menstrual periods become irregular or stop. In men or boys - erections and wet dreams stop, testicles shrink How your body behaves You might find it harder to eat because your stomach has shrunk You feel easily bloated after only eating small amounts of food Feeling tired, weak and cold as your body's metabolism slows down You might feel dizzy and/or faint Being constipated Your hair might fall out and fine hair might appear over your body Your bones might become more fragile and break easily You will develop osteoporosis if your body weight is too low You will be prone to fracture You are unable to get pregnant Your heartbeat becomes slower In extreme cases, you may die. Anorexia Nervosa has the highest death rate of any psychological disorder. Page 3

4 Bulimia Nervosa: Worrying more and more about your weight Overeating compulsively Compensating for overeating by making yourself vomit and/or use laxatives Having irregular menstrual periods Feeling tired Feeling guilty and ashamed Staying at a normal weight, in spite of your efforts to diet How your body behaves If you vomit, you will: Lose the enamel on your teeth (it is dissolved by the stomach acid in your vomit) Damage your oesophagus and throat Get a puffy face (the salivary glands in your cheeks swell up) Notice your heart beating irregularly - palpitations (vomiting disturbs the balance of salts in your blood) If you vomit you may: Feel weak Feel tired all the time Damage your kidneys Have epileptic fits Be unable to get pregnant. If you use laxatives regularly, you may: Have persistent stomach pain Get swollen fingers Find that you can't go to the toilet any more without using laxatives (using laxatives all the time can damage the muscles in your bowel) See your weight going up and down. You lose lots of fluid when you purge, but take it all in again when you drink water afterwards (no calories are lost using laxatives). Sometimes people swing between anorexia and bulimia Page 4

5 How eating disorders make you feel Initially you may feel very strong and a sense of achievement because of any weight loss. Eventually, how you feel about yourself becomes very much related to weight gain or loss. This can affect your mood You might start isolating yourself from people You might feel very lonely and detached from people or irritable Binge eating often brings about feelings of, shame, guilt and disgust You can feel disappointed with yourself and out of control even when you've eaten very little. In the long term this affects your self-esteem and confidence. How eating disorders make you behave You might make excuses to avoid eating around other people You might go to specific places where you know what food you can order and feel safe with it You might tend to eat secretly as you feel ashamed by your loss of control over eating and hording of high-calorie food You feel compelled to go to the bathroom straight after meals You may tend to isolate yourself and cut yourself off from friends You may avoid intimate relationships as you feel uncomfortable with your body and appearance. Page 5

6 What causes eating disorders? Although eating disorders generally begin with obesessions about food and weight, they are usually about much more than this. When you have an eating disorder, you often use food and the control of it to make up for feelings and emotions that may seem over-whelming. The feeling of controlling your diet and weight might make you feel like you are in control of your life, but ultimately, it will damage your physical and emotional health. There are many factors that can contribute to developing an eating disorder. These include: Psychological - Low self-esteem, feeling of inadequacy, lack of control in your life, depression, anxiety and loneliness can contribute to eating disorders Relationships - Difficult family relationships, difficulty expressing emotions, teasing or bullying because of weight or history of physical or sexual abuse can play a role in developing an eating disorder Cultural - Pressures to be "thin" or get the "perfect body" or cultures that value people based on the way they look, rather than their personal qualities and strengths Genetic - Eating disorders often run in families. Current research indicates that there are significant genetic contributions to eating disorders however this does not make it inevitable. How does it start? Anorexia nervosa You start to focus on eating healthily' but gradually cut out important nutrients until eating only vegetable and fruit You may start exercising in excess, smoking, using slimming pills or purging to lose more weight You can't stop thinking about food Your obsession with controlling your weight makes you more determined to keep losing weight Bulimia nervosa You start to focus on eating healthily' by following a strict diet Eating too little leads to constant thoughts about foods which leads to cravings resulting in you binge eating You might still feel hungry and think constantly about food The fear of gaining weight and breaking makes you feel guilty, so you make yourself vomit or use laxatives to make up for the binge eating Gradually food comes to dominate your life and thinking Page 6

7 What treatment is available? Mental health professionals can help diagnose an eating disorder and any physical problems resulting from it. You can access help by speaking to your GP who can refer you to a mental health professional. In general outpatient treatment is preferred unless there is serious physical or psychological instability.the long-term aim will be to help you change your attitude, behaviour and ways of thinking, to help you recover or cope with your eating disorder. Treatments can include: Specialist dieticians Self help - in both anorexia nervosa and bulimia, self-help strategies can be very helpful. (please see refer to the end of the leaflet for useful books/websites) Psychological and psychotherapy - with bulimia nervosa and binge eating disorder a course of psychotherapy (cognitive behavioural or interpersonal) can be effective. Psychological and psychotherapy intervention can help those caring for you understand why the illness developed and how to help you overcome it. However, access may be limited. Especially in young people with anorexia, psychological treatment may involve both the individual with the illness and other family members. Medication - sometimes medication to reduce the urge to binge or to treat symptoms of depression or anxiety can be used. Hospital treatment - you might need to be admitted to hospital if you are dangerously underweight. Staff will help you control your eating and talk about your problems in a supervised and structured enviroment. What can I do to help myself? Don't be afraid or ashamed. Talk to somebody you can trust about your problems. Stay in contact with friends and family who may be able to support you. Self-help books can provide help and advice on how to improve your eating. Voluntary organisations and helpful websites can also provide initial support. Remember that you don't have to do it all on your own as overcoming an eating disorder is a long and difficult journey and sometimes professional help is necessary. Page 7

8 What can partners, friends and relatives do to help? First of all, it is alright not to know or understand eating disorders. You can't force those with an eating disorder to change their behaviour or beliefs, but you can make a difference by showing that you care, offering your support, and encouraging the person to seek professional help. Try to avoid being judgemental or react with anger; eating disorders are mental health conditions and people affected often cannot easily improve by themselves but need professional help. Avoid comments on appearance as they can be easily interpreted in a negative way. Remember that, despite the potential dangerousness of the condition, this is the only way that sufferers have to manage their difficulties and need support to find alternative ways to deal with their emotions and problems. Page 8

9 Useful organisations beat - beating eating disorders beat is a national charity for people with eating disorders and their families. beat provides helplines for adults and young people, online support and local self-help groups. Helpline: (available to anyone over the age of 18 and is open Monday to Thursday 1.30pm pm. Youthline: (available to anyone age 25 or over and is open Monday to Thursday 1.30pm pm Text: Young Minds Tel: (Parents support line) Web: Young Minds is a UK charity committed to improving the emotional wellbeing and mental health of children and young people. Services include a support line for parents and online resources for children and young people. Eating Disorder Hope Web: American website offering information, eating disorder treatment options, recovery tools and resources to those suffering from eating disorders, their treatment providers and loved ones. Bodywhys - The Eating Disorders Association of Ireland Tel: Helpline: Web: Page 9

10 Online CBT resources Overcoming Bulimia Overcoming Anorexia Helpful books Breaking free from anorexia nervosa: a survival guide for families, friends and sufferers by Janet Treasure (Psychology Press). Anorexia nervosa and bulimia: how to help by M. Duker & R. Slade (Open University Press). Eating Disorders: A parents' guide by Rachel Bryant-Waugh and Brian Lask (Penguin Books). Bulimia Nervosa and Binge eating: A guide to recovery by P. J. Cooper and Christopher Fairbairn (Constable and Robinson). Overcoming binge eating by Christopher Fairburn (Guildford Press). Getting better BITE by BITE: A survival kit for sufferers of bulimia nervosa and binge eating disorders by Janet Treasure and Ulrike Schmidt (Hove Psychology Press). Anorexia Nervosa and Related Eating Disorders (ANRED). Self-help tips: For more information about conditions and local services availble to help, please visit: Page 10

11 Page 11

12 You can ring for a translation Monday - Friday 9.00am pm. Please give this number: and also for Audio, Large Print and Braille, call now on: Produced By: Date of Publication: Page 12Review Date: Reference: Communications 27/05/ /05/2017 lc

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