Are we clued up with what Eating Disorders are?
Does anyone know about this World Day?
Do we know what it means for us on the street?
Do we know anyone who has an Eating Disorder?
Do we fit the categories mentioned but don’t yet know it?
WHY are most of us not aware of how serious this illness is?
What is the official website telling us?
World Eating Disorders Action Day is a grassroots movement designed for and by people affected by an eating disorder, their families and the medical and health professionals who support them. Uniting activists across the globe, the aim is to expand global awareness of eating disorders as genetically linked, treatable illnesses that can affect anyone.
2017 is the second annual World Eating Disorders Day.
Advocating for early intervention and evidence-based treatment.
Parents/Families as key players in their children’s/loved one’s treatment and recovery.
Increased diversity in research, narratives, media and professionals working in the field.
Break down barriers to care including among underserved populations.
Promoting that eating disorders are treatable at all ages/stages. (1)
What are Eating Disorders?
Eating disorders are defined as a distorted pattern of thinking about food and size/weight.
The pressures of work and social commitments often result in people picking up a snack while they are ‘on the go’. It is therefore hard in modern day society to define ‘normal’ eating.
Cultural ideas of perfection, which are heavily influenced through the media, can result in people feeling the need to be thinner, and increase their risk of developing an eating disorder.
Biological and genetic factors are also thought to further affect a person’s risk of developing certain types of eating disorders. It is more likely to be a combination of many factors, events, feelings or pressures that lead to the sufferer feeling unable to cope, resulting in the maladaptive coping mechanism. Examples of such factors include –
Lack of confidence
Trouble with friends
Problematic family relationships
Death of someone special
Difficulties at work, college or university
Sexual or emotional abuse (2)
People with eating disorders use food as a way of externally expressing their internal emotional pain; as a coping mechanism for this pain, which they cannot express in any other way. People with eating disorders tend to focus on what they look like, rather than who they are as a person.
Often people with eating disorders say that the eating disorder is the only way they feel they can stay in control of their lives but, as time goes on, it becomes evident that the eating disorder itself is controlling them.
It is common amongst those with eating disorders to experience feelings of despair and shame.
They may also identify with feelings of failure or lack of control, due to an inability to overcome these feelings about food alone.
Contrary to popular belief, eating disorders do not only affect women.
Despite the figures being significantly lower, men can also suffer with anorexia, bulimia and compulsive or binge eating. (2)
Eating Disorders and Men
The incidence of eating disorders is on the rise among men, with some estimates suggesting that men now account for one in four cases.
Poor recognition of the signs and symptoms of eating disorders in men is likely to mean that the true prevalence may be higher.
Study published in British Medical Journal Open (3)
The men said it was only reaching a crisis point of being admitted as an emergency that triggered the realisation of what was happening to them.
Their experiences of the health system were mixed with long waiting times and sometimes being misdiagnosed, or as in one case, told by a doctor “to man up”.
Men with eating disorders are under diagnosed, under treated and under researched.
Our findings suggest that men may experience particular problems in recognising that they may have an eating disorder as a result of the continuing cultural construction of eating disorders as uniquely or predominantly a female problem. (4)
Haines who was once obese was hospitalised after losing 45 kilos.
Like many who have an eating disorder, Haines had restricted his caloric intake, exercised excessively and obsessed over his physique. He was irritable, constantly cold and doubled over with stomach pains after eating.
His dramatic weight loss was overlooked because he never dropped to what the body mass index charts indicate as ‘underweight’. For more than a year the clinicians did not think anything was wrong. (5)
So how wrong was that and can we blame our clinicians?
If we are being honest, would it be fair to say that they cannot keep up with what is going on?
Could it be possible our human body is showing so many symptoms and their training cannot simply keep up with everything?
What if we applied some real common sense here?
If someone feels constantly cold and in severe pain after eating, then do we need to dig deep and ask questions like –
What is the actual food that is being consumed?
What is the quality of the food in terms of real nutrition?
What is the time the food is being eaten?
What is the person’s relationship with food?
What if the past obesity issue is still not truly healed.
In other words, the root cause and their relationship with food has not been addressed?
What if the obsessive exercise was doing more harm than good?
What if we need to address all areas – in other words the whole being and not just one part?
An eating disorder is an illness that permeates all aspects of the sufferer’s life.
It is a serious health condition that can be both physically and emotionally destructive.
It can affect our relationships leading to social withdrawal.
Eating Disorders: Causes
It is difficult to specify a single cause for the development of an eating disorder; instead it is believed to be a combination of biological, genetic, psychological and social factors. (2)
Tendency to be ‘perfectionists’
Expecting the very best of themselves
Failure resulting in feelings of shame
Belief things are good or bad – no middle ground
Eating Disorders in Academia
UK and Swedish researchers found more eating disorders occur in those schools with higher proportions of female students and those where parents are university educated.
For a long time clinicians in the field have noted that they seem to see more young people with eating disorders from some schools than others, but this is the first empirical evidence that this is the case.
Dr Helen Bould – Lead Researcher, Child and Adolescent Psychiatrist
University of Oxford, Department of Psychiatry (6)
The Multi-Service Eating Disorders Association (MEDA) cites the following statistics on college student eating disorders:
15% females aged 17 to 24 have eating disorders.
20% college students said they have or previously had an eating disorder.
91% female college students have attempted to control weight with dieting. (7)
Family history of eating disorders
Further research suggests levels of serotonin (5HT2A receptor) in the brain can also contribute to the development of eating disorders, as those with high levels of this chemical are less likely to crave food.
Family and Friends
Media presenting thin as normal
Magazines depicting celebrities as role models
Pressure from the above contributes towards the development of eating disorders.
These ‘role models’ do nothing to promote healthy eating. (2)
6 May 2017
New law in France banning the use of unhealthy thin fashion models has come into effect.
Models will need to provide a doctor’s certificate attesting to their overall physical health, with special regard to their body mass index (BMI) – a measure of weight in relation to height.
The health ministry says the aim is to fight eating disorders and inaccessible ideals of beauty.
Digitally altered photos will also have to be labelled from 1 October 2017.
Employers breaking the law could face fines up to 75,000 Euros / $82,000 US dollars.
Italy, Spain and Israel already have legislation on underweight models. (8)
This news story is saying there can be a fine line between a so called ‘healthy eating obsession’ and an ‘eating disorder’.
An unhealthy obsession with cleaning up our diet is known as orthorexia nervosa, which means a “fixation on righteous eating”.
There is a risk of malnutrition by being too strict with your diet and stripping out nutrients.
Dr. Bryony Bamford – London Centre for Eating Disorders and Body Image
Social media is increasing among young adults according to researchers at London University.
It has been shown to have negative effects on body image, depression, social comparison and disordered eating.
Higher use of photo sharing apps was associated with greater tendency towards orthorexia.
No other social media channel was having this effect.
Web giants have been branded “morally bankrupt” for hosting thousands of images showing youngsters how to starve themselves and self-harm.
The posts glamorise eating disorders with pictures of dangerous skeletal bodies and carry a series of practical tips on how to stave off hunger on the ’no food diet’.
It is vital to recognise the huge danger created by any site or social media trend that promotes or glamorises self-harm, suicide or eating disorders.
These are incredibly serious problems. (9)
Stephen Buckley – Mind Mental Health Charity
Further social pressures also come from a person’s occupation.
Jockeys and dancers are encouraged to keep low body weight as this can ‘enhance performance’.
Female Athlete Triad is a common and serious disorder that affects young female athletes and dancers. This includes:
Eating Disorders including Anorexia
Amenorrhea (absence or irregular periods)
Osteoporosis (bone loss, which is related to low weight) (10)
Jockeys – often adolescent boys and adult men will engage in very restrictive diets and extreme behaviours in order to meet strict and specific weight requirements.
Some of the unhealthy behaviours include self-induced vomiting, abusing laxatives and diuretics to lose water weight, using saunas and hot baths, skipping meals or avoiding food and taking pills.
Weight requirements for horse jockeys range from 112 – 126 lbs (52 – 57 kg).
75% routinely skipping meals
81% restricted food intake in the 24 hours prior to racing
29% sauna induced sweating
22% diuretics to aid weight loss prior to racing (11)
What percentage of jockeys have an eating disorder is not known, presumably due to the stigma associated with eating disorders and likely fear that confessing problems may lead to an end in their careers.
The impact of extreme weight loss practices on riding performance remains elusive as well.
Other sports – like wrestling and boxing also have specific weight requirements that tend to promote risky eating behaviours. (11)
Eating Disorders can become chronic, debilitating, and even life-threatening conditions.
Eating Disorders: Complications
There are a large number of side effects and complications associated with eating disorders.
Common Symptoms of Eating Disorders include:
Obsession with weight
Obsession with the calorie and fat content of food
Dramatic change in weight within a short period of time
Feelings of anxiousness, loneliness or depression
Obsession with food and body image
Loss of sexual desire
Low self-esteem or lack of confidence
Fear of eating around others
Insomnia or poor sleeping habits
Unusual food rituals or eating secretly (2)
Cutting food into small pieces
Disappearing after eating
Large quantities of food disappearing in short periods of time – common with binge-eating
Hiding wrappers/containers underneath bed, out of shame of what they have been doing (12)
Circulation and Digestion
People with eating disorders can suffer from poor circulation of blood around the body as a result of lowered blood pressure.
When the body is starved it slows everything down to conserve the limited energy that is available. The heart would beat more slowly to protect its weakened muscle. As a result, blood pressure drops and circulation of blood to extremities is poor.
This can cause loss of sensation in fingers, numb arms and legs. (13)
This link gives us some real life stories of the effects –
Fingers turning blue
Wearing thick coat whole summer
Repeated baths to keep warm
Unable to sense water temperature, so burning themselves
Blood vessels shrunk, so difficult to get blood samples
Passing urine 5 times each night due to bladder muscle loss
Under pressure to hold head up as back losing muscle
Headaches due to neck unable to hold head up well
Bruising over body on waking
Eating Disorders and Thought Patterns
Negative Thought Patterns
This youth health talk organisation state that many people are taken over by constant negative thoughts, particularly about themselves.
Some referred to this as “eating disorder voice” – a super critical, relentless and intrusive voice.
They said the voice makes them feel low and ‘not good enough’ pushing them to restrict (severely limit eating), binge (eat excessively) or purge (rid the body of food).
A few people commented that they felt like the voice belonged to a different person, compelling them to behave in harmful ways. (14)
It is like having somebody in your head telling you that everything you do is wrong, like you cannot please it no matter what you do. If you go for a walk, you have not walked far enough.
If you eat a lettuce leaf you still should have not had it. – Eva
The voice was “shouting and calling me a disgrace.” – Andrew
I had a constant screaming voice in my head.
It was exhausting to have conversations as the voice was so loud. – Maria aged 18 (14)
If we are being honest here –
How many of us have this negative voice in our head most of the time?
How many of us hate the sound of this ugly voice that tells us what to do?
How many of us listen to this voice and carry out what it says to us?
How many of us can relate to things in our mind that we can feel are not us?
How many of us know that voice, which is hard and critical, telling us something?
How many of us pay attention to that voice, in our mind, that takes us off track?
How many of us think it is really us when we hear a voice prompting us to do something?How many of us feel the voice is like a force and we have no control over it?
How many of us dismiss that this voice may be coming from outside of us?
Do we ever think that this voice may actually be real but it is not us?
Do we ever consider that we need to discern at all times if this voice is true or not?
Eating Disorders: Prevention
It is important that parents and those responsible for educating on eating disorders focus on the following:
Explain how dieting can have a negative impact on a person’s health.
Identify factors, which could contribute towards the development of an eating disorder.
Teach the negative side effects diet pills and other substances can have on the body.
Teach respect and tolerance for the diversity of body sizes.
Teach how to eat properly – i.e. Eating when hungry, stopping when full, eating balanced diet. (2)
Could it be possible that to teach anything on any subject, we need to have lived the quality we are presenting to others?
Could it be possible that if we have a blind spot, in this case our own eating issues, then we cannot truly expect real change in another?
Could it be possible that we need to apply common sense and a dose of honesty before telling anyone else what to do and not do?
Could it be possible that no amount of theory can dictate or change us if we are not ready?
Could it be possible that we need a deep understanding before we make any real change?
Could it be possible that educating us how to eat properly is not a true approach?
Could it be possible that we simply cannot teach anyone to stop eating when they are full?
Could it be possible that a balanced diet means different things to different people?
Could it be possible that the hunger we register may not really be a hunger from lack of eating?
The onset of anorexia is usually under the age of 20, which typically begins with young girls trying to lose weight. This gradually develops into an obsession with dieting, losing weight and food.
While the overall incidence rate remained stable over the past few decades, there has been an increase in the high risk-group of 15-19 year old girls. It is unclear whether this reflects earlier detection of anorexia nervosa cases or an earlier age at onset. (15)
Anorexia is a serious perception disorder.
It causes people to see themselves in a distorted way. They regard themselves as overweight and needing to lose extreme amounts of weight. It is through this that they become obsessive about food and develop unusual eating rituals. They are often very secretive about food. They may check their weight more than once a day and carry out intense exercise regimes.
The condition is often diagnosed along with
Substance abuse disorder (2)
Anorexia has the highest death rate of all adolescent psychiatric conditions. (4)
Physical signs and symptoms
Many of the physical signs and symptoms of anorexia nervosa are attributable to starvation.
Amenorrhea is commonly present and appears to be an indicator of physiological dysfunction. If present, amenorrhea is usually a consequence of the weight loss, but in a minority of individuals it may actually precede the weight loss. In prepubertal females, menarche may be delayed.
Some individuals evidence a yellowing of the skin associated with hypercarotenemia. (16)
Suicide risk is elevated in Anorexia Nervosa.
What exactly is Comorbidity?
It is telling us that two chronic dis-eases in the body are occurring at the same time.
So, we could say this is really serious as chronic means constantly recurring.
Bipolar, depressive and anxiety disorders commonly co-occur with anorexia nervosa.
Many individuals with anorexia nervosa report the presence of either an anxiety disorder or symptoms prior to onset of their eating disorder. OCD (Obsessive Compulsive Disorder) is described in some individuals with anorexia nervosa, especially those with the restricting type.
Alcohol use disorder and other substance use disorders may also be comorbid with anorexia nervosa, especially among those with the binge-eating purging type. (16)
Oedema (retention of fluid)
Reduction in white blood cell count
Abnormal electrolyte and mineral levels
Weight loss of at least 15-25% of original body weight
Extreme fear of becoming fat
Hypothermia (drop in body temperature)
Menorrhea (menstruation stops)
Lanugo (neonatal-like body and facial hair)
Ritualised eating habits
Abuse of slimming tablets
Intense and strict exercise regimes
Hoarding or hiding food
Obsession with food preparation, recipe books and other people’s eating habits
Denial of the severity of the illness and refusal to participate in therapy/rehabilitation (2)
Under the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), for a diagnosis of anorexia to be made, the following criteria needs to be met:
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Significantly low weight is defined as weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of become fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Two Subtypes of Anorexia
During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the mis-use of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting and/or excessive exercise.
Binge Eating/Purging Type
During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the mis-use of laxatives, diuretics, or enemas). (16)
Side Effects and Complications Associated with Anorexia
Loss of Hair
Poor blood circulation
Low heart rate
Sensitivity to bruise
Dry fragile bones and nails
One of the most common and serious health risks linked to anorexia nervosa is osteoporosis. (13)
Low self esteem
Distorted self-image of body
Pre-occupied with obsessive thoughts about food and weight
Refuse to listen to family or health professionals
Refusal to accept weight as seriously low and very dangerous
The excessive exercise and food restriction means that people with anorexia are socially isolated as they become withdrawn from everyday life and no longer engage or connect through relationships with others.
They have a form of secretive behaviour, which inevitably leads to feelings of shame and embarrassment. They struggle with eating when others are present and this leads to further isolation and withdrawal from family and friends.
Avoiding social settings would be something the individual has to ensure is carried out to support them with their illness. They are concerned with being judged and having attention drawn to them.
This obsessive un-natural way of living makes them over sensitive to others about their weight and appearance and some find a solution by taking an interest in cooking for others to hide their own deep suffering.
The very nature of this debilitating illness if not treated, can bring on self-harm or substance abuse in order to cope with and numb the inner tension they live with every day.
Some studies indicate that patients with anorexia have ‘Avoidant Personalities’ which is characterised by the need to be a perfectionist, being emotionally and sexually inhibited and being terrified of being ridiculed, criticised or feeling humiliated.
66% of people with Anorexia may develop Obsessive Compulsive Disorder. (10)
Treatments for Anorexia
Psychotherapy or Counselling
Talking to a therapist about our thoughts and feelings can help us to understand how the problem started and how we can change our ways to think and feel about things.
It is to help us cope and feel better and offers support to value ourselves and rebuild a sense of self-esteem and self-worth.
Advice and Help with Eating
A dietician may talk about healthy eating as they are experienced and can advise about vitamin supplements.
This is an option if there is severe weight loss and other symptoms of illness are presented.
This happens if someone has their life or health in danger and is unable to make clear decisions for themselves and need to be protected.
How Effective is the Treatment?
More than half recover well, although it can take a long time. (17)
What are the solutions that we use to get over Anorexia and function again in our world?
Do we replace it with finding something else our mind takes over with?
Do we let our mind rule our body with the non-stop ill thoughts that pass through it?
Do we find another way of dis-regarding our body that looks ok to the world out there?
Do we turn to body building as a way to tell the world we are sorted out now?
Do we see others do something that may not feel right but we jump on the band wagon?
Do we replace our current illness with another one that is more socially acceptable?
Do we find ways to not stand out or do we go to the extreme and make sure we stand out?
Do we truly deal with our deep self-worth issues that hurt us so much?
Do we make sure we put our stamp on the earth and claim that we are worthy?
Do we avoid at all costs the attention and pressure that comes with Anorexia?
Bulimia nervosa (also known as bulimia) is closely linked to anorexia and shares many of its essential features. People with this condition may think about food constantly and experience extremely strong cravings. After a binge, they may induce vomiting or use laxatives as a method of avoiding weight gain.
Someone suffering from bulimia is usually aware of their abnormal eating pattern, and there are feelings of guilt and self-loathing after vomiting. They typically fear that they will not be able to stop eating voluntarily.
Frequently vomiting can cause a vast number of side effects, such as tooth decay, mouth ulcers, heart problems and muscular weakness. The use of laxatives on a regular basis can also cause serious damage, and does not actually assist in weight loss. This is because calories are absorbed in the upper bowel, whereas laxatives work mainly by removing the fluid in the lower bowel.
Bulimia can be an easier condition for the sufferer to hide compared to anorexia, as people with the condition do not always lose weight. (2)
A. Recurrent episodes of binge eating.
An episode of binge eating is characterised by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating.
B. Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.
C. The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa. (16)
Development and Course
Bulimia Nervosa commonly begins in adolescence or young adulthood. Onset before puberty or after age 40 is uncommon.
The binge eating frequently begins during or after an episode of dieting to lose weight. Experiencing multiple stressful life events also can precipitate onset of bulimia.
Suicide risk is elevated in Bulimia.
Comorbidity with mental disorders is common in individuals with bulimia nervosa, with most experiencing at least one other mental disorder and many experiencing multiple co-morbidities. (16)
With bulimia, this is saying that some may experience multiple co-morbidities so even more diseases in the body because they have multiple mental disorders.
Is this the confirmation we need that EATING DISORDERS ARE A MENTAL ILLNESS?
Is it something to do with our mind where our thoughts lead us to this ill behaviour?
Are any of us truly aware of how serious this actually is?
The lifetime prevalence of substance use, particularly alcohol or stimulant use, is at least 30% among individuals with bulimia nervosa. Stimulant use often begins in an attempt to control appetite and weight. (16)
Menstrual cycle ending
Frail hair or nails
Intense exercise regime
Knuckles blistering from forced vomiting
Frequent pain in the stomach
Frequently feeling tired and weak
Frequently going to bathroom immediately after a meal
Dramatic increase in food intake without change in weight
Isolation from family and friends (2)
Side Effects and Complications Associated with Bulimia
Problems during pregnancy
Problems with teeth and gums
Dry fragile bones, hair and nails
Broken blood vessels in the eyes
Chronic irregular bowel movements
Kidney problems, even kidney failure
Principle Complications Associated with Bulimia
Stomach pain and inflamed sore throat may be the first physical side effects of bulimia. It affects the entire digestive system. The lack of digestive enzymes and healthy bacteria needed for digestion make it difficult to digest food naturally and absorb the nutrients that the body needs. Chronic irregular bowel movements, constipation and other gastrointestinal problems are now created because of the cycle of eating and vomiting.
The stomach produces acid that is needed for food digestion and this is disturbed by the constant need to eat and vomit thus bringing the acid juices into the oesophagus. The high levels of acid can lead to further complications of irritation and inflammation to the oesophagus.
The stomach lining becomes sensitive and acid reflux becomes a common side effect.
The sufferer becomes more sensitive to food as the body moves away from the natural process of digestion where enzymes and acids are needed to breakdown food.
Not digesting the food means the body simply cannot receive any nutrients required.
Damage to the intestines can cause bloating, constipation and diarrhoea.
The inability to have bowel movements can cause straining and lead to haemorrhoids.
Mis-use of laxatives, diuretics and diet pills affects the natural bowel movement and can lead to a point where the body relies on these substances.
Sufferers show signs of anxiety and repeated panic attacks with physical reactions such as
Weakness in general
Heart feeling racy
The constant monitoring of food and weight can become an obsession and the binge eating and secret way of living to hide evidence of food and laxatives contributes to the cycle of stress and anxiety. Due to this constant demanding way of living everyday, moods and emotions are affected and the sufferer can become irritable adding to their stress levels.
The focus on food and how to control it together with compulsive exercising and pre-occupation with appearance can mean that the sufferer lives in a chronic state of anxiety. There can be feelings of shame and embarrassment, which would trigger intense anxiety in social situations because of the self-consciousness.
There is evidence suggesting Bulimia can result in depression.
With an episode of eating, the sufferer can feel self-loathing, which could lead to feelings of low self-worth, this adding to the depression. The endocrine system is affected and the hormonal imbalance could lead to the menstrual cycle becoming disrupted in women.
The heart muscle is extremely sensitive and is affected when there is nutritional deficiency.
Mineral and electrolyte imbalances are common with bulimia and can lead to cardiac arrest.
Frequent purging can cause dehydration, which will lead to dry skin, weak muscles and extreme fatigue. The electrolyte imbalances with low levels of potassium, magnesium and sodium are found in bulimia sufferers.
This means that the heart is affected and it can lead to irregular heartbeat, known as ‘arrhythmia’, weakened heart muscle and in serious cases heart failure.
Chest pains and extreme muscle weakness are a result of the stress on the body.
Research has shown that bulimia sufferers have the racy heartbeat as the body tries to cope with the constant assault of the cycle it is under of eating and purging.
Low blood pressure and a weak pulse are often found in people with bulimia, which confirms there is a greater risk of heart failure.
Repeated vomiting causes damage to the enamel of the teeth because the gastric and stomach acids are highly erosive. When the enamel layer is worn away, the next layers of the tooth such as the dentine and the pulp become more exposed and these are very sensitive and painful when drinking or eating hot or cold foods or anything with sugar.
Decalcification of teeth, enamel loss, staining, severe tooth decay and gum disease are all as a result of repeated exposure to stomach acid.
The appearance of the teeth will start to look glassy and yellowish and if the sufferer is drinking fruit juices or carbonated ‘fizzy’ drinks then this will accelerate the acid erosion of the teeth. This will lead to tooth decay. Dry mouth is also common with bulimia sufferers and this can lead to drinking sugary drinks which increases the rate of tooth decay.
Obsessive Compulsive Disorder may occur in up to 33% of people with Bulimia. (10)
4% of people with bulimia are likely to die prematurely from the condition. (18)
Treatments for Bulimia
Cognitive Behavioural Therapy (CBT) to look at links between our thoughts, feelings and actions.
This can be done with a –
Self Help Book
Usually done with an individual therapist.
The treatment focuses on our relationships with other people.
To help get back to regular eating without starving or vomiting.
Antidepressants can reduce the urge to binge.
However, without other forms of help, the benefits wear off after a while.
How Effective is the Treatment?
About half of sufferers recover.
Recovery usually takes place slowly over a few months or many years. (17)
Are we ready to be really honest and ask –
Are we needing a deeper understanding as to WHY eating disorders start in the first place?
Are our well intended treatments simply solutions and there may just be MORE we need?Are our self-help books actually going to change deep set patterns for bulimia?
Are our computer programmes the answer for someone with a mental illness?
Are our group sessions the right place for people who see this as a secret thing?
Are our therapists living a quality of life that is consistent in all of their relationships?
The most common eating disorder yet it is less well known than anorexia and bulimia.
Binge Eating Disorder is a psychological illness which can lead to obesity, diabetes, high blood pressure and high cholesterol. (19)
Binge Eating Disorder (BED) is now an actual eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, released in May 2013 by the American Psychiatric Association.
This is the official “rule book” of mental health diagnosis and important so that everyone is using a common language when talking about a specific disorder.
In the past 20 years there have been over 1,000 research papers published that support the idea that Binge Eating Disorder is a specific diagnosis that has validity and consistency.
Russell Marx – National Eating Disorders Association (20)
The disorder is characterised by the person eating large quantities of food, but unlike bulimia they do not use laxatives or vomit afterwards. It is due to this that they are likely to gain weight. People with the disorder feel they are unable to control what they are doing.
Binge-eating disorder has a number of characteristics, which include the sufferer eating secretly where there is no-one else around, eating quicker than usual, and eating even when they are full.
They may also eat foods, which are regarded as ‘naughty’, but they do not feel as though they can control their habit.
People with binge-eating disorder tend to be overweight due to the nature of the disorder, although people of a normal healthy weight can also be affected. Sufferers often turn to food as a source of comfort when they are feeling sad or simply bored.
Due to the feelings of guilt and shame, many sufferers do not seek professional help, as it would involve having to admit to someone that they have a problem. (2)
Eating even when full
Eating large quantities frequently
Feeling guilty after a binge
Feeling out of control
Obsessed with food and body
Frequent changes in weight
Feeling anxious or depressed
Low self-esteem/low confidence
Eating for comfort when sad, bored or lonely
Binging twice a week or more, over a period of months
Unable to stop binging, even when aware of emotional distress it will cause (2)
A. Recurrent episodes of binge eating.
An episode of binge eating is characterised by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. The binge eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed or very guilty afterward.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
The disorder is more prevalent among individuals seeking weight-loss treatment than in the general population.
Development and Course
Little is known about the development of binge-eating disorder.
Both binge eating and loss-of-control eating without objectively excessive consumption occur in children and are associated with increased body fat, weight gain, and increases in psychological symptoms.
Binge eating is common in adolescent and college-age samples. Loss-of-control eating or episodic binge eating may represent a prodromal phase of eating disorders for some individuals.
Binge eating disorder typically beings in adolescence or young adulthood but can begin in later adulthood. (16)
Can we just stop here and press the pause button please?
WHY is little known about the development of binge-eating disorder?
WHY has it only been on the DSM-5 diagnosis since 2013?
WHY did it take 20 years to be recognised as a mental disorder?
WHY are we not getting to the root cause of this illness?
WHY are we not hearing about this in the media?
WHY are we so vague about something that is killing us?
WHY are we not demanding research into finding out what is going on?
WHY do we call ourselves an advanced species, yet we do not know how we develop this mental illness?
WHY is our current form of Intelligence not able to join the dots and get to the WHY questions?
WHY is binge eating generally starting in adolescence?
What is really going on in the minds of our Youth of today?
How are they truly feeling that they need to overeat?
What is coming up for them that the overeating is pushing back down?
WHY are we not asking some common sense questions here?
WHY are we simply choosing not to join the dots?
Could it be possible that the transition from child to adult is difficult for many with the pressures placed on them?
Could it be possible that our young people feel they do not fit in with what the systems want from them?
Could it be possible that many of our adolescents simply do not know how to Be who they truly are?
Could it be possible the young person lost a sense of who they are?
Could it be possible that ill mental health in our teenagers is not being taken seriously by us who think we know what’s best?
Could it be possible that losing a grip on life means we turn to food to bury what we do not want to feel?
Could it be possible that binge eating happens because it is our ‘go to’ when things don’t feel great in life?
Could it be possible that our body constantly brings up stuff and we shove it down with excess eating?
Could it be possible that our non-stop ugly thoughts make us eat and eat and we simply do not know how to make changes that last?
Could it be possible that there is a direct correlation between Binge Eating and Obesity?
Would it be true to say that many of us would tick the boxes under this diagnosis but we just see it as normal as the world and its brothers are doing it too?
WHY would anyone overeat to the point of feeling uncomfortable?
Are we as a race of beings comfortable in our uncomfortableness?
Side Effects and Complications Associated with Binge Eating
Lack of energy
Feeling tired and weak
High blood pressure
Type 2 Diabetes
Some types cancer
Obsession with appearance
Feelings of anxiety and depression
Low self-esteem and confidence
Binge eating (without purging) is most common in Type 2 Diabetes and the Obesity it causes may even trigger this Diabetes in some people. (10)
Eating disorder diagnoses are delayed among patients who were once overweight or obese.
Leslie Sim, PhD – Journal of Adolescent Health, 2014
For some people who undergo bariatric surgery, the dieting process itself can trigger an unhealthy obsession with controlling food intake. (5)
Other Specified Feeding or Eating Disorder
Atypical anorexia nervosa:
All criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range.
Bulimia nervosa (of low frequency and/or limited duration):
All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviours occur, on average, less than once a week and/or for less than 3 months.
Binge-eating disorder (of low frequency and/or limited duration):
All of the criteria for binge-eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than 3 months.
Recurrent purging behaviour to influence weight or shape (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating.
Night eating syndrome:
Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication. (16)
People with eating disorders need to seek support as soon as possible, before the condition becomes life-threatening. In the UK, if admitted into hospital for eating related disorders, counselling is offered and the client is given a fair amount of choice regarding food.
However, if the condition is severe, some hospitals may use Electroconvulsive Therapy (ECT), drugs or force-feeding techniques. This is particularly the case if they are admitted into hospital under the Mental Health Act.
Those who have eating disorders often use food as a way of taking some control of their lives. This often results in a loss of control as the disorder takes over their life.
A therapeutic relationship where the client feels safe and confidentiality is practiced throughout, is needed so that the underlying issues which are causing the eating distress, such as low self-esteem and lack of confidence can be discussed. (2)
This is the word used to describe a situation where someone deliberately and regularly reduces the amount of insulin taken due to concerns over body weight or shape.
The long-term impact is severe hyperglycaemia and weight loss as the body has to breakdown fat and muscle in order to get energy.
Without insulin, glucose levels build up in the blood.
Hyperglycaemia leads to polyuria. This means that any calories taken in by eating are passed straight through and out of the body in the urine. As a result, the calories are not used and the body is starved of its source of energy, which is needed for every organ to function.
If hyperglycaemia remains untreated, it develops into Diabetic Ketoacidosis (DKA), which is life threatening. In DKA the body starts to break itself down in the hunt for energy, which leads to weight loss and other complications. If DKA is left untreated, heart and organ failure occurs.
Diabulimia is extremely dangerous.
Research shows people who do not give themselves enough insulin over a long period of time, have a much shorter life span. (21)
Complications linked to Diabetes, including retinopathy, neuropathy and nephropathy, appear more quickly and it can lead to infertility.
It is important to know that Diabulimia is a mental illness, although it is technically not a medically recognised condition. (21)
Why do people do it?
Obsession with food labels
Negative attention to weight
Constant awareness of numbers
Parent attitude towards Type 1 Diabetes
Shame over management
Negative relationships with healthcare providers
Difficulty losing weight due to insulin
All the above have been listed as diabetes-specific causes that can lead to eating disorders in people with Type 1 diabetes.
It is unlikely that any of these exist by themselves as diabulimia usually develops from a complex combination of biological, psychological and social difficulties.
40% all women aged 15 – 30 with Type 1 Diabetes take less insulin to lose weight.
60% Type 1 women will experience a ‘clinically significant’ eating disorder by age 25.
It is not just women that can be affected by Diabulimia.
Research has shown that men with Type 1 diabetes have a ‘higher drive for thinness’ than their non-diabetic counterparts, making them more susceptible to Diabulimia. (21)
Children and Body Image
Children as young as three are showing signs of being unhappy with their appearance and bodies.
The research carried out by the Professional Association for Childcare and Early Years (PACEY), suggests worries around image and weight begin before a child has even started school and highlights concerns that children are becoming anxious at a younger age than before.
More research was needed in the area but speculated “contributing factors” were likely to include television and images in story books and animations.
There is research evidence to suggest that some 4 year olds are aware of strategies as to how to lose weight.
Dr. Jacqueline Harding – Advisor to PACEY (22)
The report from PACEY advises parents to be aware that even very young children can be influenced by the way they talk about their own body and appearance and that parents and peers are likely to be the biggest influences of all.
Childhood is when our mental health is developed and patterns are set for the future – so it is crucial that parents reassure their children about how they look, set a positive example and build their self-esteem.
Nick Harrop – Young Minds Children’s Mental Health and WellBeing Charity (22)
Problematic Dieting in Children Can Predict Obesity and High Blood Pressure.
Problematic eating behaviours at age 11.5 years strongly predicted new-onset obesity, high blood pressure and high fat mass index at age 16.
These results remained significant despite the socioeconomic background.
The data also suggested that obesity (adiposity) in early life, based on the body mass indices obtained at age 6.5 years, may be an underlying cause of problematic eating attitudes, which in turn predicts future cardiovascular risks and further weight gain.
Study published on problematic eating and cardio metabolic health in children and teenagers – American Journal of Clinical Nutrition (23)
Alcohol and Body Image Problems
Recent U.S. study suggests high school girls who have issues with body image and weight are more likely to be drinkers.
Researchers focused on body image behavioural misperceptions (BIBM) – when girls try to gain or lose weight to change how they look even though there is no medical need for them to alter their weight.
Study of more than 6,500 teenage girls
38% had misperceptions
66% had tried alcohol
22% more likely to be heavy drinkers
The findings add evidence linking body image issues with risky behaviours.
Dr. Benjamin Shain – Head of Child & Adolescent Psychiatry
NorthShore University Health System, Chicago (24)
Older Women and Eating Disorders
15% women aged 40 – 60 suffered an eating disorder at some point in their life.
First time prevalence has been investigated in the older women population.
Factors associated with onset of an eating disorder included –
Parental divorce or separation
Relationship with parents
20% reduced chance of developing bulimia associated with good mother-daughter relationship.
Research study from University College London (UCL). (25)
For many women it was the first time they had spoken about their eating difficulties.
Dr. Nadia Micali – Lead Author, UCL and Department of Psychiatry
Icahn School of Medicine, New York
These are really high figures. There are not any other studies looking at this age span.
We also see from this study that very few of these women have had treatment.
Christopher Fairburn – Professor of Psychiatry
University of Oxford (25)
1.6 million now suffer from Eating Disorders
11% are male
14 – 25 age group are most affected by an Eating Disorder
10% of those affected are Anorexic
40% of those affected are Bulimic (26)
£60,000,000 – NHS average cost of Eating Disorders. (4)
Men receiving treatment for an eating disorder has grown twice as fast in last three years.
27% increase in male patients
33% under 18 in 2016
400 boys seen in 2016
38% increase from 2015 (27)
NHS England have chronic bed shortages to cope with growing number of anorexia, bulimia and other forms of psychiatric illness linked to eating habits.
Patients in England with seriously ill eating disorders are being sent to Scotland for treatment.
It is a concern. Patients should be treated nearby and should be in contact with family.
They need support and it is much harder to get that when families have to travel long distances.
Dr. Jon Goldin – Consultant Psychiatrist (28)
Hospital admissions for eating disorders in England are increasing.
Number of deaths in England and Wales from eating disorders has risen.
Office of National Statistics quoted in The Guardian (29)
Northern Ireland has no specialist eating disorders unit.
Doctors worry about a lack of resources, with demand outstripping supply. (29)
30,000 – 40,000 are affected by Anorexia
90% are women (8)
30,000,000 Americans have an eating disorder at some point in their lives. (30)
62 minutes – how often one person dies as a direct result of an eating disorder. (31)
70 million individuals worldwide affected by eating disorders. (2003) (32)
Dear World, WHY have we only got one global statistic that is 14 years old?
We have done our best to research more, but cannot find anything.
WHY have we not made this research funding a global priority?
WHY have we allowed our media NOT to report on this hot news topic?
WHY have we not stopped and asked how come there is so little research?
WHY have we not bothered to research more on something that is so serious?
Who actually benefits if we are kept in the dark about eating disorders?
If we started with a dose of real honesty –
Could it be possible that the true figure today is very high?
Could it be possible that many of us have eating disorders but would never admit it?
Could it be possible that our dishonesty means the real statistics are simply not there?
Could it be possible that we are fed images non-stop about eating this and that?
Could it be possible that we simply cannot keep up with all this eating business?
Could it be possible that we cannot stomach how things have turned out in life?
Could it be possible that we cannot accept who we truly are?
Could it be possible we have deviated away from who we naturally are?
Could it be possible our eating patterns stem from our childhood issues?
Could it be possible that we feel pressure to conform in certain ways about eating food?
Could it be possible that we eat in a dis-ordered way to not feel something?
Could it be possible that our current world intelligence is not cut out to deal with the huge eating disorder epidemic that is out of control?
Could it be possible that things are now so bad that we need to ask –
IS THERE ANOTHER WAY?
Could it be that Simple?
Written by Bina Pattel
Community Mental Health and Psychiatry – Level 4 Award
Depression Management – Level 3. Grade: Distinction
Advanced Psychotherapy – Level 4. Grade: Distinction
Advanced Psychology – by examination. Grade: B
Stress Consultant – Corporate & Professional Level 3. Grade: Distinction
If you are feeling suicidal, contact your GP for support or the Suicide Helplines.
In a crisis contact your emergency services.
UK – Samaritans available 24 hours
Tel: 116 123
Childline – for children and young people
Tel: 0800 1111
USA – National Suicide Prevention Lifeline
Check International Association for Suicide Prevention Resources on Crisis Centers
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(2) (2016). Community Mental Health & Psychiatry Level 4. UK Distance Learning & Publishing
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