Eating Disorders

Anorexia Nervosa

What is anorexia?

Anorexia is a serious mental illness where an individual restricts their energy intake; as a result leading to a significantly low body weight. The sufferer will limit the amount of food they eat but may also exercise excessively and/or have episodes of bingeing followed by purging. The sufferer is likely to have in incorrect perception of themselves and their body believing they’re larger than they really are. Individuals experience a deep rooted fear of gaining weight or of becoming fat due to the disturbance in the way they seem themselves. If questioned or told to gain weight the sufferer will often deny seriousness of their low body weight and/or challenge the suggestion that they should gain weight to be within a healthy range. (Eatingdisorders.org.au, 2016)

Signs of anorexia

Behavioural signs:

• Eating slower than normal
• Missing meals
• Hiding food
• Not being honest about what they have eaten
• Saying that they have eaten earlier or will eat later
• Avoiding eating in front of other people
• Refusing to eat certain foods
• Restricting their diet
• Eating low calorie foods
• Obsessive behaviours and rituals around food
• Exercising excessively
• Vomiting after meals and/or using laxatives
• Using diet/slimming pills and/or appetite suppressants

Physical signs:

• Weight loss
• Fatigue
• Tiredness
• Hair loss
• Low blood pressure
• Insomnia/difficulty sleeping
• Lanugo
• Physical weakness/loss of physical strength
• Dizziness
• Constipation
• Bloating
• Stomach pain
• Unstable hormone levels
• Amenorrhea (loss of period in females)

Psychological signs:

• Fear of being fat and persistent efforts to become thin despite already being underweight
• Obsessive thoughts/fantasizing about food
• Distorted perception of their body and what they look like
• Poor body image
• Low self-confidence and self-esteem
• Low self-worth
• Difficulty concentrating
• Anxiety around eating and eating around other people
• Overly focussed on their body weight and body image

Effects of anorexia:

• Loss of bone density leading to osteoporosis
• Heart problems (tachycardia, increased risk of cardiac arrest)
• Infertility
• Acid reflux
• Increased risk of fractures

Bulimia Nervosa

What is bulimia?

Bulimia is a serious mental illness that is recognised by an individual having recurrent episodes of binge eating where they may feel a lack of control over what they’re eating and then following the event the recurrent use of inappropriate compensatory behaviours in order to prevent weight gain. The behaviours may be purging (self-induced vomiting), excessive exercise, fasting laxatives, diuretics or other medications. Usually the self-evaluation of the sufferer is unduly influenced by their body shape and weight and how they perceive themselves. (Eatingdisorders.org.au, 2016)

Signs of bulimia:

Behavioural signs:

• Exercising excessively
• Hidden food wrappers
• Withdrawal from friends and family after a meal to go to the bathroom
• Episodes of binge eating (although usually done alone)

Physical signs:

• Bloating
• Constipation
• Abdominal pain
• Tiredness

Psychological signs:

• Low self-confidence and self-esteem
• Low self-worth
• Excessive focus on their body weight and body image
• Irritability
• Mood swings
• Poor body image
• Difficulty concentrating

Effects of bulimia:

• Heart problems
• Irregular periods (in females)
• Erosion of tooth enamel

Binge Eating Disorder

What is binge eating disorder?

Binge Eating Disorder is a mental illness where an individual will have recurrent periods of binge eating, eating a larger than normal amount of food within a short period of time, and occurring without the use of inappropriate compensatory behaviours. During a binge eating episode the individual may eat faster than normal, eat alone, eat until they feeling uncomfortably full are or not feeling physically hungry. The sufferer may then feel guilty, disgusted with themselves and/or depressed afterwards and distress regarding the binge eating is present. (Eatingdisorders.org.au, 2016)

Signs of binge eating disorder:

Physical signs:

• Eating large amounts of food in a short space of time
• Eating large amounts of food rapidly
• Eating despite feeling full
• Frequently eating on your own
• Hiding empty wrappers/packaging
• Hoarding food
• Repeated attempts to diet without weight loss

Psychological signs:

• Low self-confidence and low self-esteem
• Low mood
• Lack of control once beginning to eat
• Feelings of guilt and shame
• Anxiety around eating with other people

Effects of binge eating disorder:

• Feelings of a lack of control can impact other areas of people’s lives and can have repercussions on relationships, family life, social activities and work

Other Specified Feeding/Eating Disorder (OSFED)

What is OSFED?

OSFED is a mental illness and eating disorders are diagnosed as OSFED when they don’t fit the exact diagnostic criteria for other eating disorders. This does not make the eating disorder any less serious; the symptoms are just presenting in a different way.

Examples of OSFED:

• Atypical anorexia – when a person presents with the symptoms of anorexia but their weight remains within a ‘normal’ range.
• Bulimia nervosa (low frequency of purging/limited duration)
• Binge eating disorder (low frequency of purging/limited duration)
• Night eating syndrome – when a person eating excessively after either waking up in the night or after eating their evening meal.

(Beat, 2019)

Signs of OSFED:

• Low self-confidence and self-esteem
• Low self-worth
• Tiredness
• Poor body image
• Withdrawal from social activities
• Difficulty concentrating
• Irritability
• Mood swings
• Anxiety around eating and eating around other people

Effects of OSFED:

Depending on the symptoms of the eating disorder; whether it is more similar to anorexia, bulimia or binge eating disorder will depend on the effects that their eating disorder will have on the body.

Compulsive Eating

What is compulsive eating?

Compulsive eating happens when an individual has a sense that they have lost control over their eating whether they are constantly picking at food or binge eating. This constant eating is usually accompanied by feelings of guilt or remorse and the individual might be trying to deal with it by restricting the food their eating, dieting, taking slimming pills or purging. National Centre for Eating Disorders.

Signs of compulsive eating:

• Binge eating or eating larger amounts of food within a short period of time
• Eating uncontrollably even when they are feeling full
• Eating rapidly and faster than normal
• Overly focussed on their body weight
• Tendency to eat alone
• Eating very little in public and around other people
• Withdrawal from social activities
• Weight gain
• Tiredness
• Fatigue
• Awareness of their eating patterns
• History of unsuccessful dieting
• Secretive eating patterns ie. when people aren’t around, or at unsociable hours

Effects of compulsive eating:

• Heart problems
• Diabetes
• High blood pressure
• High cholesterol
• Kidney disease
• Arthritis
• Increased risk of strokes

Orthorexia

What is orthorexia?

Orthorexia is a condition where an individual develops an obsession with only eating ‘healthy’ and/or ‘pure’ foods. This leads them to eliminating many types of foods and even food groups from their diet limiting their dietary intake. (Beat, 2019)

Signs of orthorexia:

• Obsessive concerns over their health and the impact of their choice of food ie. it’s potential effects on mood, anxiety, physical health
• Increased avoidance of certain types of foods
• Increased use of supplements, probiotics and herbal remedies
• Overly concerned about preparation of food and the need for sterilization of equipment and washing of food
• Significantly reduced due to what the person considers acceptable to consume

Effects of orthorexia:

• Obsessive thoughts about food
• Increased time planning food
• Anxiety and fear about eating food prepared by other people or eating away from home
• Low mood
• Anxiety

Body dysmorphic disorder

What is body dysmorphic disorder?

Body dysmorphic disorder is a mental illness where an individual spends an excessive amount of time worrying about their perceived flaws in their physical appearance. Due to this the individual may develop compulsive behaviours and routines such as checking their body in mirrors very frequently or picking their skin to try and manage the feelings associated with how they look. (Mind.org.uk, 2019)

Signs of body dysmorphic disorder?

• Intense obsession over appearance and body image
• Belief that they have flaw in their appearance that makes them ‘ugly’
• Looking in mirrors frequently
• Avoiding mirrors altogether
• Refusal to be in photographs
• Avoiding social situations
• Comparing themselves to other people
• Picking their skin/plucking hair
• Having cosmetic procedures without satisfaction
• Wearing excessive makeup to camouflage perceived flaws

Bigorexia

What is bigorexia?

Bigorexia is a mental illness and a subtype of body dysmorphic disorder, however, is also classified as an eating disorder. Bigorexia is characterised by people having the thought that no matter how hard they try their body is never muscular enough. A person suffering with bigorexia is likely to also have a very strict diet regime and the use of drugs such as anabolic steroids to increase muscle mass, despite the side effects, is common.

Signs of bigorexia:

• Individuals prioritizing muscle building activities over every other aspect of their life
• Needing to go to the gym multiple times a day
• Having a strict exercise and/or food regime
• feeling constantly unsatisfied with their current muscle mass
• Excessive use of steroid and/or substance abuse
• Excessive use of supplements/muscle building products
• Obsessively comparing their muscle and body size to other people
• Obsession over the flaws they perceive they have
• Withdrawal from social situations as their perception makes them embarrassed about their body shape

Effects of bigorexia:

• Addiction to steroids/substance if used excessively/abused
• Heart problems due to excessive activity and strain on the heart muscle
• Increased risk of cardiac arrest

Pica

What is Pica?

Pica is an illness where a person displays persistent eating of non-nutritional substances and the eating of non-nutritional substances is inappropriate to the developmental level that would be expected in the individual. The eating behaviour is not part of a culturally supported or socially normal practice. The illness may occur in the presence of another mental illness (ie. autism) or a medical condition (ie. pregnancy). (Eatingdisorders.org.au, 2016)

Examples of non-nutritional substance which might be eaten are hair, ice, vomit, soil, raw potatoes, coal, rocks, plastic, and paper.

Signs of Pica:

• Eating non-nutritional foods
• Eating foods which are not deemed to be edible or suitable for eating

Effects of Pica:

• Unintentional weight loss due to inability to meet calorific and diet needs
• Malnutrition due to inability to meet nutritional needs characterized by hair loss, brittle nails, tiredness, fatigue, difficulty concentrating and reduction in bone density

Rumination disorder

What is rumination disorder?

Rumination disorder is where a person repeatedly regurgitates food; the regurgitated food may be re-chewed, re-swallowed or spit out. This behaviour is not also related to any medical condition that would induce such behaviour (ie. gastrointestinal condition). (Eatingdisorders.org.au, 2016)

Signs of rumination disorder:

• Malnutrition
• Weight loss
• Vomiting partially digested food on a regular basis
• Avoidance around eating with other people
• Hiding their behaviour ie. by covering their mouth, coughing, using napkins
• No clear physical illness causing the behaviour
• Re-chewing and swallowing food that they have brought up
• If in a young person or child not reaching the expected weight gain of their age

Effects of rumination disorder:

• Tooth erosion
• Malnutrition and possible nutritional deficiencies (ie. anaemia or iron deficiency) characterized by hair loss, brittle nails, tiredness, fatigue, difficulty concentrating and reduction in bone density
• Electrolyte imbalance

Avoidant Restrictive Food Intake Disorder (ARFID)

What is AFRID?

Avoidant/Restrictive Food Intake Disorder (AFRID) is characterised by an individual restricting their food by eliminating certain food groups and/or reducing the amount that they eat. However, is different to anorexia and bulimia because the person may not experience the same extreme level of body image disturbance that somebody with anorexia or bulimia might. AFRID also doesn’t seem to affect the persons beliefs and perceptions about their body image and weight, and for example, wouldn’t usually experience the same fear of gaining weight as a person with anorexia would. AFRID sufferers are also less likely to present with eating disorder behaviours such as purging and excessive exercise. (Eatingdisorders.org.au, 2016)

Signs of AFRID:

• No appetite for no known reason
• Very slow eating
• No longer gaining weight as expected in child/adolescence growth
• Losing weight
• No growth/delayed growth
• Fear of choking/vomiting/having pain
• Difficulty eating meals with family/friends

Effects of AFRID:

• Developmental growth is stunted
• Weight loss
• Malnutrition and possible nutritional deficiencies (ie. anaemia or iron deficiency) characterized by hair loss, brittle nails, tiredness, fatigue, difficulty concentrating and reduction in bone density
• Heart problems
• Kidney and liver failure
• Low blood sugar
• Electrolyte imbalances
• Gastrointestinal issues

Unspecified Feeding or Eating Disorder (UFED)

What is UFED?

The diagnosis, according to the DSM-5 guidelines, applies to when an individual’s behaviours do not meet the criteria for any of the feeding/eating disorder criterion. This diagnosis is often used when insufficient information is present for example in emergency room scenarios. or clinicians choose not to specify why certain criteria aren’t met, (Eatingdisorders.org.au, 2016)

Beat. (2019). [online] Available at: https://beateatingdisorders.org.uk/ [Accessed 10 Feb. 2019].

Eatingdisorders.org.au. (2016). DSM-5 | Eating Disorders Victoria. [online] Available at: https://eatingdisorders.org.au/eating-disorders/what-is-an-eating-disorder/classifying-eating-disorders/dsm-5 [Accessed 10 Feb. 2019].

Mind.org.uk. (2019). Home | Mind, the mental health charity – help for mental health problems. [online] Available at: https://mind.org.uk/ [Accessed 10 Feb. 2019].