getting started with eating disorder recovery
  • May 27, 2023

Getting Started with Eating Disorder Recovery | Imbodi Health Eating Disorder Dietitian Clinic

Feeling overwhelmed with getting started with eating disorder recovery? If you have clicked on this blog post, you have likely […]

Feeling overwhelmed with getting started with eating disorder recovery?

If you have clicked on this blog post, you have likely made the important decision to start your recovery journey from an eating disorder (ED), or maybe you think someone close to you may be struggling with one. At The PNW Eating Disorders Clinic in Australia, we know this can be a very daunting process and it is often hard to even know where to begin. 

To help get you started, we’ve outlined the first crucial action steps to getting started with eating disorder recovery and your journey to a life free from your ED. 

 

 

What is an eating disorder? 

An eating disorder is a mental illness. While there are several different types of eating disorder, they are often characterised by disordered thoughts, behaviours and attitudes to food and eating (1). The associated thoughts and behaviours can significantly interfere with day-to-day emotional, physical and social health as well as overall quality of life. 

There are currently five types of eating disorders recognised by The Diagnostic and Statistical Manual of Mental Disorders (DSM) (2). 

 

Binge Eating Disorder (BED)

Out of all eating disorders, this is the most common. It is characterised by frequent binge eating episodes which involve eating large quantities of food in a short period of time. This often also happens alone and in secret and creates strong feelings of shame and guilt (4). 

 

Anorexia Nervosa (AN) 

AN is characterised by restriction of amounts and/or types of food, alongside a significant fear of weight gain. It leads to weight loss which can be quite substantial amongst other quite serious medical concerns. Diagnosis also requires a low body weight (5).

 

Bulimia Nervosa (BN)

Bulimia nervosa is similar to BED in that a person with BN may partake in binge eating episodes where they feel a loss of control followed by a feeling of intense guilt and shame. However, BN also involves engagement in compensatory behaviours afterward with the intent to prevent weight gain. This may be food restriction, purging, extreme exercising or laxative abuse (6). 

 

Avoidant/Restrictive Food Intake Disorder (ARFRID)

This is an avoidance/aversion to eating particular foods which leads to a restricted food intake. A primary characteristic of the condition is that the food restriction is not due to body image disturbances. Instead it is as a result of anxiety/phobia toward foods, increased sensitivity to sensory aspects of food (texture/taste/smell), or a lack of food interest as a result of low appetite (7).

 

Otherwise Specified Feeding or Eating Disorder (OSFED)

OSFED is diagnosed when eating disorder symptoms are present, however they may not meet the specific criteria of other eating disorders such as AN or BN. For example:

  • Atypical anorexia nervosa – all criteria for AN is met however body weight is not low
  • Binge eating disorder of low frequency or duration 
  • Bulimia nervosa of low frequency or duration 

It is important to remember that just because these diagnoses don’t meet full criteria of AN, BN or BED, they should not be taken any less seriously (8).

 

 

How do I know if I have an eating disorder? 

To start thinking about whether you might have an eating disorder, you can ask yourself this question: 

Are there any areas of my diet or body image that I feel distressed or anxious about? 

Common signs to look out for

No eating disorder presents in the same way, but there are a few common signs and symptoms of an eating disorder or disordered eating: 

Behavioural 

  • Constant or repetitive dieting including
    • counting calories
    • skipping meals
    • avoiding certain foods or food groups
  • Vomiting or laxative abuse 
  • Excessive or compulsive exercise patterns e.g.
    • exercising injured or in bad weather,
    • an inability to interrupt or skip planned exercise for any reason
  • Development of patterns or obsessive rituals around food preparation and eating
  • Avoidance of social situations involving food
  • Cooking meals for others but not consuming them yourself
  • Obsessive body checking behaviours

 

 

getting started with eating disorder recovery

 

 

Physical

  • Sudden or rapid weight loss
  • Frequent changes in weight
  • Increased sensitivity to the cold
  • Loss or disturbance of menstrual periods (for females)
  • Fainting, dizziness and fatigue

 

Psychological 

  • Increased preoccupation with body shape, weight and appearance
  • Intense fear of gaining weight
  • Constant preoccupation with food or with activities relating to foo
  • Extreme body dissatisfaction/ negative body image
  • Increased anxiety around mealtime
  • Depression or anxiety
  • Moodiness or irritability
  • Rigid ‘black and white’ thinking around food (e.g. labelling food as either ‘good’ or ‘bad’)
  • Feelings of life being ‘out of control’ when eating

Completing the EDEQ questionnaire is also a great place to start. Ideally, it is recommended you complete it with your dietitian or psychologist if you already have one. Otherwise, you can complete it alone or with someone you trust and feel safe with. The quiz is available on the Inside Out Institute here. Please contact our eating disorders clinic in Australia if you would like to go through it with a professional.

 

 

Short-term and long-term effects of an eating disorder 

Eating disorders come with a whole host of consequences for your physical, mental and emotional health. Early intervention is crucial, as the longer the eating disorder exists, the more difficult it can be to overcome. In some cases, they even cause serious, irreversible and even life-threatening health complications. A few of the common side effects that can arise include:  

 

Heart health 

When you aren’t eating adequate calories to support your body’s needs, the size and strength of your heart can start to substantially decrease. This can make it more difficult for your heart to properly pump blood around your body (9,10). This can cause:

  • Fatigue 
  • Fainting or dizziness, especially upon standing
  • Increased sensitivity to the cold
  • Irregular heartbeat and/or experience chest pains
  • Frequent vomiting or laxatives/diuretic use can also cause an irregular heartbeat, and may even lead to heart attack

 

Bone health 

Loss of bone density is another common side effect of eating disorders (especially anorexia nervosa) and can occur quite early on. Unfortunately, this is also an irreversible side effect. This damage to your bones makes them become more fragile and increases the risk of fractures and developing osteoporosis later in life (9,10).  

 

Hormonal health 

Good nutrition and weight are important in maintaining hormone health. As a result, all eating disorders can disrupt normal hormone production. As a result, this may cause (9,10): 

  • Low libido (sexual desire) in men and women 
  • Irregular or a complete loss of menstrual periods in women (amenorrhoea)
  • Erectile dysfunction in men 
  • Infertility 
  • High levels of stress hormones cause sleep problems, anxiety, depression
  • May also impact hormones involved in appetite, puberty and growth

 

Digestive concerns 

Gastrointestinal (or digestive) problems are also very common in eating disorders. This may include (9,10): 

  • Stomach pain and bloating
  • Nausea and vomiting
  • Constipation or diarrhoea 
  • Long-term laxative use can even cause your bowels to become so dependent on them that they will not function properly without them 

 

 

getting started with eating disorder recovery

 

 

When vomiting occurs regularly, it can affect health in several ways (9): 

  • Gastric acid in the mouth can erode tooth enamel, causing irreversible tooth decay and increased sensitivity
  • Swollen salivary glands causing the cheeks to look enlarged and puffy
  • Ruptures and bleeding in the oesophagus 
  • Imbalances in the body’s electrolytes can cause:
    • Fainting, fever, digestive problems, confusion, blood pressure changes, heart palpitations, seizures, cardiac arrest and even death

 

Other side-effects (9

  • Lack of concentration and reduced memory which can cause poorer performance at work or school
  • Muscle loss and weakness 
  • Increased risk of depression and anxiety  
  • Breakdown of relationships with family, friends and partners 
  • Disturbed sleep
  • Dry skin and brittle nails/hair including hair loss
  • Nutritional deficiencies including iron deficiency anaemia 

 

Increased risk of mortality

  • The mortality rate for people with eating disorders is up to six times higher than that for people without eating disorders (11).
  • Suicide is up to 31 times more likely to occur for someone with anorexia nervosa and 7.5 times higher for someone with bulimia nervosa than the general population (11).

 

BOOK IN A FREE DISCOVERY CALL WITH OUR DIETITIANS
 

Taking the first steps to recovery 

Luckily, with recovery you can reverse or even prevent many of the above side effects and start to regain back many of the positive things that your ED has taken from you.

To get you started with eating disorder recovery, we’ve outlined the first steps:

 

Step 1: Opening up to others 

The first step to ED recovery is starting to open up about it to others. This can be one of the most difficult steps as eating disorders thrive in secrecy. But, in order to recover, it is important you first start building a support network as it is not something you can do alone. This should start with people you feel safe with such as friends/family or your psychologist, dietitian or general practitioner (GP). 

Once you’ve overcome the initial hurdle of telling one person, it becomes much easier to continue the process. There is no need to open up to everyone in your life just yet, if you don’t feel comfortable doing so. 

 

Step 2: Finding eating disorder specialised healthcare practitioners

Your care team will involve a GP, dietitian and psychologist who are all well-versed in eating disorders. 

If you already have a GP you have been working with for a while that you feel safe with (and they are experienced in eating disorders) this is a great place to start.

If not, they can provide you with a referral to a different GP with ED experience. Alternatively, the Butterfly Foundation has a database of GPs here: https://butterfly.org.au/get-support/butterflys-referral-database/ 

The same goes for your dietitian and psychologist. 

It may take a bit of time to find suitable practitioners who you feel safe with and who fit your needs. It’s okay to ‘shop around’ to find the best fit for you as everyone practices differently.

Social media platforms such as Instagram can be a helpful way to get an idea of what an eating-disorder-experienced health practitioner such as a dietitian is like (e.g. their personality and philosophy). There are also eating disorder clinics in Australia that are specifically dedicated to treating EDs.

 

Step 3: Medical monitoring

It is important that your recovery involves medical monitoring by a GP. This should initially start as weekly or fortnightly in the early stages to reduce the risk of medical complications. This might include testing for: 

At baseline:

  • Bone density assessment
  • Blood tests including – Iron Studies, Vitamin D, Zinc, Vitamin B12 (including serum and active B12), Folate
  • Electrocardiogram (ECG)

Weekly or at least fortnightly:

  • Lying and standing blood pressure and heart rate
  • Core temperature
  • Full blood examination – urea, electrolytes, creatinine, phosphate, calcium, magnesium, glucose, liver function tests
  • Weight (blind weights might be appropriate)

 

 

Step 4: Assessing eligibility for an Eating Disorder Care Plan (EDCP)

This is a specific type of referral that your GP may be able to provide you with. If you are eligible, this means you will be able to access Medicare rebates on: 

  • up to a maximum of 40 psychological treatment sessions with a mental health clinician in a 12-month period
  • up to a maximum of 20 sessions with a dietitian in a 12-month period

If you have already completed the EDEQ, you can bring it to your appointment in preparation.

Additionally, some GPs may not be fully across it if they are not well-versed in the ED space. If your GP requires guidance around the EDCP, Inside Out has developed a useful guide to assist.  

Unfortunately, the EDCP does require strict criteria for eligibility for you to access it. You do not need this referral to start your recovery journey, but it is a helpful resource to have. 

 

 

What happens in psychology appointments?

Eating disorders are mental illnesses and support from a psychologist is a crucial part of recovery. During appointments, your psychologist may take you through one of a few different psychological therapies based on your needs.

These include: 

  • Dialectical Behavioural Therapy (DBT)
  • Cognitive Behavioural Therapy (CBT)
  • Family Based Therapy (FBT) – this is especially common in adolescents with EDs 

 

 

What happens in dietitian appointments?

The dietitian also plays an important role in ED recovery to help re-nourish your body with the nutrition it needs to thrive and to heal your relationship with food and your body in a safe space. 

A dietitian can help you to start to: 

  • Nourish and fuel your body with nutritious food 
  • Remove any guilt surrounding foods and start to eat from a place of enjoyment 
  • Learn to accept your body for all it can do for you 
  • Challenge and reframe anxious thoughts around food 
  • Stop the binge-restrict cycle 

 

Initial consultations with a dietitian will usually include: 

  • In-depth assessment of your medical history and lifestyle 
  • Unpacking the issues and concerns you’ve been experiencing (within their scope of practice and training)
  • An assessment of your current intake, eating behaviours/patterns, food rules and feared foods
  • Exploring motivation to change and recover 
  • Development of treatment goals (short-term and long-term)
  • The development of a treatment plan to reach your goals with practical, individualised strategies 
  • Assistance, guidance, and support along the way 

You can read more about what to expect in a dietitian appointment at the PNW eating disorder clinic in Australia here.

 

 

getting started with eating disorder recovery

 

 

During ED recovery, dietitians will often work with you through the RAVES model (developed by Shane Jeffrey) which includes focusing on:

  • Regularity – establishing a regular eating pattern
  • Adequacy – ensuring adequate nutritional intake 
  • Variety – increasing dietary variety and challenging diet rules and fear foods
  • Eating Socially – increasing confidence and reducing anxiety about eating out and in social situations 
  • Spontaneity – encouraging flexibility in food thinking and eating behaviours

You will likely be seeing your dietitian at least weekly in the initial stages of recovery. The frequency of appointments may slowly reduce as treatment continues. 

 

 

Some helpful resources for more information  

Eating Disorders Queensland: https://eatingdisordersqueensland.org.au/ 

Butterfly Foundation: https://butterfly.org.au/ 

Lifeline: https://www.lifeline.org.au/ 

 

Remember, recovery from an eating disorder can be a long journey (up to 12 months or more) and not always linear – but recovery is possible and always worth it! 

If you’re ready to start on your recovery journey or even just contemplating it, you can book an appointment or free 15-minute discovery call with one of our eating disorder dietitians here

BOOK IN A FREE DISCOVERY CALL WITH OUR DIETITIANS
 

 

Article written by: Dietitian Georgia D’Andrea

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