understanding eating disorders: a detailed overview
  • May 9, 2024

Understanding Eating Disorders: A Detailed Overview

What are Eating Disorders?  Eating disorders are complex, serious mental health conditions, associated with disturbances and changes in the individuals […]

What are Eating Disorders? 

Eating disorders are complex, serious mental health conditions, associated with disturbances and changes in the individuals thoughts and eating behaviours.

These thoughts and behaviours are often coupled with persistent preoccupation with one’s body, shape and weight, and psychological distress. 

A combination of genetic, psychological, situational and sociocultural factors play a role in the development and sustaining of an eating disorder (1). 

Overwhelmingly – it’s important to remember, eating disorders are not just about the food. 

It’s not exclusively a result of wanting to be smaller. 

And importantly, it isn’t a choice.

 It’s far more complex, and unique to each and every person struggling. 

 

Types of Eating Disorders

Eating disorders include:

  • Anorexia Nervosa (AN)
  • Bulimia Nervosa (BN)
  • Binge Eating Disorder (BED)
  • Avoidant Restrictive Eating Disorder (ARFID)
  • Other Specified Feeding and Eating Disorder (OSFED)
  • Pica
  • Orthorexia Nervosa

 

How Common are Eating Disorders? 

Approximately 1 million Australians are living with an eating disorder. This is 4% of  our population (2)

From this, less than a third receive treatment or support (3)

Within this 1 million, approximately 47% of people have Binge Eating Disorder, 12% have Bulimia Nervosa, 3% have Anorexia Nervosa, and 38% have other eating disorders (4)

Beyond those diagnosed, many people have symptoms and disordered behaviours. 

2022 research by the Butterfly Foundation found that in Australia, 17% of our population, either have an eating disorder, or have greater than 3 symptoms of disordered eating (5)This is almost one fifth of the Australian population.

 

These behaviours may include:

  • Binge eating 
  • Laxative use
  • Compulsive exercise 
  • Restrictive dieting and calorie counting (6). 

 

Who is at Risk? 

Television, movies, media and societal stigma have long painted eating disorders as an illness only occurring in young, white, thin females.

Despite this being a common representation, the reality is that anyone can develop an eating disorder. This is regardless of gender identity, sexuality, racial backgrounds, age, weight and body.

Eating disorders do not discriminate, and are not mutually exclusive to the generalised stereotype. There is no distinct box that everyone with an eating disorder falls into. No two people with the same diagnosis will be identical and suffering in the exact same way. 

A mixture of factors place you at an increased risk for developing an eating disorder.  Biological and genetic, psychological and behavioural, socio-cultural and community factors contribute to development of an eating disorder, and also perpetuate the illness. 

 

Common Risk Factors May Include

  • Family member with a history of an eating disorder
  • Living in a larger body 
  • Starting your period at a younger age 
  • Transition period from childhood to adolescence
  • Transition period from teenage years to adulthood 
  • Pregnancy, postpartum, menopause 
  • Family history of living in a larger body
  • Genetic predisposition for perfectionism (7).
  • Mental health conditions
  • Traumatic event/events 
  • Growing up surrounded by diet culture 

 

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What is Anorexia Nervosa?

Anorexia nervosa is an eating disorder characterised by low body weight, an intense fear of gaining weight, and a distorted perception of self (8)

As a result of this fear, someone with anorexia may develop an unhealthy relationship with over exercising, and follow a restrictive diet. They may become underweight, but perceive themselves to be living in a larger body than they actually are. 

 

Signs and symptoms of Anorexia may look like:

  • Weighing food
  • Counting calories 
  • Restricting foods/entire food groups
  • Body checking
  • Poor body image
  • Overexercise 
  • Body dysmorphia – when the perception of self greatly differs from reality
  • Insecurity 
  • Intense fear of gaining weight 
  • Specific food fears

 

There are two subtypes of anorexia; binge-purge (AN-BP) and restrictive (AN-R): 

AN-R is characterised by limiting the amount and types of food you may consume. This may look like calorie counting, weighing food, and limiting overall calorie intake. 

AN-BP is characterised by periods of restriction, followed by episodes of binge eating and purging. This looks like eating large amounts of food in a short time, which is then followed by a perception of compensating for the episode through vomiting, laxatives or diuretics (9). 

Anorexia has the highest mortality of any other psychiatric illness (10) and is accompanied with intense psychological distress, emotional and social implications, and physical consequences, putting one’s life at risk. 

 

Common physical complications include:

  • Low body weight 
  • Bone density loss 
  • Brittle hair and nails
  • Gastrointestinal motility complications
  • Anaemia/muscle wasting 
  • Lowed blood pressure
  • Bradycardia (slow heart rate) or tachycardia (fast heart rate)

 

Atypical anorexia is another diagnosis, with the individual meeting all diagnostic criteria for an anorexia nervosa diagnosis, but is not underweight/living in a weight suppressed body. 

Studies have found that the psychological distress surrounding food and body image was more severe in atypical anorexia than anorexia nervosa (11). 

A lesser understood eating disorder, atypical anorexia is just as severe and painful as anorexia nervosa. Stigma surrounding the stereotype of anorexia, and the way it is portrayed on social media, prevents individuals from getting the support, care and treatment that they are deserving of. 

Weight is not an indicator of severity. 

In both anorexia nervosa and atypical anorexia, despite what society has led us to believe, this condition doesn’t stem purely from insecurity, or fixation on appearance. 

Like all eating disorders, it is often a physical manifestation of the way you are feeling internally. It’s a coping mechanism, a way to manage difficult experiences, feelings and emotions. 

 

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder characterised by recurrent episodes of binge eating, followed by compensatory behaviours (12). 

These episodes may include eating past the point of physical fullness, and compensating through self-induced vomiting, laxatives, diuretics, intense exercise – or, often a combination of these. 

Accompanying these behaviours is the persistent feeling of losing control. These episodes of binge-eating can feel almost involuntary, often leading to an intense sense of shame, guilt and regret over what has been eaten. 

As a result, the individual engages in compensatory behaviours. 

 

Signs and symptoms of bulimia may include:

 

This condition is life threatening, placing your body at risk of serious and dangerous complications.

 

These complications may include:

  • Inflamed/sore throat
  • Dehydration
  • Electrolyte imbalance: (high or low levels of sodium, potassium, calcium) 
  • Acid reflux 
  • Degradation of tooth enamel 

 

People with bulimia often feel great shame about their behaviours, keeping their struggles and behaviours private. This internalised shame can lead to periods of depression, anxiety and isolation.

 

What is Binge Eating Disorder?

Binge eating disorder (BED) is an eating disorder characterised by recurrent episodes of binge eating, eating large amounts of food in a short period of time. 

Someone with BED can feel out of control during these episodes.

Unlike bulimia, these episodes are not followed by purging/compensation.

BED is a serious mental health condition, affecting more people than any other eating disorder. It affects men and women equally (14). 

 

Symptoms may include:

  • Eating beyond physical comfort 
  • Eating quickly
  • Feeling out of control
  • Eating when not physically hungry
  • Eating alone/in secret 

 

These behaviours are often followed by feelings or depression, intense guilt, shame and regret. 

Similarly to bulimia, following these episodes of binge eating, the individual may attempt to restrict or miss meals. 

Ultimately, this perpetuates the cycle. The more you restrict yourself, the more likely you are to repeat the cycle, and have another episode of bingeing. 

This condition is unique to each and every person, does not have a ‘look’ and can happen to anyone in any shape, size or weight. It presents differently for everyone. 

Stigma and shame prevents many from getting the help they need and deserve. 

As humans, it is normal to ‘emotional eat’, or eat beyond fullness. Overeating is part of being human, part of the human experience. Socialising and celebrating often centres around meals and sharing moments with loved ones. We may eat beyond comfort because we love the food, we want to experience the joy of eating a delicious meal.

A binge episode is greatly distinctive from this experience. Driven by an intense, persisting need to eat, and needing to eat a large amount of food alone, quickly and secretly – BED can be incredibly isolating.

 

What is Avoidant Restrictive Food Intake Disorder?

Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterised by fear or disinterest in eating. 

Unlike anorexia or bulimia, this is not driven by insecurity, or distorted perception of body, weight, size or shape (15). 

Instead, ARFID is often due to sensory based avoidance, fear of unfamiliarity, texture and smell. 

It can also be due to a fear of choking, contamination, or a fear of becoming sick/vomiting. 

ARFID is much more complex than just ‘picky eating’.

 

Symptoms of ARFID include:

  • Disinterest in food
  • Fear of new smells, textures and tastes 
  • Fear of colours, shapes, touching of foods 
  • Fear of adverse food related experiences – vomiting, choking, becoming unwell
  • Sensory overload when eating 
  • Anxiety and dread about eating
  • Restricting intake, without the desire to lose weight or manipulate size and shape (16).

 

ARFID can cause a state of malnutrition, vitamin and mineral deficiencies, low body weight, anxiety and depression. 

ARFID is more common in younger children with developmental disorders such as autism spectrum disorder and ADHD

Research has found that children with autism are five times more likely to develop issues associated with eating when compared to their peers (17). 

 

What is Other Specified Feeding and Eating Disorder?

OSFED is an eating disorder characterised by disordered eating patterns and behaviours, coupled with insecurity and anxiety surrounding their weight, size and shape. People with OSFED may meet some criteria, but not all, for other eating disorders. 

OSFED is just as serious, dangerous and painful for the individual as other eating disorders. It does not mean the illness is less severe, less consuming or difficult. 

It can occur in children, adolescents and adults, and is not exclusive to any specific weight, shape or size. 

 

The OSFED diagnosis may be specified:

  • Atypical anorexia nervosa: the individual may meet all criteria for anorexia nervosa, however the individual’s weight may be within or above the normal range (18)
  • Bulimia nervosa of low frequency/limited duration: the individual may meet all criteria for bulimia nervosa, but the frequency of the bingeing and purging behaviours occurs less than once a week, and/or for less than three months 
  • Binge eating disorder of low frequency and/or limited duration: the individual may meet all criteria for binge eating disorder, but the frequency of the binge eating occurs less than once a week, and/or for less than three months 
  • Purging disorder: the individual has persistent episodes of purging/vomiting, without binge eating episodes
  • Night eating syndrome: the individual wakes up throughout the night with feelings of extreme hunger, and an inability to fall back asleep without eating.

 

The medical complications of OSFED are just as serious as other eating disorders. It may cause:

  • Weight fluctuations
  • Electrolyte imbalances 
  • Fatigue
  • Missing/loss of period
  • Bloating, constipation
  • Isolation
  • Shame 

 

How Do I Know If I Have an Eating Disorder?

If you resonate with any of these symptoms, if you can identify that you are engaging with any of these behaviours, it is a clear sign that you are struggling.

It may be intermittent, not occurring every day. But, living with disordered eating behaviours directly increases the risk of developing an eating disorder. 

Catching these behaviours out early is crucial in allowing yourself the capacity and ability to heal your relationship with food and your body.

Seeking treatment and support is not failure. It is a sign of strength. 

Reaching out to your GP, organising an Eating Disorder Care Plan, can help you take those initial steps towards a life that is not consumed by this pain.

If you are thinking that you may have an eating disorder, it’s likely that you do. You know yourself best. Pay attention and listen to that little voice inside that is fighting for you. The voice beyond the messy disordered thoughts. The voice of your true self that knows this isn’t normal, it can’t be justified and that you want and deserve freedom.

 

What Does Treatment Look Like?

Treatment for an eating disorder varies greatly depending on your individual circumstances. 

No two people with the same diagnosis will have identical symptoms or behaviours. 

 

Depending on your situation, treatment may look like:

  • Family based therapy (FBT)
  • Outpatient eating disorder day program
  • Inpatient eating disorder program 
  • Medical stabilisation in a hospital 
  • Individual/group therapy
  • Nutritional counselling
  • Psychology/therapy 

 

In Australia, booking an appointment with your GP can be the first step towards finding a pathway that works for you. 

A GP is able to create a Medicare Eating Disorders Care Plan for you, that can give you the ability to access support from a dietitian and psychologist. 

 

 

Through a multidisciplinary, collaborative team approach, you can become equipped with the skills and tools necessary to overcome the thoughts and behaviours that restrict your ability to live a full and complete life. 

 

With a dietitian, this may look like:

  • Working together to create a meal plan, of foods that you love and that provide nourishment for your body
  • Organising a regular routine of meal times to establish some normality
  • Education surrounding nutrition and the impact on your body
  • Writing a grocery list together
  • Creating recipes that are easy and stress free to prepare

With a psychologist, this may look like:

  • Discussing alternative coping mechanisms to disordered behaviours
  • Learning to identify your triggers and risk factors 
  • Being provided with a safe space to be vulnerable 
  • Working together to find the factors promoting and sustaining the disorder

 

Medical monitoring from your GP can help to keep you safe and progressing in your journey to recovery. While eating disorders are a psychological condition, they can have dangerous impacts on your physical health. It is important for this to be monitored by a doctor, and professionals to keep you safe. 

The important part of this treatment is for the team to work together. Sending progress letters to each other, working collaboratively to provide you with treatment tailored to you, and your unique needs. 

Listening to you, giving you a voice – this is all important in providing an avenue for growth and healing. 

 

 

Am I ‘Sick Enough’ to Get Help?

The idea of not being ‘sick enough’ is a common mentality for those struggling with these thoughts and behaviours. 

You may think it’s okay to continue the way you are going. That ‘it could be worse’, that you are ‘functional’. But the reality is, there is no such thing as having a ‘functional’ eating disorder. 

Sustaining an eating disorder does not align with living truely and freely. It does not align with the capability to live a complete and fulfilling life. You are depriving yourself of food freedom, body neutrality and acceptance. Depriving yourself of the ability to create memories, have experiences, and partake in life. In living. 

This idea of not being ‘sick enough’ stems entirely from the eating disorders desire to stay present and remain consuming. It thrives off the idea that you need to be worse before you get better.

This is incredibly far from the truth.

You don’t need to wait and become as ‘sick as possible’ to be worthy and deserving of help.

 

Is It A Choice?

A common misconception is that eating disorders are a choice. That they are always driven by a desire to ‘be skinny’, lose weight and get attention.

This is entirely untrue, and the more this is perpetuated, the less likely people are to seek support when they need it most.

The conditions are complex, individual, complicated and painful – and very prominently misunderstood. Despite what you may have heard, they aren’t just a ‘cry for attention’. 

Underneath, the nuances and complexity of your eating disorder depends on you, the individual.

Recovery from an eating disorder is not easy, and this is often painful. But with proper support, care and guidance, each and every person struggling is capable of a full, lasting and sustainable recovery. 

 

Where Can I Learn More About Eating Disorders?

It’s hard to learn more in a world saturated by social media. 

It’s important to read and view content that promotes recovery, rather than causing comparison and fuelling your disorder. 

In Australia, the Butterfly Foundation has a national hotline, open from 8am-12am, 7 days a week. This hotline can provide information surrounding body image and eating disorders, information about treatment and support, referrals to specialists, and counselling (19)

The Inside Out Institute is a national eating disorder research and clinical institute (20). The platform has a database of eating disorder specialists nationally, and you can enter your postcode to find treatment providers close to you.

 

Will I Ever Recover?

Recovery is hard. It is messy, it is confronting, it is overwhelming. It feels wrong going against your mind each and every day. It’s exhausting, fighting the urges and behaviours every second of every day. 

The behaviours provide a safety net. A way to isolate yourself from reality, from freedom, and become completely consumed by your mind. 

Whatever purpose your eating disorder serves, there are ways to challenge and confront this. 

With support, vulnerability and reaching out for help, you are capable of building and fostering a relationship with food and your body that is not consumed by your mind. 

Everyone is deserving to recover. Everyone is able to get better. Even when it feels impossible, if you consider yourself too far gone – you are never beyond help. 

Again, when treatment is tailored to you, it is completely tangible to find a method and take actions that promote recovery, rather than fuel and sustain your eating disorder. To do this, you need to reach out for help.

 

 

How We Can Help You

At Imbodi Health, we specialise in eating disorder treatment and management. We are a leading, online dietitian clinic, providing focused and specialised support for treatment. 

We firmly believe you deserve a life free of obsession or fear around food. 

We open conversation around fad diets, strict exercise routines and unrealistic body standards – aiding and equipping you with the necessary tools to overcome your eating disorder. 

We know that 75% of people with an eating disorder don’t seek professional support (20).  We want to change that. We want to be a space safe for you to mend your relationship to food and self.

Reach out for a free discovery call to begin your journey to freedom and healing.

BOOK IN A FREE DISCOVERY CALL WITH OUR DIETITIANS
 


Written by: Student Dietitian Tara Finn
Review by: Imbodi Health Dietitian Jade Wrigley

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