Eating disorders are serious and potentially life-threatening mental health disorders. The common types of eating disorders are anorexia nervosa, bulimia nervosa, binge eating disorder or a mixed type with a combination of symptoms.
People with eating disorders use food and weight as a way to cope with emotional distress. The central problem for people with eating disorders is that they judge their self-worth predominantly or entirely in terms of their shape and weight and their ability to control their shape and weight.
In contrast the majority of people appraise their self-worth on multiple domains of their life (relationships, work, creativity etc.). This core thinking problem in eating disorders results in an intense preoccupation with weight and leads to marked changes in eating, exercise interest and use of other weight compensatory behaviors. These thoughts and behaviours become an unhealthy preoccupation and become severe enough to interfere with the person’s functioning and relationships.
Eating disorders require appropriate assessment and treatment to address the complex physical, nutritional, psychological and mental health needs of those suffering with these disorders. Early detection and treatment has been found to have a better outcome.
All age groups, gender, socio-economic and cultural background can be affected by eating disorders, though adolescents and young woman are at heightened risk.
A person with an eating disorder can be underweight, normal weight or overweight.
In Western countries, 5-10% of young women have some form of eating problems, though 1-3% have an eating disorder.
Types of eating disorders
Anorexia nervosa is characterised by significant restriction of food, excessive weight loss, dangerously low body weight, intense fear of weight gain and thinking one is overweight despite being seriously underweight.
Bulimia nervosa is diagnosed when a large amount of food (more than most people would eat in a meal) is eaten over a short period of time which is then followed by the use of compensatory weight loss behaviour; vomiting, use of laxatives, over-exercising or frequent dieting or fasting.
People with bulimia nervosa may be very secretive and ashamed of their bingeing and compensatory behaviour.
Binge eating disorder
Binge eating disorder is characterised by periods of uncontrolled, impulsive or continuous eating to the point of being uncomfortably full. There is usually no compensatory behaviour after bingeing which may result in obesity. Repeated binges often result in feelings of shame and self-hatred. Many people with binge eating disorders may also suffer with depression and alcohol problems.
The majority of people who have eating disorders may not be diagnosed with anorexia, bulimia or binge eating disorder and these individuals may be found to have other specified feeding and eating disorder (OSFED).
These people may have some features of the various eating disorders. OSFED is an equally serious disorder which also requires professional help.
It may appear that each of these disorders is distinct. However, these disorders have much in common and individuals may migrate between the disorders.
Signs and symptoms
It can be sometimes difficult to determine whether a person has an eating disorder, some individuals can be within a healthy weight range, there may be shame and guilt about their behaviour and they may go to great lengths to hide it away. Many do not realise they have a problem and others do not want to give up their behaviour as it may serve some purpose for them.
The following are symptoms and signs of a possible eating disorder and any combination can be present. A person may also present with several of these symptoms and yet may not have an eating disorder.
- Dieting behaviours - restriction of food, calorie counting, avoidance of certain food types/groups (forbidden foods)
- Vomiting and/or laxative use (periods spent in bathrooms, immediately after meals)
- Excessive periods of exercise which may be carried out in a ritualistic manner, experiencing distress if unable to exercise
- Binge eating (disappearance of food and hoarding large amounts of food)
- Avoidance of eating meals, particularly in social settings
- Development of behaviours around body shape and weight (excessive time spent looking in the mirrors, repeated weighing of self, body checking such as pinching around waist, measuring parts of the body regularly)
- Behaviours focused around food (interest in nutrition, cookbooks, preparing meals for others but not consuming it oneself)
- Social withdrawal and gradual decline in interests previously enjoyed
- Extreme body dissatisfaction
- Distorted body image (reports looking/being fat when normal or underweight)
- Sensitive to any comments about exercise, food, body shape or weight
- Heightened anxiety around mealtimes
- Weight loss or weight fluctuations
- Changes or loss of the menstrual cycle
- Swelling around the cheeks or damage to teeth from vomiting.
Causes of an eating disorder
Studies suggest that anorexia, bulimia and binge eating disorders are complex genetic diseases, in which the risk of developing eating disorders in first-degree relatives is increased 10-fold. About one-third of genetic risk for eating disorders, depression, anxiety and addictive disorders may be shared.
Developmental changes of puberty (hormonal increase, and brain development), stressful events and challenges could trigger eating disorder behavior and the subsequent nutritional deprivation on the developing brain may maintain the difficulties. Birth-related perinatal complications and premature delivery increases the risk of developing an eating disorder.
Clinical perfectionism, core low self-esteem, mood intolerance, difficulties in expressing emotions, fear or avoidance of conflict, competitiveness and interpersonal difficulties
History of teasing bullying particularly when based on weight and shape, sexual or physical abuse, personal or family history of obesity.
Need for early intervention
Eating disorders are complex mental health problems with potential physical complications. Individuals affected will benefit from professional assessment and intervention. For most people, the earlier the treatment is given, the easier it may become to overcome the problem. A delay in seeking treatment is associated with poorer physical and mental health outcome.
Admitting to having an eating disorder can be a big step for many people. Following this initial step, what to do next can also seem overwhelming for individuals and their families. A medical practitioner should perform an initial assessment, preferably one with some experience in the area of eating disorders, so that the severity of symptoms can be determined and an appropriate treatment plan can be collaborated with the individual and family. Your GP would be an advisable first point of call for many people.
If you feel that you or someone you love may be exhibiting signs or symptoms of an eating disorder, it is important to get help.
01 249 3471 (inpatient unit & day programme service)
01 249 3333 or email firstname.lastname@example.org (Support and Information Service)
Treatment options for people are based on the severity of physical and psychological symptoms. Due to the complex nature of eating disorders several different professionals may be required in the care and treatment of the individual. Different treatment settings (inpatient at medical or psychiatric hospital, day programme, outpatient, private/public psychological therapies, support groups) and treatment plans may be effective for different people depending on the stage and associated complications of the disorder, age, the type of disorder, underlying causes and support networks available to the individual.
There is evidence that some treatment options are more effective at certain age groups or particular type of disorders, though no one treatment modality has been shown to be effective for all cases of eating disorders. An eating disorder may be a long-term struggle for some and long-term treatment may be required for these individuals.
The main treatment interventions for eating disorders are nutritional rehabilitation, physical health management, psychological and psychiatric management. In some cases, drug treatments may be required and have shown to be effective. Some individuals with mild symptoms may also do well with self-help programs and support group attendance.
In St Patrick’s Mental Health Services, our Eating Disorders Service provides a comprehensive assessment and tailored treatment according to the needs of the individual. Assessment and delivery of treatment is led by a consultant. The services are seamless and service users can step up or step down from one aspect of the programme to another depending on their needs and stage of recovery. Treatment is delivered by an innovative multidisciplinary team.
New approach to eating disorder treatment
The psychology department is now accepting referrals for The Compassion Focused Therapy group for Eating Disorders (CFT-E). CFT-E is a 25-session closed group which offers comprehensive psychological therapy for individuals who can manage recovery from their eating disorder in the community.
The group operates according to a trans-diagnostic model and can facilitate individuals with a range of eating disorders. The individuals who will benefit from this intervention tend to share many common problems including being worried about their size, shape, and weight. They are also likely to use food, dieting, activity, vomiting or weight loss drugs to manage difficult experiences, relationships, or painful thoughts, feelings and memories.
The group incorporates psycho-education for both patients and their family members; skill building and therapeutic elements. It aims to target both biological starvation and the underlying psychological processes which underpin and maintain an eating disorder. The group helps patients to develop a more compassionate sense of self and fosters social connectedness. The group is particularly suitable for individuals who struggle with shame, guilt or self-criticism.
This group is a day patient group for individuals who meet the referral guidelines outlined below:
Guidelines for referral
BMI of 16.5 or above
Presence of an eating disorder (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified)
Patients must have access to a service (e.g., MDT, GP) that will monitor their physical health (bloods, ECG where applicable) throughout the duration of treatment.
The group is open to all individuals with eating disorders who do not require supervision of their eating and who have expressed a desire to recover from their eating disorder.
Active substance misuse
Medical complications requiring hospitalisation
Autistic spectrum disorder
St Patrick’s Mental Health Services Support & Information Line
Bodywhys - Bodywhys is the national voluntary organisation dedicated to supporting the 200,000 people in Ireland affected by eating disorders
B-Eat - Beat provides helplines, online support and a network of UK-wide self-help groups to help adults and young people in the UK beat their eating disorders
Something Fishy - Eating Disorders, Anorexia, Bulimia & Compulsive Overeating - Dedicated to raising awareness and providing support to people with Eating Disorders, and their loved-ones
Body Positive - BodyPositive looks at ways we can feel good in the bodies we have.
Centre for Clinical Interventions - Psychotherapy, Research & Training
Victorian Centre of Excellence in Eating Disorders (CEED) - The Victorian Centre of Excellence in Eating Disorders (CEED) is a service that provides consultation, training and education to health professionals treating individuals with eating disorders and their families.
Getting Better Bit(e) by Bit(e) – Schmidt/Treasure
Anorexia Nervosa – Janet Treasure
Golden Cage – Hilde Bruch
Overcoming Anorexia Nervosa – Christopher Freeman
Check the Information Centre Book Shop for availability and a wider selection of books.
Continue to…Personality Disorders