Eating disorders

What is an eating disorder?

An eating disorder is a serious mental health condition that involves an unhealthy obsession with eating, exercise or body shape.

Anyone can get an eating disorder, whatever your cultural background, sex or age. Eating disorders affect about 4% to 16% of Australians.

If you have an eating disorder, you may have any of the following:

• Concern about your appearance, food and gaining weight.
• Extreme dissatisfaction with your body — you would like to lose weight even though friends or family think that you are underweight.
• A fear of gaining weight.
• You let people around you think you have eaten when you haven’t.
• You are secretive about your eating habits because you know they are unhealthy.
• Eating makes you feel anxious, upset or guilty.
• You feel you are not in control around food.
• You keep checking your body — for example, weighing yourself or pinching your waist.
• Making yourself vomit or using laxatives in order to lose weight.

What are the common types of eating disorder?

There are many types of eating disorder, including the following.

Binge eating disorder (BED)

BED makes up almost half of all cases of eating disorders in Australia. People with this disorder will often eat large amounts of food, even when they aren’t hungry. This is known as ‘binging’. They often feel shame and guilt after an eating binge. Often people with binge eating disorder will fast or go on a diet in response to the way they feel after a binge. However, people with BED don’t purge (vomit) their food.

Bulimia nervosa

People with bulimia have frequent eating binges. These often occur in secret. They then get rid of the food by vomiting (being sick), taking laxatives or diet pills. This is known as ‘purging’. Bulimia nervosa often begins during or after a diet.

People with bulimia often feel out of control. About 12% of people with eating disorders have bulimia nervosa.

Anorexia nervosa

Of people with eating disorders in Australia, 3% have anorexia nervosa. People with anorexia nervosa can be severely underweight, are preoccupied with food and fear putting on weight.

They often have a distorted body image and see themselves as fat. Changes happen in the brain due to starvation and malnutrition. This can make it hard for someone with anorexia nervosa to recognise that they are unwell. They may also struggle to understand the impact of their condition.

Other specified feeding or eating disorder

A person with other specified feeding or eating disorder (OSFED) has many of the signs of other eating disorders. But their condition doesn’t match a specific disorder.

People with OSFED often have very disruptive eating habits and can have a distorted body image. Around 1 in 3 people who get treatment for an eating disorder have OSFED.

Orthorexia

Orthorexia is an obsession with healthy or “clean” eating. Orthorexia isn’t recognised as an official eating disorder diagnosis.

What are the symptoms of eating disorders?

It’s not always easy to tell if someone has an eating disorder. They may try to hide it because of shame or guilt. However, some of the behaviours linked with eating disorders are:

• Dieting — counting calories/kilojoules, fasting, skipping meals, avoiding certain food groups.
• Binge eating — including hoarding of food or the disappearance of food.
• Purging — frequent trips to the bathroom during or after eating.
• Too much exercise — continuing to exercise when sick or in bad weather.
• Eating in private — you may stop eating with other people.
• Body image — you may be very sensitive to comments about your body and weight.
• Change in clothing style — you may start wearing baggy clothes.

There are also physical signs that you may have an eating disorder, such as:

• Weight changes — changes in weight or rapid weight loss.
• Disturbed menstrual cycle (periods) — loss of or disrupted periods.
• Dizziness — feeling light-headed or faint.
• Fatigue — constantly feeling tired and not sleeping well.
• Being cold — even in warm weather.

Some of the emotional signs of an eating disorder are:

• obsession with weight, body appearance or food
• meal-time anxiety
• feeling out of control around food
• distorted body image
• using food as a source of comfort or as self-punishment

What causes eating disorders?

The factors that lead to the development of an eating disorder are complex. They involve a range of biological, psychological and sociocultural factors. These factors vary from person to person.

Biological and genetic risk factors may include:

• a family history of eating disorders
• high body weight in childhood
• periods starting before 12 years of age

Psychological and behavioural risk factors may include:

• low self-esteem
• neurodiversity
• previous trauma or abuse

Socio-cultural risk factors may include:

• problems with friends or family relationships
• high academic expectations
• bullying

Research has shown that protective factors may lower your chance of getting an eating disorder. These include:

• high self-esteem
• good social skills
• a healthy relationship with food and eating

How are eating disorders diagnosed?

Many people who have eating disorders keep their condition a secret or won’t admit they have a problem. However, it’s important to get help early (see, ‘Where to get help’).

Early treatment may limit the progression of eating disorders and improve outcomes.

The first step is to see your doctor, who can refer you to the right services. A doctor or mental health professional can diagnose an eating disorder.

There is no single test to decide whether you have an eating disorder. There are a number of assessments that can lead to a diagnosis. These include:

• Physical examinations: Disordered eating can take a toll on the body, so your doctor must first check that you are physically OK. The doctor is likely to check your: height, weight and vital signs (heart rate, blood pressure and temperature).
• Blood and urine tests may also be recommended to check your physical health.
• Psychological evaluations: Your doctor or mental health professional may talk to you about your eating and body image. What are your habits, beliefs and behaviours? They may ask you to fill out a questionnaire or self-assessment.

Treatments for eating disorders

There is no ‘one size fits all’ approach to treating eating disorders since everyone is different. Often a team of health professionals is involved in your treatment. This can include a psychologist, dietitian, social worker, occupational therapist and doctor.

Some of the treatment options include the following.

Psychotherapy

Psychotherapy is a group of therapies designed to help you change your thinking patterns and improve your coping skills. This usually involves regular visits to a psychologist.

A common therapy is ‘cognitive behavioural therapy’ (CBT). This helps you identify and change your thoughts, feelings and behaviours associated with your eating disorder.

Another therapy is dialectical behaviour therapy (DBT). It helps you manage your emotions and accept who you are.

Family approach

The ‘family approach’ is most common when young people are being treated for an eating disorder. The aim is to treat you, while also supporting and educating your entire family — which strengthens family relationships. The family learns how to care for the person with the eating disorder.

Nutrition education

A dietitian can help you learn healthy eating habits and behaviours. This will help you return to a healthy weight. They can also check that you get the right levels of vitamins and minerals.

Medicines

There is no medicine to specifically treat eating disorders. However, you may be prescribed medicines to treat other illnesses such as depression or anxiety.

Medicines should be used alongside other treatments.

What is stepped care?

Person-centred, stepped care means that your treatment is customised to suit your illness, situation and needs.

Stepped care knows that you and your family may need to use different services. How often you need these supports can vary across the course of your illness and recovery.

Recovery isn’t linear. Your response to treatment is individual.

With the right professional, social and emotional support, you can get better from an eating disorder.

What should I do if I think I have an eating disorder?

If you think you have an eating disorder, talk to someone you trust. This might be a close friend or family member. You can also call Butterfly for advice about a family member or friend.

Your doctor will suggest possible treatment options. These will depend on your individual circumstances and the type of eating disorder you have.