Eating disorders

A person with an eating disorder may focus excessively on their weight and shape, leading them to make unhealthy choices about food with damaging results to their health.

Types of eating disorders

Eating disorders include a range of conditions that can affect someone physically, psychologically and socially. The most common eating disorders are:

• anorexia nervosa
  - when someone tries to keep their weight as low as possible, for example by starving themselves or exercising excessively
• bulimia
  - when someone tries to control their weight by binge eating and then deliberately being sick or using laxatives (medication to help empty their bowels)
• binge eating
  - when someone feels compelled to overeat

Some people, particularly young people, may be diagnosed with an eating disorder not otherwise specified (EDNOS). This means you have some, but not all, of the typical signs of eating disorders such as anorexia or bulimia.

Causes of eating disorders

Eating disorders are often blamed on the social pressure to be thin, as young people in particular feel they should look a certain way. However, the causes are usually more complex.

There may be some biological or influencing factors, combined with an experience that may provoke the disorder, plus other factors that encourage the condition to continue.

Risk factors that can make someone more likely to have an eating disorder include:

• having a family history of eating disorders,
  depression
  or substance misuse
• being criticised for their eating habits, body shape or weight
• being overly concerned with being slim, particularly if combined with pressure to be slim from society or for a job (for example ballet dancers, models or athletes)
• certain characteristics, for example, having an obsessive personality, an anxiety disorder, low self-esteem or being a perfectionist
• particular experiences, such as sexual or emotional abuse or the death of someone special
• difficult relationships with family members or friends
• stressful situations, for example problems at work, school or university

Do I have an eating disorder?

Doctors sometimes use a questionnaire called the SCOFF questionnaire to help recognise people who may have an eating disorder. This involves asking the following 5 questions:

• do you ever make yourself sick because you feel uncomfortably full?
• do you worry you've lost control over how much you eat?
• have you recently lost more than 1 stone (6 kilograms) in a 3-month period?
• do you believe yourself to be fat when others say you're too thin?
• would you say that food dominates your life?

If you answer “yes” to 2 or more of these questions, you may have an eating disorder.

Spotting an eating disorder in others

It can often be very difficult to realise that a loved one or friend has developed an eating disorder.

Warning signs to look out for include:

• missing meals
• complaining of being fat, even though they have a normal weight or are underweight
• repeatedly weighing themselves and looking at themselves in the mirror
• making repeated claims that they've already eaten, or they'll shortly be going out to eat somewhere else
• cooking big or complicated meals for other people, but eating little or none of the food themselves
• only eating certain low-calorie foods in your presence, such as lettuce or celery
• feeling uncomfortable or refusing to eat in public places, such as a restaurant
• the use of 'pro-anorexia' websites

If you're concerned about a friend or family member, it can be difficult to know what to do. It's common for someone with an eating disorder to be secretive and defensive about their eating and their weight, and they're likely to deny being unwell.

Who is affected by eating disorders?

Around 1 in 250 women and 1 in 2,000 men will experience anorexia nervosa at some point. The condition usually develops around the age of 16 or 17.

Bulimia is around 5 times more common than anorexia nervosa and 90% of people with bulimia are female. It usually develops around the age of 18 or 19.

Binge eating usually affects males and females equally and usually appears later in life, between the ages of 30 and 40. Because of the difficulty of precisely defining binge eating, it's not clear how widespread the condition is.

Treating eating disorders

If it's not treated, an eating disorder can have a negative impact on someone’s job or schoolwork and can disrupt relationships with family members and friends. The physical effects of an eating disorder can sometimes be fatal.

Treatment for eating disorders is available, although recovering from an eating disorder can take a long time. It's important for the person affected to want to get better, and the support of family and friends is invaluable.

Treatment usually involves monitoring a person’s physical health while helping them to deal with the underlying psychological causes. This may involve:

• using self-help manuals and books, possibly under guidance from a therapist or other healthcare professional
• cognitive behavioural therapy (CBT)
  – therapy that focuses on changing how someone thinks about a situation, which in turn will affect how they act
• interpersonal
  psychotherapy
  – a talking therapy that focuses on relationship-based issues
• dietary
  counselling
  – a talking therapy to help people maintain a healthy diet
• psychodynamic therapy – counselling that focuses on how a person’s personality and life experiences influence their current thoughts, feelings, relationships and behaviour
• family therapy – therapy involving the family discussing how the eating disorder has affected them and their relationships
• medication – for example, a type of antidepressant called
  selective serotonin reuptake inhibitors (SSRIs)
  may be used to treat bulimia nervosa or binge eating