Characterized by repeated episodes of binge eating (i.e., eating an excessively large amount of food in a short period of time) followed by purging behaviour to get rid of the food. This is most often accomplished through self-induced vomiting, but can also include abuse of laxatives and diet pills or excessive exercise. The main difference between AN and BN is that individuals with BN are often normal weight or overweight, whereas individuals with AN are always significantly underweight. Individuals with BN feel guilty or embarrassed about their binges and purges, and largely base their self-esteem on their weight and body shape:
- Binge: eating excess amounts of food
- Eating is perceived as uncontrollable
- Self-induced vomiting, diuretics, laxatives
- Some exercise excessively, whereas others fast
- Most are over-concerned with body shape
- Fear of gaining weight
- Most have co-morbid psychological disorders
Characterized by severe intentional weight loss or refusal to gain weight. Anorexia is often accompanied by excessive exercising, obsession with body image, and a distorted body image. Some women lose their menstrual periods. Although not necessary for diagnosis, they also may appear very tired and lack energy; count calories constantly; exercise obsessively; use laxatives; avoid eating in public or in front of others; take diet pills, often in secret; act irritable and anxious at mealtime; skip meals; lie about how much food they have eaten; deny being hungry; faint or complain of dizziness; have fine hair growth all over their body; hide food; wear baggy clothes; and have difficulty concentrating:
- Defined as 15% below expected weight
- Intense fear of obesity and losing control over eating
- Anorexics show a relentless pursuit of thinness
- Often begins with dieting
- Most show marked disturbance in body image
- Most are co-morbid for other psychological disorders
- Methods of weight loss have life threatening consequences
Eating disorders that are not severe enough to be diagnosed as AN or BN, but are sufficiently concerning to warrant professional attention. Binge Eating Disorder (BED) is considered an EDNOS, and is characterized by episodes of compulsive overeating where the individual feels a lack of control over his or her behaviour and often feels embarrassed, disgusted, or depressed after the binge. BED differs from BN because there is no purging behaviour.
Eating Disorders are not the patient’s fault
- The risk of developing an eating disorder is 50-80% determined by genetics.
- Dieting, a normalized behavior in our culture, is a risk factor for the development of an eating disorder and can trigger eating disorders in those with a genetic predisposition.
- Even young children in our society are influenced to feel bad about their bodies and encouraged to engage in unhealthy dieting behaviors.
- Our society’s emphasis on appearance and idealization of thinness promotes dangerous dieting behaviors and blinds us to people suffering and in need of treatment.
- Genetic predisposition does not spell destiny. Our strongest approach is to focus on modifying the environmental factors that influence risk and perpetuate the disordered eating.
- Due to the cultural misunderstanding of eating disorders and the idealization of thinness, patients are often unable to perceive the gravity of the illness or seek assistance on their own without the assistance of family, friends, or clinicians.
Who can get it?
These disorders usually appear in young women between the ages of twelve and twenty-five, although there are both older and younger exceptions. At least 10% of those affected are male.
Are eating disorders dangerous?
Eating disorders have the highest mortality rate of any mental illness, upwards of 20%. Eating disorders can lead to major medical
complications, including cardiac arrhythmia, cognitive impairment, infertility, osteoporosis, and most seriously death. The mental
anguish of an active eating disorder is tremendous, and persists beyond the medical consequences. The toll of inadequately treated illness is crippling for the patient and their family.
How are Eating Disorders treated?
Eating disorders can require a range of professional treatments, which may include:
- Medical Treatment - In some situations, medication may be prescribed to help reduce bingeing/purging behavior or to help increase weight and decrease weight obsession. Unfortunately, current research hasn’t found that medication is effective at reducing eating disordered behaviour in the long-term, although it may help treat coexisting depression and anxiety symptoms.
- Nutritional Counseling - A dietician may be involved to teach better eating habits and how to select healthier foods.
- Family Therapy - Family therapy is one of the most effective treatments for adolescents with Anorexia Nervosa. It focuses on family dynamics and how they may be helping to maintain the eating disorder. It also helps family members understand the eating disorder better and learn how they can support each other.
- Cognitive Behavior Therapy (CBT) - CBT appears to be one of the more effective treatments for Bulimia Nervosa and Binge Eating Disorder. It helps people learn to problem solve and change their negative thoughts and behaviours into more positive ones. When used in a family format, it may also be effective at treating Anorexia Nervosa.
- Psychoeducation - This treatment is usually done in a group and teaches individuals to recognize their symptoms so they can learn to seek treatment when needed and prevent relapse.
- Hospitalization - Sometimes if the person is physically unwell, refuses to eat, or has health problems, the doctor will send him or her to the hospital to gain weight, deal with underlying mental health issues, and improve his or her physical health.
HOW LONG DOES TREATMENT LAST?
There is no set number of days for treatment. Treatment length depends on the individual’s needs, and lifelong maintenance can be required to prevent relapse.
How to help a friend who has an Eating Disorder
If you suspect your friend has an eating disorder, you should encourage them to seek professional help. Remember that people with eating disorders often don’t realize the severity of their problem, so your friend may not be receptive to your help. They may even get angry with you. This doesn’t mean they don't need your help. Try to get your friend to open up and talk about his or her feelings, but don’t focus discussion around food or enable their behavior. Let your friend know you are concerned without forcing anything on them or laying blame.
Here are a few other tips to consider before approaching your friend:
- Focus on feelings, not on weight and food.
- Use “I” statements (e.g., I feel worried about you because…) instead of “You” statements (e.g., You are not eating enough). “You” statements are more likely to make your friend feel blamed, causing him or her to act defensive and shut you out.
- Stay positive; the best influence is a positive one.
- Express your concerns; knowing that someone cares about them may make it easier for your friend to open up to you.
- Try not to comment on how they look, as it will likely only reinforce an obsession with body image.
- Don’t nag about his or her eating behavior. This is likely to make your friend more defensive and likely to hide his or her eating behavior from you.
- Be supportive and compassionate. Try not to judge.
- Remember the person has a disorder; but it does not define who they are.
- Encourage your friend to get help.
- Be patient; it takes time for someone to admit they need help and they cannot be rushed or forced.
- Educate yourself about the disorder to help understand it.
A young woman examines her eating disorder recovery. She consciously resists the temptation to rely on visuals of starvation and specific body weights, instead seeking to articulate the deeper questions: why do eating disorders develop? Why do eating disorders persist? And how does healing happen?
Positive Mealtime Affirmations
- Life is more than a number.
- Food is not the enemy.
- I deserve to nurture myself.
- I trust my body to feed me in such a way that I remain at a natural, comfortable weight.
- Strength and control come from exercising my personal power in the world not from refusing to eat.
- I trust my body to make appropriate food choices and to know when it is satisfied with food.
- I deserve to respect my body and to treat it with care and love.
- My happiness depends on who I am and what I do, not my weight or size.
- Food will not make me gain unnecessary weight.
- My feelings have nothing to do with whether or not I should eat.
- Food will be absorbed by my body, and used for energy and healing.
- Fats are necessary: lipids do not fatten us, but nourish us.
- This feeling too shall pass.
"I disliked my body when I was at my lowest weight.
I disliked my body when I was at my highest weight.
Today, I’m not the biggest fan of my body, and I have not got a clue what my weight is.
Therefore, when I dislike my body, I might as well carry on eating so I can do fun things that I am unable to do when I am malnourished and lacking in both energy and life."