Eating disorders The Royal College of Psychiatrists Eating disorders are driven by an intense fear of becoming overweight, damaging both physical and mental health. The two most common eating disorders are anorexia nervosa and bulimia nervosa, although their symptoms are often mixed.

In this article

Symptoms

Treatment

Professional help

Eating disorders affect seven girls in every 1,000, and one boy in every 1,000. It usually begins to be a problem in teenage years, but can happen at any time.

It’s not known for certain what causes then, but many factors could play a part:

• Social pressure, particularly caused by the media idealising being thin.
• Losing weight can make us feel good and in control.
• Puberty - anorexia reverses some of the physical changes of becoming an adult.
• Family problems - saying “no” to food may be the only way you can express your feelings.
• Depression and low self-esteem - binges may start off as a way of coping with unhappiness.
• Genes - it can run in families.

Anorexia nervosa:

• Becoming extremely stressed about losing weight
• Being unable to stop losing weight, regardless of your size
• Smoking and chewing gum to keep your weight down
• Losing interest in sex
• In women, periods become irregular or stop, in men and boys, erections and wet dreams stop and testicles shrink

Bulimia nervosa:

• Becoming extremely stressed about losing weight
• Binge eating
• Making yourself vomit
• Using laxatives
• In women, periods become irregular
• Feeling extremely guilty about your eating pattern, but staying a normal weight

Binge Eating Disorder has recently been recognised as a condition. It involves dieting and binge eating, but not vomiting. Although distressing, it’s less harmful than bulimia. People with the condition are more likely to become overweight.

Self help

Try to stick to regular mealtimes – breakfast, lunch and dinner. If your weight is very low, have extra snacks. Keep a diary of what you eat and your thoughts and feelings, you can use this to see if there are links between how you feel, think and eat. Contact b-eat or join a self-help group.

Your GP can refer you to a specialist counsellor, psychiatrist or psychologist. Your eating disorder may have caused physical problems or you may have an unrecognised medical condition.

A specialist will want to find out when the problem started and how it developed. You will be weighed and, depending on how much weight you've lost, may need a physical examination and blood tests. A dietician may talk to you about healthy eating. You may need vitamin supplements.

With your permission, the specialist might want to talk with your family or a friend to see what light they can shed on the problem.

Psychotherapy or counselling involves talking to a therapist about your thoughts and feelings. It helps you understand how the problem started and how you can change some of the ways you think and feel about things. Although it can be upsetting, a good therapist will help you talk about things in a way that helps you cope with your situation, and builds your self-esteem

Hospital admission is only an option if you are dangerously underweight or just not getting better. It involves controlling your eating, completing physical checks and talking about problems. Compulsory treatment (sometimes called sectioning) only happens if someone is so unwell that their life or health is in danger, or they cannot make proper decisions for themselves and need to be protected.

Cognitive Behavioural Therapy (CBT) helps you to look at the links between your thoughts, feelings and actions. It can be done with a therapist, with a self-help book, in group sessions, or a computer program.

Interpersonal therapy is usually done with an individual therapist, focusing on your relationships with other people.

Dietary advice helps you get back to regular eating, without starving or vomiting.

Antidepressants can reduce the urge to binge eat. Unfortunately, without the other forms of help, the benefits wear off after a while.

About half of patients make a recovery, although it can take place slowly over a few months or years.