Not all of us spend much time thinking about what we eat. People affected by an eating disorder, however, find they’re totally absorbed in their eating, thinking about it almost obsessionally between meals.
This article was first published in May 2011.
Eating disorders is a broad name for a number of problems we face with food in our society. While many of us slip into overeating or comfort eating at some point, for some the problem goes to life-threatening extremes.
In both anorexia nervosa and bulimia, there is a deep fear of being overweight that leads to an obsession about restricting the number of calories the person is taking in. This leads to an extreme state of starvation, which in turn has a number of effects on the way that the body functions and how hormones are produced.
This is complicated in bulimia, when the person still finds comfort in the feeling of being full but dreads taking on the extra calories. This is when they may induce vomiting, causing long-term problems for their throat and teeth on top of psychological problems.
Common behaviour of someone affected by an eating disorder includes:
Many anorexics and bulimics have researched the issue of diet quite deeply and know the damage they are doing to themselves but are still unable to stop. This just makes the feelings of despair and self-loathing even worse, causing their condition to continue.
While there is evidence that eating disorders can run in families, it isn’t yet clear how much risk for developing anorexia or bulimia is carried by genes.
The social and psychological factors have been better identified, but they are complicated.
Socially, it doesn’t help that we are sometimes pulled in two directions by the media.
The first way is with images of physical perfection - the man with the perfect six-pack on the cover of a magazine, or a young woman in a bikini. A review of research in 2002 found that women who viewed images of thin models were significantly more dissatisfied with their body images afterwards than women who viewed images of average-size models. This dissatisfaction was higher among younger women and women who already had issues with their body image.
The second way is the encouragement to eat foods packed with calories made up of saturated fat and simple carbohydrates, the two food types most likely to make you put on weight. Another research review in 2009 took international data on children’s television viewing, food advertising and childhood obesity. They found exposure to food advertising was related to childhood obesity, although the strength of the relationship varied from country to country.
Psychologically, at the root of an eating disorder may be a combination of a number of issues, including:
Each person affected by an eating disorder brings their own unique experiences to the problem. For each, the meaning of anorexia or bulimia has aspects that are personal to them.
There is limited evidence that some psychiatric drugs can help with anorexia and bulimia, and that some psychotherapy approaches can have some effect.
Cognitive behavioural therapy (CBT) makes a good start to alleviate the issues. For longer term recovery, psychological approaches that look at how the person relates to those around them might have more effect. These could psychotherapy focussing how on interpersonal relationships work and family therapy.
The effectiveness of family therapy in treating eating disorders has lead to some theories about family environment as a cause. The evidence suggests that while it can make a contribution, family functioning is not enough on its own to set off an eating disorder. It appears that a number of factors need to come together, including obsessive-compulsive disorder like symptoms and depression.
When families are faced with a loved one with an eating disorder, the idea they may have caused it is not only inaccurate but can also lead to feelings of guilt and recriminations that can get in the way of helping the person to recover.
Family members as well as the person with the eating disorder need to focus their energies on:
Recovery can take years and how recovery is defined can be difficult. Even if the person manages to regain and retain a healthy weight, they may still find food and eating to be difficult and emotive issues.
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Ruby Wax talks to Matthew about his experience with anorexia.
Thin, Grace Bowman, 2007. An honest account of life with anorexia nervosa. Recommended for anyone hoping to understand more about eating disorders and overcoming addiction.
Overcoming Anorexia Nervosa, Christopher Freeman, 2009. The author is one of the UK's authorities on anorexia nervosa and its treatment using cognitive behavioural techniques.
Anorexia Nervosa: A Survival Guide for Families, Friends and Sufferers, Janet Treasure, 1997. A self-help book for both families and sufferers offering useful ideas on how to overcome this illness.
The Invisible Man: A Self-help Guide for Men with Eating Disorders, Compulsive Exercise and Bigorexia, John Morgan, 2008. A self-help book for men with body image issues and eating disorders.
Getting Better Bit(e) by Bit(e): Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders, Ulrike Schmidt and Janet Treasure, 1997. A self-help manual offering detailed step-by-step advice for those with bulimia.
Overcoming Binge Eating, Christopher G. Fairburn, 2009. An authoritative self-help book for anyone who is working alone or with a therapist to recover from binge eating disorder.
Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method, Janet Treasure, Gráinne Smith and Anna Crane 2007. Provides carers with the skills and knowledge needed to support and encourage those suffering.
Eating Disorders: A Parents' Guide, Rachel Bryant-Waugh and Bryan Lask, 2004. A straightforward introduction to the subject with practical advice.
Anorexia and Bulimia Care offers a professional, personal and caring service, from a team of staff with experience in eating disorders, providing encouragement, advice and support for all involved (sufferers and family members) to help make full recovery possible.
b-eat is a UK charity for people with eating disorders and their families. There are separate confidential helplines - one for adults and one for young people under 25. Under 25s can also text or chat online to a member of the youth team.
Overeaters Anonymous is a fellowship of individuals who, through shared experience, strength and hope, are recovering from compulsive overeating. They welcome everyone who wants to stop eating compulsively.
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