eating; disorder; anorexia; nervosa; bulimia; compulsive; overeating; diet; binge;
Before talking about what an eating disorder is, let's look more closely at what is and is not normal eating. Then it will be easier to understand when something is a problem that needs help.
What is normal eating?
Normal eating is not how much or what you eat, but your attitude towards food and eating.
When you feel you can eat without feeling guilty, eat when you feel hungry and can stop when full, you have a positive and normal attitude to food.
It is also normal to eat different amounts on different days, to eat more of the foods you like and less of what you don't like, and to overeat or restrict intake sometimes.
What is not normal eating?
Eating that is not normal is not so much about what you do (eg. skipping meals, restricting food, overeating) but about the thinking behind it, how often it happens, and the feeling that you have to eat this way.
What IS, and IS NOT normal eating can look very similar.
- For example, you run out of the house without breakfast because you slept in and are worried about missing the bus. At school or work you feel hungry and grab a snack and eat a larger lunch than usual without even thinking about it. This is normal eating.
- Your friend skips breakfast because she feels fat and believes she is being strong and in control. This cheers her up. Later, when she gets hungry she tries hard not to eat but when she can no longer resist she has a snack and feels 'bad' for losing control and being weak. This is NOT normal eating. Both of these look very similar but there is different thinking behind it.
Eating that is driven by this strange thinking is called disordered eating and can be quite common.
What about dieting?
Many people have 'gone on a diet' to lose weight at some time. Dieting is so common some people see it as a normal part of eating. Dieting is not the best way to lose weight. People often gain back all the weight they lost when they stop dieting, sometimes becoming heavier than they were before dieting. It can leave you feeling down and unsuccessful.
For most young people dieting doesn't last long and they soon return to 'normal' eating. This kind of dieting is not a problem, but it should never be encouraged. It is better to encourage healthy eating and regular physical activity for long term healthy weight.
For some vulnerable young people who feel anxious about their looks and body, dieting can be dangerous. They may feel they have failed if it is not successful. It can lead to more serious eating problems and increase their risk of developing an eating disorder.
What is an eating disorder?
An 'eating disorder' is a clinical diagnosis that may be made when strange thinking about food and eating increases to the point where it affects your life. People with an eating disorder become intensely worried about their body and anxious about their weight. They can't see they are worrying about something that is not true and they may do dangerous things to try to lose weight.
An eating disorder is a complex psychological condition and only a trained professional such as a doctor or mental health professional can diagnose it.
Some of the most well-known eating disorders are:
- Anorexia nervosa – where the young person believes she is fat, even when she is not and may have lost a lot of weight.
- Bulimia nervosa – where the young person eats very large amounts of food because she has been starving herself, and then makes herself vomit, takes laxatives to make herself poo to excess or exercises to extreme.
- Binge eating disorder – where the young person has times when she eats very large amounts of food but does not vomit, purge or exercise to 'work it off'.
- Compulsive overeating – where she is constantly overeating to make herself feel better. Food is used as a replacement for what is missing.
Eating disorders can have serious physical, emotional and social impacts. They can take many years to resolve and may involve time in hospital.
What an eating disorder looks like
Emotional and social changes could be:
- not being as happy as usual
- not wanting to mix with friends or family
- being moody
- being less confident
- not wanting to do anything
- doing poorly at school
- sleeping a lot
- being angry.
There are many other symptoms of an eating disorder. These may not relate to everybody, and sometimes it can be difficult to notice any signs at all. Some of these signs can relate to different problems and not to eating disorders.
- Thinking and talking about food and dieting a lot of the time.
- Knowing about the amount of energy (joules) in every type of food.
- Eating very little, although the person may cook elaborate meals for others - or eating very large amounts of food sometimes.
- Going to the toilet often after meals and vomiting.
- Strenuous exercise routine, even exercising when she is injured or unwell.
- Severe weight changes:
- looking very thin, and still losing weight
- weight going up and down all the time or very large weight gains.
- Sudden mood changes, irritability, depression, sadness, anger, difficulty in expressing feelings.
- Poor concentration and being unusually tired.
- Intense shame about her body and fear of gaining weight .
- Constant pursuit of thinness.
If there are several of these signs together, it could mean she has an eating problem.
Causes of eating disorders
There is no clear cause for eating disorders. This makes it more upsetting for the person, family and friends, as they all try to think about what could have started it and what to do about it. However, the following factors may add to the risk that someone has of developing an eating disorder.
- High personal expectations - always striving to be perfect in everything.
- Setting unrealistic goals that the person believes will bring love and respect from family and friends.
- Feeling the need to gain control over one's life.
- Overwhelming feelings of not being good enough, leading her to starve herself so that she gains a sense of being in control again, or following the binge-purge cycle.
- Having low self-esteem - this can be hard to see because some people seem to be really 'together' on the outside, even when they are feeling bad inside.
- Depression; being sad or irritable much of the time, avoiding doing things with friends.
Those who have difficulty expressing their own needs and feelings (particularly negative feelings) may be at risk.
There are no typical family patterns, but problems with relationships and communication, or family conflict can make the person feel unvalued and alone.
A family emphasis on being worthwhile only when you are very good at study or sport, very well behaved, thin and attractive can have an impact on some young people, who feel worthless if they do not match up to the family expectations.
We are constantly bombarded with the message that you have to be thin to be beautiful or desirable. The media portrays happy, successful and feminine women as always thin.
Women who are required to be thin for their careers (models, dancers and athletes) are more frequently affected by eating disorders.
Research suggests more men are suffering from eating disorders because the muscular and lean image of men in the media is having an effect on men's health in the same way it does on women's. More men are over-exercising in the attempt to develop the ideal body shape. This can cause health problems too.
What can trigger eating disorders?
Many things can trigger an eating disorder if someone is already vulnerable (that is they have some of the problems listed above). These include:
- a life crisis or the death of a loved person
- family changes
- moving home or school
- a change of job
- school problems
- a personal failure.
An eating disorder may also develop when there is a gradual build-up of problems which on their own seem small. The person may interpret each small problem or failure as 'evidence' that they are not worthy.
Do you or your friend have a problem with disordered eating?
Check this out:
- Do you avoid eating meals or snacks with others?
- Are you always counting kilojoules and working out how much fat there is in everything that you eat?
- Are you always weighing yourself and stressing about your weight?
- Do you only exercise to lose weight and do you exercise even if you are injured or unwell?
- Are you scared about putting on weight?
- Do you ever feel 'out of control' when you are eating?
- Do you regularly diet then overeat?
- Do you have set ways of eating, like always having to have some foods, or you must eat different types of foods in a certain order?
- Is your day geared around control of food, weight loss and dieting?
- Do you feel ashamed, guilty or disgusted with yourself after eating?
- Do you constantly worry about the weight, size and shape of your body?
- Do you feel that no one will care about you or your opinions unless you have a certain size, shape and weight?
- If you or your friend have answered yes to several of these questions, then your thinking could be too focused on your weight, food and eating. It's time to get some help.
Helping someone with an eating disorder
The first thing to do is let the person know that you are worried and that you care about them. Even if they deny that there is a problem, or get upset and not want to talk about it, it is worthwhile trying to encourage them to seek professional help. This could include encouraging them to see and talk to a general practitioner (GP), the school counsellor, a psychologist, or specialist mental health worker. If they are not ready to do this, don't force it (unless they are significantly underweight and their health it at risk). Just try to be there for them as they might wish to talk soon.
Someone with an eating disorder needs expert help. There are several services in South Australia listed below. Once an eating disorder has been diagnosed, a range of health practitioners may be involved, because the illness affects people physically and mentally - this may include psychiatrists, psychologists, doctors, dietitians, social workers, occupational therapists and nurses. Admission to hospital may be needed for people who are severely malnourished through lack of food. Medication may be useful for depression and to correct hormonal and chemical imbalances. Counselling and specific therapies are used to help change unhealthy thoughts about eating.
Being a friend or partner or family member of someone with an eating disorder can be very difficult at times, particularly if the person denies she has an eating problem and will not talk to you openly. Be ready to go slowly. The problem will not be solved overnight.
Recognise that the eating disorder started with an emotional issue that may not be fully worked out yet.
Your friend may find dealing with the eating disorder stressful and have days when she does not want to change.
Accept your friend for who she is. Do things together that you have enjoyed before. Make comments about reasons why you like having her as a friend. Don't talk about her eating disorder all the time. Be honest with your friend, and by showing her your love and care she will feel supported and able to accept the help that she needs. Don't talk about your own weight issues or talk about dieting.
- your local Community Health Centre
- your doctor (General Practitioner)
- your school or university counsellor
- your local library for further reading
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).