Eating disorders: A quick guide
EATING DISORDERS: A QUICK GUIDE
By Joyce Chong
Hot on the heels of our previous articles on Food, Mood + The Brain, and How to Really Make Diets Work we're taking a look at when your relationship with food and eating becomes unhealthy.
THERE ARE MANY DIFFERENT TYPES OF EATING DISORDERS
Eating Disorders, in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1] released in 2013, are grouped together with other disorders linked with food to form the diagnostic category of Feeding + Eating Disorders. Despite the varied types of disorders, they are all marked by certain commonalities, namely:
1) Disturbed pattern of eating (or eating behaviours) that leads to compromised consumption or absorption of food;
2) There exists significant impairment to functioning, be it occupational, physical, or psychosocial.
Overall, the disorders listed in the Feeding + Eating Disorders category include:
Pica where non nutritious substances (e.g. dirt, chalk) are repeatedly eaten
Rumination Disorder which involves repeatedly regurgitating (in the forms of re-chewing, re-swallowing, and spitting out) food after eating.
Avoidant/Restrictive Food Intake Disorder where problems in eating lead to weight loss or nutritional deficiencies.
Anorexia Nervosa is where there is significant restriction to dietary intake in response to an intense fear of gaining weight.
Bulimia Nervosa involves a cycle of binging and engaging in unhealthy behaviours aimed at preventing weight gain due to a heighted focus on body weight and shape.
Binge-Eating Disorder involves eating an excessive amount of food in one sitting. Unlike in Bulimia Nervosa there are no attempts to minimise weight gain through unhealthy behaviours.
Today we’ll talk a bit more about Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder as these are the more common presentations that we see in our clinical work. It’s estimated that Eating Disorders affect around 9% of the Australian population.[2]
ANOREXIA, BULIMIA + BINGE-EATING DISORDER
Anorexia Nervosa refers to a condition wherein there is continued restricted intake of food, an intense fear of weight gain or behaviours that prevent weight gain, and a distorted perception of weight or shape.
Bulimia Nervosa is wherein there are recurring instances of binge eating, behaviours (e.g. vomiting, laxative/diuretic use, excessive exercising) designed to prevent weight gain, and a heightened focus on weight or shape. The binge/purge cycle must occur at least once each week for a period of 3 or more months.
Binge-Eating Disorder refers to recurring instances (at least once a week for 3 months) wherein an excessive amount of food is consumed relative to what most would consume in a similar amount of time, there’s a sense of lack of control associated with the binge, and there is significant distress associated with the bingeing.
PSYCHOLOGICAL FACTORS LINKED TO EATING DISORDERS
Several psychological mechanisms have been proposed to underlie the above eating disorders, including:[3]
Low self-esteem. Negative self-evaluations are a feature of eating disorders. They can derail positive progress by impacting on belief in capacity to change, dismissing any improvements, and impact on treatment adherence.
Overemphasis on weight and shape. One of the defining criteria for Anorexia and Bulimia (but not Binge-Eating Disorder) is an overemphasis on one’s weight and shape, typically characterised by a drive for thinness. It’s been suggested that factors contributing to this drive for thinness include gender, cultural factors, and the media.[4]
Perfectionism is another feature linked to eating disorders – in particular, the relentless pursuit of unrealistically high standards when it comes to controlling weight and shape, thus setting oneself up for failure.
Negative moods and difficulties tolerating such negative moods have been suggested as triggers for binge eating and compensatory behaviours designed to mitigate any weight gain due to bingeing.
Unhelpful thinking styles including Labelling of oneself in a negative way (weak, failure, fat), Black and White thinking wherein minor transgressions of the rigid diet are considered a complete failure, and Catastrophising where the consequence of eating a ‘bad food’ is over-exaggerated. For more on unhelpful thinking styles, check out this post.
SEEKING HELP FOR EATING DISORDERS
It’s essential for an individual with an eating disorder to seek appropriate assistance. Anorexia and Bulima, in particular, are linked with an increased risk of suicide. [1]
So if you recognise the signs in yourself or in a loved one, here are some simple steps to take:
Educate yourself on eating disorders and its challenges from a reputable website such as The Butterfly Foundation or the National Eating Disorders Collaboration.
Open up about what's going on or about how you feel, rather than trying to carry the burden on your own.
Seek assistance It’s important to get checked out when you’re dealing with an eating disorder so that you can start to make changes. Depending on the severity of the eating disorder, a hospital admission (or similar) may also be required. Getting help with an eating disorder means drawing on the skills of a whole team – including your GP, psychiatrist, nurse, dietitian or psychologist (Contact us to make an appointment).
Want more? You can connect with The Skill Collective in the following ways:
Contact us to make an individual appointment to get started on making changes.
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REFERENCES
[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
[2] http://www.nedc.com.au/eating-disorders-in-australia
[3] Fairburn, C.G., (2003). Cognitive behavior therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509-528.
[4] Weissman, R.S., & Bulik, C. (2007). Risk factors for Eating Disorders. American Psychologist, 62, 181-198.