What is an eating disorder?
In a general sense, eating disorders are experienced as disturbances in eating habits and are accompanied by physical and emotional distress. They lead to a deterioration of physical and psychological well-being, and ultimately can cause death. To understand what an eating disorder means for the person experiencing these difficulties, it is more helpful to think of the eating disorder as something that a person has developed, in order to feel that they can cope with their lives and feelings. However, the more the person relies on the eating disorder to cope, the more they need the eating disorder to cope, and very quickly they spiral into a situation where they feel they will only be able to cope and live if they hold onto the eating disorder. The person’s sense of who they becomes entrenched on them holding onto the eating disorder and this is why it is so difficult and terrifying for a person to think about letting it go. Therefore, while it is clear to everyone else that the person is harming his / herself, the only way the person with the eating disorder feels they can survive is by maintaining the eating disorder. See for example, the eating disorder voice.
What causes an eating disorder?
There is no single cause that can explain why a person develops an eating disorder.
It is usually a combination of risk factors (biological, psychological, familial, environmental and socio-cultural) that come together to create conditions in which an eating disorder is more likely to develop.
The disorder often develops gradually as a response to an upset in a person’s life. This could be a traumatic event, a loss or major change in a person’s life, bullying, an overload of stress, and/or critical comments about weight or shape. Sometimes, it is not obvious what the trigger may have been.
A person with low self-worth or without a strong sense of identity may be more vulnerable. People who develop eating disorders tend to be overly concerned with meeting the standards and expectations of others, and are highly-sensitive to other peoples’ feelings.
This explains why eating disorders occur so often during adolescence when identity is an issue, the opinion of peers is so important, and parental expectations are resisted.
Eating disorders do not start out as a conscious choice and are not a wilful form of ‘attention seeking’.
Understanding the emotional background of the eating disorder is crucial to developing an appropriate response and treatment approach.
What treatment is available for eating disorders in Ireland?
No one form of treatment suits everybody. Some people find that they are able to recover from an eating disorder using self-help methods and support services alone. Help is available from a variety of sources, e.g. GPs, counselling, psychotherapy, cognitive behavioural therapy-enhanced (CBT-E), family based treatment (FBT), dietitians, social workers, psychologists, psychiatrists, eating disorder recovery programmes in hospitals or in other treatment centres. For many, the combination of a professional help and a non-professional support service works well. Sometimes a person might attend a combination of people using a multi-disciplinary approach, for example, a GP or dietitian who looks after their physical health, and a psychotherapist who will help the person to examine, understand and work through the issues underlying the eating disorder. Each person needs to decide what works best for themselves. They will also need continuing support throughout the recovery process. For further details, see our treatment guide and the HSE’s Model of Care for Eating Disorders in Ireland. For information on support offered by Bodywhys, see here.
It is precisely because the eating disorder serves a purpose that it becomes very difficult to stop its progress.
For the person affected, the eating disorder can seem like an effective coping mechanism and it can take hold very quickly. This is why it is difficult to stop its progress. The longer it is established, the more it takes on a life of its own and takes over the life of the person affected, so early intervention is really important.
Often, by the time they begin to understand what is happening, they are unable and too scared to try and stop. It is as if the eating disorder is now controlling them. Also, for many, overwhelming feelings of helplessness, guilt, shame and self-loathing become an insurmountable block to seeking help.
Recovery begins with
- a will to change
- an acknowledgement that the eating disorder is a problem
- working to build up a strong sense of self and a new, healthy way of coping that does not need the eating disorder to feel safe
Recovery requires working on underlying issues, building self-esteem, and learning to manage and express feelings, as well as addressing the physical and nutritional aspects of the disorder.
Recovery takes great courage and commitment. Much sensitivity, compassion, respect, understanding and patience will be needed by those around them (family, friends, G.P., and other members of the treatment team) if a person is to be successfully encouraged and supported on their journey towards recovery.
PEOPLE CAN AND DO GET BETTER
Further information can be found in the books listed on our Booklist and from other websites for eating disorders and related issues. See our list of Websites or contact the Bodywhys Helpline: lo call 1890 200 444.
What are Eating Disorders?
The term ‘eating disorder’ refers to a complex, potentially life-threatening condition, characterised by severe disturbances in eating behaviours.
Eating disorders can be seen as a way of coping with emotional distress, or as a symptom of underlying issues.
- Eating disorders are not primarily about food
- People can and do recover
- Eating disorders can affect anyone
Eating disorders are characterised by a variety of disordered eating behaviours such as:
- Self-starvation – by fasting and/or food restriction
- Purging – by self-induced vomiting, over-exercising, or laxative abuse
- Bingeing – by consuming quantities of food beyond what the body needs to satisfy hunger
An eating disorder can be very destructive, both physically and emotionally, and people can get trapped into the destructive cycle of the eating disorder without knowing how to cope with it.
An eating disorder is not primarily about food and weight, but also feelings and a person’s sense of who they are.
Treatment of an eating disorder will require attention to both the physical and the psychological/emotional aspects of the person. Treatment must always include respect for and sensitivity for the overall well-being of the person.
The distress of a person experiencing an eating disorder, whether or not it is acknowledged, may have a considerable impact on family and friends.
The Main Eating Disorders
Although the term ‘eating disorder’ is applied to a wide range of disordered eating behaviours, there are three main classifications: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder.
- A person will make determined efforts to attain and maintain a body weight lower than the normal body weight for their age, sex and height
- They will be preoccupied with thoughts of food and the need to lose weight
- They may exercise excessively and may engage in purging behaviours.
- A person will make determined efforts to purge themselves of any food eaten, sometimes following a binge, and often following ‘normal’ food intake.
- They will engage in high-risk behaviours that can include fasting, excessive exercising, self-induced vomiting, and/or the misuse of laxatives, diuretics or other medications
- They may maintain a body weight within the normal range of their age, sex and height. As a result, bulimia is often less obvious than anorexia and can go unnoticed for longer.
Binge Eating Disorder
- A person will engage in repeated episodes of bingeing without purging
- They will likely gain considerable amounts of weight over time
- They find themselves trapped in a cycle of dieting, bingeing, self-recrimination and self-loathing.
Just because somebody doesn’t fit in absolutely with one particular category doesn’t mean they don’t have an eating disorder. A large number of people with eating disorders don’t fit strictly into one category but fluctuate between the three.
People experiencing an eating disorder may
- have dieted
- have low self-esteem– though this may not be obvious, as people who develop eating disorders are often ‘high achievers’
- show a marked over-concern with body shape, weight and size, and an obsession with food
- see thinness as a magical solution to problems, while weight gain is feared
- have difficulty identifying and expressing their real needs
- view their body as larger than it actually is (distorted body image)
- have problems around control
- find it hard to talk about their feelings and to deal with conflict
- be depressed and may become isolated
- experience mood swings
Can you fully recover from an eating disorder?
The short answer to this question is YES. People with eating disorders can and do make full recoveries. People sometimes describe recovery as learning to re-connect with oneself, building up a trust in one’s ability to cope without needing to control, not translating life issues into food issues as a way of dealing with them, letting go of the need to control food intake in order to feel okay. Recovery has a very individual meaning for each person so it is difficult to generalise and give a time scale to the recovery process. Factors such as how long the person has had the eating disorder and the quality of support they receive will influence the length of time the recovery process takes.
How do I support someone who is experiencing an eating disorder? What can I do?
It can be extremely difficult to support someone who has an eating disorder and is going through the recovery process. People often experience confusion, frustration, and desperation as they witness a person they care for experiencing the difficulties and set-backs that are a natural part of the recovery process. The person in recovery is facing the task of re-learning how to cope and live their life without using disordered eating behaviours. This can be extremely difficult and frightening for them. This is why recovery often occurs slowly and why the role of supporting someone can be very difficult. There are a few things to remember about supporting someone: try to accept the person as they are and show your willingness to be there for them; listen to their needs without judgement and without trying to fix or problem solve. Let the person know that you love them and value them for who they are. Communicate a belief that recovery is possible and your belief in their ability to recover. Take the focus away from food and eating and bring it to how the person is feeling. Communicate an appreciation of the energy it takes to struggle with an eating disorder. This same energy is the person’s most valuable resource for recovery. It is also very important not to put the needs for the person you are trying to support above your own needs. Looking after your own needs first not only models healthy behaviour but will put you in a stronger position to be of support to them.
I am concerned about someone who may have an eating disorder, what should I do?
How do I know if I have an eating disorder?
The following are a few questions you may ask yourself to try and answer this question: Do you feel that the way you eat and behave around food is dependent on how you feel about yourself, on your emotional state? (Are you using food to make yourself feel better?) What behaviours are you engaging in that lead you to ask this question? Do you feel trapped into your behaviours around food and eating? Maybe it’s not about getting an answer, but something prompted you to look up this website. What do you feel you need to do for yourself right now?
My child is a picky eater. Does this mean he/she has an eating disorder?
Many children are fussy eaters and come to use food as a currency in their relationship with their parents and caregivers. This does not necessarily mean that they have an eating disorder. An eating disorder is a manifestation of something that the child is experiencing as difficult or overwhelming at an emotional level. The child copes with a difficulty by controlling food intake. It is useful then for a parent who is concerned about the way their child is eating to try to bring a focus on how their child is feeling rather than on what their child is or is not eating. Creating a safe atmosphere to explore feelings will be of huge benefit to the child who feels unable to express what they are feeling without resorting to eating behaviours as a means of doing this. If a parent has any concerns they should visit a GP and remember that early intervention of a supportive nature is very beneficial. If someone has sensory challenges related to food, or worries about what will happen when they eat, they may be experiencing ARFID.
My child seems to be preoccupied with dieting, do they have an eating disorder?
There are many people who are preoccupied with dieting in today’s world, and not all of these people have an eating disorder. However, if you are concerned there are a few things to think about which may give you a clearer understanding of whether or not your child has an eating disorder. An eating disorder is a manifestation of something that the child is experiencing as difficult or overwhelming at an emotional level. The child copes with a difficulty by controlling food intake. It is useful then for a parent who is concerned about the way their child is eating to try to bring a focus on how their child is feeling rather than on what their child is or is not eating. Creating a safe atmosphere to explore feelings will be of huge benefit to the child who feels unable to express what they are feeling other than through their eating habits. If a parent has any concerns they should visit a GP and remember that early intervention of a supportive nature is very beneficial. Do you feel that the way your child eats or diets depends on her / his emotional state? Is she dieting to make herself feel better? Are there issues about body image that could be talked about and addressed? Do you feel your child is trapped into a dieting cycle? How would your child be if she were not able to diet? Are you aware of what was going on in your child’s life when she began to get preoccupied with dieting, and has this preoccupation intensified since then? These are all questions that will help you to gain a better understanding of the role that food (and eating / not eating) is playing in your child’s life. There would be concern around an eating disorder if your child is depending on food and body control to feel ok about herself / himself.
What role do the media play in causing eating disorders?
Media influence is frequently blamed for breeding a normative discontent in relation to body image and this is often seen as being a causal factor in the development of eating disorders.
The causes of eating disorders are multiple and very complex. A whole range of factors combine to contribute to the development and maintenance of an eating disorder. However, two of the major risk factors for eating disorders are low self-esteem and dieting.
A culture which promotes obsession with appearance and which markets a particular body shape (thinness in women / leanness and muscularity in men) as desirable and as a means of achieving success and/or happiness can contribute to the erosion of self-esteem in vulnerable individuals. In this context, the constant promotion of dieting also can contribute to creating an unhealthy relationship with food and body. It is in the light of this that the media can be seen as playing a part in the development of eating disorders.
The effect of the media is to further undermine those individuals who are already vulnerable to developing an eating disorder; and to exacerbate and maintain eating disordered thinking where it is already established. This is why it is so important that the media take responsibility for what they report and recognise the potential impact of messages that have the capacity to undermine healthy self-image and self-esteem which are the cornerstones of mental well-being.
My daughter has lost a lot of weight and has been diagnosed with anorexia. Why can’t she just eat?
It can be extremely frightening and frustrating for a parent when trying to understand why their child just can’t eat. This seems to contradict everything that they take for granted about being ill, about feeling hunger, and about how they have brought their child up as a healthy individual. This is why it is really important to understand the role the eating disorder plays in your child’s life. The eating disorder, and the disordered eating behaviours that are part of it, are ways your child uses to feel safe and in control. He / she can’t just eat (at the moment) because it takes some time to re-learn how to cope with life without using the disordered eating behaviours. Through the recovery process, your child will slowly begin to eat and re-learn what feeling hungry is like and why it is ok to eat and nourish him / herself. The eating disorder works as a coping tool because it helps the person disconnect from their feelings, which also includes feeling hungry. So, the person often does not feel hungry when they are in the midst of the eating disorder. When a person starts to eat again, it can be very frightening to suddenly begin to reconnect with their feelings. This can be experienced as overwhelming. This is why it is so important not to rush or force a person to eat. They might feel so threatened that they will defend themselves by further retreating into the eating disorder.
My child is very unwell and the doctor is looking at referring him / her to an eating disorder programme. They do not want to attend, what should I do?
This is a very difficult situation and a very difficult question to answer.
The most important thing to try and keep at the centre of any decision making about what course of action to take, is that in so far as this is possible your child needs to feel that they are as much in control of what is happening as all of you are. An eating disorder is in many ways all about control and any decisions about treatment need to be made in a way that is not experienced as threatening. Achieving this can present many challenges, depending on how ill your child is.
Have you discussed what your child’s fears are about attending an eating disorder programme?
Can these fears be addressed before your child takes up a place on the programme?
Have you explored with your child all the various treatment options, to see whether there is another appropriate course of action that your child feels less frightened by?
What supports have you sought for your child and yourself both prior to and following a treatment programme?
Being open and honest with your child will benefit them in the long run. Allowing your child to feel as in control as possible of what is happening to them is as crucial to laying the foundations for recovery. Involve them in any decision making process and even if you may not feel that you can accommodate their wishes, ensure that your child knows that you have demonstrated that you value their feelings and respect their views. When a person with an eating disorder feels threatened, or pushed into doing something that they are not ready for, then the fear is that they will further retreat into the eating disorder. This is very frustrating to those around them, and difficult to understand. Allowing the person to take their recovery at their own pace will benefit them in the long term.
I am doing research /an article on eating disorders, where can I find information?
You could start right here on the Bodywhys website. Here you will find general information on eating disorders, on getting help and treatment, and on some of the wider issues relating to eating disorders. You can also access our resources section, which links you to other websites for further information on this topic. You may also call us at 01 2834963 and we will send you a full information pack which includes an extensive booklist and website list.
Do men/boys get eating disorders too?
Yes. Eating disorders are not specific to women and girls. Most literature asserts that one in ten people with an eating disorder is male, however, more recent studies suggest that the figure may be substantially higher. It is often more difficult for men to seek out help because eating disorders are still perceived by many to be something that only affects women and girls. Click here to learn more about eating disorders and men.
I have just discovered my son has been making himself sick after meals. He doesn’t know that I know. What should I do?
The question to ask yourself is what do you feel is the right course of action for you to take right now? In some ways, the fact that he doesn’t know that you know, gives you some time to think through how you are going to handle this situation. This is a delicate issue. Rushing into reacting may cause your son to retreat and defend his behaviours more. Before approaching him about this, you might find it helpful to read through our information on approaching someone. This will allow you time to think through how you can approach the situation in as constructive and supportive a manner as possible. Before you approach your son, inform yourself as much as possible about eating disorders. Your son may be experiencing feelings of shame around his behaviours and it will be important that you approach him in as gentle and safe a way as possible. Try to view your son’s behaviour as a way he has developed of coping. It then becomes possible for you to understand to what extent it will be important for him that this coping mechanism isn’t threatened by how you approach him. So, it is about trying to dialogue with him in such a way that he feels he can talk to you about why he is doing this at the moment. Eating disorders are manifestations of underlying emotional distress. The most important thing for him will be that he feels listened to and not judged. Try to accept him where he is at, and to focus on how he is feeling rather than what he is doing. If you think it would help, you could tease out ways of addressing the situation with a helpline volunteer (1890 200 444). This can provide you with a space to explore your own feelings which can put you in a better position to be the non judgemental listener that your son needs you to be at this time.
I am a teacher in a school and I am concerned about a particular pupil. What should I do?
The first thing you can do as a teacher is to inform yourself of the issues that can be involved when a person develops an eating disorder. Early intervention in eating disorders greatly improves the outcome. It is important for you to take clear concise notes of the incidents and observed behaviours that have led you to believe there is a problem. Although you cannot “diagnose” what the issue is with the pupil in question, your notes will assist a health professional in the assessment and diagnostic process should this need arise. It is important that you share your concerns with the school counsellor, or the person in charge of pastoral care. Then decide who is the most appropriate person to approach the young person and his / her family.
I am a manager of a gym and we are quite concerned about one of our members. What should we do?
If you are concerned about somebody using your gym, it is important that, before you approach the person, you are very clear in your own mind about what your concerns are and about what you have observed. It is also really important that you make yourself aware of what the gym’s health and safety policy around this issue is. It will be very helpful if you inform yourself about eating disorders and about what help and support there is available to somebody with an eating disorder. When approaching the person in question try to find a way of taking the person aside privately and at a time when you have the available time to express your concerns about what you have observed and to listen to them without judging them. They may not wish to talk to you about it and may even react negatively. Make sure you have information available for them about where they can get support and help so that you can offer it to them. Even if they are not ready to seek help now, they may feel ready to do so at a later stage. Knowing that you were supportive in your initial approach will make it possible for them to approach you again if they feel they need your support at a later stage.
What role can support from a voluntary organisation like Bodywhys play?
Bodywhys can play an important role at any stage for people affected by eating disorders. The various support services that Bodywhys provides are designed to offer non-judgemental, confidential support and understanding to people affected by eating disorders at any stage of their journey. A person may turn to Bodywhys in the midst of an eating disorder, when they are just beginning to think about letting it go and getting treatment; they may be in treatment and reaching out for additional support to help them with the challenges they are encountering; they may be looking for support because they are going through a bad patch; they may have completed a treatment programme and need support as they try to cope with living at home again, they may simply want to talk to someone because they do not know what to do; they may be a family member or a friend of a person experiencing an eating disorder who needs to talk in confidence and be supported as they try to support somebody else. They may wish to benefit from the experience of others who have faced challenges similar to those they find themselves facing now. Contact with others who understand can help people to feel less isolated and more confident about recovery. For those who are not yet ready to engage with recovery, supportive contact can help them to accept themselves fully as they are now. This acceptance is the only place to start if recovery is to begin. Recovering from an eating disorder is an extremely difficult process, and each day presents its own challenges. Bodywhys services provide confidential and non-judgemental support that can help carry a person through difficult times, whether they may be in the process of recovery or in need of that encouraging word and listening ear that gives them the courage to seek out help for themselves.