Approaching Eating Disorders
Updated: Oct 21, 2022
Eating disorders are a genuine and complex mental health concern. An eating disorder is characterised by continued disturbed eating conduct, linked with distorted thoughts and emotions about one’s own body image, such that it results in serious physical health or psychosocial issues (American Psychiatric Association [APA], 2013). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) differentiates between six types of eating disorders: pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, and binge-eating disorder. These are considered mutually exclusive diagnoses, as whilst they share similarities in presentation, they differ greatly regarding treatment, outcome, and other such needs (APA, 2013). This article does not focus on any specific disorder, but on the broad symptoms, prevalence, and causes, and some ways in which both sufferers and those seeking to help someone they care for can provide support.
Lifetime prevalence of any eating disorder mentioned in the DSM-5, within Australia, was theorised to be roughly 7.2%, based on a study on South Australian adults in 2015 (Hay et al. 2017). Allen et al. (2013), estimated a figure ranging from 1.2-8.5% at 14 years of age of developing an eating disorder of any type; a figure which rose to 2.9-15.2% by 20 years of age. Binge eating disorder is one of the most significant, or at least most recognised, dietary disorders, influencing an estimated 6% of the population, whilst anorexia and bulimia nervosa occur in less than 1% of the total population at any one point in time (National Eating Disorders Collaboration [NEDC], 2017). The COVID-19 pandemic has increased the risk of developing eating disorders whilst decreasing the available support (Rodgers et a., 2020), and exacerbated the progression of eating disorders for individuals who suffer from them (Phillipou et al., 2020), and so this figure itself may increase following the COVID-19 crisis. Eating disorders do not discriminate and can influence individuals of every sex, gender, age, ethnicity, race, cultural and linguistic background, ability, shape and socioeconomic group. A known barrier to treatment and due attention — academically, socially, and medically — is the misinformation and stereotype that eating disorders affect only young women (Bruch 1973, as cited in Hart, Mitchison, & Hay, 2018). It is important to recognise the potential for eating disorders to occur across all demographics; though lower prevalence has been recorded in some migrants in Australia, relative to Australia-born citizen prevalence (Cheah et al. 2020).
Many individuals with a dietary issue may not understand or recognise they have an issue, as warning signs may be misinterpreted or confused. Compounding on this, an individual with a dietary issue may regularly experience shame or blame from themselves and others about their behaviour, and will try to conceal it. This shame can also prevent the sufferer seeking help from others, or professional treatment (Swan & Andrews, 2010). Eating disorders may cause numerous physical complications and other health problems. They have also been linked to life-threatening problems including coronary failure, seizures, kidney problems, brain damage and infertility. With these problems, an individual may likewise face further social or behavioural downsides, like poor performance at school and work, isolation, low confidence, disregarding important activities, and mood swings (Mayo Clinic, 2021). The most well-known warning signs and symptoms that individuals ought to know are included below, split into physical, psychological, and behavioural (Eating Disorders Victoria 2021; Healthdirect Australia, 2021; Mayo Clinic, 2021).
Physical: frequent changes in weight, disturbance of menstruation, fainting or dizziness, feeling tired and not sleeping well, sensitivity to cold weather, calluses on knuckles and loss of tooth enamel from induced vomiting, and general low energy.
Psychological: Increased distraction or obsession with body shape, weight or appearance, intense fear of gaining weight, irritability around eating times, distorted body image, using food as self-punishment (e.g., declining to eat due to depression, stress, or other emotional reasons), low self-esteem, and heightened anxiety and depression.
Behavioural: Constant or repetitive dieting, evidence of vomiting or other purging behaviours, changes in food preferences, compulsive or extreme workout, obsessive ceremonies around food preparation and eating, social withdrawal, marked change in clothing style (e.g., noted change to baggy clothing), obsession with appearance in mirrors and photographs, eating excessive amounts of sugary or high-fat foods, and leaving during meals to use the bathroom.
The specific causes of eating disorders remain largely unknown (APA, 2013), and can be be triggered by a complex and unpredictable confluence of psychological risk factors, sociocultural influences, and biological and hereditary inclinations (Mayo Clinic, 2018). In terms of biological predisposition, no particular gene has been established as causing a higher incidence of eating disorders, despite the heritability of eating disorders ranging between 28-83% (Mayhew et al., 2017). Theories about the development of eating disorders invariably include a biopsychosocial model of triggers. That is to say, it is theorised that the risk of developing eating disorders is increased through psychological and environmental factors, including but not limited to media pressure, ‘thin-ideal internalisation and expectancy’, perfectionism, Obsessive Compulsive Disorder, negative emotionality, and broader socio-cultural variables compound upon genetic predispositions (Culbert, Racine, & Klump, 2015). Youth are especially at risk from socio-cultural pressures, given their state of development and identity formation (Shure et al., 2011, as cited in NEDC, 2012).
Eating disorder treatment changes dependent on the specific disorder and symptoms. It typically includes a combination of psychological therapy, nutrition education, clinical observation, and sometimes medication (APA, 2013). Treatment may last from a couple of months to years. It can help to normalise eating behaviours and accomplish a healthy weight along with exchange unhealthy habits for healthy ones. Another key tool it helps foster is the self-analysis and recognition of unhealthy dispositions and eating behaviours to avoid future incidences. Treatment may include a blend of various kinds of treatments, for example:
Cognitive behavioural therapy: This sort of psychotherapy focuses on behaviours, thoughts, and feelings identified with your dietary issue. It involves the joint formulation of approach between patient and therapist regarding self-monitoring, collaborative goal-checking, and education about the issue (Murphy et al. 2010). Once the most pressing concerns are alleviated, the therapist and patient investigate the triggering factors, as well as future pathways to avoid relapse.
Family-based treatment: During this treatment, relatives figure out how to assist you with re-establishing smart dieting designs and accomplish a healthy weight until you can do it all alone (Lock & Grange, 2005). This sort of treatment can be particularly valuable for guardians figuring out how to assist a teen with a dietary problem.
If the above forms of therapy or treatment are not working for you, there are other forms of therapy that can focus in on specific forms of eating disorders, or their potential contributing factors. These can include focal psychodynamic therapy, which focuses in on specific childhood and subjective experiences that may have contributed to eating disorders (Grilo & Mitchell, 2009); or the Maudsley Model of Anorexia Treatment in Adults (MANTRA), which focuses on the collaborative overcoming o