How do I recognise the signs?
You can’t tell just by looking at someone whether they have an eating disorder or not. The signs can be subtle and often difficult to identify. A person with an eating disorder may also go to great lengths to mask or hide their symptoms from others.
Eating disorders aren’t just about dramatic weight loss or frequent trips to the bathroom after meals. They are very often associated with feelings of low self-worth, deep emotional distress and an inability to cope with this distress. You may have noticed a change in the way someone close to you behaves and relates to other people, such as withdrawing from friends, relationships or avoiding social contact all together. Or you may have noticed a change in the person’s mood, for example, being more tearful, hopeless, angry or defensive than usual. Physical changes to their body might also be visible, but not always.
For some people, the warning signs of an eating disorder can include anxiety or irritability around meal times, avoidance of eating with others or avoidance of food in general, preoccupation with topics around food, calories or weight, or frequent self-criticism in relation to body image. For others, none of these warning signs might be present.
Each individual’s experience of an eating disorder will be different and the various types of eating disorders are associated with different symptoms. The main types of eating disorders are described below:
Anorexia Nervosa
Anorexia is when a person restricts the amount they eat and drink to lose weight, or to maintain a very low body weight (below the recommended healthy weight for their height and age). Someone with anorexia will intensely fear gaining weight or losing control over what they eat.
Someone with anorexia may also have a distorted view of their body, believing they are overweight even when they are very thin, and they may also obsessively exercise in their drive for thinness. They may feel that their weight or body image directly reflects on their value as a person, leading to, or adding to already, low self-esteem. This constant sense of self-dissatisfaction drives a need to ‘do better’ or to have greater control and maintains the disorder.
There are two sub-types of anorexia; restrictive and binge-purge. Someone with the binge-purge subtype of anorexia may have episodes of over-eating or ‘bingeing’ as well as prolonged periods of restricting food and drink. They may also engage in compensatory ‘purging’ behaviours in an attempt to rid themselves of any calories consumed. This may occur after a binging episode or in reaction to the anxiety and guilt associated with eating even small or ‘normal’ amounts of food.
Some symptoms of anorexia include:
- rapid or dramatic weight loss
- obsessions around dieting, food and calories
- low self-esteem and weight complaints
- visible food restriction or unusual rituals around eating
- loss of periods in females, or loss of sex drive in males
- dehydration, constipation, or complaints of abdominal pains
- dizziness and headaches
- poor circulation or feeling cold all the time
- difficult making decisions and concentrating
- poor sleep, and restlessness
Binge – Purge Explained
A binge is when a person rapidly consumes a large amount of food in a short amount of time, far more than a person would be expected to consume in the same time frame, under similar circumstances. Food choices for binges are typically high calorie or junk foods, but can also be whatever is available to the person, depending on their circumstances and finances. Binge episodes are often associated with feelings of being out of control, an inability to stop, and the sense of being in an altered mind state or ‘trance’. Binges often occur in secrecy and may be planned, for instance, when no one is around.
To purge is to engage in any behaviour that the person believes compensates for or gets rid of the calories they have consumed. This includes self-induced vomiting, taking laxatives, diet pills or water tablets (diuretics), or exercising vigorously. Purging behaviours are often ineffective, very dangerous, and can cause severe harm to the body.
Bulimia Nervosa
Bulimia is characterised by a vicious cycle of binge-purge behaviours and feelings of a loss of control over eating. Bingeing can occur in response to attempts to restrict food intake to lose weight or to emotional distress, and is followed by purging behaviours, such as self-induced vomiting, in an attempt to prevent weight gain.
Feelings of guilt, disgust and shame are common before, during and after the binge episode. Low self esteem, emotional problems, or stress can both cause and maintain the disorder. A person with bulimia may have frequent weight changes or may maintain an average or just above average body weight, meaning the disorder can go unnoticed for a long time.
Some common symptoms of bulimia are:
- secretive hoarding of food, or abnormal amounts of money spend on food
- low mood or increased irritability, mood swings
- feelings of guilt after eating
- sore throats, tooth decay or frequent mouth infections
- heart burn, stomach pains or intestinal problems
- swollen hands, feet or ankles, puffy cheeks
- dehydration
- dry or poor skin
Medical Risks of Eating Disorders
Both anorexia and bulimia can be life-threatening. Medical complications can arise due to low weight, starvation, or frequent vomiting or laxative abuse which can cause a fatal imbalance of ‘electrolytes’ in the body (essential for our cells and organs and therefore preserving life). Eating disorders also carry high risks of permanent damage to the vital organs of the body, such as the heart, kidney, and digestive system. If you recognise any of these symptoms in yourself or another person, make sure you seek medical advice as soon as you can.
Binge Eating Disorder
Someone with binge eating disorder will engage in binge episodes at least once a week in which they experience marked distress and eat abnormally large amounts of food, eat very rapidly, or continue to eat past the point of being uncomfortably full. The eating behaviour differs from that expected if you were to sit down to a regular meal.
The binge episodes share many of the same qualities as with bulimia, such as being conducted in secrecy, associated with feelings of shame and guilt, and a loss of control over eating. A person with a binge eating disorder however will not regularly engage in compensatory purging behaviours to prevent weight gain. For this reason, weight can steadily increase over time and puts the person at risk of obesity, and associated health problems.
Some common symptoms of binge eating disorder are:
- low mood
- emotional behaviour
- guilt after eating
- weight gain
- high blood pressure and cholesterol
- increased risk of obesity, diabetes and heart disease
Other Specified or Unspecified Eating Disorder
This diagnosis may be given if you do not meet the full criteria for one of the above disorders or if you have considerable difficulties around food and eating but do not fit neatly into one of the above categories. These eating disorders have many of the same characteristics as the above disorders and carry the same physical and psychological risks. They are no less distressing or serious.
BMI Explained
BMI stands for ‘body mass index’ and this is a number which is calculated using a person’s height and weight. A healthy BMI is considered to be between 20 and 25 and you should aim to keep your BMI between these figures for good health. A BMI below 20 indicates that a person may be underweight, and above 25 indicates a person may be overweight.
BMI is only a guideline, and generally applies to adults between the ages of 18 – 60. It also does not take into account your body frame or build so also is not accurate, for instance, for athletes, weight trainers or women who are pregnant or breast-feeding.
You can check your BMI using the BMI calculator on the NHS website at: http://www.nhs.uk/live-well/healthy-weight/bmi-calculator/
