Body Image & Eating Disorders Awareness Week is an Australian public education and outreach campaign that runs throughout the first week of September. Awareness is the critical first step in helping people identify when someone they love is at risk.

Recognising a problem

Most people are aware of some types of eating disorders such as bulimia nervosa and anorexia nervosa, yet they don’t always recognise those suffering in their own lives. If someone you care about is spending more time at the gym than with friends, rarely wants to join the family for dinner or is always on a diet, they may be exhibiting early warning signs that a bigger problem is developing.

A mental health issue

Eating disorders are a mental health issue with devastating effects on one’s physical health and quality of life. Underlying the food and exercise behaviours are distorted and self-critical attitudes towards shape, size and self-worth.

Equal opportunity disorders

Eating disorders do not affect just young females, as once thought. Research is showing that eating disorders are becoming more of a concern for men and women of all ages. While men experience all forms of disordered eating, they are more likely than women to engage in compulsive eating. Men are less likely than women to abuse laxatives or vomit but are more likely to use excessive exercise to control their weight.

Binge eating disorder

One of the most common forms of disordered eating, and perhaps the least understood, is binge eating disorder (BED). Those experiencing BED compulsively eat large quantities of food and tend to feel secretive and shameful about their eating.

Binge episodes are preceded by strong urges and a sense of being out of control. A person with BED has very similar drives and feelings as someone with bulimia, but they don’t attempt to compensate for their binges through overexercising, laxative abuse or vomiting.

What causes eating disorders?

Eating disorders arise from a complex combination of behavioural, biological, psychological, interpersonal and social factors.

Personality traits

Some of the known personality traits associated with eating disorders are perfectionism and low self-worth.

People who have difficulty identifying and regulating emotions are also at risk. One study that focused on boys concluded that those who cope with problems through self-blame were more predisposed to develop an eating disorder.

Trauma

Traumatic life events such as a sexual assault or even transitional events such as relationship changes, moving away from home or loss of a loved one can trigger eating disorder behaviours.

Research indicates that the lack of necessary supports during the transition rather than the transition itself is what may precipitate the onset of an eating disorder. Those who experience depression, anxiety or obsessive compulsive tendencies are also at increased risk.

Understanding the illness

Sometimes families or friends have a hard time understanding how the desire to be thinner and to eat better or exercise more can lead to a serious illness. From the outside, the behaviours demonstrated by someone with an eating disorder don’t make sense and the temptation may be to encourage them to change their eating habits. However, recovery is about much more than food or weight.

According to eating disorder counsellor Shannon Gander, eating disorders fulfill important functions for those who are suffering.

Familiar rituals provide comfort

“Despite the costs to health, relationships and loss of opportunity, eating disorders fulfill needs that people haven’t yet learned to meet elsewhere,” said Gander. She explained that the familiar rituals can be soothing; they help people cope with intense emotions and provide comfort.

Behaviours offer sense of control

Gander’s clients are encouraged to view their illness with compassion as they > come to understand how the behaviours developed as a way to deal with feelings of shame, anxiety or powerlessness. She explained that eating disorders may also provide a sense of control: “Individuals may use food or exercise as a form of discipline or punishment or as a way to maintain a sense of order when their lives feel chaotic”.

Dealing with underlying issues

Recovery requires addressing the underlying issues that motivated the behaviours and helps people learn new ways to cope with emotions and life’s normal stressors.

Signs of eating disorders

Friends or family members may not always be sure when someone has a problem, but there are some warning signs to be aware of:

  • preoccupation with food and weight
  • distorted body image
  • secrecy
  • withdrawal
  • skipping meals or making excuses for not eating
  • eating only certain foods; refusing others
  • cooking for others, but not eating themselves
  • wearing baggy or layered clothing
  • eating large amounts of sweet or high-fat foods
  • using laxatives
  • hoarding food
  • exercising excessively

Chemical dependency

It is not uncommon for those with an eating disorder to experience chemical dependency. Research indicates that rates of substance abuse are higher among those with an eating disorder than in the general population. Approximately one-quarter of people with bulimia and over half of men with binge eating disorder struggle with alcohol dependence.

What to do

If you think that someone you care about is suffering from an eating disorder, it is important to speak up. People with eating disorders are often afraid or reluctant to seek help on their own. Others simply don’t see themselves as worthy or deserving of help.

Approach the conversation with compassion and without judgment. Keep the focus on your feelings and on the relationship you have, not on weight or food. Comments on appearance, both positive and negative, have been shown to perpetuate the problem.

Providing empathetic support and helping to facilitate access to professional services can set the stage for recovery.

What do the new buzzwords mean?

These terms are not used by treatment practitioners for clinical diagnoses, but they describe current trends and may help you identify when someone you care about has a problem.

Drunkorexia may apply to someone who restricts their food intake all day in order to offset the alcohol kilojoules that will be consumed in the evening. Drunkorexia typically involves binge drinking and sometimes purging. Research shows a strong link between those who diet and drink and other high-risk activities.

Anorexia athletica is used to refer to people whose drive to exercise is fuelled by guilt and anxiety. Exercise may be the most important activity in that person’s life; while they are overtraining they are not eating enough to adequately fuel their activity level. The initial motivation may be sports performance rather than body image concerns, but the mental and physical health outcomes are as dangerous as other eating disorders.

Orthorexia may apply to someone who will only eat foods that they consider to be “natural” or “clean”. This is a concern when it involves kilojoule restriction and an obsessive preoccupation with healthy eating. Some people also secretly binge on and then purge the foods that they consider to be forbidden.

Pregorexia is used to refer to women who are engaging in disordered eating behaviours while pregnant. The fear of weight gain and external pressures to be thin may interfere with a woman’s desire or ability to properly care for herself and her baby. Under-eating, abusing laxatives, taking diet pills, purging and overexercising can increase health risks for both the woman and her developing foetus.

About the Author

Lisa Naylor is a counsellor specialising in eating disorders.