What is an eating disorder?

Eating disorders are about much more than just dieting. The most common eating disorders occur when a person becomes so focused on their eating habits and weight that their emotions, thoughts, and behaviors are drastically impacted. Eating disorders can lead to a host of psychological, social, and physical health problems and often coexist with other mental illnesses, like Depression, Social Anxiety, Obsessive-Compulsive Disorder, and Substance Use.

There are three main categories of eating disorders: 

Anorexia Nervosa (AN) – Characterized by severe intentional weight loss or refusal to gain weight. Anorexia is often accompanied by excessive exercising, obsession with body image, and a distorted body image. Some women lose their menstrual periods. Although not necessary for diagnosis, they also may appear very tired and lack energy; count calories constantly; exercise obsessively; use laxatives; avoid eating in public or in front of others; take diet pills, often in secret; act irritable and anxious at mealtime; skip meals; lie about how much food they have eaten; deny being hungry; faint or complain of dizziness; have fine hair growth all over their body; hide food; wear baggy clothes; and have difficulty concentrating

Bulimia Nervosa (BN) – Characterized by repeated episodes of binge eating (i.e., eating an excessively large amount of food in a short period of time) followed by purging behaviour to get rid of the food. This is most often accomplished through self-induced vomiting, but can also include abuse of laxatives and diet pills or excessive exercise. The main difference between AN and BN is that individuals with BN are often normal weight or overweight, whereas individuals with AN are always significantly underweight. Individuals with BN feel guilty or embarrassed about their binges and purges, and largely base their self-esteem on their weight and body shape

Binge-Eating Disorder (BED) – Characterized by repeated episodes of binge eating (i.e., eating an excessively large amount of food in a short period of time) but without the purging behaviour seen in Bulimia Nervosa. During a binge episode, someone with BED will also eat much faster than normal, even when he or she isn’t hungry, and until he or she feels uncomfortably full. Afterwards, he or she will often feel disgusted, depressed, or guilty. Consequently, people with BED often binge eat when they are alone due to embarrassment. 

In addition to these three main categories of eating disorders, there are several other less common types of eating disorders:

Pica – Although most commonly occurring in childhood, Pica, which is the repetitive eating of nonnutritive, nonfood substances, can also occur in adolescence or adulthood. When present, it often co-occurs with intellectual disability. 
 
Rumination Disorder – Characterized by repeatedly regurgitating food, which is then re-chewed, re-swallowed, or spit out. Rumination Disorder is more common in people with intellectual disabilities and is not due to a gastrointestinal or other medical condition.

Avoidant/Restrictive Food Intake Disorder – Characterized by persistent inability to meet appropriate nutritional or energy needs, resulting in significant weight loss, nutritional deficiency, dependence on feeding or nutritional supplements, and/or impacts on psychosocial functioning. This avoidance of food may be due to lack of interest, issues with the sensory aspects of food (e.g., taste, texture, smell), or concern about negative consequences that will result from eating. Unlike Anorexia Nervosa or Bulimia Nervosa, someone with Avoidant/Restrictive Food Intake Disorder does not have a distorted view of their weight or shape, nor do they have a persistent fear of gaining weight.

Other Specified Feeding and Eating Disorder – Diagnosed when someone experiences clinically significant impairment or distress due to symptoms similar to one of the specific eating disorders listed above, but does not meet the full criteria to be diagnosed with that disorder. Other Specified Feeding and Eating Disorders include Atypical Anorexia Nervosa, Bulimia Nervosa of Low Frequency and/or Limited Duration, Binge-Eating Disorder of Low Frequency and/or Limited Duration, Purging Disorder, and Night Eating Syndrome. With this diagnosis, the clinician will explain why the specific disorder was not diagnosed.

Unspecified Feeding and Eating Disorder – Similar to Other Specified Feeding and Eating Disorder but the clinician does not explain why the criteria were not met for the full disorder, often due to insufficient information.

 Eating Disorders Myths & Truths

Myth: Only teenage girls get eating disorders.

Truth: Although eating disorders are most common in girls in their teens and early twenties, males can also develop eating disorders. BED, in particular, is equally common among men and women and is seen more frequently in an adult population than AN or BN.

Myth: People with Anorexia Nervosa do not eat junk food.

Truth: Even though people with AN eat very little, they sometimes will binge eat on junk food, or if they allow themselves to only have so many calories per day, they may count a piece of candy within those calories allowed.

Myth: People with Bulimia Nervosa always vomit after eating.

Truth: Not all people who have BN vomit after eating. Many abuse laxatives or diuretics, exercise, or fast to keep their weight under control.

Myth: You cannot die from an eating disorder.

Truth: AN has the highest mortality rate of all mental illnesses, (>10%). Causes of death include suicide, electrolyte imbalances, and starvation consequences like cardiovascular or respiratory problems.

How are Eating Disorders diagnosed?

Eating disorders are diagnosed by doctors and mental health professionals, who will ask the patient a number of questions based on their symptoms, eating habits, perception of body image, and dieting behaviours. The doctor will also do a physical exam to check the person’s weight, blood pressure, skin condition, bone density, etc. Blood work will also be done to check organ function and electrolyte balance, among other things, to determine the person’s overall health level. This will also help rule out any other medical conditions.

How are Eating Disorders treated?

Eating disorders can require a range of professional treatments, which may include:

  • Medical Treatment - In some situations, medication may be prescribed to help reduce bingeing/purging behaviour  or  to help increase weight and decrease weight obsession. Unfortunately, current research hasn’t found that medication is effective at reducing eating disordered behaviour in the long-term, although it may help treat coexisting depression and anxiety symptoms.
  • Nutritional Counseling - A dietician may be involved to teach better eating habits and how to select healthier foods.
  • Family Therapy - Family therapy is one of the most effective treatments for adolescents with Anorexia Nervosa. It focuses on family dynamics and how they may be helping to maintain the eating disorder. It also helps family members understand the eating disorder better and learn how they can support each other.
  • Cognitive Behavior Therapy (CBT) - CBT appears to be one of the more effective treatments for Bulimia Nervosa and Binge Eating Disorder. It helps people learn to problem solve and change their negative thoughts and behaviours into more positive ones. When used in a family format, it may also be effective at treating Anorexia Nervosa.
  • Psychoeducation - This treatment is usually done in a group and teaches individuals to recognize their symptoms so they can learn to seek treatment when needed and prevent relapse.
  • Hospitalization - Sometimes if the person is physically unwell, refuses to eat, or has health problems, the doctor will send him or her to the hospital to gain weight, deal with underlying mental health issues, and improve his or her physical health.

How long does treatment last?

There is no set number of days for treatment. Treatment length depends on the individual’s needs, and lifelong maintenance can be required to prevent relapse.

I think I have an eating disorder – what do I do?

If you are struggling with an eating disorder, you are not alone!

There’s nothing shameful about asking for help. If you feel comfortable, consider telling a friend or someone else you trust first. Seeking professional help can be a huge step. Having someone you trust with you for support will make it easier. Your family doctor, psychologist, or school health/counselling centre are excellent resources. There, a trained professional will be able to help you take the next step toward recovery.

Facts

  • According to a 2002 survey, 3% of women and 0.3% of men will have an eating disorder in their lifetime.
  • At any given time, 70% of women and 35% of men are dieting.

How to help a friend who has an Eating Disorder

If you suspect your friend has an eating disorder, you should encourage him or her to seek professional help. Remember that people with eating disorders often don’t realize the severity of their problem, so your friend may not be receptive to your help. He or she may even get angry with you. This doesn’t mean he or she doesn’t need your help. Try to get your friend to open up and talk about his or her feelings, but don’t focus discussion around food or enable his or her behaviour. Let your friend know you are concerned without forcing anything on him or her or laying blame.

Here are a few other tips to consider before approaching your friend:

  • Focus on feelings, not on weight and food.
  • Use “I” statements (e.g., I feel worried about you because…) instead of “You” statements (e.g., You are not eating enough). “You” statements are more likely to make your friend feel blamed, causing him or her to act defensive and shut you out.
  • Stay positive; the best influence is a positive one.
  • Express your concerns; knowing that someone cares about him or her may make it easier for your friend to open up to you.
  • Try not to comment on how he or she looks, as it will likely only reinforce his or her obsession with body image.
  • Don’t nag about his or her eating behaviour. This is likely to make your friend more defensive and likely to hide his or her eating behaviour from you.
  • Be supportive and compassionate. Try not to judge.
  • Remember the person has a disorder; but it does not define who he or she is.
  • Encourage your friend to get help.
  • Be patient; it takes time for someone to admit they need help and they cannot be rushed or forced.
  • Educate yourself about the disorder to help understand it.

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