Eating disorders

What is an eating disorder?

An eating disorder is a mental health condition where food is used to cope with negative emotions or situations. It is characterised by persistent abnormal eating behaviours that negatively impact health, emotions, and ability to function in important areas of life. Individuals are so preoccupied with food and weight that they can focus on little else.

Research shows that the sooner an eating disorder is treated, the less chance the behaviour and thoughts that cause it to have to become ingrained, and the greater the chance of recovery.

There are four categories of eating disorders described in ICD 10 and DSM V:

For a patient to be diagnosed with an eating disorder, they must have a psychological preoccupation with body weight and shape and abnormal eating behaviours.

Disordered eating is common; however, eating disorders are more persistent and cause more impairment in various aspects of physical, psychological and social functioning.

Obesity is not classified as an eating disorder.

Who may be affected by an eating disorder?

It is estimated that around 1.25 million people in the UK suffer from an eating disorder. Although more common in certain age groups, eating disorders can affect people of any age.

1 in 250 women and 1 in 2,000 men will experience anorexia nervosa at some point
Bulimia is around two to three times more common than anorexia nervosa, and 90% are female
Binge eating affects males and females equally and is estimated to affect around 5% of the adult population

Causes and signs of eating disorders

Factors that may cause an eating disorder

An eating disorder may be associated with biological, genetic, or environmental factors combined with a particular event that triggers the disorder. There may also be other factors that maintain the illness:

Family history of eating disorders or other mental health conditions
Difficult relationships and stressful situations
Being criticised for eating habits, body shape, and weight or being overly concerned with being slim
Underlying characteristics; obsessive personality, an anxiety disorder, low self-esteem or being a perfectionist
Emotional or sexual abuse or the death of someone special

Signs of an eating disorder

It is common for someone with an eating disorder to be secretive and defensive about their eating and their weight, and they are likely to deny being unwell.

Missing meals; repeated claims they’ve eaten are or eating later
Only eating certain low-calorie foods such as lettuce or celery
Cooking big or complicated meals for other people, but eating little or none themselves
Feeling uncomfortable or refusing to eat in public places
Complaining of being fat, even though they have a normal weight or are underweight
Repeatedly weighing themselves and looking at themselves in the mirror

Complications of eating disorders

Eating disorders frequently produce severe medical complications in sufferers.

Physical complications of eating disorders include

Reduced heart rate and blood pressure, abnormal heart rhythm, reduced cardiac muscle mass, and eventually heart failure
Electrolyte abnormalities caused by vomiting can cause serious abnormalities of heart rhythm, even death
Slowed gastric emptying, which results in pain and bloating, feeling easily full
Acid reflux and hiatus hernia due to repeated vomiting
Constipation due to reduced food volume weakened intestinal muscles
Rupture of the stomach or oesophagus which can be life-threatening (extremely rare)
Sex hormones oestrogen and testosterone fall
Menstruation can stop or become irregular
Reduced sex hormones increase the risk of bone loss (osteoporosis) and bone fractures
Damage to the myelin around nerves can affect conduction, and cause numbness and tingling in the hands and feet
Sleep disorders

Psychological and social impacts include

Feeling out of control and helpless, guilt, shame, anxiety and self-doubt, obsessive thoughts and preoccupations, feelings of alienation and loneliness, increased isolation, and loss of connection
Disruption of the family, through conflict over food, weight, treatment
Family members often struggle with anxiety, guilt, and frustration
Friendships and romantic relationships are damaged or destroyed
The person with an eating disorder becomes emotionally withdrawn, irritable, loses libido, is secretive and controlling

Myths about eating disorders

Several myths exist regarding eating disorders, including:

Eating disorders are a choice
Only women get eating disorders
Only young people get eating disorders
Someone needs to be underweight to have an eating disorder