January has become a month known for its almost slavish loyalty to the “new year, new me” regime peddled by a large portion of our media. January is a month for diets, detoxes and the demonisation of food. After a Christmas of indulgence, it’s time to get off the couch and into the gym. There is nothing wrong with trying to live better and eat more healthily but what happens when these diets and detoxes go too far? What happens when the idea of being the “perfect” weight becomes detrimental to your health?
An eating disorder is defined as a psychological disorder which presents with unusual or abnormal eating habits. They can be seen as way to cope with emotional trauma or stress or a symptom of an underlying condition. In 2015 12% of under 18’s admissions to Irish psychiatric units had a primary diagnosis of an eating disorder with females accounting for 87% of all those admitted. The Health Research Board estimates that up to 200,000 people in Ireland are affected by eating disorders with 400 new cases every year. It’s estimated that 80 people die every year as a result of eating disorders.
There may not be one single cause of an eating disorder. One cause may be a triggering event such as a deep trauma such as the loss of a family member or friend. The person feels like their life is out of control and begins to scrutinise their food intake and weight in order to regain some form of that control. Another cause may be low self-esteem. The person believes that they cannot meet standards portrayed to them by the media and this causes low self-worth. This can also be caused by bullying or critical comments made about weight or appearance, in person or online.
Weight, diet and fitness are well covered topics in the media and yet very little is heard about eating disorders in general. We know the names; anorexia, bulimia and binge eating but do we know the symptoms? Do you we really understand the underlying mental health issues of these disorders?
Anorexia Nervosa
What is it?
Anorexia nervosa is an eating disorder that causes the person to actively seek and maintain a very low body weight that is lower than what is normal or healthy for their age, their sex and their height.
Physical Symptoms
Intense or excessive exercise regime.
Poor circulation
Bloating of stomach, fluid retention.
Dry and thinning hair.
Lack of sleep.
Lack of interest in sex.
Amenorrhea (lose of periods)
Abdominal pain, constipation
Psychological Symptoms
Low self-esteem
Mood swings
Social isolation
Obsessive or compulsive behaviour
Depression
Behavioural Symptoms
Rigid diet
Weighing yourself frequently
Secret disposal of food
Episodes of bingeing
Excessive thinking about food
Lying about food intake
Health Risks
There are many health risks associated with anorexia. A restricted or excessively controlled diet results in the body entering periods of starvation. In this case, the body will seek to conserve energy which results in a number of physical effects including dehydration which can cause kidney failure, muscle weakness which can cause muscle loss and an abnormally slow heart rate and low blood pressure which risks heart failure.
Starvation can also affect your way of thinking and your behaviour as poor nutrition results in changes in your brain chemistry. Lack of proper nutrition can also cause problems with concentration, decision making and problem solving. Anorexia can also cause depression which if severe, can lead to suicide.
Bulimia Nervosa
What is it?
An eating disorder where the person will undergo repeated cycles of binge eating followed by purging behaviour which seeks to rebalance or compensate for the bingeing. This purging could include fasting, self-induced vomiting, laxative/diuretic use or excessive exercising. The objective of these behaviours is to prevent weight gain.
Physical Symptoms
Frequent weight changes
Insomnia, lethargy
Digestive problems such as cramps, constipation, diarrhoea
Irregular periods
Headaches
Tooth enamel erosion/tooth decay
Psychological Symptoms
Mood swings, irritability, feeling out of control, inadequate, worthless, feeling guilty or shameful, anxiety, depression.
Behavioural Symptoms
Binge eating regularly, obsessing about dieting, laxative abuse, vomiting after meals, excessive exercising, lying, risk taking behaviour like drug or alcohol misuse, secret food hoarding/secret disposal of vomit.
Health Risks
Again there are many health risks associated with bulimia. Excessive laxative use and vomiting can lead to dehydration which impedes the body’s ability to function correctly. This puts vital organs at risk of failure, particularly the heart. Excessive vomiting also causes tooth decay which is irreversible.
Depression and anxiety are common symptoms of bulimia. These symptoms can often led the person to become emotionally overwhelmed. These symptoms in particular must be understood and treated correctly in order to aid proper recovery.
Binge Eating Disorder (BED)
What is it?
BED is similar to bulimia in the sense that the person suffering from the disorder will engage in repeated periods of binge eating and dieting but they will not engage in the purging aspect of bulimia. This kind of behaviour can (but not always) lead to significant or noticeable weight gain. Binges will almost always occur in secret in a bid to present an image of normal eating in front of others. The food eaten is usually high in calories and is eaten quickly. This disorder affects nearly as many men as it does women and is believed to be more common than anorexia or bulimia.
Physical Symptoms
Significant weight gain, digestive issues, poor skin condition, pain in muscles and joints.
Psychological Symptoms
Depression, anxiety, low self-esteem, feeling of inadequacy and worthlessness, feeling guilty, shameful and out of control, unhappiness with body image.
Behavioural Symptoms
Eating alone, eating lots of food even when not hungry, eating more than the body needs at a time/eating until uncomfortably full, out of control eating, eating more quickly during a bingeing period.
Health Risks
Health risks from BED include physical, emotional and overall general health of the person who has the disorder. A person may suffer from digestive issues like cramps, diarrhoea or constipation as well as malnutrition. Significant gain can cause problems as it can result in high blood pressure, high cholesterol, diabetes, heart disease and gallbladder disease.
Other Specified Feeding or Eating Disorder (OSFED)
What is it?
This is the name we give to disorders or conditions where the person suffering from a disorder that incorporates symptoms and behaviours from several disorders but does not fit all of the criteria for one disorder alone. An example would be Binge Eating Disorder which shares many similarities with bulimia but does not involve the purging behaviour needed to classify it as bulimia. These disorders make up roughly 50% of eating disorders however due to lack of diagnostic criteria, they aren’t recognised as easily as anorexia or bulimia. These disorders can be associated with distress, impairment and risk of pain, disability or death. People affected by these sorts of disorders may present with emotional distress meaning they require constant support and treatment.
OSFED’s can be broken down into subtypes such as;
Atypical anorexia nervosa: Having all the symptoms of anorexia without significant weight loss.
Bulimia nervosa; low frequency: Having all the symptoms and behaviours of bulimia but these occur less than once a week over a 3 month period.
Purging disorder: The use of purging behaviours to modify weight without binge eating.
Night eating syndrome: A person repeatedly eating at night such as be binge eating after an evening meal. The disorder cannot be explained by things such as medication or sleep cycle and causes great distress.
Treatment
Treatment for eating disorders can vary from person to person. Both medical and psychological help are required to tackle the various aspects of the disorder. In a medical sense, the most critical point of treatment is the restoration of a healthy body weight and the re-establishment of healthy eating patterns. It is also important to treat any physical problems that have arisen such as digestive or heart problems.
Psychological treatment is equally important in both tackling the underlying emotional problems such as anxiety and depression and possible emotional trauma that may underpin the condition.
Recovery from eating disorders is possible and for anyone wishing to seek help, your first port of call should be your local GP. Your GP may take an active role in your treatment
and they will be able to point you in the direction of therapists and councillors who specialise in the treatment of eating disorders. Medication may be prescribed for individual cases such as antidepressants in the case of severe anxiety or depression. Treatment for each person will be unique to them.
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Recognition
If you are concerned that a friend or family member may be suffering from an eating disorder, it is important to know how to approach them and broach such a sensitive topic. The most important thing is non-judgement, you’re trying to show the person you care about their well-being without them feeling that you’re judging them or that you want to fix them somehow. Having a good support network is key to recovery so asking someone how they are could be a the first step on the road to recovery.
When approaching someone, you should be informed about eating disorders and approach them in a non-pressure environment where you won’t be interrupted. Be sure to let them know that they’re valued and cared for. Be specific on what is cause your concern about their well-being as this prevents denial of more general behaviours. Be open and honest but don’t judge or criticise them. Make sure to show that you know the eating disorder is separate from the person you know and that recovery is possible. Let them know that you’re there for support but remember to look after yourself too. Don’t be discouraged if they reject or resist your help. Eating disorders are incredibly difficult topics and so it may take time before they’re ready to accept help.
Remember, wanting to lose weight or live better does not mean you have an eating disorder. However, it’s important to have a balanced life overall. Skipping meals or becoming obsessed with dieting or exercising could be an indicator that something is wrong. If you feel like you might have some issues with food, talk to your GP or a trusted friend or family member. There is lots of help out there and you are never alone.
Your entire self-worth should not be based around what you look like or how much you weigh. Perfection is unobtainable no matter what the media tells us. Maybe it’s time we stopped letting them dictate how we feel about ourselves.
Please note that the author is not a medical professional. If you are in any doubt about your health or would like more information, please contact your GP. Also see www.bodywhys.ie or www.spunout.ie for more information and guidance. You can contact the UCD Medical Service for an appointment at (01) 716 3134.
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Rachel O’Neill | Features Editor
