Eating disorders: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder (compulsive over-eating) are serious mental illnesses affecting 1.6 million people in the UK. They are most likely to develop during teenage years and although more girls are affected, around a quarter of those who experience an eating disorder at school age are boys.
A specialist will need to diagnose an eating disorder but some signs
include those listed in the tables below.
1. Anorexia Nervosa
Anorexia Nervosa is an illness where there is a clinically established weight loss, measured either using the Body Mass Index (BMI) or weight and height criteria. There is a relentless aim for weight loss, mainly through restricted eating; excessive exercise and other behaviours aimed at weight control may also occur.
- Feeling tired- finding it harder to do all the things you usually do and having low immunity.
- In girls, absence of three or more consecutive periods.
- Other physical effects such as low blood pressure; messing up your brain chemicals, affecting your fertility, thinning your bones, poor skin.
- Loss of body weight
- Obsessive thoughts; not being able to switch off from thinking about food and weight.
- Difficulty concentrating and memory lapses.
- Low self esteem.
- Thinking and feeling fat.
- All efforts are completely focused on maintaining low weight.
- Avoiding social situations especially if food is involved.
- Obsessive behaviour such as being stuck in a variety of routines, constant checking (these may include frequent checking of weight, other food- related checking or routines around cleanliness)
- Perfectionism and very high standards.
- Feeling alone and trapped by the condition.
- Mood swings.
- Increased irritability.
- Increased anxiety and / or depression.
2. Bulimia Nervosa
Bulimia Nervosa is a condition where there is a relentless pursuit of thinness, which includes periods of starvation mixed by periods of binge eating. The person thinks and feels fat. A number of behaviours are carried out to lose weight and these may include vomiting, the use of laxatives or diuretics and excessive exercise.
- Variable body weight.
- Sore throat & stomach pains.
- Swollen face and dental problems.
- Sleep problems.
- Constant thoughts around food.
- Body dissatisfaction.
- Difficulty concentrating.
- Low self esteem.
- Getting rid of food in different ways.
- Secretive shopping and eating behaviour.
- Avoidance of social situations especially if food is involved.
- Irritability and anger
3. Binge Eating Disorder
Binge Eating Disorder is a condition where the person regularly binges, usually with weight gain. This can lead to obesity, which is measured using the BMI.
- Weight gain.
- Risk of ill health, e.g. higher risk of diabetes and heart disease.
- Fertility affected.
- Bones affected.
- Over focus on body shape.
- Low self esteem.
- Body dissatisfaction.
- Difficulty concentrating.
- Restricted in what physical activities you can do.
- Avoiding social situations.
- Secrecy around eating activities.
- Anger at self.
4. Other Eating Related Disorders
There are also other forms of disordered eating. Although these are not formally categorised as Eating Disorders, they are worth managing early in order to prevent them from developing into full-blown eating disorders.
- These include fear and avoidance of certain groups of food either due to bad association with food/eating or due to a fear of vomiting.
Body Dysmorphic Disorder
- In this condition, there is an obsessive and distorted focus on how a part or the whole body is viewed.
- This is when the need to exercise becomes compulsive or has no flexibility. There is a relentless pursuit of exercise, daily, whether tired or not. There is a fear of altering or reducing exercise. There is an increase in the number of repetitions of an exercise, eg. stomach curls; using the machines that burn the most amount of calories. There is a pattern of increasing physical activity due to increasing tolerance of effort.
- Exercise addiction occurs in both boys and girls but may be more common in boys. Sometimes in boys, exercise addiction can lead to what has been termed ‘Bigorexia’ where, just as in Anorexia there is a relentless pursuit of thinness at all cost, in ‘Bigorexia’ there is a relentless pursuit of body building.
- Obviously exercise in moderation is healthy, over-exercising can lead to many negative effects such as its effects on bones, potentially causing fractures. In women it can affect menstruation. It can also lead to irritability, anxiety and depression.
Read each of our sections below. They are divided so that there’s one for you if you are a teenager and looking for some help; one for friends who may be concerned; our third section is for parents or carers and the fourth and final one for schools.
You can also look up the following websites
Beat is a charity supporting anyone affected by eating disorders or difficulties with food, weight and shape.
MGEDT (Men Get Eating Disorders Too!) supports men with eating disorders, carers and their families.
Mind provide advice and support to anyone experiencing a mental health problem.
Rethink Mental Illness
Rethink Mental Illness supports those with mental illness.
Syeda is the South Yorkshire Eating Disorders Association and is a support service for those with eating disorders and their carers.
If you’ve read our introduction you will already have an idea about Screening for early signs and about who you may be able to refer someone to talk to. Listed below are some ways of Making a Change.
Work with the individual to increase motivation to change
The positives of not changing
This might include some of the following statements:
- It makes me feel in control
- I like the fact that I can wear anything I want to
- It stops me from feeling bad
The negatives of not changing
- It stops me from being able to concentrate
- It makes me feel really ill
- It keeps me isolated and lonely
- It affects my health in a dangerous way
The dangers associated with an eating disorder cannot be stressed enough. Eating disorders carry the highest death rate of all psychiatric conditions and can have long-term physical and mental impact.
4 Danger Areas
- Starvation effects include negative effects include excessive hair growth, poor skin, fainting, poor circulation and many more.
- Vomiting and laxatives: affect the water and salt balance in our bodies which can have many negative effects such as damage to our heart, kidneys, stomach and brain.
- Over exercise destroys muscles, this includes the heart muscle and can also lead to low sugar levels.
- In addition to physical damage, an eating disorder impacts on your psychological wellbeing. It can affect your concentration and memory. It can often also lead to anxious, obsessive and depressive feelings.
- Eating Disorders also have a huge effect on social skills and social life. They can lead people to isolate themselves and feel lonely, which bit by bit can lead to the sufferer distancing themselves from friends, partners and family.
4 Steps to Change
- As a professional you can work with helping a person accept they have an eating disorder. This might take several meetings
Encourage ways in which Children and Young People can support themselves. These include encouraging they
- Work on moderation – try and find ways to slowly hold back from your bad eating related habits.
- Stop trying to diet – eat a healthy meal without feeling the need to calorie count.
- Eat regularly – aim to have 3 full meals a day.
- Exercise in moderation – exercise a few times a week to help calm you down, but don’t overdo it.
- Stop taking laxatives and diuretics straight away.
- Encourage them to stop being sick – explain how throwing up gives an excuse to binge.
- Encourage them to work on ways to improve your self- esteem – for example to note some positive comments that people say about them regularly that are not related to weight or shape.
- Most importantly refer them to a specialist unit for a physical and psychological assessment – CAMHS will assess and make suggestions.
- Contact BEAT – the National Eating Disorders Association. They have a useful website with links to Helpfinder for local help and Youthline 08456347650. See also our section on links.
- Maintain regular contact with the child or young person throughout their treatment. This may also include the need to regularly monitor their physical wellbeing
- This means keeping regular contact, creating a safe environment where people can bring their difficulties to without feeling they have done something wrong, being able to help them problem solve and making relevant referrals as necessary
Help with developing school policy and procedures