About Eating Disorders

What is an Eating Disorder? 

An eating disorder is a relationship you may have with food that you find difficult. It can not only be a challenge for the sufferer, but also for the people surrounding the sufferer. Changing your eating habits now and again is normal, but if you feel food is taking over your life then it may become a problem. 

In our current society, we are bombarded with images of what we are supposed to look like and are presented with an unrealistic, warped ideal of what beautiful is. 

Social media, television, celebrity culture and the media reinforce the notion that we are not good enough, telling us how we need to look to achieve ‘perfection’ which is often unachievable. Due to these societal expectations, our body image and the way we see ourselves can become distorted, and as our sense of self-worth decreases, a constant pressure to be perfect increases, which can easily develop into an eating disorder. 

An early diagnosis is much better for recovery because of the extent that people will go to in order to hide their eating disorder, and the longer it goes unnoticed the harder it is to break it. 

The causes of an eating disorder are often hazy and difficult to pinpoint and can be linked to peer pressure, poor self-image and confidence issues, along with the media as discussed above. The images portrayed that we should aspire to look like are not real, they are often photo-shopped. 

Eating disorders help some sufferers feel a sense of control in one aspect of their life, but they often see their friends less and less and shut themselves away and become lonely and isolated. 

An eating disorder is a mental illness and needs to be talked about so that we can take greater care of each other and be less judgmental.  

Do I have an Eating Disorder? 

Does eating rule your life or do you struggle with control of eating and weight? If the answer is yes, then you may have an eating disorder.  

An eating disorder is an illness, but unlike, say, chicken pox or a broken arm, it is not something that can easily be seen at first, plus it is not something that can be cured, but it can be controlled. Not all people fit exactly into an eating disorder category and some people suffer only with one disorder, which may evolve into another disorder, whereas others suffer with features of all eating disorders. 

Eating disorders stem from thoughts, feelings and behavior. How you think about food is paramount – whether you obsess about the food you eat or what you weigh, have bad thoughts about your eating habits, compare yourself constantly to other people and/or have strict rules about what you should or shouldn’t eat. These thoughts can escalate into feelings of guilt, anxiety and fear. You may feel scared about eating normally and feel helpless around food, and when you do eat you may hate yourself for doing so and feel fat even if your friends and family say otherwise. This can all lead to how you behave with food – whether you binge eat in secret, vomit or use laxatives, are always on a diet and constantly weigh yourself, exercise excessively to control your weight, keep on eating even though you are full or starve yourself because you feel you might never be able to stop once you start eating. 

People with an eating disorder lose sight of what is normal eating and lose the ability to enjoy food. Some are in denial, whilst others believe they have no right to seek help because they feel their eating disorder is not serious enough. 

If your relationship with food and eating is having a detrimental effect on your life, it is ok to seek help. It doesn’t matter how much you weigh or what your body looks like. 

Identifying Eating Disorders 

Anorexia Nervosa 

Symptoms include: 

  • Over evaluation of shape and weight and control 
  • Judging self-worth largely and even exclusively in terms of shape and weight and the ability to control 
  • Active maintenance of low body weight – less than 85% of that expected or a body mass index of 17.5 or below 
  • Inadequate food intake 
  • Fear of weight gain 
  • Obsession over weight and food 
  • Inability to understand the severity of the situation 

Bulimia Nervosa 

Symptoms include: 

  • Over evaluation of shape and weight 
  • Recurrent binge eating and a sense of loss of control at the time 
  • Extreme weight control behaviour – sustained dietary restriction, recurrent  self-induced vomiting or laxative misuse 
  • Feeling out of control during binge eating episodes 
  • Self-esteem and self-worth related to body image 

Binge Eating Disorder (BED) 

Symptoms include: 

  • Episodes of eating large amounts of food without behaviours of attempting to prevent weight gain such as vomiting or taking laxatives 
  • Feeling out of control during binge eating episodes 
  • Feeling shame or guilt because of the binge eating 
  • Eating when not hungry, eating alone due to being embarrassed about the behaviour or eating to the point of being uncomfortable and overly full 

Emotional Overeating 

Symptoms include: 

  • Eating large amounts of food in response to negative emotions 
  • Used as a coping mechanism for dealing with emotions 
  • Low self-esteem and negative body image 

Other Eating Disorders  

There are many types of disordered eating that don’t quite fit into neat categories but can cause significant distress or impairment. 

Other Specified Feeding and Eating Disorders (OSFED) diagnoses include: 

  • Atypical anorexia nervosa (weight is not below normal) 
  • Bulimia nervosa (with less frequent behaviours) 
  • Binge-eating disorder (with less frequent occurrences) 
  • Purging disorder (purging without binge eating) 
  • Night eating syndrome (excessive nighttime food consumption) 

Unspecified Feeding or Eating Disorders (UFED)/Eating Disorders Not Otherwise Specified (EDNOS) 

This is a catch-all category that will be recognised by varying forms of behaviour and thinking patterns around eating, which can cause significant problems in day to day life and tend to be entered around self-worth based on shape and weight. 

 

How it can affect your life 

 

Psychological effects 

Being consistently underweight can cause long term health problems, and influence all your bodily functions, including physically, psychologically and socially. 

Thinking: 

  • Lack of concentration 
  • Difficulty in decision making 
  • Pre-occupation with food 
  • Disinterest in hobbies and activities 
  • Less spontaneous 

Feelings: 

  • Easily irritated or upset 
  • Feel anxious and depressed 
  • Isolated from friends and family 
  • Unwilling to maintain friendships 

Behaviour: 

  • Obsessional, ritualised behaviour and routines 
  • Setting rigid rules around what you must not eat or must not do 
  • A need to be clean and tidy or hoarding behavior 
  • Avoid eating in restaurants or in public and avoid social occasions 
  • Drop out of school, college or work and stop doing things you enjoy 

Physical effects 

Heart and Circulation: 

  • Loss of heart muscle 
  • Lower blood pressure and pulse 
  • Heart beat irregularities 

Sex Hormones and Fertility: 

  • All non-essential processes are stopped to preserve energy 
  • Menstrual periods may stop which could result in infertility 

Bones, Muscles and Joints 

  • Reduction in bone strength 
  • Increased risk of osteoporosis and fractures 
  • The Muscles weaken and joints become swollen 

Skin and Hair 

  • A downy hair covering can start to grow on the face, forearms, back and abdomen. 
  • Hair loss from scalp. 
  • Dry skin 

Temperature regulation 

  • Reduction in body temperature, feeling cold 

 

It requires real effort and application to regain a healthy mind-set and body weight. However, if you regain weight to a low, but healthy level, many of these symptoms will go away. 

 

Who are Therapy Partners?  

Therapy Partners are a fully trained and accredited team of multi–agency professionals offering both online and telephone counselling. They offer a person centred assessment of your needs and advise on a suitable counselling approach.  Therapy Partners therapists can offer the full range of therapies available ranging from short to long term therapy based on your individual needs. They understand people’s anxieties about waiting to see someone for therapy and will take the time to listen to your concerns.  Their service is designed to meet your needs as quickly and efficiently as possible. 

Enhanced CBT for Eating Disorders 

Therapy Partners is pleased to offer Enhanced CBT for Eating Disorders 

CBT-E uses cognitive and behavioural strategies to overcome eating disorders and to address the underlying mechanisms that keep them in place. The treatment works collaboratively with clients to address limiting behaviours and provides education on the effects of these behaviours. Treatment is a personalised program that fits with all types of eating disorders, it focuses on the client’s individual experience and their personal difficulties. Clients learn to de-centre from their eating disorder and adopt skills and strategies to limit the maintaining mechanisms that keep the eating disorder going. 

 

Aims for Treatment 

  • To remove the underlying issues around disturbed ways of eating, extreme weight control behaviours and over-concern around shape and weight. 
  • To correct and effectively manage the mechanisms that maintain the eating disorder. 
  • To ensure that changes are lasting. Treatment helps clients learn to respond to set-backs. 

 

About the Treatment 

It was developed by Christopher Fairburn and the team at the Centre for Eating Disorders Oxford and remains the most effective treatment for eating disorders. 

Treatment lasts for 20 weeks and requires prioritization and regular unbroken attendance to be successful.  Sessions are 50 minutes in duration, twice weekly in Stage One, reverting to weekly from session 8, then in Stage Four they may become 2-weekly, with a final follow up review session some 20 weeks after the full treatment recommended. 

 

STAGE IN TREATMENT  WEEK IN TREATMENT  SESSION NUMBER 
Stage One  1  0 (1.5-2hr assessment), 1 
  2  2,3 
  3  4,5 
  4  6,7 
  5  8 
  6  9 
  7  10 
Stage Two  8  11 
  9  12 
Stage Three  10  13 
  11  14 
  12  15 
  13  16 
  14  17 
Stage Four  15   
  16  18 
  17   
  18  19 
  19   
  20  20 
Post-Treatment Review Session    20 Weeks post-treatment 

 

Adolescents 

Eating disorders generally start in adolescence and can contribute significantly to mental health issues in this age group.  Adolescents will normally be developing a sense of identity, learning to become independent and developing new and changing inter-personal relationships as well as adjusting to the changes of puberty. 

Having an eating disorder can interrupt normal development and contribute to clients becoming socially withdrawn and dependent.  Prompt treatment is therefore of great importance. 

CBT is well accepted in the younger age groups and can enhance a sense of control which is a typical concern.   Treatment can help with developing autonomy and personal responsibility. 

Although treatment by a multi-disciplinary team is not generally advisable for adults in treatment, collaboration with significant adults will be an important part of the initial treatment assessment for those clients under 18 years of age. 

While treatment is a confidential collaboration between the young person and therapist, it is recommended that parents/care-givers work to facilitate the ongoing goals of treatment, where the young person is agreeable. 

It is therefore recommended that significant adults are kept informed in order to ensure the success of the treatment. 

Care-giver Attendance Recommended:  

  • At initial assessment for 30 minutes at start of treatment 
  • Review Session: End of Session 2 – final 10 minutes 
  • Review Session: End of Stage One (Session 7 – final 10 minutes) 
  • Review Session: Early Stage Three (Session 12 – final 10 minutes) 
  • Review Session: End of Stage Three (Session 17 – final 10 minutes) 
  • End of Treatment Review: Stage Four Session 20   – final 20 minutes 

 

Criteria for Accepting Adolescent Clients 

  • 15-years old or over 
  • BMI of >17.5 
  • Willing to engage with treatment 
  • Not more than 20% underweight 
  • Absence of severe co-existing psychiatric problems and suicidal risk 
  • Absence of physical risk (e.g. rapid weight loss 
  • Parental consent and support evident 

 

Recommended books and guidance 

Websites and Other resources 

  • National Institute of Mental Health https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml   
  • Overview, Signs and Symptoms, Risk Factors, Treatments and Therapies, Join a Study. National Health Service https://www.nhs.uk/conditions/Eating-disorders/Pages/Introduction.aspx   
  • Types of Eating Disorders, Causes, Do I Have an Eating Disorder? Spotting an Eating Disorder in Others, Who’s Affected? Treatment. Eating Disorders Org. https://eating-disorders.org.uk/   
  • Professional Training, Eating Disorders Treatment, Finding an Eating Disorders Counsellor, Eating Disorders Information, Join our Counsellor Network, Book an Assessment. Mind https://www.mind.org.uk/information-support/types-of-mental-health-problems/eating-problems/#.WfCcRI9SzIU   
  • Types of Eating Disorder, Causes of Eating Problems, Recovery and Self-Care, Treatment and Support, For Friends and Family, Useful Contacts. Beat https://www.beateatingdisorders.org.uk/  
  • Types of Eating Disorder, Recovery Information, Support Network, Training and CPD, Get Involved, News and Research, Your Stories, Donate. Priory http://www.priorygroup.com/eating-disorders   
  • What is an eating disorder? video, Brochure of eating disorder services (to download).