An eating disorder is diagnosed when there is a severe disturbance in eating behaviour that is disrupting a person’s daily functioning. There are often physical side effects and symptoms that become evident such as an increase or decrease in weight, malnutrition and overall ill health.

The three most common forms of eating disorders are anorexia, bulimia and binge eating disorder.

Anorexia has become more prevalent over the past few decades and was brought to the forefront with the death of singer Karen Carpenter. It is a disorder where there is an intense fear of gaining weight, a distorted view of one’s body (seeing it as being larger than it is) and loss of menstrual period for three months or more. Anorexia is diagnosed when someone is less than 85 per cent of his/her ideal body weight and refuses to gain weight. Other symptoms include an obsession with food, label reading, caloric intake, grocery shopping, menu reading, recipe books, etc. There is often hatred of the physical body and an excessive focus on the body and how it looks to self and others. An anorexic will restrict calories when eating and tend to pick menu choices that are low calorie, low fat. They may even remove certain food groups from their daily eating, such as carbs or fats.

There are two categories of anorexia: purging type or restricting type. The restricting type tries to lose weight through dieting, fasting or excessive exercise. The purging type will use self-induced vomiting, misuse of laxatives, diuretics, enemas or diet pills to manipulate their weight.

Bulimia is an eating disorder where the person binge eats and uses inappropriate methods to try and prevent weight gain. There are two types of bulimics: purging and non-purging. The non-purging type does not use self-induced vomiting but does engage in other means to get rid of the food they have eaten, such as misuse of laxatives and diuretics, fasting or excessive exercise, in an attempt to manipulate their weight. Bulimics may be thin, normal weight or overweight. Like anorexics, they also have distortions about their body, hate their bodies and are obsessed with food and weight.

Binge eating disorder is diagnosed when a person has developed a pattern of binging, which is to eat a substantially large amount of food during a specific period of time that is definitely larger than what others would consume. It also involves a sense of being out of control and not being able to stop eating. Often the binge will continue until the person is in physical pain and may even be used as a form of punishment. There is no compensatory behaviour to prevent weight gain. Occasional overeating and even snacking a lot through the course of a day do not point to binge eating disorder.

What causes an eating disorder?

There are many factors involved in the development of an eating disorder. There is never "one thing" that causes the disorder but a number of factors that build upon each other and eventually tip from struggles with food to disordered eating. Some factors for eating disorders may include a genetic predisposition to anxiety and/or depression, messages about food/weight/appearance from home and/or society, stressful events, trauma, emotional sensitivity, athletic pressures from coaches or parents regarding performance, perfectionist tendencies and need for control/ fear of the unknown. People with an eating disordered member in the family, especially a parent, have an increased potential for eating disorder development.

Warning signs to watch for

No one sets out to get an eating disorder! A person often "dabbles" in issues related to food, thinking they can stop whenever they want to. They may start out with some excessive dieting or restricting certain elements of normal eating from their diet. They may start to work out a little more and when they get affirmation from our beauty-obsessed culture, they may work out excessively. (A moderate amount of physical activity for most people is three to five days per week, no more than an hour per day). Some people even develop an eating disorder after being sick with the flu or coming home from a missions trip where they contracted a parasite, having received so many positive comments about how "good they look" since they lost weight. These affirmations can serve as an attack on a person’s self-esteem. The person may second-guess the acceptability of their appearance since they never received these positive responses before.

Unfortunately, the eating disorder does "work" – providing a temporary, albeit destructive, form of relief from distress. A person may start out in a position of control, simply playing with disordered eating. If a person can stop and turn this around they do not develop a full-blown eating disorder. They are very fortunate! For some people, the sense of control is lost and the eating disorder ends up being in control. The eating disorder behaviours take over and the person cannot stop their engagement with it. They are now spiralling out of control with an eating disorder, caught in a shaming cycle of destruction to the body.

One warning sign is a shift in social relationships. Eating disorders are somewhat like an abusive partner, demanding the full attention of the person they are trying to control. They like to isolate and cause a person to withdraw from their friends and family.

There is also a shift in the person’s relationship with food wherein the person becomes increasingly focused on food. Whether it is reading labels on food products or taking long periods of time to choose menu items at a restaurant, the person is obsessed with food – to eat it, hide it, refuse it or overindulge. Their life revolves around finding or avoiding food. They usually develop very "all or nothing" thoughts about food, assigning the food a title of good or bad. When you meet with them around meal time, they may tell you they have already eaten so as to keep suspicion off their eating habits.

With bulimia, a person may start taking laxatives or diuretics. They may complain about constipation or make excuses for why they need to take the medications. In truth, they hate the feeling of having food in their system and want it gone as soon as possible. You may notice an increase in exercise. This is of concern if they are doing large amounts of exercise without properly fuelling their body nutritionally to support their level of activity. Watch for exercise when the person is sick, tired or hurt – this indicates an invalidation of the body’s need for proper care/limits. This may include an insistence to exercise in bad weather or to points of exhaustion. Check motives for exercise. Is it to be healthy and supporting a moderate, balanced lifestyle or is it strictly to work off whatever was just eaten? If the motives are always about weight loss and the need to "correct," then it may indicate a problem.

Eating disordered people have food rituals they participate in. This involves a number of behaviours related to the eating process. It ranges from cutting everything into tiny bits, eating incredibly slowly, putting condiments on everything so as to cover up the taste of the food, moving the food around on the plate without actually consuming much of it, eating quickly, refusing to eat food they haven’t prepared or seen prepared, etc. These food rituals have to do with the obsessive thoughts and compulsive behaviours that attempt to alleviate the distress a person feels around eating, or an attempt to deceive anyone who might be watching their intake.

Another thing you can watch for is leaving the table immediately after eating to use the bathroom. If this is a pattern, it may indicate purging. Things like bloodshot eyes, swollen cheeks or glands beneath the jaw line, cuts on the knuckles and complaints of light-headedness following a meal may be warning signs. Teeth that look clear and an increase in cavities and gum damage may also be a result of purging.

Some practical things to listen for are complaints of being cold all the time, being tired and easily fatigued. You might also notice lots of negative comments about the person’s body and self-hating comments about being fat/big. They may start to wear baggy clothes which hide their frame and keep their weight change less noticeable. When going out for supper, even to a friend’s, they may insist on knowing what will be served before agreeing to go. It is not uncommon for an eating disordered person to hide the fact they have eaten or not eaten. Their mood may also be sad or irritable.

Persons with an eating disorder will say what needs to be said to "protect" their eating disorder. People who normally value honesty and integrity will develop patterns of manipulation and deception in an attempt to keep their secret safe. Their need to maintain the eating disorder starts to overrule their own personal values and belief systems. Sometimes the eating disorder will be used as a means to rebel or exert control, essentially sending the message that "you can’t make me eat/stop eating!" "This is one thing I can do and I’m good at it!" Identity becomes entangled with the eating disorder and the person often feels as though they cannot get rid of it because it’s who they are.

Dangers of an eating disorder

Eating disorders are one of the most deadly forms of mental illness. If they do not kill the person, there are numerous irreversible consequences such as fertility problems, osteoporosis, heart damage and more. The risks are real and serious. The eating disorder is a very subtle and evasive problem because many of its symptoms are not visible until it is too late. Most people with an eating disorder believe they will not die from it. They are "smart" at how they hide their eating disorder! There is an air of infallibility that breeds and supports the denial of the problem. Eating disorders kill. Unfortunately the statistics on eating disorder deaths are skewed because death certificates are issued for eating disorder complications rather than listing anorexia/bulimia or binge eating as "cause of death." For example, a cardiac arrest from bulimia will simply be coded as a cardiac arrest.

What to do

If you are struggling with an eating disorder, seek help! Admit to yourself that you have a problem that is serious and dangerous. Depending on the severity and length of your eating disorder, you may want to consider inpatient treatment. A good first step is to contact a medical professional who is familiar with eating disorders for a full medical assessment and to confirm medical stability. You may need to go into inpatient care in order to stabilize medically, then determine next steps.

There are several eating disorder facilities that offer inpatient, residential and day programs. Depending on the severity of the eating disorder, it may be possible to attempt recovery through an outpatient process where you work with a team compromised of a clinical therapist or psychologist, medical doctor and registered dietician who is familiar with eating disorders. A psychiatrist may also need to be in the equation for medication management.

Focus on the Family has resources for eating disorders and you can also look for resources on the internet. Be sure to interview any potential therapists and ensure they fit with your worldview/beliefs and approach to treatment. For example, I am a Christian therapist/registered psychologist who believes in full recovery from eating disorders.

If you or someone you love is struggling with an eating disorder, reach out and get help. There is hope! There is healing!

© 2009 Beth Murray. All rights reserved. Used with permission.

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