By: Emma Timmins, Clinical Psychology Registrar

Eating disorders are mental disorders characterised by disturbances in thoughts and behaviours and feelings towards eating and food. All eating disorders are dominated by an intense and at times, overwhelming preoccupation with weight and shape. About one million people in Australia are living with an eating disorder. This is about 4% of the population[1]. Eating Disorders affect both physical and mental well-being. Eating disorders include Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant Restrictive Food Intake Disorder (ARFID), as well as other non-specific eating disorders.

Anorexia Nervosa is characterised by an intense fear of weight gain. There are 2 subtypes of Anorexia; restricting type and binge-eating/purging type. Restricting sub-type involves severe restriction of an individual’s food intake. Binge-eating/purging type also includes food intake restriction, followed by engagement in binge-eating or purging behaviours e.g., self-induced vomiting.

Bulimia Nervosa is characterised by bingeing followed by compensatory behaviours like purging, excessive exercise or laxative use.

Binge Eating Disorder is the most common eating disorder in the Australian adult population. People with binge eating disorder experience periods of binge eating alongside feelings of loss of control, however it is not followed by compensatory behaviours as in bulimia nervosa.

Avoidant Restrictive Food Intake Disorder is characterised by restricted eating that is not driven by a fear of gaining weight or by shape concerns. ARFID may develop as a result of sensory issues and/or a general lack of interest in food and/or a bad experience with food eg. a severe vomiting illness or a choking episode.

Common myths and misconceptions

• MYTH: It is JUST about food. FACT: Food and eating are significant components of eating disorders, but they are much more complex than this.
• MYTH: Eating disorders are a choice or an extreme diet. FACT: Eating disorders can begin with dieting, however this is not a conscious choice the individual makes.
• MYTH: Eating disorders are an attempt to gain attention. FACT: Often the individual does not want anyone to notice the symptoms of their eating disorder.
• MYTH: Eating disorders are only experienced by adolescent females. FACT: Eating disorders are experienced differently for each person, and there is no personality type that define eating disorders.
• MYTH: If someone looks healthy, they do not have an eating disorder FACT: Eating disorders do not discriminate and affect all body types.

Physical warning signs

The physical complications that can arise from eating disorders are vast, ranging from mild and temporary, to extreme and lifelong. Most physical warning signs are due to malnourishment, particularly in the case of Anorexia, however there are other physical symptoms of eating disorder to look out for if you are worried about a loved one or yourself:

• Dramatic changes in weight; this can be either weight loss or weight gain.
• Changes in hair; hair can become brittle and thin.
• Changes in skin; yellowish complexion, growth of thin hair all over the body (lanugo), feeling cold often.
• Changes to the teeth and gums; build-up of stomach acid (due to self-induced vomiting).
• Facial changes e.g., swollen cheeks and puffy eyes (due to self-induced vomiting)
• Increase in fatigue/dizziness.
• Low energy.
• Irregularity or cessation of menses for females.
• Changes in sleeping patterns e.g., interrupted sleep, waking more, waking earlier, not feeling rested. 

Psychological warning signs

Eating disorders cause significant psychological distress for the individual. They are preoccupied with thoughts about their body shape, food, mealtimes, exercise, and scheduling any compensatory behaviours. This creates significantly high levels of anxiety for the individual. Below are some psychological alarm bells you might want to consider if you are concerned for a loved one or yourself:

• Thoughts dominated by body image, shape and weight.
• Mentally categorising food to be ‘good’ or ‘bad’.
• Thoughts being ‘Black or White’ and having ‘rules’ around food and behaviours e.g., ‘If I eat that piece of bread, I must do an extra 30 minutes on the treadmill.’
• Experiencing high levels of anxiety that are only managed by adherence to these ‘rules’.
• Feeling pressure to be fully in control around food.
• Developing an overall negative view of yourself.
• Experiencing fluctuations in mood e.g., feeling happy and then down.
• Making up excuses to avoid eating with others.
• Feeling disconnected from peers and family.
• Experiencing shame and guilt if eating occurs in secrecy.

Behavioural warning signs

It is important to remember that eating disorders (not the individual experiencing them!) are very secretive so it can be difficult to spot subtle changes the person may be making to their food and exercise routine. A few things that may be helpful to monitor if you or someone you love may be experiencing an eating disorder:

• Restrictive eating and/or dieting.
• Conversation revolving around food, exercise, body weight/shape.
• Avoiding meals with others.
• Eating in secrecy.
• Significant increase in exercise duration and frequency.
• Going to the bathroom after meals.
• No longer engaging in hobbies that were once enjoyable.
• Frequently weighing oneself.
• Social isolation and disengagement from friends and family. 

Where to go for help?

There are many avenues of care available for people of all ages who are experiencing an eating disorder. It is important to ensure there is a multidisciplinary team around the individual who is living with the eating disorder. This can include:

• A General Practitioner (GP).
• Individual Psychologist.
• Family Therapist.
• Psychiatrist.
• Dietician.
• Physiotherapist.
• Occupational Therapist.

Please note that these are just some of the options that exist. It is important to remember that recovery is not a linear process, but a journey. Recovery is possible.

If you are concerned that you or a loved one may be experiencing an eating disorder, the best place to start is at a GP. It is important to check that everything is okay medically. The GP will be able to provide information and any necessary referrals for the professional supports that may be required. If an individual is medically compromised, hospitalisation may be required.

Eating Disorders are a mental illness; therefore, it is essential that the psychological needs of the individual and their families are supported. Mental health professionals, including Registered and Clinical Psychologists can provide a range of therapies under an Eating Disorder Mental Health Care Plan and provide up to 40 sessions per year.

Please get in touch with Spencer Health as we have clinicians with an interest in supporting individuals with emerging and diagnosed Eating Disorders.

[1] Deloitte Access Economics (2015). Investing in need: cost-effective interventions for eating disorders. Report commissioned for Butterfly Foundation. Sydney: Butterfly Foundation.
Butterfly.org.au