Contents. Eating Disorders: Introduction. Who Gets Eating Disorders? What is Anorexia Nervosa?

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1 Contents Eating Disorders: Introduction Who Gets Eating Disorders? What is Anorexia Nervosa? Physical and Psychological Effects What is Bulimia Nervosa? Physical Effects What is Eating Disorders Not Otherwise Specified (EDNOS)? What is Binge Eating Disorder? What Causes Eating Disorders? What Type of Treatment is Available? Recommended Further Reading Eating Disorders: Introduction Eating habits vary between cultures and individuals and usually involve a normal and healthy relationship with food. Unfortunately, sometimes individuals develop eating habits which are damaging to their physical and psychological health. In general, eating disorders develop over time and often at times of personal stress and uncertainty. There are three main categories of eating disorders; Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders not Otherwise Specified (EDNOS), which includes the category of Binge Eating Disorder (BED). Although they differ in some ways, they also share common features and sufferers can move from one diagnosis to the other over time. Who Gets Eating Disorders? Anorexia Nervosa and Bulimia Nervosa is ten times more common in females than males, although they are becoming increasingly common in males. They also occur more often in people who have been overweight in childhood. What is Anorexia Nervosa? People with Anorexia Nervosa strive to maintain a low body weight by dieting excessively, vomiting after eating, using laxatives and diuretics or exercising excessively. Central to this illness is an intense fear of becoming fat and a need to exert extreme control over eating and body weight. People experiencing Anorexia Nervosa see their weight loss and control as a positive achievement which improves their self-esteem. Anorexia Nervosa can also serve a 1

2 number of other useful purposes for the individual, for example, it can provide a means of communicating distress to others. Another important feature of Anorexia Nervosa is distorted body image. People with Anorexia Nervosa often do not see themselves as others do, and usually do not recognise that they are underweight. As a consequence of these features, people with Anorexia Nervosa are usually very reluctant to enter treatment for their eating problems. Physical and Psychological Effects Anorexia Nervosa is a serious condition that can cause severe physical problems because of the effects of starvation and vomiting on the body. At its most severe, these effects can be life threatening and Anorexia Nervosa has the highest death rate of all psychological disorders. Some of these psychological effects include: Loss of bone mass, causing an increased risk of fracture, which increases the longer the person remains underweight Loss of menstrual periods and fertility Liver damage Digestive problems and constipation Tiredness, weakness and feeling cold, due to a slowed metabolism Heart problems Psychological symptoms include: Poor sleep Poor concentration Feeling depressed Being preoccupied with thoughts about food and eating Anorexia Nervosa usually starts in teenage years or early adulthood. Anorexia Nervosa in children and young people is similar to that in adults in terms of its psychological and physical symptoms. However, in addition to being low weight, growth may be affected so that individuals may be smaller and slower to develop. What is Bulimia Nervosa? As in Anorexia Nervosa, people with Bulimia Nervosa worry excessively about their weight and shape and evaluate themselves largely in these terms. Individuals experiencing Bulimia Nervosa are not underweight and maintain their body in the normal weight range. People with Bulimia Nervosa are caught in a cycle of eating very large quantities of food (termed 'binge eating') and then vomiting, taking laxatives and diuretics (termed 'purging') or excessive exercising and fasting in order to prevent weight gain. 2

3 These behaviours, which are usually hidden from others, can escalate and come to dominate the sufferer s life. People with Bulimia Nervosa also usually have emotional difficulties: mood swings and anxiety, and may also have low self-esteem. They may try to harm themselves in other ways, such as by cutting. Physical Effects Tiredness Bloating Constipation Irregular periods A puffy face (due to the swelling of the saliva glands) Dental problems due to loss of enamel Heart palpitations What is Eating Disorders Not Otherwise Specified (EDNOS)? This category of eating disorder covers more than half of people experiencing eating disorders and includes eating disorders that do not exactly fit the description of either Anorexia Nervosa or Bulimia Nervosa, although they may have features of one or both. Of this group, most is known about Binge Eating Disorder (BED). What is Binge Eating Disorder? People with Binge Eating Disorders have episodes of binge eating, but do not try to control their weight by purging. It is often associated with obesity problems and, like other eating disorders, is often accompanied by emotional difficulties and low self-esteem. What Causes Eating Disorders? Eating Disorders are very complex in nature and a number of factors may contribute to causing them and keeping them going. Such factors include: Aspects of personality Social pressure Depression Low self-esteem Emotional distress Relationship and family issues 3

4 What Type of Treatment is Available? Anorexia Nervosa Treatment for Anorexia Nervosa is normally provided within specialist settings and should include: Good general supportive care Appropriate psychological treatment. Psychological treatment involves a series of meetings with a healthcare professional who works with the individual, alone or together with their family or with a group of other patients with similar difficulties, to help deal with the eating problem. A number of psychological treatments have been modified for Anorexia Nervosa, including: Cognitive Analytic Therapy (CAT), Cognitive Behaviour Therapy (CBT), Interpersonal Psychotherapy (IPT), Focal Psychodynamic Therapy, Family Therapy and Motivational Enhancement. Good medical care, both physical monitoring and treatment with medication Good nutritional care provided by dietetic services The treatment provided depends on the age of the sufferer and the severity of their illness. It may be provided on an outpatient basis, as a day patient, or when the illness is very severe or longstanding, on an inpatient basis. Occasionally, treatment may be provided against the will of the sufferer, under the terms of the Mental Health(Care and Treatment)(Scotland)Act Bulimia Nervosa More is known about effective treatment for Bulimia Nervosa than for Anorexia Nervosa. Effective psychological treatments include: Self-help - This may be a first step which may involve following a self-help manual or programme received and possibly guided by a healthcare professional. This help may be successful on it own in treating milder symptoms. Therapies - CBT is Cognitive Behavioural Therapy. Specialist CT for Bulemia nervosa is called CBT-BN. It may be offered if self-help has not been successful Interpersonal Psychotherapy (IPT) may be offered as an alternative to CBT-BN. IPT is a short term therapy typically lasting around weeks. Medication - Effective medical treatment involves treatment with an anti-depressant called Fluoxetine. Fluoxetine is in the group of anti-depressants known as Selective Serotonin Reuptake Inhibitors (SSRIs). It can be helpful in reducing the frequency of binge eating and purging. 4

5 EDNOS The type of treatment for these eating disorders will depend on whether they most closely resemble Anorexia Nervosa or Bulimia Nervosa. Effective treatment for binge eating disorder include CBT and treatment with Fluoxetine. Recommended Further Reading Anorexia Nervosa and Bulimia: How to Help. M Deuchar and R Slade (2003), Open University Press. Breaking Free from Anorexia Nervosa A Survival Guide for Families, Friends and Sufferers. Janet Treasure (1997), Psychology Press. Getting Better Bite by Bite. A Survival Guide for Anorexia Nervosa and Binge Eating Disorders. Janet Treasure and Ulrike Schmidt (1993), Routledge. Eating Disorders: A Parent s Guide. Rachel Bryant-Waugh and Brian Lask (1999), Penguin Books Ltd. Eating Disorders in Children and Adolescents, 3rd Edition. 2007, Bryan Lask and Rachel Bryant- Waugh (2007), Routledge. Overcoming Anorexia Nervosa. Christopher Freeman (2002), Robinson Publishing. Overcoming Binge Eating. Christopher Fairburn (1995), Guilford Press. Useful Links These web sites may be useful. Please note that we are not responsible for external sites; if you find any broken links or inappropriate content please report it to the site administrators using the feedback page. All external links will open in a new browser window. National Self Harm Network is a survivor-led organisation campaigning for the rights and understanding of people who self-harm. No Bodies Perfect is the Scottish charity for eating disorders. 5