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Mar 06

Eating Disorders: Types and Indicators

Recently I posted about common myths surrounding eating disorders.  I had a wonderful response to this, and I’m so grateful to all of you for taking the time to read it.  Whilst it delighted me that people are informing themselves, it saddened me when people wrote to me about some of the things that had been said to them.  Before I go on to descirbe different types of eating disorders, I’d like to mention two more myths that have been brought to my attention since my original post.
Myth: an eating disorder is something you can ‘snap out of’.
Reality: An eating disorder is a mental illness just like depression or anxiety. We can’t just ‘snap out’ of those, so why should we be able to do so for an eating disorder?  A mental illness is just as real and challenging as a physical one.  You wouldn’t ever tell someone to ‘snap out of it’ if they had a broken leg or a heart condition.  To do so for a mental illness is equally ludicrous and insensitive.
Myth: Eating disorders are a sign of vanity.
Reality: I could hardly believe my eyes when I saw this one!  People with eating disorders are the opposite of vain.  Many of them believe their bodies are disgusting and can’t stand to look at themselves.  They may even believe that they are so overweight it’s unhealthy.  Like the friend I wrote about in an earlier post they may wear frumpy or baggy clothes to cover themselves up and hide their issues.  There’s no vanity here at all, folks.  Quite the reverse.
So, what types of eating disorder are there, and what sort of behaviour in yourself or someone else might give cause for concern?
Anorexia
Distorted body image

People with anorexia often see themselves as being bigger than they really are.

Anorexics often see themselves as much larger than they really are, and aim to control their weight by extreme calorie restriction, often coupled with over-exercising.  They may fear and avoid certain food groups, most often carbohydrates and fats.  They are terrified of gaining weight, and will do almost anything to avoid doing so.  Some anorexics have cycles of bingeing and purging, whilst others severely limit what they eat at all times.  Anorexia often stems from a need to be in control; if the sufferer is not able to control certain aspects of their lives they use restricted eating to regain a feeling of control.
It’s very common in our society for people to be concerned with weight.  However, if someone seems excessively obsessed with being overweight when in fact they are of normal weight or underweight, and shows fear towards eating all foods or certain food groups, this could be a cause for concern.
do not feed

Eating disorders are real. Can we help young people master healthier ways of thinking?

You might also be concerned if someone exhibits sneaky or obsessive behaviours around food.  These include pretending they’ve eaten when they haven’t, avoiding eating around others, obsessive calorie counting, taking diet pills or laxatives when there is no clinical need or hiding food. You might also be concerned if the person shows knowledge of or spends time on pro-ana websites.  For those of you who don’t know, these are websites that promote anorexia as a lifestyle choice rather than recognising it as an illness. I’ve seen young girls who have started to exhibit medical symptoms of anorexia, such as hair loss, and stopping their periods.  If this happens to a young woman you know, please seek help for her as soon as possible.
Bulimia
Bulimia is a pattern of binge eating followed by purging via vomiting and/or laxitives and/or excessive exercise.  Binge eating is not to be confused with overeating; many people overeat occasionally or regularly, but are quite aware of what they’re doing.  Bulimics feel out of control or disconnected with how much or how quickly they’re eating, and then feel terrible about it and resort to purging.  Bulimic binge eating may involve eating foods that the person would normally avoid.  Bulimics may have a distorted body image, which makes them believe they are much larger than they reallly are.
Bulimia can be hard to spot because the sufferer rarely looks excessively thin.  Probably the most famous bulimic ever was Princess Diana, who was lauded as a style icon for many years.  In the later stages of bulimia, the vomiting may cause stained teeth.  You may also notice changes in mood and behaviour, and secretive behaviour around food.
Emotional Overeating and Binge Eating
Which emotions make you want to eat?

Which emotions make you want to eat?

Lots of people are emotional eaters from time to time.  It’s common for people to eat when they’re upset, angry, lonely, bored, or even happy.  It sometimes involves cravings for particular ‘comfort foods’, and will occur even if the person isn’t hungry.  Emotional eating on occasion isn’t necessarily a problem; it becomes a problem when it happens frequently, when the eater no longer feels in control of what they’re eating, and when it’s used as a coping strategy instead of addressing the issue which has triggered the eating.
Binge eating is when a very large amount of food is eaten over a short period of time, but the eater feels out of control of what they are eating.  Some people plan their binges, whilst others binge spontaneously.  Bingeing is not pleasurable; often binge eaters want to stop eating during their binge but can’t.  Sometimes they find it diffiuclt to remember what they’ve eaten afterwards. Binge eaters can experience huge guilt, embarrassment or shame during or after the binge.
Binge eaters may avoid eating in front of others or show shame or anxiety around food.  They may be obsessed with food, and structure their whole lives around eating episodes. They may buy much larger quantities of food than they need or hoard food.  They can eat very rapidly, eat even when they’re not hungry, not stop eating even when they are uncomfortably full, and not be able to recall what they’ve eaten.  A lot of these behaviours happen in secret, so they can be very hard to notice.
Orthorexia
An interest in healthy food is great, but it shouldn't dominate your life

An interest in healthy food is great, but it shouldn’t dominate your life

It may sound like a contradiction, but orthorexia is an unhealthy obsession with healthy eating.  From personal experience, this isn’t taken as seriously as other eating disorders, or even recognised.  I’ve even heard some therapists refer to it as a ‘good thing’ and question whether they should address it at all.
Many people are interested in healthy eating, and that’s generally a positive thing.  If I didn’t think so I wouldn’t be here!  But if people become phobic about certain foods, describing them as ‘dirty’ or ‘poison’ and have an excessively restricted diet all the time for no medical reason it could be a sign of trouble.  As you know, I’m not a fan of the whole ‘clean eating’ movement (read more here), especially because it can trigger this type of obsessive behaviour.  Orthorexia can have a serious impact when it stops people from having social interactions because they are too worried about their food, or when their relationships suffer because they disengage from people who don’t share their dietary habits or beliefs.
'clean eating' on a post-it note

Is someone you know obsessed with ‘clean eating’? What does “clean eating” even mean?

Very restrictive eating can also lead to nutrient deficiencies and mental health issues.  Sounds pretty serious to me.
Other Specified Feeding or Eating Disorder (OSFED)
Mental illnesses are complex, and many people present differently with symptoms that are unusual or unexpected, but still have an eating disorder.  Eating disorders that don’t fit neatly into any of the other categories are known as OSFED.  Examples can include purging without bingeing, and night eating (eating large amounts of food at night after their evening meal, sometimes coupled with eating little during the day).  These disorders are just as important and serious as other eating disorders, and should be regarded accordingly.
Eating Disorders versus Disordered Eating
It’s possible for people to have disordered eating habits without having an eating disorder.  Disordered eating may mean, for example, being the victim of cravings, yo-yo dieting, self-worth based on size or body shape and obsessive calorie counting.  Disordered eating may, but doesn’t necessarily become an eating disorder.  As a nutritional therapist, I can work with disordered eating, but I’m not qualified or insured to work with eating disorders, which absolutely need the support of a medical practitioner.
What’s Normal?
chocolate cake

Would you enjoy this occasionally? Me too. Fabulous; we’re both completely normal…

If these are considered aberrant behaviours then what’s normal?  Does everyone have a degree of disordered eating?  Of course there will be lots of variation between individuals, but here are some perfectly normal and healthy behaviours around food.
  • It’s normal to enjoy food
  • But it’s also normal not to obsess about it, and to treat it as one element of a balanced life
  • It’s normal to eat more on some days and less on others
  • It’s normal to eat every day
  • It’s normal to take an interest in healthy eating
  • It’s normal to enjoy foods just because they taste good

    Array of healthy foods

    …especially when we can enjoy some of these delights every day.

  • It’s normal NOT to anthropormorphise food; food is not ‘good’, ‘bad’, ‘clean’ or ‘dirty’.  It has no personality
  • It’s normal to dislike some foods and to have different preferences from others around you
  • It’s normal that people of certain religions will avoid certain foods
  • It’s normal to enjoy a huge slice of cake on your birthday!
What if you’re concerned?
If you know anyone who may be suffering from an eating disorder, or you may be that person yourself, it’s important to get help, and the sooner you do so the sooner you can make a full recovery.  The BEAT Eating Disorders website is a good place to start, and has a helpline.  Find it here.
If you think you may have disordered eating patterns I may be able to help you put things in perspective and find a more balanced way.  Let’s talk!
For recipes, tips and links to informative articles from myself and others, body positivity, celebration of great food and plenty of fun, please join my FREE Facebook Group, ‘Susannah’s Nutrition Kitchen’.

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