Understanding and Addressing Eating Disorders

Food addiction is a mental illness focused on feelings not food

Eating disorders are a complex mental illness. It is typically started from a combination of social, genetic and psychological factors.  It is considered that they are a ‘Maladaptive’ coping mechanism that developed in order to support someone to cope but they have the effect of being detrimental to their mental and physical health.

Negative experiences, such as bullying at school or on social media sites, can play a role in the development of an unhealthy eating issue. This then leads to trauma and feelings of anxiety and stress and the eating disorder serves a purpose to reduce those levels of anxiety and stress by the focus being switched to eating, including body image and other related behaviours around food. These may include limiting the amount of food eaten, eating very large quantities of food at one sitting, getting rid of food eaten through unhealthy means, for example making themselves sick, misusing laxatives, fasting or excessive exercise or a combination of these behaviours.

It is important to remember that addictive eating problems are not all about food but about feelings. The way a person treats food may make them feel able to cope or may make them feel in control and yet they may not realise or even be fully aware that this behaviour that has now started could be the beginning of a downward journey. 

There are a number of eating disorders that someone can be diagnosed with and it is even possible for someone to move between diagnoses if their symptoms change. This is why there can be a lot of overlap between the different typologies.  The NICE guidance, National Institute for Health and Care Excellence, states that “people with an eating disorder should be assessed and receive treatment at the earliest opportunity” and this applies in all cases. The earlier you can get treatment the better the chance of Recovery.

Binge Eating Disorder (BED)

Binge eating disorder is a serious mental illness that can affect anyone of any age, gender, ethnicity or background and is probably more common than other eating disorders. People with this condition will eat large quantities of food over a short period of time. They will not normally get rid of the food in an unhealthy way and will then wait until there is another binge. 

During a binge they will generally eat their food faster than normal, eating until feeling uncomfortable and even eating large amounts of food when not even hungry. Generally, to be diagnosed with BED, then there will be at least one of these episodes a week for a period of around 3 months. It may be that the gap between binges is also shortening.

The recommended treatment for BED by NICE is mainly based around Cognitive Behavioural Therapy, in either individual CBT or group CBT sessions. The treatment is based around reducing the binges and not about weight gain or loss. It is about processing the thoughts and behaviour that are triggering a binge.  It is important to try, via CBT, to introduce a planned meal schedule and introduce the keeping of honest food diaries.

Bulimia Nervosa or Bulimia

Bulimia is a mental illness where people are caught in a cycle of eating large quantities of food and then getting rid of the food via induced vomiting or use of laxatives (purging) or exercising excessively. Episodes of binge eating can be very distressing, and people can feel trapped in the cycle of binging and purging. Also, with Bulimia as with other eating disorders, it is the thought process that leads to the eating as a continued distraction. Bulimia is not always easy to spot as there may not be evidence of weight gain or loss

A serious side effect of long-term Bulimia can be suicidal thoughts and levels of self-harm.  At this stage outpatient treatment should be moved to the safety of residential treatment and care in an addictions rehab. At The Haynes Clinic we will normally have people stay with us for a longer period of time in treatment to also help break the addictive cycle and for daily therapy to help process their thoughts and, over a period of time, to establish a regular healthy meal plan. 

Anorexia Nervosa or Anorexia

Anorexia is another very serious mental illness and possibly the one condition most heard about and associated with an eating disorder. It is where people are of a very and unhealthy low weight as they will constantly limit the amount of food they eat and also restrict their liquid intake to a minimum.

It is common for weight and shape to play a part and someone with anorexia will not see themselves as being underweight and will not see themselves as others see them. They will actually think they look larger or weigh more than they do. Constant daily use of scales is part of the ritual, and they will challenge any suggestion that they should gain weight. This quite often leads to a very disruptive family lifestyle.

Suicidal thoughts and self-harm are also associated with anorexia. There is therefore a need for the individual to be in a safe, caring, therapeutic environment such as a residential addictions unit as, if left untreated, it can often be the case that an individual has to be admitted to hospital in order to save their life as their weight loss has reached such dangerous levels.  CBT therapy would be used to challenge the irrational thinking around weight and food.

OSFED: Other Specified Feeding or Eating Disorder

Anorexia, bulimia and binge eating disorders are diagnosed using a list of expected behavioural, psychological, and physical symptoms.  However, sometimes a person’s symptoms don’t actually match the expected symptoms. There are eating disorders that might have a part of the various types. In these instances a person will be diagnosed with “other specified feeding or eating disorder.”

All eating disorders are treatable but they firstly need to be recognised and diagnosed to get the appropriate help. This could be through individual or group therapy, self-help support groups or the safety of a residential addictions unit offering a daily programme of therapy and a structured ongoing care package.