Understanding Eating Disorders - Which one of these people has an eating disorder?

Understanding Eating Disorders - Which one of these people has an eating disorder?
      Eating Disorders
             The Eating Disorders Association Inc. (Queensland)

Which one of these
  people has an
 eating disorder?

                                                            ...they all do.
Understanding Eating Disorders - Which one of these people has an eating disorder?
Front cover by: Beth Mitchell Photography,
Beth Mitchell photographer, Tim Orange
assistant photographer, Begitta Stolk              This booklet was generously funded by the
fashion stylist, Madison Colless assistant         English Family Foundation. We thank members
stylist, Fiona Claire makeup artist, Vanessa
                                                   of the Foundation for making the update of this
Mulkearns hair stylist.
                                                   booklet possible and for giving us an opportunity
Image talent: Broghan Campbell, Tracey             to engage creatively with the community.
Walker, Ayden Melhop, Taymin Marks,
Mel Marks, Andi Coleman, Ben Matheson.             Understanding the nature of eating disorders is
                                                   key to recovery. We hope this booklet is helpful
Copyright 2014
Eating Disorders Association Inc.
                                                   for all people and families affected by eating
                                                   disorders, for the health professionals who
ISBN 978-0-646-90889-2
                                                   support them and for the broader community.

This booklet was first printed in 1992 and     The artwork and slogans used in the booklet were the result of
has since had four revisions. The booklet      months of consultations with the community and the Eating
has been in constant demand by people
throughout Queensland (and other states)       Disorders Association.
who are seeking information relating to        The theme of being underwater was used as a metaphor for
eating disorders.
                                               living with an eating disorder; swimming to the surface and
We thank the EDA staff and board who           breaking through, a metaphor for recovery. We thank all the
have contributed to the development of
Understanding Eating Disorders, 2014.
                                               people involved in creating the concepts, slogans and wording
The Eating Disorders Association Board         for this booklet. The booklet is a collaborative community effort
Members: Broghan Campbell, Keryn (Keri)        involving people with a lived experience of an eating disorder,
Campbell, Leanne Chapman, Lexi Crouch,         their carers, health professionals and community supporters.
Catherine Doyle and Holly Kirkham.
Thanks also to the Eating Disorder
Association Service Workers Melissa
                                               Photographic acknowledgements
Marks, Mary Anne Kissane, Jasmine              Beth Mitchell Photography: Beth Mitchell photographer, Tim
Melhop and Amy Tidbold. Special thanks
to Coordinator Desi Achilleos for her
                                               Orange assistant photographer, Begitta Stolk fashion stylist,
leadership with community development,         Madison Colless assistant stylist, Fiona Claire makeup artist,
grant writing, project management and          Vanessa Mulkearns hair stylist.
for revising and updating this booklet.
                                               Additional photography by Mark Broadbent.
Appreciation for feedback on this edition:
Dr Leanne Barron, Carmel Flemming,             The people photographed are community supporters wanting to
Kim Hurst, Shane Jeffrey, Andrea Muller,       contribute to raising awareness about positive body image and
Loretta Ryan. With special thanks to Tania
                                               eating disorders. They are: Lil Crump, Sophia McGregor, Mollie
Rotili and Dr Suellen Thomsen.
                                               McGregor, Lexi Crouch, Tennille Carrier, Angel, Luke Melhop,
Acknowledgement to previous                    Ayden Melhop, Jasmine Melhop, Desi Achilleos, Taymin Marks,
contributors: Lynda Melville, Dr Suellen
Thomsen, Mary Barram, Margaret                 Mel Marks, Broghan Campbell, Keryn (Keri) Campbell, Keiran
McAllister, Pin Ying Lim, Joanne Blair,        Garland, Tracey Walker, Ben Matheson, Nicole Gibson of The
Karen Hollands, Kirsten Braun, Carmel          Rogue and Rouge Foundation, Sarah Dakhili (Social Worker),
Fleming, Julia Arnold.                         Dominique O’Leary, Andi Coleman, Toni Woods and Hillary
First Edit: Susan Prior of Write-now!          Green.
Second Edit: Darryl Rosin.
                                               Thanks also to the people who collaborated with us to create
Booklet Design: Emily Jarvis at Liveworm,
                                               the slogans used in the booklet including Mary Lawson,
Queensland College of Art, Griffith
University.                                    Charlotte Durand, Madeleine Henderson, Amy Bannatyne, Karla
                                               Cameron, Kim Hurst, Shelly Read, Amanda Dearden, Cathy Dart,
The publication of this booklet would
not be possible without the support of         Dr Leanne Barron, Dr Suellen Thomsen, Carmel Flemming, Sarah
Queensland Health for funding of the EDA.      Walker, Eating Disorders Victoria, the Eating Disorders Network
Further copies of this booklet can
                                               of Queensland, the Eating Disorders Outreach Service, ISIS - The
be obtained from the EDA.                      Eating Issues Centre and the Child Youth and Mental Health
                                               Services (CHYMS) at South Brisbane and the Gold Coast. Special
                                               thanks to Tania Rotili.

b Understanding Eating Disorders
Understanding Eating Disorders - Which one of these people has an eating disorder?
SECTION ONE                                              SECTION THREE                                           Therapy and Support ��������������������� 56
Description of Eating Disorders��� 5                    Seeking Help, Recovery                                  ÊÊ Psychiatrist��������������������������������� 56
What Are Eating Disorders? ������������� 5              and Recovery Strategies������������� 31                ÊÊ Psychologist������������������������������� 56
The Effects of Starvation and                            Telling Someone ������������������������������31       ÊÊ Social worker����������������������������� 56
Refeeding����������������������������������������� 8    How to Approach Someone                                 ÊÊ Counsellor��������������������������������� 57
Why Do People Develop                                    with an Eating Disorder ����������������� 32
                                                                                                                 ÊÊ Mental health services��������������� 57
Eating Disorders? ��������������������������� 10        ÊÊ Get information about
                                                             eating disorders������������������������� 32       Family-based Treatment (FBT) for
ÊÊ Risk factors ������������������������������� 10                                                             Children and Adolescents with
ÊÊ Triggers for the onset of                            ÊÊ Make a time to discuss                              Eating Disorders����������������������������� 58
    eating disorders������������������������� 12           the eating disorder ������������������� 32
                                                                                                                 ÊÊ The treatment model����������������� 58
ÊÊ Factors that maintain an                             ÊÊ Going to a doctor, when
                                                             to call an ambulance and                            ÊÊ Does the treatment
   eating disorder ������������������������� 13                                                                     program work?������������������������� 58
                                                             hospitalisation��������������������������� 33
                                                                                                                 ÊÊ Who will be involved
SECTION TWO                                              Recovery����������������������������������������� 34
                                                                                                                     with the treatment ������������������� 59
Clinical Diagnosis of                                    Recovery Strategies������������������������� 35
                                                                                                                 Adult Recovery Therapies ��������������� 60
Eating Disorders��������������������������� 17          Understanding the Stages of
                                                         Change in the Recovery Process����� 40                 ÊÊ Psychological therapy����������������� 60
What is Anorexia Nervosa?������������� 17
                                                                                                                 Eating Disorder Diagnosis, ATAPS
BMI vs Body Mass Composition ����� 18
                                                         SECTION FOUR                                            and Better Access Schemes������������� 64
ÊÊ Warning signs of
    anorexia nervosa����������������������� 18          Treatment Options����������������������� 45
                                                                                                                 SECTION FIVE
ÊÊ What are the risks associated                        Getting Help and Choosing
                                                         the Right Health Practitioner����������� 45            How Are Family and
    with anorexia nervosa��������������� 19                                                                     Friends Affected?������������������������� 66
ÊÊ Involuntary treatment orders ����� 20               Your Rights when Seeking Help������ 46
What is Bulimia Nervosa?����������������21              ÊÊ Guiding Principles ��������������������� 46         SECTION SIX
What is Binge Eating Disorder?������� 23                ÊÊ Questions or complaints?����������� 47              What Can Family and
                                                         Different Types of Treatment                            Friends Do?����������������������������������� 69
Other Specified Feeding
or Eating Disorder��������������������������� 24        and Therapy����������������������������������� 48      Advice for Carers ��������������������������� 70
Unspecified Feeding                                      ÊÊ Hospital system������������������������� 48         Carer Allowance������������������������������71
or Eating Disorder��������������������������� 25        Medical Issues��������������������������������� 50
                                                                                                                 SECTION SEVEN
ÊÊ Pica������������������������������������������� 25   ÊÊ Medical practitioners����������������� 50
                                                                                                                 Recovery Stories ������������������������� 73
ÊÊ Rumination Disorder ����������������� 25             ÊÊ Medical check-ups��������������������� 50
                                                                                                                 ÊÊ I choose to reclaim my life... ����� 73
ÊÊ Avoidant or Restrictive                              Medical Complications
    Food Intake Disorder����������������� 25            of Laxative Misuse ������������������������� 52        ÊÊ Anorexia Recovery:
                                                                                                                     Finding My Way������������������������� 73
What is the Overlap of the Different                     ÊÊ How to stop misusing laxatives � 52
Types of Eating Disorders?��������������� 26                                                                    ÊÊ Where I Came From: My Journey
                                                         ÊÊ What to expect from laxative
                                                                                                                     of Recovery From Bulimia����������� 75
ÊÊ Sub-clinical conditions��������������� 26                withdrawl ��������������������������������� 52
                                                                                                                 ÊÊ A Parent’s Perspective ��������������� 77
ÊÊ Warning signs of                                     Dental Health and Eating Disorders� 53
    an eating disorder��������������������� 26                                                                  ÊÊ A Mother’s Story ����������������������� 78
                                                         ÊÊ Finding a dentist ����������������������� 53
ÊÊ Complications of                                                                                             ÊÊ A voice from someone who has
                                                         ÊÊ Some other helpful hints����������� 53
    eating disorders ����������������������� 27                                                                     lived with many eating disorders79
                                                         Nutritional Rehabilitation
How Common Are                                           and Normalising Eating������������������� 54           Eating Disorder Community
Eating Disorders?��������������������������� 29
                                                         ÊÊ The role of a dietitian����������������� 54         Services in Queensland��������������� 82
                                                         ÊÊ Guidelines for normal eating����� 54                References ����������������������������������� 84
                                                         ÊÊ Out-patient nutritional
                                                             management����������������������������� 55
Understanding Eating Disorders - Which one of these people has an eating disorder?
EDA Mission Statement                   EDA Philosophy
    The mission of the EDA is to improve    The EDA is a non-profit organisation
    the intervention, education and         dedicated to providing a service to
    support for all people affected by      people of all ages, gender and cultures.
    eating disorders, and to work towards
                                            The EDA recognises that eating
    the prevention and elimination of
                                            disorders are serious and complex
    these disorders in society.
                                            issues that require multi-dimensional
                                            approaches to care and support.
                                            We believe that all people experiencing
                                            eating disorders, and their friends,
                                            family and carers, should be treated
                                            with dignity and compassion, and
                                            should be included in all levels of
                                            The Association promotes the
                                            acceptance of all body types and sizes,
                                            and is committed to valuing people as
                                            whole beings.
                                            Everybody, no matter what shape or
                                            size, can take steps towards improving
                                            their health.
                                            Recovery is possible, help is available.

2 Understanding Eating Disorders
Understanding Eating Disorders - Which one of these people has an eating disorder?
The Eating Disorders Association Inc. [EDA]
The Eating Disorders Association Inc (EDA)               have recovered, and from carers. Included in the
is a state-wide, not-for-profit organisation             newsletter are personal experiences, recovery
started by a group of people with a lived                strategies, art work, book and media reviews,
experience of eating disorders and carers. The           health professional contacts, eating disorder
EDA opened its centre in 1996 to all people              sector research, events and support group
affected by eating disorders and maintains a             advertisements, and opportunities for people to
peer-orientated model of service delivery. The           get involved at the EDA and other organisations.
EDA welcomes the input of people affected             ÊÊ specialist eating disorder library.
by eating disorders in all aspects of the
                                                      ÊÊ community education about eating disorders, as
Association’s initiatives and the services it
                                                         a to improve the understanding and treatment
provides to the community.
                                                         of eating disorders, and to contribute to the
The EDA provides Queensland-wide recovery                prevention of these disorders in society.
orientated support, information and referral,
ÊÊ recovery orientated support, information and
                                                          EDA Contact details
   referral sessions — by telephone, email, face-
   to-face or using video conferencing — for              ÊÊ Opening hours: 9 am to 4 pm,
   individuals with eating disorders and for people          Monday to Thursday
   who care about them. Face-to-face sessions are         ÊÊ 12 Chatsworth Road,
   by appointment only.                                      Greenslopes Q 4120
ÊÊ support groups, workshops and peer-support             ÊÊ PO Box 346, Stones Corner Q 4120
   groups, for people with eating disorders and for       ÊÊ Telephone: 07 3394 3661
   those who care about them.
                                                          ÊÊ Fax: 07 3394 3663
ÊÊ after-hours support by volunteers who have
                                                          ÊÊ Email: admin@eda.org.au
   recovered from an eating disorder, or carers
   who have supported someone to recover.                 ÊÊ Web: www.eda.org.au

ÊÊ information packs about eating disorders.
                                                          Other EDA publications:
ÊÊ referrals to health professionals with a special
   interest in treating and supporting people with        Consume Magazine
   eating disorders throughout Queensland.                www.consumemagazine.com

ÊÊ A peer- and carer-driven monthly newsletter
                                                          Find us on Facebook:
   called Through the Looking Glass, with
   contributions from people with a lived                 www.facebook.com/edaqld
   experienced of an eating disorder, people who          or on friend’s page

                                                                              The Eating Disorders Association 3
Understanding Eating Disorders - Which one of these people has an eating disorder?
Your reflection may be
      distorted by socially
      constructed ideas of
      beauty and worth

4 Understanding Eating Disorders
Understanding Eating Disorders - Which one of these people has an eating disorder?

                    Description Of Eating Disorders
What Are Eating Disorders?
Eating disorders are serious and complex                   becoming an adolescent, an individual’s personality,
issues, with strong medical and psychological              menopause, or going on a diet to be ‘healthy’. As
components, relating to negative body image,               a consequence, it is only when someone becomes
weight and shape concerns, problematic                     quite obviously unwell that treatment is sought.
eating and compensatory behaviours,
                                                           Eating disorders often coexist with other mental
including starvation, binging, vomiting,
                                                           health issues, such as depression, anxiety, body
compulsive exercise and the abuse of diuretics.
                                                           dysmorphia, mood disorders and obsessive-
A person with an eating disorder will often assess         compulsive disorders.
 themselves negatively in terms of their weight and
                                                           Most people recover from an eating disorder
 shape, and what they have eaten or not eaten. It is
                                                           and recovery is always possible regardless of
 important to understand that even though eating
                                                           age and length of illness. However, people with
 disorders encompass harmful eating practices
                                                           eating disorders are at a high risk of developing
 and related compensatory behaviours, they are
                                                           serious medical complications and dying from
 often the outward sign of deeper psychological
                                                           their illness. In fact, eating disorders have a
 issues and ways that people have coped with life
                                                           higher death rate than any other mental illness.
 stressors. Recovery from an eating disorder is not
                                                           The earlier treatment is sought the greater the
 as simple as the person recognising the need to
                                                           opportunity for recovery, therefore treatment
‘just eat normally’. Eating disorders are complex
                                                           is encouraged as soon as possible. A multi-
 mental health problems and are potentially life-
                                                           disciplinary treatment team including a doctor,
 threatening illnesses.
                                                           dietitian and therapist is recommended.
Eating disorders can have serious effects on all
                                                           When someone with an eating disorder is
aspects of a person’s life — physical, emotional
                                                           approached about their concerning behaviours,
and social. They are often very private and hidden
                                                           they will often deny the existence or the
problems, which can exist for a long time before
                                                           seriousness of their behaviours and refuse to
they are recognised, particularly when the early
                                                           acknowledge any problem. Alternatively, they may
warning signs are similar to the restrictive fad
                                                           recognise they have a problem, but choose to do
dieting that is so commonplace in western culture.
                                                           nothing about it. Sometimes the shame around
People close to an individual may notice significant
                                                           certain behaviours is so great that the individual
behavioural changes — such as heightened
                                                           feels they cannot be honest with anyone about
moodiness, anxiety, stress, depression, secrecy,
                                                           what they are doing. This denial, ambivalence,
obsessiveness or anger — without necessarily
                                                           or shame can be a source of real confusion and
understanding the causes of the behaviours.
                                                           frustration for families and friends who want to
Sometimes these behaviours are mistaken for
                                                           support their loved one to get well.

                                                                                  The Eating Disorders Association 5
Understanding Eating Disorders - Which one of these people has an eating disorder?
I’m a hairdresser and have been getting help
                                      to recover from anorexia nervosa. I now
      Men get eating                  know that recovery is possible and support is
      disorders too.                  available. I no longer suffer in silence and no
                                      one else needs to either.
                                      Recovery is possible and support is available.

ÊÊ How do you get someone to a doctor if                 Eating disorders are not lifestyle choices. No one
   they refuse to go?                                    chooses a mental illness, however one can choose
ÊÊ How do you encourage someone to eat                   to recover. Understanding the nature of eating
   when they don’t want to?                              disorders is vital to recovery. The more eating
                                                         disorder information a person, their family, friends
ÊÊ How do you support someone to stop
                                                         and health practitioners have, the better their
   vomiting or binge eating, when they have
                                                         understanding of how to recover and how best
   been doing it for many years?
                                                         to support someone to recover. Reading recovery
Answers to these questions can be the cornerstone        stories and connecting to other people who have
 of supporting people to get well. Refusal or            been through similar experiences can give hope
 ambivalence about getting well, despite the threat      and be a great support. Gaining information
 to one’s life, highlights eating disorders as serious   about eating disorders, trying strategies that have
 mental health problems. The terms ‘mental health’,      helped others recover, understanding the pitfalls to
‘mental illness’, ‘eating disorder’, ‘eating issues’,    avoid, finding the best evidenced based therapies,
‘eating problems’ and ‘psychiatric conditions’ will      discovering useful ways to support someone and
 be used interchangeably in this booklet as an           getting on-going support is encouraged.
 acknowledgement of the variety of ways people
 describe their problematic eating experiences.

6 Understanding Eating Disorders
Understanding Eating Disorders - Which one of these people has an eating disorder?
A multi-disciplinary approach to recovery is           Although some eating disorders present most
recommended including seeing a doctor for              commonly among young adolescent women in
a medical assessment and on-going physical             cultures influenced by western health and beauty
monitoring, a dietitian for nutrtional advice and      ideals, women and men of any age, from any
a therapist for psychological recovery. In the first   social and cultural background can develop eating
instance, a doctor is recommended to make an           disorders. Over the last decade, there has been an
assessment. If you suspect a child is developing       increase in young men, children and middle-aged
an eating disorder, trust your instincts and take      people diagnosed with eating disorders.
them to the doctor as soon as possible. If you are
                                                       Before a diagnosis, an individual, friends or family
supporting an adult, keep encouraging them to
                                                       may sense that something is not quite right. We
go to the doctor. Their life may depend on your
                                                       encourage people to trust their instincts and seek
                                                       support as soon as possible. Unfortunately, many
The medical profession defines the three most          carers have had the experience of being turned
common eating disorders as anorexia nervosa,           away from health services because their children
bulimia nervosa, and binge eating disorder,            have been assessed as not being ‘ill enough’. We
each with specific diagnostic criteria. People who     encourage people to seek health professionals
suffer from complex eating issues and do not meet      who understand how to treat eating disorders and
the diagnostic criteria are categorised as having an   what is needed to prevent mild cases developing
other specified feeding or eating disorder.            into clinical disorders. The time and effort put
                                                       into finding the right treatment team will be
                                                       worth it. We also encourage doctors and health
                                                       professionals to carefully consider the concerns of
     People with eating disorders can
                                                       individuals and carers.
     be any weight and do not have to
     be underweight to be suffering the                Although most people who develop eating
     effects of starvation. Most people                disorders will recover, eating disorders can have
     with eating disorders are in the                  serious consequences and often irreversible
     healthy weight range or above.                    medical implications if left untreated. The
    ‘Obesity’ or being above your healthy              sooner professional help is sought and treatment
     weight range, is not classified as an             commenced, the greater the chance of recovery
     eating disorder, however, eating                  and a happier, more fulfilling life for the individual
     disorder services internationally are             and their family.
     starting to respond to people who                 A good start is to support adequate, regular and
     are above their healthy weight range.             nutritious eating, and to take care with our words
                                                       and actions. Be conscious of the body image and
                                                       health messages we send and the way we talk
There is an increase in the number of people           about our own body and eating, and that of others.
with eating disorders, an increase in people who
are overweight or obese, and an increase in the
amount of people who have a negative body
image. With such a diversity of people with eating
issues and body, weight and health concerns, we
need to understand social and cultural factors that
contribute to these problems.

                                                                               The Eating Disorders Association 7
Understanding Eating Disorders - Which one of these people has an eating disorder?
The Effects of Starvation and Refeeding
Before explaining the nature of eating                    self-criticism and vomiting. One man left the
disorders, it is very useful for everyone to              experiment after developing a dangerous a
understand the effects of starvation on                   starve–binge–purge cycle.
physical, social and mental health. A well-            ÊÊ Stress, anxiety, depression, mood swings,
known starvation study carried out at the                 irritability, disorganisation, hysteria,
University of Minnesota (Keys et al, 1950)                hypochondria, outbursts of anger and severe
highlights that many symptoms of eating                   emotional distress increased.
disorders are actually symptoms of starvation,
                                                       ÊÊ Some men became neurotic and psychotic. One
and that anyone who engages in prolonged
                                                          man mutilated himself by amputating three of
and severe dietary restriction can suffer
                                                          his fingers with an axe.
serious physical, social and psychological
complications.                                         ÊÊ The men became more withdrawn and isolated,
                                                          with growing feelings of social inadequacy.
The study included a six-month period of food
                                                          Humour and mateship diminished. Social
restriction for 36 young, healthy, psychologically
                                                          contacts became strained and declined, and
normal men. The men ate about half of their
                                                          sexual interests drastically reduced.
normal food intake (approximately 1560 calories,
or 6552 kilojoules, a day) and lost about 25 per       ÊÊ Concentration, comprehension, alertness and
cent of their former weight. The men were then            judgement became increasingly impaired;
gradually renourished during the following three          however, there seemed to be no signs of
months.                                                   diminished intellectual abilities.
                                                       ÊÊ Physical changes included hair loss; dizziness;
Changes in the men after six months of
                                                          headaches; hypersensitivity to noise and light;
                                                          increased sensitivity to cold temperatures; cold
ÊÊ Despite little interest in food or food                hands and feet; reduced strength; poor motor
   preparation prior to the experiment, there was         control; gastrointestinal problems; decreased
   a dramatic increase in food preoccupation,             need for sleep; oedema (excessive fluid causing
   including incessant and intrusive thoughts             swelling); visual disturbances, such as an
   about food, menus, food preparation and                inability to focus; aching eyes or seeing ‘spots’;
   eating, including dreaming about food.                 auditory disturbances, such as ringing in the
ÊÊ Abnormal and ritualistic behaviours around             ears; and tingling or prickling sensations.
   food increased, including making strange food       ÊÊ An overall slowing of the body’s physiological
   combinations and concoctions.                          processes occurred, such as decreases in body
ÊÊ There were often conflicting desires between           temperature, heart rate, and respiration, as well
   wanting to gulp food down ravenously                   as in basal metabolic rate, which is the amount
   and prolonging the time taken to eat food,             of energy burned at rest.
   sometimes for hours.                                ÊÊ Most of the men eventually became tired,
ÊÊ A significant increase in the use of salt, spices      weak, listless, and apathetic, and complained
   and gum chewing. Drinking of coffee and tea            of lack of energy. Some maintained exercise
   increased so dramatically they had to be limited       regimes and some attempted to lose weight by
   to nine cups a day!                                    excessive exercise in order to obtain more food,
ÊÊ Some had a complete breakdown in control,              or to stop a reduction in their food rations.
   unable to stick to their restrictive diets and      ÊÊ Apathy also became common, and some men
   reported episodes of binge eating followed             neglected various aspects of personal hygiene
   by emotional upset, self-reproach, disgust,            when previously they had taken great care.

8 Understanding Eating Disorders
I will feed myself and fight                    Your body hears
                                  this illness, not feed this                     everything your
                                                                                  mind says.
                                  illness and fight myself.

During the three months of the renourishment,        the study did not identify why. The fact that serious
most of the emotional disturbances, abnormal         binge eating developed in a small subgroup of
attitudes and behaviours in regard to food           men supports research indicating that people who
continued to be quite severe. Particularly in        regularly diet by restricting food, develop binge
the first six weeks, some men actually became        eating behaviours.
more depressed, irritable, argumentative and
                                                     Although the effects of starvation are very clear
negative than they had been during the semi-
                                                     from this study, the men were voluntary research
starvation. After between five and nine months
                                                     subjects. If we are to understand why eating
of renourishment, most men had returned to
                                                     disorders develop, we also need to understand why
normal body weight, normal eating patterns and
                                                     individuals engage in self-imposed starvation.
physical, psychological and social functioning was
restored. A few were still binge eating; although,

                                                                            The Eating Disorders Association 9
Why do People Develop Eating Disorders?
Eating disorders develop from a complex                 to meet this ideal. Society tells us that to be happy,
interplay of many factors. There is ‘no one’            successful and desirable, we need to meet this single
cause for developing an eating disorder, or             beauty ideal, which often is so digitally altered it does
for self-induced starvation and its consequent          not reflect anybody’s reality.
effects on the individual. No individual or
                                                        Trends in the fashion and media industries have
parent is to blame.
                                                        created the ideal as being underweight, despite the
We will highlight some issues that people who           health risks of malnutrition. Digital modification of
have recovered identified as contributing factors       images has also created an unrealistical over-muscular
to the development of an eating disorder and            beauty ideal for men. People have a diversity of
some strategies that have been shared with us           backgrounds and come in all shapes and sizes, and
regarding recovery. It is important to note that not    most do not physically meet these narrow undrealistic
all conditions are experienced by everyone who has      definitions of beauty. Beauty ideals used as a standard
a lived experience of an eating disorder. They are      of comparison, can cause dissatisfaction, low self-
meant to give an insight into some commonalities        esteem and a lack of self worth when not achieved.
and to offer some understanding about the
                                                        The fad diet industry sells the ‘thin as ideal’ concept,
complexities of why a person may develop an
                                                        and promotes diet products, artificial sweeteners,
eating disorder, in the context of having no clinical
                                                        diet pills, diet shakes, food group restriction, fad
evidence to that end.
                                                        super foods, protein shakes, processed food, and the
                                                        like, as a way to make money from people’s feelings
Risk factors
                                                        of inadequacy. Not everyone who diets goes on to
Societal and cultural factors                           develop an eating disorder, but most people who have
Eating disorders are most prevalent in western          developed an eating disorder have dieted. Weight is
cultures and in those becoming westernised. The         seen as ‘the’ measure of health, instead of being one
way our society adversely affects our health is too     measure among various health measures.
broad to detail in this booklet, so we have made        Other complex factors that influence our body image,
a list of things that culturally contribute to low      how we eat and what we think include the following
self-esteem, negative body image, problematic           topics, too broad to cover thoroughly in this booklet.
eating behaviours and poor mental health. This
                                                        ÊÊ Our culture shames people into improving their
list is not exhaustive. It comes from the common
                                                           health at the same time as having a vast array of
stories individuals have shared with us about being
                                                           conflicting nutritional information.
affected by eating disorders.
                                                        ÊÊ“Fat phobia” promotes the myth that all
We are all influenced by social institutions. Social       overweight people are unhealthy, unhappy, eat
institutions include human languages; governments,         junk food, and are lazy, which is not the case.
the family, education, health, the law, and business
                                                        ÊÊ The advertising industry promotes the idea that we
including advertising, food and media corporations.
                                                           are incomplete and need to purchase a product to
Our society affects the way we speak, think and
                                                           be happy. This idea of being flawed, or incomplete,
relate to each other.
                                                           has seen the demand for cosmetic surgery grow
Societal influences that may affect the development        and a proliferation of cosmetic surgery procedures.
of eating disorders include the importance that
                                                        ÊÊ Hand-held computers with cameras, the arrival
is placed on our appearance, what is considered
                                                           of the digital age, and the general acceptance of
beautiful and what defines healthy eating. The
                                                           social media has increased the amount of ‘selfies’
ideals of beauty change over time. The present
                                                           being published. How you look and what you are
beauty ideal is considered young, white, tall, thin
                                                           doing is documented online.
and/or well-muscled, with flawless skin. Images we
see in popular media have been digitally altered        ÊÊ Patriarchy, sexism, racism, homophobia, ageism
10 Understanding Eating Disorders                          and seeing abled bodies as ideal.
Society perpetuates one unrealistic, often digitally
    Beauty and Worth                       altered, beauty ideal that most people don’t measure
    Cannot Be Measured                     up to. Many industries make money from people feeling
                                           inadequate or not good enough. Don’t be bound by
    Break free. Start a revolution.        society’s beauty ideals. Every body is unique, beautiful
    Love your body.                        and valuable regardless of weight, shape and size.

ÊÊ The sexual objectification of women and children,     the age of 15, or joining no-eating clubs at the age
   and the increasing sexual objectification of men      of eight.
ÊÊ The ‘pornification’ of human relations and sexual     According to the annual Mission Australia Youth
   relationships.                                        Survey, the largest youth survey in Australia, young
ÊÊ Access to an abundance of food, including             people consistently rank body image as being
   convenient, unhealthy processed food, which is        one of their top three concerns, along with family
   high in salt, sugar and trans fats. These are often   violence, and drug & alcohol issues.
   marketed to children.                                 ÊÊ Body dissatisfaction in Australian adolescents is
ÊÊ Plate and portion sizes have increased in a super-       at least 75% for girls and 50% for boys.
   size-me fast-food culture.                            ÊÊ Approximately 50% of girls and 33% of boys
ÊÊ Industrial farming and agriculture produces food         in Australia, believe they are overweight, when
   with fewer nutirents and encourages an over-             they are at a healthy weight and
   consumption of animal products.                       ÊÊ One in five girls try to lose weight through
ÊÊ We moralise about our food, declaring it is ‘good’       dangerous behaviours like not eating for two
   or ‘bad’, which manifests in judging ourselves on        days, taking laxatives, vomiting and smoking.
   what we eat.                                             (Wade and Wilksch, 2009)

ÊÊ Many people judge themselves and others largely       Research shows that teaching young people media
   on their physical appearance. ‘Body bullying’         literacy about body image helps prevent risk factors
   is increasing and has become more harmful,            that lead to the development of eating disorders.
   particularly in the new realm of cyber bullying.      (Wade and Wilksch, 2009). There is also much evidence
ÊÊ The increase in steroid abuse for body image          to suggest that health changes motivated by self-
   instead of athletic performance enhancement.          love and self-compassion are more successful than
                                                         those motivated by self-hatred.
ÊÊ 95% of people who engage in restrictive dieting
   fail to maintain their weight loss, over time         Sociologists have said that people who develop
   putting their lost weight back on and more.           eating disorders are like the ‘canary in the coal
                                                         mine’, in that they indicate how society’s messages
Our social messages are wrong if young men are
                                                         are affecting us all. Children are not born hating
turning to protein shakes and steroids for a ‘healthy’
                                                         their bodies, they learn that from society. What can
body image ideal, or if young women are saving for
                                                         you do to help reverse this process?
cosmetic surgery, having botox birthday parties at
                                                                              The Eating Disorders Association   11
Genetics and personality traits                           An individual’s temperament or personality may
                                                          also indicate a predisposition to developing an
There may be a genetic predisposition to
                                                          eating disorder, including the following traits:
eating disorders and research is being gathered
internationally to identify possible links with certain   ÊÊ a perfectionist
genes. The Anorexia Nervosa Genetics Initiative           ÊÊ high achiever
(ANGI) is a global effort to identify the genes that
                                                          ÊÊ disciplined
may contribute to eating disorders. The goal of
the study is to transform our knowledge about the         ÊÊ obsessive compulsive
causes of eating disorders and to work towards            ÊÊ rigid thinker
greater understanding and ultimately a cure for           ÊÊ sensitive
eating disorders. Researchers in the United States,
                                                          ÊÊ unassertive or passive
Sweden, Australia, and Denmark will collect clinical
information and blood samples from more than              ÊÊ avoidant or detached
8000 individuals, both with and without eating            ÊÊ eager to please
disorders. If you have suffered from anorexia             ÊÊ anxious
nervosa at any point in your life, you can help
                                                          ÊÊ depressive
achieve this goal.
                                                          ÊÊ stubborn or strong willed
To become part of this important research go to
www.angi.qimr.edu.au for the online survey.               Some of these traits can be seen as assets, however,
                                                          when coupled with restrictive dieting they may
Genetics may help explain why eating disorders            hasten the adverse effects of starvation and
can develop when there are certain factors                contribute to an increase in problematic eating
present like a family history of eating disorders,        disorder behaviours.
anxiety, depression, obsessive compulsive disorder,
substance abuse, or other mental health conditions.       Triggers for the onset of eating disorders
A predisposition to these issues may explain why
                                                          Common factors indicated as contributing to the
one person develops an eating disorder and
                                                          onset of eating disorders often involve a change,
another doesn’t. It may explain why some men
                                                          loss or trauma of some description, along with
in the starvation study made a full recovery, while
                                                          related stress, anxiety, depression and difficult
others developed binge eating. Genetics may
                                                          emotions. Despite having genetic or personality
explain if comorbidities develop or are exacerbated
                                                          predispositions to developing eating disorders, not
by the effects of starvation. For example, some
                                                          everyone with these predispositions will go on
people may have depression before developing an
                                                          to develop an eating disorder. Sometimes trigger
eating disorder, while others develop depression as
                                                          events are described as contributing to self-
a consequence of their eating disorder. Either way,
                                                          starvation and the development of eating disorders,
starvation exacerbates depression and other eating
                                                          and eating disorder behaviours are often described
disorders issues, such as binging and purging.
                                                          as ways to cope with life stressors.
Brain imaging research indicates that people
who develop anorexia have major differences in            Some of the stressors that can trigger eating
their brain functioning compared with control             disorders include the following:
populations. Perhaps genetic research can help            ÊÊ Major life changes or life stressors:
unlock information about genetic predispositions             adolescence, becoming an adult, menopause,
and the effects of starvation on the brain.                  ageing, changing schools, entering high school
                                                             or university, marriage, divorce, changing jobs,
                                                             moving house, and so on.
                                                          ÊÊ Trauma: death of family member, grief, loss,
                                                             bullying, being a victim of crime, sexual
                                                             violence, etc.
12 Understanding Eating Disorders
ÊÊ Occupational stress on body image: acting,            emotional, social and behavioural issues. These
   performance, dance, modelling, gymnastics,            problems are not likely to be the experiences of
   athletics, sport and fitness, or careers with an      families who actively seek to support their children,
   emphasis on your physical appearance.                 however, some family and peer problems identified
ÊÊ Physical illness that impedes appetite:               by people in recovery include:
   cystic fibrosis, diabetes, celiac disease, viruses,   ÊÊ having to deal with difficult decisions, or
   glandular fever or tonsillitis, etc.                     difficult emotions within the peer group or
Triggers can result in food restriction and weight
loss because people do not feel well enough to eat.      ÊÊ domestic violence, verbal abuse, sexual abuse,
Losing weight from grief, loss or illness may push          relationship difficulties
the individual into a state of malnutrition along        ÊÊ family or peer group drug and alcohol issues
with its detrimental effects on the mind and body.
                                                         ÊÊ bullying, including body bullying and cyber
Low self-worth, low self-esteem and the inability           bullying
to cope with difficult emotions and life stressors,      ÊÊ peer pressure to starve, vomit, use harmful
are very common for people with eating disorders.           diuretics or steroids
Food can be used as a means to cope emotionally.
                                                         ÊÊ pressures around physical appearance, body
Some may feel their eating patterns are the only            weight and shape or an over-emphasis on
thing that they can control when other aspects              fitness in the family home, at school or in peer
of their life seem out of control. As we receive            groups
cultural validation for food restriction and weight
                                                         ÊÊ high expectations to succeed in sport, creatively,
loss, people may continue to restrict or control food
                                                            academically or with a body image ideal
intake to try and increase positive worth and self
esteem.                                                  ÊÊ authoritarian parenting
                                                         ÊÊ dynamics that foster a fear of growing up, a
Others may use food to reflect on how they feel, so
                                                            desire to disappear or a desire to be noticed
low self-esteem and feeling out of control can be
mirrored in their relationship with food. Starvation,    ÊÊ identity confusion driving behaviours to fulfil
binging and purging can reflect a low self-worth            a sense of belonging or driving behaviours to
and feelings of guilt, shame or disgust in oneself.         express a sense of not belonging

Therefore strict control and loss of control over food   ÊÊ role models who do not have a positive body
and compensatory behaviours, can be seen ways to            image
cope with upheavals in one’s life, difficult emotions    ÊÊ family or peer conflict, confrontation or poor
and a low self-esteem.                                      communication.
Family problems and peer pressure                        People have described the above issues as
                                                         impacting on the development of their eating
Most people with eating disorders come from
                                                         disorder, but no one issue or person is
loving, nurturing and functional families with
                                                         responsible for an eating disorder. An inability
supportive peer groups. When someone develops
                                                         to develop one’s own identity as separate from
an eating disorder the whole family and friendship
                                                         parents, other family members or peers, can leave
circle can be affected, because eating disorders
                                                         a person unsure of who they are and what they are
often pose a serious threat to life. It is important
                                                         capable of. These issues and other complex factors
to understand that no one chooses to develop
                                                         underlying the reasons for developing an eating
an eating disorder and neither parents or carers
                                                         disorder are best addressed through therapy. Most
are responsible for the development of an eating
                                                         families want the best for their loved one and there
disorder. However, there can be a range of peer
                                                         is no doubt that supportive friends and family can
and family problems that contribute to complex
                                                         be vital to recovery.

                                                                               The Eating Disorders Association   13
Factors that maintain an eating disorder                 develop around gaining weight. In fact the fear of
                                                         gaining weight can be a much stronger motivator
Reinforcing aspects of weight loss creates an
                                                         than the reality of being physically compromised or
ambivalence to get well
                                                         dying from starvation. Hours can be spent looking
Weight loss can change your relationship to mind,        into mirrors with self-disgust. To avoid gaining
body and food in negative ways. For much of              weight, compensatory behaviours like purging or
human history food has been scarce and our minds         compulsive exercising can develop, despite being
focused on food for our survival. Today, despite an      malnourished and medically compromised from
abundance of food in Australia, cultural messages        starvation. Although adequate, regular nutrition is
say only a thin body is healthy. Being praised           vital for eating disorder recovery, adequate support
for weight loss can give a sense of achievement,         is not as simple as saying ‘just eat’ any more than
success, strong will power and feelings of being         it is to tell someone with a spider phobia that
special and happy. It is easy to want more validation    they step into a room full of spiders to get well.
and continue with restrictive eating, dieting rituals    Sometimes fat phobias can be so strong that the
of calorie counting, weighing food, excessive            idea of gaining weight in order to get well increases
exercising and engagement with harmful practices         anxiety levels, which can be disabling and counter
like vomiting or diuretic abuse.                         to recovery. Consequently, when starvation has
Developing a mental illness and phobias                  been the self imposed goal for such a long time the
                                                         brain changes in ways that are unhealthy, including
There comes a point when one’s physical and
                                                         an ambivalence to get well despite serious risks to
mental health becomes severely compromised by
starvation and related compensatory behaviours.
The effects of starvation on healthy bodies and          Starvation–binge–purge cycle
healthy minded people has been well documented,          Most people who struggle with eating issues
and demonstrates that levels of anxiety, depression,     engage in ‘black-and-white’ thinking. This means
moodiness, obsessiveness, compulsivity, rigidity,        moralising food as being ‘good’ or ‘bad’. Food
binging, purging and over-exercising can become          morals then affect our behaviour and the way we
exacerbated after severe food restriction. The           think about ourselves. We are good when we eat
effects of starvation can develop even if the            good food, and we are bad, or failures, when we
individual is not underweight. It is easy to deduct      don’t. We alternate between seeing ourselves as
that people who are predisposed with certain             either good or bad, perfect or a failure, on or off our
genes or to the personality traits of perfectionism,     diet. The dieting industry tries to convince us that
obsessiveness, rigid thinking or anxiety for example,    eating one piece of anything ‘bad’ will make us fat,
may experience the effects of starvation more            and if we are fat we are bad. In reality, one piece of
readily or intensely. Understandably, the intellect is   anything doesn’t make anybody fat. And fat doesn’t
one of the last qualities to be affected as we have      mean bad. Absolutely everybody is valuable.
evolved from people who needed their intellect in
                                                         It is a fairly common story that when a person
time of food scarcity. It is common for a person to
                                                         feels pressured to lose weight or to get healthy
be very unwell from starvation but continue to be a
                                                         they immediately think of restricting food or only
high academic achiever.
                                                         eating ‘good’ food. What constitutes good or bad
For some individuals who develop eating disorders,       food can depend on the fad diet being promoted
their mental health can be so compromised                at the time and sometimes staple food such as
that they develop an increasingly negative body          bread and essential fats are considered ‘bad’. Most
image or a distorted body image, for example the         people cannot maintain severe food restriction and
thinner they get, the larger they feel. Delusions        extreme hunger. It is very common for people to
can manifest, like the belief you will absorb            eat too quickly and eat too much when extremely
calories by holding food, or that water or the           hungry. When starvation leads to binging it can
air you breathe contains calories. Phobias can           evoke feelings of guilt and self-loathing. ‘Breaking’
14 Understanding Eating Disorders
our diet and eating something ‘bad’ means we have         of the cancer. Similarly, it can be useful to see the
‘blown it’ leading to feelings of being out of control.    eating disorder as the reason for the individual’s ill
 Of course, binging makes one feel ‘bad’ and so            health, not the individual or the family being the
 the cycle to be ‘good’, get healthy and lose weight       reason for it. For example, when someone is in a
 begins again, usually on a Monday. Binging can            state of high anxiety at a weigh in, thinking they
 also lead to purging behaviours like compensatory         have gained weight when in reality they have lost
 exercise, vomiting or laxative abuse with an ethos        weight, it offers an opportunity to highlight how the
 of redemption to ‘rid’ the amount of food eaten in        illness or the eating disorder affects their perception.
 the binge.                                                When someone throws a tantrum about eating a
                                                           meal, it often means the illness is having a powerful
People can spend decades being on and off diets
                                                           affect at that moment. With meal support it can be
and, as a consequence, feeling inadequate. The
                                                           useful to think we need to support our child to eat
diet–binge–purge cycle is maintained because
                                                           more than the illness allows them to eat. It is the
this way of life can become habitual and can help
                                                           illness that can make someone with anorexia upset
deal with underlying uncomfortable feelings. For
                                                           about the weight restoration that is needed for their
example, purging can bring with it a feeling of self-
                                                           survival. This separation can help carers understand
disgust, but also a sense of relief. It can be easy to
                                                           the illness and also help the individual separate
fall into familiar coping patterns and can mean an
                                                           the illness from their identity. Glimpses of recovery
inability to see yourself changing or getting better.
                                                           are apparent when the individual’s true personality
Strong identity with the eating disorder                   returns as a result of regular, adequate nutrition.
Someone with an eating disorder is often spending          Malnutrition
a lot of time obsessing about their weight and
                                                           Eating disorders are extremely complex medical
shape, and about food. Eating disorders may
                                                           conditions, exacerbated by the profound effects
be masking underlying issues, including why
                                                           of malnutrition within the brain. Only recently
self-starvation was imposed. Starvation can shift
                                                           have scientists had brain-imaging tools to examine
the focus of one’s life to incessant and intrusive
                                                           the neurobiology of eating disorders. Starvation
thoughts about food and eating disordered
                                                           or malnutrition, binging and purging and other
behaviour. These incessant thoughts are often
                                                           harmful behaviours can be maintained because of
interpreted as the ‘self’ rather than seeing the
                                                           the physiological responses compounding mental
thoughts and behaviours as being the result of the
                                                           illness and problematic behaviours. For example,
effects of starvation. The eating disordered thoughts
                                                           the starving brain loses volume and regresses, and
or behaviours can become a means of coping with
                                                           vitamin and mineral deficiencies can create hormone
other issues, and can create a false sense of security
                                                           loss, electrolyte imbalances, altered serotonin and
and perceived control over life.
                                                           dopamine metabolism, and sleep disruption, which
Separating or externalising the eating disordered          can affect our fear and stress response to food,
thoughts and related behaviours can be very useful         anxiety, mood, body image distortion and further
in recovery. We all have negative thoughts but             mental health problems. More research is being
often they are balanced with positive thoughts.            conducted to ascertain the causes of differences in
Sometimes when someone develops an eating                  brain imaging for people with eating disorders in
disorder, the healthy self, true self, or the positive     hope for new treatments. Many people with eating
thoughts are overpowered by incessant critical             disorders are relieved to know that their brains are
thoughts that rule one’s behaviour. When these             working differently to control groups. The discovery
negative thoughts become fused with one’s identity,        of neuroplasticity, that our thoughts can change the
there can be a denial that there is a problem and an       structure and function of our brains, is an important
ambivalence to change.                                     breakthrough in our understanding of the brain and
If a child is affected by a cancerous tumour, it is easy   means that despite the effects of eating disorders on
to see that the child’s ill health is a consequence        the brain, most people can and do recover.

                                                                                  The Eating Disorders Association   15
Eating disorders
    run deep
    The deeper you sink under the
    weight of an eating disorder
    the darker it gets. It’s like being
    tied to an anchor, it happens so
    fast that it blindsides you. The
    impact of the negative rigid
    thinking of an eating disorder,
    interprets things as all or
    nothing, black or white, perfect
    or a failure, rather than a sea of
    Recovery can mean finding
    your worth and realising that
    no one is perfect.

16 Understanding Eating Disorders

            Clinical Diagnosis Of Eating Disorders
What Is Anorexia Nervosa?
The most obvious characteristic of someone             There are two subtypes of anorexia nervosa:
who has developed anorexia nervosa is                  1. Restricting type
significant, deliberate, self-starvation and              During the last three months, the individual
consequent weight loss, together with an                  has not engaged in recurrent episodes of
intense fear of being fat irrespective of their           binge eating or purging behaviour (specifically,
current weight and shape. Initially, behaviour            self-induced vomiting, or the misuse of
around developing anorexia may be difficult               laxatives, diuretics, or enemas). This subtype
to distinguish from normal dieting, but it                describes presentations in which weight loss is
soon becomes obvious that the behaviour has               accomplished primarily through dieting, fasting,
an abnormal drive and resolve to it, and it is            and/or excessive exercise.
relentlessness. Anorexia nervosa is a serious
                                                       2. Binge eating or purging type
and complex mental health condition and
                                                          During the last three months, the individual has
people may die if it is left untreated.
                                                          engaged in recurrent episodes of binge eating
To be diagnosed with anorexia nervosa using the           or purging behaviour (specifically self-induced
DSM-5 Diagnostic tool, a person will meet the             vomiting, or the misuse of laxatives, diuretics, or
following criteria:                                       enemas).
ÊÊ Restriction of energy intake relative to            The minimum level of severity is based, for adults,
   requirements, leading to a significantly            on current body mass index (BMI) or, for children
   low body weight in the context of age,              and adolescents, on BMI percentile. The ranges
   sex, developmental trajectory, and physical         below are derived from World Health Organization
   health. Significantly low weight is defined as      categories for thinness in adults. For children and
   a weight that is less than minimally normal         adolescents, corresponding BMI percentiles should
   or, for children and adolescents, less than that    be used. The level of severity may be increased to
   minimally expected.                                 reflect clinical symptoms, the degree of functional
ÊÊ Intense fear of gaining weight or becoming          disability, and the need for supervision.
   fat, or persistent behaviour that interferes with
                                                           Mild Anorexia: ≥ 17 BMI
   weight gain, even though the person is a at
   significantly low weight.                               Moderate Anorexia: 16–16.99 BMI
ÊÊ Disturbance in the way in which one’s body              Severe Anorexia: 15–15.99 BMI
   weight or shape is experienced, undue                   Extreme Anorexia: < 15 BMI
   influence of body weight or shape on self-
                                                           (American Psychiatric Association, 2013)
   evaluation, or persistent lack of recognition of
   the seriousness of the current low body weight.

                                                                                The Eating Disorders Association   17
BMI vs Body Mass Composition
Body Mass Index ( BMI ) is a measurement of a          ÊÊ fine hair appearing on face and body (bodies
person’s weight in relation to their height.              response to stay warm)
The world Health Organisation BMI scale indicates;     ÊÊ loss or disturbance of menstrual periods in
    Underweight: < 18.5 BMI
                                                       ÊÊ decreased libido.
    Health weight range: 18.5–25 BMI
                                                       Psychological signs
    Overweight: 25–30 BMI
                                                       ÊÊ preoccupation with eating, food, body shape
    Obese: 30 + BMI                                       and weight
The problem with BMI is that it does not reflect       ÊÊ feeling anxious and/or irritable around meal
the changes in body composition when weight               times
changes. Body mass composition indicates what          ÊÊ an intense fear of gaining weight
percentage of the body is fat, water, protein,
                                                       ÊÊ refusal to maintain a normal body weight for
mineral, bones, organs, etc. Malnutrition can be
                                                          the person’s age and height
defined as a loss of body cell mass which includes
non-fat cellular components of tissues, skeletal       ÊÊ depression and anxiety
muscle, internal organs, blood and brain. The BMI      ÊÊ slowing down of thinking and an increased
measure does not give you this figure. For example,       difficulty concentrating
two people with a BMI of 20 may have different
                                                       ÊÊ ‘black-and-white’ thinking or rigid thoughts
body compositions, one may be suffering from
                                                           about food being good or bad, which extends
malnutrition and the other may not.
                                                           to feelings of being perfect or a failure
Warning signs of anorexia nervosa                      ÊÊ having a distorted body image (for example,
                                                          seeing themselves as fat when in reality they are
Contrary to popular myths, most people with
anorexia nervosa do eat, just not enough to sustain
themselves. Although the term ‘anorexia nervosa’       ÊÊ low self esteem
is derived from the Greek word meaning loss of         ÊÊ increased sensitivity to comments relating to
appetite, a person can retain an intense appetite         food, weight, body shape, exercise
and interest in food.                                  ÊÊ extreme body image dissatisfaction.
The warning signs of anorexia nervosa can be           Behavioural signs
physical, psychological and behavioural and include:
                                                       ÊÊ dieting behaviour, for example, fasting, skipping
Physical signs                                            meals, counting calories/kilojoules, and avoiding
ÊÊ rapid weight loss or frequent changes in weight        food groups such as fats and carbohydrates.
                                                          Becoming a vegetarian is common, but is often
ÊÊ fainting or dizziness
                                                          more aligned with restricting food groups than
ÊÊ feeling cold most of the time, even in warm            for animal liberation reasons. Other radical
   weather (caused by poor circulation)                   changes can include suddenly disliking food
ÊÊ feeling bloated, constipated, or developing            they have always enjoyed, and reporting of
   intolerances to certain foods                          food allergies and intolerances
ÊÊ feeling tired, lethargic and not sleeping well      ÊÊ laxatives, appetite suppressants, enemas and
ÊÊ facial changes to pale looking, sunken eyes,           diuretics misuse
   brittle hair

18 Understanding Eating Disorders
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