An eating disorder can be devastating to a person’s life, health and relationships. Let’s understand a bit more about these conditions…
***Trigger warning — this post makes brief reference to sexual abuse and sexual violence***
‘I am forever engaged in a silent battle in my head over whether or not to lift the fork to my mouth, and when I talk myself into doing so, I taste only shame.’ Jena Morrow, Hollow: An Unpolished Tale
Eating disorders are a huge — but sadly still often invisible — issue in our society. In fact, it is estimated that between 1.25 and 3.4 million people in the UK alone are affected by an eating issue. What’s more, these conditions are responsible for more loss of life than any other mental health condition. And over the past thirty years, they have actually been on the increase.
It is crucial that action is taken sooner rather than later as the earlier a person gets help, the better their chances are of recovery. This is why we’ll be taking a look at some of the different ways eating disorders can show up in an individual’s life, as well as common causes of these conditions and recommended therapies.
When people think of eating disorders, they often think of the two best known ones: anorexia and bulimia. Yet there are actually a number of different issues around food and eating that people can develop, including the following:
— Avoidant Restrictive Food Intake Disorder (ARFID) — this is a very strong sensitivity and distaste for foods with certain tastes, smells, textures, temperatures or appearance, or just a low interest in eating in general. However, ARFID is more than just ‘picky eating’ as it can have a significant impact on a person’s life and wellbeing.
— Anorexia Nervosa — a severe fear of gaining weight, even when dangerously underweight. As well as restricting calorie intake, people with anorexia might also keep weight low via extreme exercise or purging through laxatives. They often also have a distorted body image and see themselves as bigger than they really are.
— Bulimia Nervosa — an obsessive desire to lose weight combined with bouts of binge eating. These binges are then followed by vomiting, purging, fasting or extreme exercise.
— Binge Eating — regularly consuming large amounts of food in a short amount of time, in a way that you feel you can’t control or stop.
— Orthorexia — an unhealthy obsession with eating healthily, so much so that trying to stick to the perfect diet can disrupt your life.
However, it’s important to note that people often move between these (and other) categories and that there are many core commonalities between them. In fact, most people don’t actually fit into these categories and are grouped into what’s known as the EDNOS (Eating Disorder Not Otherwise Specified) category. There are many ways in which someone’s relationship with food can become unhealthy — for example comfort eating to soothe painful feelings — but these don’t necessarily fall into neat diagnostic categories. That is why it’s usually more helpful to focus on a person’s specific eating behaviours — and the underlying functions and mechanisms of them — rather than focusing on a specific diagnosis.
Over the years, research has shown that the causes of eating disorders are complex and can’t be reduced to one simple explanation such as family relationships. In fact, attempts by researchers to find a single explanation for the different disorders have actually proven to be fruitless.
Instead, eating issues seem to be down to a range of factors that can show up in different combinations for each individual. These can include mental, emotional, cognitive, cultural, social, familial, environmental and perhaps even genetic. But what is often true for people affected by this kind of disorder is that it begins with some form of preoccupation with food or eating and then, like a virus, slowly takes hold of their thoughts, body and life.
However, the most important thing to remember is that an individual’s relationship with food and eating will always be pointing to deeper issues — there will be something else going on underneath the eating disorder. In fact, the ‘disordered’ eating patterns will usually be a coping mechanism for these deeper issues. In other words, the condition itself is not the sole issue and instead, is a surface symptom of underlying mental and emotional distress.
That said, researchers have found a number of key risk factors for developing eating issues. These can include personality traits, culture and trauma (however, not all people with eating issues have had a traumatic experience).
In terms of personality traits, some could include:
1. A previous background of anxiety or depression that started before the eating disorder.
2. Being quite sensitive to things that are happening in your environment, for instance, moving house or conflicts between family members.
3. Perfectionist or people pleasing tendencies. For instance, you might feel you always have to show your best or ideal self to others, or be quite competitive and driven to succeed.
4. Tendencies towards obsessive and compulsive behaviours, or rigid thinking.
5. A difficulty in making big life decisions, for instance, what to do with your future.
Cultural and social factors can also have an impact. For instance, depending on the specific eating issue, you might have internalised messages from family, peers and the media that ‘I’m not acceptable’ or ‘I don’t fit in’ if your body doesn’t look a certain way. You may have been humiliated by something someone said about your appearance or you might be looking to find a sense of connection through having the ‘right body’ and see it as a route to feeling worthy, valuable and secure — particularly if you’ve grown up in an environment where there was frequent criticism. Or you might be in a career or sport where there is pressure to be a certain weight, for instance, modelling or dance. Or you just might have grown up in an environment where there was a strong focus on image and thinness, or people said negative comments about other people’s bodies. That said, as we will explore in our second post, not all eating disorders are about body shape or weight.
Finally, you might have been through a trauma, loss or some kind of abuse. This could have left you feeling out of control and helpless, meaning that you use behaviours and rituals around eating to numb your feelings or even to create different kinds of feelings. If you grew up in an environment where there wasn’t support for difficult emotions or certain emotions weren’t allowed, eating behaviours might have developed as ways of getting rid of those feelings. Also, if you have experienced sexual abuse or violence, then it might have caused you to consciously or unconsciously change your body type as a protective mechanism, to become the opposite of what the abuser wanted (for instance, by gaining or losing weight).
A number of therapeutic approaches can help with eating disorders. These include CBT (Cognitive Behavioural Therapy), which can help you to make links between disordered patterns of eating and your thoughts, emotions and bodily sensations. CBT can also help you to identify any triggers that you might have around eating, plus challenge both your fears about weight gain and any negative beliefs you have about yourself. Similarly, therapies such as CFT (Compassion-Focused Therapy) and ACT (Acceptance and Commitment Therapy) might both take the approach of helping you to manage the harsh inner critical voice that is often a strong feature of these disorders.
If you feel that you sometimes struggle with regulating your emotions and communicating your needs, then DBT (Dialectical Behaviour Therapy) can also be helpful. DBT can help you to learn new and better ways of managing feelings and triggers that don’t involve disordered eating, plus it can also help you to develop greater self-acceptance.
Another good approach is Schema Therapy, which can help you to understand the links between your unmet needs and disordered eating, while trauma–based therapy EMDR (Eye Movement Desensitisation Reprogramming) can target any upsetting memories that might underlie the eating issues, helping you to process and release them.
Peer support systems like Beat can also be really helpful, but whichever route you choose, it is important to have a medical monitoring system in place alongside any therapy. This is because there are real physical health risks that have to be managed and tracked, especially when a person’s weight is very low or if they are vomiting. Guidance from a specialist dietitian can also be helpful and ideally, a multifaceted approach of therapy, peer support, medical support and nutritional support all working in harmony is best. So make sure that if you are seeking therapy for an eating disorder, you also speak to a GP or medical advisor.
Finally, if you are helping a loved one with an eating condition and want to understand more about it all, then this Guide for Friends & Family from Beat might help.
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