15. Eating Disorders ( Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, OSFED )

Eating Disorders

By John M. Grohol, Psy.D.

Eating disorders are one of the unspoken secrets that affect many families. Millions of Americans are afflicted with this disorder every year, and most of them -- up to 90 percent -- are adolescent and young women. Rarely talked about, an eating disorder can affect up to 5 percent of the population of teenage girls.

Why are adolescent and young women so susceptible to getting an eating disorder? According to the National Institute of Mental Health, it is because during this period of time, women are more likely to diet to try and keep a slim figure and/or try stringent dieting. Certain sports (such as gymnastics) and careers (such as modeling) are especially prone to reinforcing the need to keep a fit figure, even if it means purging food or not eating at all.

There are three main types of eating disorders:

• Anorexia
• Bulimia
• Binge Eating Disorder

Anorexia (also known as anorexia nervosa) is the name for simply starving yourself because you are convinced you are overweight. If you are at least 15 percent under your normal body weight and you are losing weight through not eating, you may be suffering from this disorder.

Bulimia (also known as bulimia nervosa) is characterized by excessive eating, and then ridding yourself of the food by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. This behavior of ridding yourself of the calories from consumed food is often called "purging."

A person who suffers from this disorder can have it go undetected for years, because the person's body weight will often remain normal. "Binging" and "purging" behavior is often done in secret and with a great deal of shame attached to the behavior. It is also the more common eating disorder.

Eating disorders are serious problems and need to be diagnosed and treated like any medical disease. If they continue to go untreated, these behaviors can result in future severe medical complications that can be life-threatening.

Treatment of eating disorders nearly always includes cognitive-behavioral or group psychotherapy. Medications may also be appropriate and have been found effective in the treatment of these disorders, when combined with psychotherapy.

If you believe you may be suffering from an eating disorder or know someone who is, please get help. Once properly diagnosed by a mental health professional, such disorders are readily treatable and often cured within a few months' time.

A person with an eating disorder should not be blamed for having it! The disorders are caused by a complex interaction of social, biological and psychological factors which bring about the harmful behaviors. The important thing is to stop as soon as you recognize these behaviors in yourself, or to get help to begin the road to recovery.

Anorexia (Anorexia Nervosa) Symptoms

By PSYCH CENTRAL STAFF

People who intentionally starve themselves suffer from an eating disorder called anorexia nervosa. The  disorder, which usually begins in young people around the time of puberty, involves extreme weight loss that is less than what is considered minimally normal. Many people with the disorder look emaciated  but are convinced they are overweight. Sometimes they must be hospitalized to prevent starvation.

People with anorexia typically starve themselves, even though they suffer  terribly from hunger pains. One of the most frightening aspects of the disorder is that people with  anorexia continue to think they are overweight even when they are bone-thin. For reasons not yet  understood, they become terrified of gaining any weight.

Food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. It is not uncommon for people with anorexia to collect recipes and prepare gourmet feasts for family and friends, but not partake in the meals themselves. They may adhere to strict exercise routines to keep off weight. Loss of monthly menstrual periods is typical in women with the disorder. Men with anorexia often become impotent.

Specific Symptoms of Anorexia

A person who suffers from this disorder is typically characterized by their refusal to maintain a body weight which is consistent with their build, age and height. The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used.

The individual usually experiences an intense and overwhelming fear of gaining weight or becoming fat. This fear is regardless of the person’s actual weight, and will often continue even when the person is near death from starvation. It is related to a person’s poor self-image, which is also a symptom of this disorder. The individual suffering from this disorder believes that their body weight, shape and size is directly related to how good they feel about themselves and their worth as a human being. Persons with this disorder often deny the seriousness of their condition and can not objectively evaluate their own weight.

Many women with anorexia develop amenorrhea, or the absence of her menstrual period, but this is no longer a required criteria in the updated 2013 DSM-5 to receive an anorexia diagnosis.

There are two types of anorexia nervosa:

• Restricting type– The person restricts their food intake on their own and does not  engage in binge-eating or purging behavior.
• Binge eating/purging type — The person self-induces vomiting or  misuses laxatives, diuretics, or enemas.

Body Mass Calculator:

Body Mass Index or BMI is a tool for indicating weight status in adults. It is a measure of a person’s weight in relation to their height. Below are the BMI ranges corresponding to degree of severity in anorexia.

• Mild: BMI ≥ 17 kg/m²
• Moderate: BMI 16–16.99 kg/m²
• Severe: BMI 15–15.99 kg/m²
• Extreme: BMI < 15 kg/m²

Bulimia (Bulimia Nervosa) Symptoms

By PSYCH CENTRAL STAFF

People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia “binge and purge” in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years.
Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia.
As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behavior is deeply ingrained and more difficult to change.

Specific Symptoms of Bulimia

This disorder is characterized by recurrent episodes of binge eating, occurring at least twice a month for a minimum of 3 months, which consists of:

• Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
• A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

Additionally, the criteria for Bulimia Nervosa requires recurrent, inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. A person’s self-image is usually directly correlated with their weight, with a great deal of attention focused on how their body looks.
This disorder can only be diagnosed if it is not better accounted for by anorexia nervosa.
The level of severity of a bulimia diagnosis is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of disability caused to the person.

• Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week.
• Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week.
• Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week.
• Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.

Body Mass Calculator:

Body Mass Index or BMI is a tool for indicating weight status in adults. It is a measure of a person’s weight in relation to their height. Individuals with bulimia nervosa typically are within the normal weight or overweight range (body mass index [BMI] ≥ 18.5 and < 30 in adults).
Formerly, in the fourth diagnostic manual (DSM-IV), there were two types of bulimia nervosa:

• Purging Type: The person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
• Non-purging Type: The person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Now, according to 2013 DSM-5, these specifiers no longer exist (remain listed here for historical/informational purposes only). The deletion of the purging/non-purging specifier types was made with the rationale that compensatory behaviors may change from purging (e.g., using laxatives) to non-purging forms (e.g., extreme dieting) within the same individual over the course of the disorder.

Symptoms of Binge Eating Disorder

By JOHN M. GROHOL, PSY.D.

The defining characteristic of binge eating disorder is recurrent episodes of binge eating that occur, on average, at least once per month (for at least 3 months). Binge eating is eating an abnormally more amount of food than a person would normally eat in a similar period of time. The specific type of food doesn’t matter — what matters is the sheer amount of food consumed in one sitting.
People with binge-eating disorder (BED) often feel ashamed and embarrassed by their eating issues, and may attempt to conceal their symptoms. Binge eating usually occurs in secrecy, or at least as inconspicuously as possible. After a binge eating episode, people with this disorder often feel depressed and ashamed of themselves.
The prevalence of binge eating disorder is 1.6 percent for females and 0.8 percent for males.

Specific Symptoms of Binge-Eating Disorder

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

• Eating, in a discrete period of time (e.g., within any 2 hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
• A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

2. The binge-eating episodes are associated with 3 or more of the following:

• Eating much more rapidly than normal.
• Eating until feeling uncomfortably full.
• Eating large amounts of food when not feeling physically hungry.
• Eating alone because of feeling embarrassed by how much one is eating.
• Feeling disgusted with oneself, depressed, or very guilty afterward.

3. Marked distress regarding binge eating is present.
4. The binge eating occurs, on average, at least once a week for 3 months.
5. The binge eating is not associated with the recurrent use of inappripriate compensatory behavior, as in bulimia, and does not occur exclusively during the course of bulimia or anorexia.
Specify if:
In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.
In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.
Severity is also noted in the diagnosis, from mild to extreme:

• Mild: 1-3 binge-eating episodes per week
• Moderate: 4-7 episodes
• Severe: 8-13 episodes
• Extreme: 14 or more episodes

What is an eating disorder?

Eating disorders are serious mental illnesses; they are not a lifestyle choice or a diet gone ‘too far.’

Eating disorders are associated with significant physical complications and increased mortality. The mortality rate for people with eating disorders is the highest of all psychiatric illnesses, and over 12 times higher than that for people without eating disorders.

Eating disorders occur in both men and women, young and old, rich and poor, and from all cultural backgrounds. About one in 20 Australians has an eating disorder and the rate in the Australian population is increasing.

There are four eating disorders that are recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM), which are Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and Other Specified Feeding and Eating Disorders (OSFED). 

Eating disorders defy classification solely as mental illnesses as they not only involve considerable psychological impairment and distress, but they are also associated with major wide-ranging and serious medical complications, which can affect every major organ in the body.

Approximately 15% of Australian women experience an eating disorder during their lifetime.

Many people who have eating disorders also present with depression, anxiety disorders, personality disorders or substance abuse problems.

Signs and symptoms

Due to the nature of an eating disorder many of the characteristic behaviours may be concealed. A person with an eating disorder may go to great lengths to hide, disguise or deny their behaviour, or do not recognise that there is anything wrong.

A person with an eating disorder may have disturbed eating behaviours coupled with extreme concerns about weight, shape, eating and body image.

Find out more about the warning signs

Onset and Duration

While adolescence represents a peak period of onset, eating disorders can occur in people of all ages.

Regardless of the age of a person at the time their eating disorder begins, there can often be a considerable period of time between onset and the time of first treatment. Furthermore, the person may see a number of health professionals before receiving a correct diagnosis. This delay is likely to negatively influence the duration of the eating disorder and the outcomes of treatment.

Evidence shows that early diagnosis and intervention can greatly reduce the duration and severity of an eating disorder. It is therefore vital to seek professional help at the earliest possible time.

Find out more about risk factors and protective factors

Eating disorders and other mental health issues

A person with an eating disorder will often be diagnosed with another mental health problem. Dual diagnosis or co-morbidity refers to the presence of one or more diseases or disorders in one individual.

There is a high level of co-morbidity of psychiatric illnesses with eating disorders. Eating disorders are most commonly accompanied by depression and anxiety disorders; however, substance abuse and personality disorders are prevalent in people with eating disorders. In fact, research suggests that approximately 60% of people with an eating disorder will also meet diagnosis for one of these other psychological disorders.

Download the Beyond Blue fact sheet: Eating Disorders, Depression and Anxiety

Recovery is possible

Eating disorders are serious, potentially life threatening mental and physical illnesses, however with appropriate treatment and a high level of personal commitment, recovery from an eating disorder is achievable.

Evidence shows that the sooner you start treatment for an eating disorder, the shorter the recovery process will be. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. If you suspect that you or someone you know has an eating disorder it is important to seek help immediately.

Anorexia Nervosa

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.

Symptoms

• Inadequate food intake leading to a weight that is clearly too low.
• Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain.
• Self-esteem overly related to body image.
• Inability to appreciate the severity of the situation.
• Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.
• Restricting Type does not involve binge eating or purging.

Eating disorders experts have found that prompt intensive treatment significantly improves the chances of recovery.  Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.

Warning Signs

• Dramatic weight loss.
• Preoccupation with weight, food, calories, fat grams, and dieting.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
• Frequent comments about feeling “fat” or overweight despite weight loss.
• Anxiety about gaining weight or being “fat.”
• Denial of hunger.
• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
• Consistent excuses to avoid mealtimes or situations involving food.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health Consequences of Anorexia Nervosa

Anorexia nervosa involves self-starvation.; The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences:

• Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing.  The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower.
• Reduction of bone density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin, hair loss is common.
• Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

About Anorexia Nervosa

• Approximately 90-95% of anorexia nervosa sufferers are girls and women.
• Between 0.5–1% of American women suffer from anorexia nervosa.
• Anorexia nervosa is one of the most common psychiatric diagnoses in young women.
• Between 5-20% of individuals struggling with anorexia nervosa will die.  The probabilities of death increases within that range depending on the length of the condition.
• Anorexia nervosa has one of the highest death rates of any mental health condition. 
• Anorexia nervosa typically appears in early to mid-adolescence.

Bulimia Nervosa

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Symptoms

• Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
• A feeling of being out of control during the binge-eating episodes.
• Self-esteem overly related to body image.

The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

Warning Signs of Bulimia Nervosa

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
• Unusual swelling of the cheeks or jaw area.
• Calluses on the back of the hands and knuckles from self-induced vomiting.
• Discoloration or staining of the teeth.
• Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
• Continued exercise despite injury; overuse injuries.

Health Consequences of Bulimia Nervosa

Bulimia nervosa can be extremely harmful to the body.  The recurrent binge-and-purge cycles can damage the entire digestive system and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.  Some of the health consequences of bulimia nervosa include:

• Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death.  Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
• Inflammation and possible rupture of the esophagus from frequent vomiting.
• Tooth decay and staining from stomach acids released during frequent vomiting.
• Chronic irregular bowel movements and constipation as a result of laxative abuse.
• Gastric rupture is an uncommon but possible side effect of binge eating.

About Bulimia Nervosa

• Bulimia nervosa affects 1-2% of adolescent and young adult women.
• Approximately 80% of bulimia nervosa patients are female.
• People struggling with bulimia nervosa usually appear to be of average body weight.
• Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.
• Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.
• Risk of death from suicide or medical complications is markedly increased for eating disorders

Binge Eating Disorder

Binge Eating Disorder (BED) is a type of eating disorder that is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.

Symptoms

• Frequent episodes of consuming very large amount of food but without behaviors to prevent weight gain, such as self-induced vomiting.
• A feeling of being out of control during the binge eating episodes.
• Feelings of strong shame or guilt regarding the binge eating.
• Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior.

Health Consequences of Binge Eating Disorder

The health risks of BED are most commonly those associated with clinical obesity.  Some of the potential health consequences of binge eating disorder include:

• High blood pressure
• High cholesterol levels
• Heart disease
• Diabetes mellitus
• Gallbladder disease
• Musculoskeletal problems

About Binge Eating Disorder

• The prevalence of BED is estimated to be approximately 1-5% of the general population.
• Binge eating disorder affects women slightly more often than men--estimates indicate that about 60% of people struggling with binge eating disorder are female, 40% are male
• People who struggle with binge eating disorder can be of normal or heavier than average weight.
• BED is often associated with symptoms of depression.
• People struggling with binge eating disorder often express distress, shame, and guilt over their eating behaviors.
• People with binge eating disorder report a lower quality of life than non-binge eating disorder.

Other Specified Feeding or Eating Disorder

Formerly described at Eating Disorders Not Otherwise Specified (EDNOS) in the DSM-IV, Other Specified Feeding or Eating Disorder (OSFED), is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.

Examples of OSFED Include:

• Atypical anorexia nervosa (weight is not below normal)

• Bulimia nervosa (with less frequent behaviors)
• Binge-eating disorder (with less frequent occurrences)
• Purging disorder (purging without binge eating)
• Night eating syndrome (excessive nighttime food consumption)

The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school or relationships. If something does not seem right, but your experience does not fall into a clear category, you still deserve attention. If you are concerned about your eating and exercise habits and your thoughts and emotions concerning food, activity and body image, we urge you to consult an ED expert.

Symptoms associated with anorexia nervosa include:

• Inadequate food intake leading to a weight that is clearly too low.

• Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain.

• Self-esteem overly related to body image.
• Inability to appreciate the severity of the situation.
• Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.
Restricting Type does not involve binge eating or purging.

Symptoms associated with bulimia nervosa include:

• Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.

• A feeling of being out of control during the binge-eatingepisodes.

• Self-esteem overly related to body image.

Symptoms associated with binge eating disorder include:

• Frequent episodes of consuming very large amount of food but without behaviors to prevent weight gain, such as self-induced vomiting.
• A feeling of being out of control during the binge eating episodes.
• Feelings of strong shame or guilt regarding the binge eating.
• Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior.

Additional Eating or Feeding Disorders

Avoidant/Restrictive Food Intake Disorder

• Failure to consume adequate amounts of food, with serious nutritional consequences, but without the psychological features of Anorexia Nervosa.
• Reasons for the avoidance of food include fear of vomiting or dislike of the textures of the food.

Pica

• The persistent eating of non-food items when it is not a part of cultural or social norms.

Rumination Disorder

• Regurgitation of food that has already been swallowed. The regurgitated food is often re-swallowed or spit out.

Unspecified Feeding or Eating Disorder

• When behaviors do not meet full criteria for any of the other feeding and eating disorders, but still cause clinically significant problems.
• Alternatively, when clinician is unable to assess whether an individual meets criteria for another disorder, for example, when there is a lack of information in an emergency situation.

What is Anorexia Nervosa?

Anorexia is a serious, potentially life threatening mental illness.

A person with Anorexia Nervosa has not made a ‘lifestyle choice’, they are actually very unwell and need help.

The reasons behind the development of Anorexia will differ from person to person; known causes include genetic predisposition and a combination of environmental, social and cultural factors.

For some people, restricting their food and weight can be a way of controlling areas of life that feel out of their control and their body image can come to define their entire sense of self worth. It can also be a way of expressing emotions that may feel too complex or frightening such as pain, stress or anxiety.

Restrictive dieting and excessive exercise can be contributing factors to the onset of Anorexia. Women and girls with Anorexia may use dieting behaviour in a bid to achieve a culturally constructed thin ideal whereas men may over exercise and control their diet to achieve a muscular body.

It is commonly accepted that Anorexia is more frequently diagnosed in females across the ages. However, a recent population study has suggested that in adolescents, there are an equal number of males and females suffering from this illness.

Defining Anorexia Nervosa

Restricted energy intake

A person with Anorexia is unable to maintain what is considered to be a normal and healthy weight. They could also have lost a considerable amount of weight in a short period of time.

A fear of gaining weight

Even when people with Anorexia are underweight, starved or malnourished they still possess an intense fear of gaining weight or becoming overweight.

Disturbed body image

When someone has Anorexia the amount of attention they place on their body image can be enormous. The person’s self worth can become entirely defined by the way they think they look. A person with Anorexia can also develop a distorted view of their body. They may see themselves as overweight when in reality they are dangerously underweight. Frequently there is a preoccupation with certain body parts, particularly the abdomen, buttocks and thighs.

Sub-types of Anorexia Nervosa

There are two subtypes of Anorexia, and both are very serious mental illnesses that require treatment.

Restricting Subtype

People with this subtype place severe restrictions on the amount and type of food they consume. This can manifest in different ways including some or all of the following:

• Restricting certain food groups (e.g. carbohydrates, fats)
• Counting calories
• Skipping meals
• Obsessive rules and rigid thinking (e.g. only eating food that is one colour)

These restrictive behaviours around food can be accompanied by excessive exercise.

Binge Eating/Purging Subtype

People with this subtype also place severe restriction on the amount and type of food they consume. In addition to this the person will display purging behaviour and may also engage in binge eating. Binge eating involves eating a large amount of food and feeling a ‘loss of control’. Purging behaviour involves self induced vomiting, or deliberately misusing laxatives, diuretics or enemas to compensate for eating food.

What are the warning signs of Anorexia?

Having awareness about Anorexia and its signs and symptoms can make a huge difference to the duration and severity of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.

Someone with Anorexia may display any combination of the following warning signs.

Physical Signs

• Rapid weight loss or frequent weight changes
• Loss or disturbance of menstruation in girls and women and decreased libido in men
• Fainting or dizziness
• Feeling cold most of the time, even in warm weather (caused by poor circulation)
• Feeling bloated, constipated, or the development of intolerances to food
• Feeling tired and not sleeping well
• Lethargy and low energy
• Facial changes (e.g. looking pale, sunken eyes)
• Fine hair appearing on face and body

Psychological Signs

• Preoccupation with eating, food, body shape and weight
• Feeling anxious and/or irritable around meal times
• Intense fear of gaining weight
• Unable to maintain a normal body weight for their age and height
• Depression and anxiety
• Reduced capacity for thinking and increased difficulty concentrating
• ‘Black and white’ thinking (e.g. rigid thoughts about food being ‘good’ or ‘bad’)
• Having a distorted body image (e.g. seeing themselves as overweight when they are actually underweight)
• Low self esteem and perfectionism
• Increased sensitivity to comments relating to food, weight, body shape, exercise
• Extreme body image dissatisfaction

Behavioural Signs

• Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)
• Deliberate misuse of laxatives, appetite suppressants, enemas and diuretics
• Repetitive or obsessive behaviours relating to body shape and weight (e.g. repeated weighing, looking in the mirror obsessively and pinching waist or wrists)
• Evidence of binge eating (e.g. disappearance or hoarding of food)
• Eating in private and avoiding meals with other people
• Anti-social behaviour (spending more and more time alone)
• Secrecy around eating (e.g. saying they have eaten when they haven’t, hiding uneaten food)
• Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
• Radical changes in food preferences (e.g. suddenly disliking food they have always enjoyed in the past, reporting of food allergies or intolerances, becoming vegetarian)
• Obsessive rituals around food preparation and eating (e.g. eating very slowly, cutting food into very small pieces, insisting that meals are served at exactly the same time everyday)
• Preoccupation with preparing food for others, recipes and nutrition
• Self harm, substance abuse or suicide attempts

 Find out more about the warning signs

What are the risks associated with Anorexia?

The risks associated with Anorexia are severe and can be life threatening. They include:

• Anaemia (iron deficiency)
• Compromised immune system (e.g. getting sick more often)
• Intestinal problems (e.g. abdominal pain, constipation, diarrhoea)
• Loss or disturbance of menstruation in girls and women
• Increased risk of infertility in men and women
• Kidney failure
• Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
• Heart problems (e.g. cardiac abnormalities, sudden cardiac arrest)
• Death

Treatment

Psychological treatment has been clinically proven to reduce the severity, impact and duration of Anorexia Nervosa. The long-term aims of psychological treatment for Anorexia Nervosa are to reduce risk and to encourage weight gain, normal eating and exercise behaviours, with full psychological and physical recovery as the ultimate goal.

Ideally, the treatment of people with Anorexia Nervosa are managed on an outpatient basis, with psychological treatment and physical monitoring provided by healthcare professionals, who will possess specialised knowledge in eating disorders.

Psychological Treatments

• Behavioural therapy
• Cognitive analytic therapy
• Cognitive behavioural therapy
• Ego-oriented therapy-adolescent focused individual therapy (for children and adolescents)
• Focal psychodynamic therapy
• Family interventions focused explicitly on eating disorders
• Maudsley family-based treatment (for children and adolescents)
• Interpersonal psychotherapy
• Specialist supportive clinical management

Other treatments

Antidepressants (specifically selective serotonin re-uptake inhibitors; e.g. SSRI) or antipsychotics can also be used to treat Anorexia Nervosa.

Please note: Medication should not be used as the sole or primary treatment for Anorexia Nervosa; rather, it should be used in conjunction with therapy appropriate for the treatment of Anorexia Nervosa.

Find out more about specific Treatment Approaches.

Is recovery from Anorexia Nervosa possible?

Yes. It is possible to recover from Anorexia, even if you have been living with the illness for many years. The path to recovery can be long and challenging, however with the right team supporting you and a high level of commitment, recovery is achievable. Treatment for Anorexia is available; seek help from a professional with specialised knowledge in eating disorders.

What is Bulimia Nervosa?

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Bulimia Nervosa is a serious, potentially life threatening mental illness.

A person with bulimia has not made a “lifestyle choice”, they are actually very unwell and need help.

The reasons for developing Bulimia will differ from person to person; known causes include genetic predisposition and a combination of environmental, social and cultural factors.

Bulimia is characterised by repeated episodes of binge eating followed by compensatory behaviours. In addition, people with bulimia place an excessive emphasis on body shape or weight in their self-evaluation. This can lead to the person’s sense of self-esteem and self worth being wholly defined by the way they look.

What is binge eating?

Binge eating involves two key features:

• Eating a very large amount of food within a relatively short period of time (e.g. within two hours)
• Feeling a sense of loss of control while eating (e.g. feeling unable to stop yourself from eating)

What are compensatory behaviours?

Compensatory behaviours are used as a way of trying to control weight after binge eating episodes. They include:

• Vomiting
• Misusing laxatives or diuretics
• Fasting
• Excessive exercise
• Use of any drugs, illicit, prescription and/or ‘over the counter’ inappropriately for weight control (inappropriate use refers to use that is not indicated and for which the drug has not been prescribed).

A person with Bulimia can become lost in a dangerous cycle of eating out of control and attempts to compensate which can lead to feelings of shame, guilt and disgust. These behaviours can become more compulsive and uncontrollable over time, and lead to an obsession with food, thoughts about eating (or not eating), weight loss, dieting and body image.

These behaviours are often concealed and people with Bulimia can go to great lengths to keep their eating and exercise habits secret. As a result, Bulimia can often go undetected for a long period of time.

Many people with Bulimia experience weight fluctuations and do not lose weight; they can remain in the normal weight range, be slightly underweight, or may even gain weight.

What are the warning signs of Bulimia?

Having awareness about Bulimia and its warning signs and symptoms can make a marked difference to the severity and duration of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.

The warning signs of Bulimia can be physical, psychological and behavioural. It is possible for someone with Bulimia to display a combination of these symptoms.

Physical signs:

• Frequent changes in weight (loss or gains)
• Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
• Feeling bloated, constipated or developing intolerances to food
• Loss of or disturbance of menstrual periods in girls and women
• Fainting or dizziness
• Feeling tired and not sleeping well

Psychological Signs:

• Preoccupation with eating, food, body shape and weight
• Sensitivity to comments relating to food, weight, body shape or exercise
• Low self esteem and feelings of shame, self loathing or guilt, particularly after eating
• Having a distorted body image (e.g. seeing themselves as overweight even if they are in a healthy weight range for their age and height)
• Obsession with food and need for control
• Depression, anxiety or irritability
• Extreme body dissatisfaction

Behavioural Signs:

• Evidence of binge eating (e.g. disappearance or hoarding of food)
• Vomiting or using laxatives, enemas, appetite suppressants or diuretics
• Eating in private and avoiding meals with other people
• Anti social behaviour, spending more and more time alone
• Repetitive or obsessive behaviours relating to body shape and weight (e.g. weighing themselves repeatedly, looking in the mirror obsessively and pinching waist or wrists)
• Secretive behaviour around food (e.g. saying they have eaten when they haven’t, hiding uneaten food in their rooms)
• Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
• Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)
• Frequent trips to the bathroom during or shortly after meals which could be evidence of vomiting or laxative use
• Erratic behaviour (e.g. spending large amounts of money on food)
• Self harm, substance abuse or suicide attempts

Find out more about the warning signs.

What are the risks associated with Bulimia?

The risks associated with Bulimia are severe. People with Bulimia may experience:

• Chronic sore throat, indigestion, heartburn and reflux
• Inflammation and rupture of the oesophagus and stomach from frequent vomiting
• Stomach and intestinal ulcers
• Chronic irregular bowel movements, constipation and/or diarrhoea due to deliberate misuse of laxatives
• Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
• Loss of or disturbance of menstrual periods in girls and women
• Increased risk of infertility in men and women
• Irregular or slow heart beat which can lead to an increased risk of heart failure

 

Treatment

Therapies to be considered for the treatment of Bulimia Nervosa include:

• Psychological Treatments
• Evidence-based self-help programs
• Cognitive behavioural therapy for Bulimia Nervosa
• Interpersonal psychotherapy
• Maudsley family-based treatment (for children and adolescents)
• Dialectical behaviour therapy
• Guided imagery
• Crisis intervention
• Stress management

Other treatments

Antidepressants (specifically selective serotonin reuptake inhibitors; e.g. SSRI) may also be prescribed for someone who is suffering from Bulimia Nervosa.

Find out more about specific treatment approaches.

Is it possible to recover?

Yes. It is possible to recover from Bulimia, even if you have been living with the illness for many years. The path to recovery can be very challenging. People with Bulimia can become entangled in a vicious cycle of eating and exercise behaviours that can impact their ability to think clearly and make decisions. However, with the right team and a high level of personal commitment, recovery is an achievable goal.

Treatments for Bulimia are available; seek help from a professional with specialised knowledge in eating disorders.

Getting help

If you suspect that you or someone you know has Bulimia, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. While your GP may not be a specialist in eating disorders, they are a good ‘first base.’ A GP can provide a referral to a practitioner with specialised knowledge in health, nutrition and eating disorders.

Find help in your local area

What is Binge Eating Disorder?

Binge Eating Disorder is a serious mental illness characterised by regular episodes of binge eating.

A person with Binge Eating Disorder will not use compensatory behaviours, such as self-induced vomiting or over-exercising after binge eating.

Many people with Binge Eating Disorder are overweight or obese.

What is binge eating?

Binge eating involves two key features:

• Eating a very large amount of food within a relatively short period of time (e.g. within two hours)
• Feeling a sense of loss of control while eating (e.g. feeling unable to stop yourself from eating)

The reasons for developing Binge Eating Disorder will differ from person to person; known causes include genetic predisposition and a combination of environmental, social and cultural factors. Binge Eating Disorder can occur in people of all ages and genders, across all socioeconomic groups, and from any cultural background. Large population studies suggest that equal numbers of males and females experience Binge Eating Disorder.

Defining Binge Eating Disorder

Frequent episodes of binge eating

A person with Binge Eating Disorder will repeatedly engage in binge eating episodes where they eat a large amount of food in a short period of time. During these episodes they will feel a loss of control over their eating and may not be able to stop even if they want to.

Eating habits

A person with Binge Eating Disorder will often have a range of identifiable eating habits. These can include eating very quickly, eating when they are not physically hungry and continuing to eat even when they are full, to the point that they feel uncomfortable.

Feelings around food

Feelings of guilt and shame are highly prevalent in people with Binge Eating Disorder. People with Binge Eating Disorder often feel guilty or ashamed about the amount, and the way they eat during a binge eating episode. Binge eating often occurs at times of stress, anger, boredom or distress. At such times, binge eating is used as a way to cope with challenging emotions.

Behaviours around food

Because of their feelings around food, people with Binge Eating Disorder are often very secretive about their eating habits and choose to eat alone.

What are the warning signs of Binge Eating Disorder?

Having awareness about Binge Eating Disorder and its warning signs and symptoms can make a marked difference to the severity and duration of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.

The warning signs of Binge Eating Disorder can be physical, psychological and behavioural. It is possible for someone with Binge Eating Disorder to display a combination of these symptoms.

Physical signs:

• Feeling tired and not sleeping well
• Feeling bloated, constipated or developing intolerances to food

Psychological Signs:

• Preoccupation with eating, food, body shape and weight
• Extreme body dissatisfaction and shame about their appearance
• Feelings of extreme distress, sadness, anxiety and guilt during and after a binge episode
• Low self esteem
• Increased sensitivity to comments relating to food, weight, body shape, exercise
• Depression, anxiety or irritability

Behavioural Signs:

• Evidence of binge eating (e.g. disappearance or hoarding of food)
• Secretive behaviour relating to food (e.g. hiding food and food wrappers around the house)
• Evading questions about eating and weight
• Increased isolation and withdrawal from activities previously enjoyed
• Erratic behaviour (e.g. shoplifting food or spending large amounts of money on food)
• Self harm, substance abuse or suicide attempts

What are the risks associated with Binge Eating Disorder?

The risks associated with Binge Eating Disorder are severe. People with Binge Eating Disorder may experience:

• Osteoarthritis - a painful form of degenerative arthritis in which a person’s joints degrade in quality and can lead to loss of cartilage
• Chronic kidney problems or kidney failure
• High blood pressure and/or high cholesterol leading to increased risk of stroke, diabetes and heart disease

Treatment

Therapies to be considered for the treatment of Binge Eating Disorder include:

• Psychological Treatments
• Evidence-based self-help programs
• Cognitive behavioural therapy for Binge Eating Disorder
• Interpersonal psychotherapy
• Dialectical behaviour therapy

Other treatments

Antidepressants (SSRIs) can also be used in treating those with Binge Eating Disorder.

If the person with the eating disorder also presents with symptoms of obesity, this will need to be managed simultaneously using the appropriate treatment.

Find out more about specific treatment approaches.

Is recovery possible?

Yes. It is possible to recover from Binge Eating Disorder, even if you have been living with the illness for many years.

The path to recovery can be very challenging but it can also shed light on what contributes to binge eating, low self-esteem and negative body image, and how to minimise relapse. Through the process of recovery a person with Binge Eating Disorder can learn how to replace their unhealthy eating habits with more helpful coping strategies.

With the right team and a high level of personal commitment, recovery is an achievable goal. Treatments for Binge Eating Disorder are available; seek help from a professional with specialised knowledge in eating disorders.

 

Getting help

If you suspect that you or someone you know has Binge Eating Disorder, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. While your GP may not be a specialist in eating disorders, they are a good ‘first base.’ A GP can provide a referral to a practitioner with specialised knowledge in health, nutrition and eating disorders.

Find help in your local area.

What is OSFED?

OSFED stands for Other Specified Feeding and Eating Disorders.

A person with Other Specified Feeding and Eating Disorders (OSFED) may present with many of the symptoms of other eating disorders such as Anorexia Nervosa, Bulimia Nervosa or Binge Eating Disorder but will not meet the full criteria for diagnosis of these disorders.

This does not mean that the person has a less serious eating disorder. OSFED is a serious mental illness that occurs in adults, adolescents and children. Around 30% of people who seek treatment for an eating disorder have OSFED.

The reasons for developing OSFED will differ from person to person; known causes include genetic predisposition and a combination of environmental, social and cultural factors.

People with OSFED commonly present with extremely disturbed eating habits, and/or a distorted body image and/or overvaluation of shape and weight and/or an intense fear of gaining weight (if underweight). OSFED is the most common eating disorder diagnosed for adults as well as adolescents, and affects both males and females.

What are the warning signs of OSFED?

Having awareness about eating disorders and the warning signs and symptoms can make a marked difference to the severity and duration of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. Many of the signs that indicate a person may have OSFED are very similar to those of the other eating disorders.

If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.

The warning signs of OSFED can be physical, psychological and behavioural. It is possible for someone with OSFED to display a combination of these symptoms

Physical Signs:

• Weight loss, weight gain or weight fluctuations
• Loss of or disturbance of menstrual periods in girls and women and decreased libido in men
• Compromised immune system (e.g. getting sick more often)
• Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
• Fainting and dizziness as a result of dehydration

Psychological:

• Preoccupation with food and eating
• Preoccupation with body shape and weight (in men this can be a preoccupation with increasing muscle bulk)
• Extreme body dissatisfaction
• Having a distorted body image (e.g. seeing themselves as overweight even if they are in a healthy weight range for their age and height)
• Sensitivity to comments relating to food, weight, body shape or exercise
• Heightened anxiety and/or irritability around meal times
• Depression, anxiety or irritability
• Low self esteem and feelings of shame, self loathing or guilt
• 'Black and white’ thinking - rigid thoughts about food being ‘good’ or ‘bad’

Behavioural signs:

• Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)
• Evidence of binge eating (e.g. disappearance or hoarding of food)
• Frequent trips to the bathroom during or shortly after meals which could be evidence of vomiting or laxative use
• Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
• Eating at unusual times and/or after going to sleep at night
• Changes in food preferences (e.g. claiming to dislike foods previously enjoyed, sudden preoccupation with ‘healthy eating’, or replacing meals with fluids)
• Obsessive rituals around food preparation and eating (e.g. eating very slowly, cutting food into very small pieces, insisting that meals are served at exactly the same time everyday)
• Anti-social behaviour, particularly around meal times, and withdrawal from social situations involving food
• Secretive behaviour around food (e.g. saying they have eaten when they haven’t, hiding uneaten food in their rooms)
• Increased interest in food preparation (e.g. planning, buying, preparing and cooking meals for others but not actually consuming; interest in cookbooks, recipes and nutrition)
• Increased interest and focus on body shape and weight (e.g. interest in weight loss websites, books, magazines or images of thin people)
• Repetitive or obsessive behaviours relating to body shape and weight (e.g. weighing themselves repeatedly, looking in the mirror obsessively and pinching waist or wrists)
• Increased isolation, spending more and more time alone and avoiding previously enjoyed activities

What are the risks associated with OSFED?

The risks associated with OSFED are severe. People with OSFED will experience risks similar to those of the eating disorder their behaviours most closely resemble:

• Inflammation and rupture of the oesophagus and stomach from frequent vomiting
• Chronic constipation or diarrhoea
• Kidney failure
• Osteoporosis - a condition that leads to bones becoming fragile and easily fractured
• Irregular or slow heart beat which can lead to an increased risk of heart failure
• Loss of or disturbance of menstrual periods in girls and women
• Increased risk of infertility in men and women

While the goal of diagnosis is to accurately describe symptoms and seek the right help for them, a large number of people have other significant eating and feeding issues and distorted body image which are not covered by these categories.

Treatment

As a result of the atypical nature of OSFED, it is most effective to follow the treatments recommended for the eating disorder that most closely resembles the individual person’s eating problem. For example, if a person presents with many but not all of the symptoms of Bulimia Nervosa, it is recommended for that person to seek the same treatment approaches recommended for people with Bulimia Nervosa.

Find out more about specific treatment approaches.

Is it possible to recover?

Yes. It is possible to recover from OSFED, even if you have been living with the illness for many years. The path to recovery can be very challenging. However, with the right team and a high level of personal commitment, recovery is an achievable goal. Treatments for OSFED are available; seek help from a professional with specialised knowledge in eating disorders.

Getting help

If you suspect that you or someone you know has OSFED, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. While your GP may not be formally trained in detecting the presence of an eating disorder, he/she is a good ‘first base.’ A GP can refer you on to a practitioner with specialised knowledge in eating disorders.

Find help in your local area

Disordered Eating and Dieting

Disordered eating is a disturbed and unhealthy eating pattern that can include restrictive dieting, compulsive eating or skipping meals.

Disordered eating can include behaviours which reflect many but not all of the symptoms of feeding and eating disorders such as Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Other Specified Feeding and Eating Disorders (OSFED) or Avoidant/Restrictive Food Intake Disorder (ARFID).

Disordered eating behaviours, and in particular dieting are the most common indicators of the development of an eating disorder. Eating disorders are severe and life threatening mental illnesses. An eating disorder is not a lifestyle choice.

Disordered eating can have a destructive impact upon a person’s life and has been linked to a reduced ability to cope with stressful situations. There is also increased incidence of suicidal thoughts and behaviours in adolescents with disordered eating.

Examples of disordered eating include:

• Fasting or chronic restrained eating
• Skipping meals
• Binge eating
• Self induced vomiting
• Restrictive dieting
• Unbalanced eating (e.g. restricting a major food group such as ‘fatty’ foods or carbohydrates)
• Laxative, diuretic, enema misuse
• Steroid and creatine use – supplements designed to enhance athletic performance and alter physical appearance
• Using diet pills

Learn how to recognise the warning signs of eating disorders

Why are disordered eating and dieting dangerous?

Not everyone who diets will develop an eating disorder but it would be hard to find a person with an eating disorder who has not been on a diet themselves. Dieting is one of the most common forms of disordered eating.

Severely restricting the amount of food you eat can be a very dangerous practice. When the body is starved of food it responds by reducing the rate at which it burns energy (the metabolic rate), this can result in overeating and binge eating behaviours that can lead to weight gain and obesity.

Feelings of guilt and failure are common in people who engage in disordered eating. These feelings can arise as a result of binge eating, ‘breaking’ a diet or weight gain. A person with disordered eating behaviours may isolate themselves for fear of socialising in situations where people will be eating. This can contribute to low self esteem and significant emotional impairment.

Diets don’t work

Contrary to popular belief, research has shown that at least one-third to two-thirds of people on diets regain more weight than they have lost within four or five years, and the true number may well be significantly higher. Weight loss and ‘fad’ diets do not take people’s individual requirements into consideration and can result in a person feeling hungry, experiencing low moods, lacking in energy levels and developing poor health.

What are the risks associated with disordered eating and dieting?

The risks associated with disordered eating are severe. People with disordered eating may experience:

• A clinical eating disorder (Anorexia Nervosa, Bulimia Nervosa, Binge Eating or Other Specified Feeding and Eating Disorders (OSFED))
• Weight gain
• Osteoporosis - a condition that leads to bones becoming fragile and easily fractured
• Fatigue and poor sleep quality
• Constipation and/or diarrhoea
• Headaches
• Muscle cramps

Is it possible to change disordered eating and dieting behaviour?

Yes. It is possible to change eating behaviour, even if you have been engaging in disordered eating and dieting for many years. With the right support and treatment and a high level of personal commitment your body can learn to function to its full capacity again.

Seeking help from a practitioner with specialised knowledge in health and nutrition can assist you in reversing the adverse effects of disordered eating and restoring emotional, mental and physical health.

Getting help

Dieting is the number one cause of the onset of an eating disorder and seeking help early is the best preventative measure. While your GP may not be a specialist in eating disorders, they are a good ‘first base.’ A GP can provide a referral to a practitioner with specialised knowledge in health, nutrition and eating disorders.

Find help in your local area

What is body image?

Body image is the perception that a person has of their physical self and the thoughts and feelings that result from that perception.

These feelings can be positive, negative or both and are influenced by individual and environmental factors.

The four aspects of body image

1. How you see your body is your perceptual body image. This is not always a correct representation of how you actually look. For example, a person may perceive themselves as overweight when they are actually underweight.
2. The way you feel about your body is your affective body image. This relates to the amount of satisfaction or dissatisfaction you feel about your shape, weight and individual body parts.
3. The way you think about your body is your cognitive body image. This can lead to preoccupation with body shape and weight. For example, some people believe they will feel better about themselves if they are thinner or more muscular.
4. Behaviours in which you engage as a result of your body image encompass your behavioural body image. When a person is dissatisfied with the way they look, they may isolate themselves because they feel bad about their appearance or employ destructive behaviours (e.g. excessive exercising, disordered eating) as a means to change appearance.

Why is positive body image important?

Positive body image occurs when a person is able to accept, appreciate and respect their body. Positive body image is important because it is one of the protective factors which can make a person more resilient to eating disorders. In fact, the most effective eating disorder prevention programs use a health promotion approach, focusing on building self-esteem and positive body image, and a balanced approach to nutrition and physical activity. A positive body image will improve:

• Self esteem, which dictates how a person feels about themselves and can infiltrate every aspect of life, and contribute to happiness and wellbeing.
• Self-acceptance, making a person more likely to feel comfortable and happy with the way they look and less likely to feel impacted by unrealistic images in the media and societal pressures to look a certain way.
• Healthy outlook and behaviours, as it is easier to lead a balanced lifestyle with healthier attitudes and practices relating to food and exercise when you are in tune with, and respond to the needs of your body.

Infographic: Body Image & Eating Disorders

Click image to enlarge

What causes body dissatisfaction?

When a person has negative thoughts and feelings about his or her own body, body dissatisfaction can develop. Body dissatisfaction is an internal process but can be influenced by several external factors. For example, family, friends, acquaintances, teachers and the media all have an impact on how a person sees and feels about themselves and their appearance. Individuals in appearance oriented environments or those who receive negative feedback about their appearance are at an increased risk of body dissatisfaction.

One of the most common external contributors to body dissatisfaction is the media. People of all ages are bombarded with images through TV, magazines, internet and advertising. These images often promote unrealistic, unobtainable and highly stylised appearance ideals which have been fabricated by stylists, art teams and digital manipulation and cannot be achieved in real life. Those who feel they don’t measure up in comparison to these images, can experience intense body dissatisfaction which is damaging to their psychological and physical wellbeing.

The following factors make some people more likely to develop a negative body image than others:

• Age – body image is frequently shaped during late childhood and adolescence but body dissatisfaction can affect people of all ages and is as prevalent in midlife as young adulthood in women
• Gender - adolescent girls are more prone to body dissatisfaction than adolescent boys; however the rate of body dissatisfaction in males is rapidly approaching that of females
• Low self-esteem and/or depression
• Personality traits - people with perfectionist tendencies, high achievers, ‘black and white’ thinkers, those who internalise beauty ideals, and those who often compare themselves to others, are at higher risk of developing body dissatisfaction
• Teasing - people who are teased about appearance/weight, regardless of actual body type, have an increased risk of developing body dissatisfaction
• Friends and family who diet and express body image concerns - role models expressing body image concerns and modelling weight loss behaviours, can increase the likelihood of an individual developing body dissatisfaction regardless of actual body type
• Body size - In our weight conscious society, larger body size increases risk of body dissatisfaction

In western society, body dissatisfaction has become a cultural norm.

Why is body dissatisfaction a serious problem?

Body dissatisfaction is the top ranked issue of concern for young people (Mission Australia, 2011). Body image issues have increased worldwide over the last 30 years and do not only concern young people but affect people of all ages. This pervasive problem is concerning because overvaluing body image in defining ones self-worth is one of the risk factors which makes some people less resilient to eating disorders than others. People experiencing body dissatisfaction can become fixated on trying to change their body shape, which can lead to unhealthy practices with food and exercise. These practices don’t usually achieve the desired outcome (physically or emotionally) and can result in intense feelings of disappointment, shame and guilt and, ultimately, increase the risk of developing an eating disorder.

 

How can you improve your body image?

While some aspects of your appearance can be changed, others, like your height, muscle composition and bone structure are genetically fixed. It is important to understand that there is no right or wrong when it comes to weight, shape, size and appearance. Challenging beauty ideals and learning to accept your body shape is a crucial step towards positive body image.

While changing your actual appearance can be counterproductive, improving your body image is a constructive goal. We have the power to change the way we see, feel and think about our bodies. Here are some helpful tips:

• Focusing on your positive qualities, skills and talents can help you accept and appreciate your whole self
• Say positive things to yourself every day
• Avoid negative or berating self-talk
• Focusing on appreciating and respecting what your body can do will help you to feel more positively about it
• Setting positive, health focused goals rather than weight loss related ones is more beneficial for your overall wellbeing
• Admiring others’ beauty can improve your own body confidence but it is important to appreciate your own beauty, avoid comparing yourself to others, accept yourself as a whole and remember that everyone is unique and differences are what make us special
• Remember, many media images are unrealistic and represent a minority of the population

Programs that effectively increase positive body image focus on reducing risk factors (e.g. thin ideal internalization, peer pressure, bullying and ‘fat talk’, perfectionism) and increasing protective factors (e.g. self-esteem, social support, non-competitive physical activity, healthy eating behaviours and attitudes, respect for diversity).

Getting help

If you feel dissatisfied with your body or are developing unhealthy eating or exercise habits seek professional help. Some counsellors and psychologists have specialised knowledge in body image. Professional support can help guide you to change negative beliefs and behaviours.

Find help in your local area 

Eating Disorders in Males

Males get eating disorders too.

Eating disorders are serious, potentially life threatening mental illnesses. A person with an eating disorder has not made a ‘lifestyle choice’, they are actually very unwell and need help. While eating disorders are often portrayed as illnesses that only affect females, large population studies suggest that up to a quarter of people suffering with anorexia nervosa or bulimia nervosa are male, and almost an equal number of males and females suffer with binge eating disorder. We also know that under-diagnosis and cultural stigma mean that the actual proportion of males with eating disorders could be much higher.

Eating disorders can develop at any age but males and females are most at risk for anorexia nervosa and bulimia nervosa in their late teens/early twenties, while binge eating disorder is more prevalent in a person in their mid-twenties.

Body dissatisfaction

Rates of body dissatisfaction in males are rapidly approaching that of females. For males, body dissatisfaction is more commonly manifested as the pursuit of a muscular, lean physique rather than a lower body weight.

Male athletes have an increased vulnerability to eating disorders, particularly those in sports with a greater emphasis on weight classes and aesthetic ideals such as weight lifters, wrestlers, gymnasts, dancers, jockeys and body builders. For some males, heightened concerns about muscularity may become part of an eating disorder, characterised by distorted perceptions about muscle bulk, and /or distorted eating and exercise patterns.

The factors that contribute to the onset of an eating disorder are complex. No single cause of eating disorders has been identified; however, known contributing risk factors include:

• Genetic vulnerability
• Psychological factors
• Socio-cultural influences

What are the risks for males?

Most of the common known risk factors for eating disorders apply to males and females (e.g. perfectionism, bullying, dieting, trauma, childhood obesity). Sociocultural influences play a role in the development of eating disorders and males are exposed to unique cultural messages that can increase their vulnerability towards developing an eating disorder. These include:

• Males should only have one body type - the ideal physical body shape for men is now more prescribed with lean, muscular body types in fashion to the exclusion of other male body types
• You are what you look like - males are more at risk if they conflate having a ‘perfect body’ with success in other areas such as dating, getting a good job, and social desirability
• Males need to be in control – males can be expected to ‘take charge’ and be ‘in control’. When coping with particular issues beyond their control, males can sometimes displace these anxieties onto their bodies, manifesting in control over the body through excessive exercise and dieting
• Eating disorders and other mental illnesses are not masculine – males can be expected to conceal personality traits and vulnerabilities that have traditionally been associated with females. A desire not to appear weak or vulnerable has led to a stigma around mental illness that has delayed treatment and support for many males with eating disorders. This stigma has been further exacerbated by the popular misconception that eating disorders are a ‘female’s disease’.

These negative cultural messages do not reflect the realities of mental and physical health in males.

Snapshot: Guys Get Eating Disorders Too

Click image to enlarge

What are the warning signs of eating disorders in males?

Being aware about eating disorders and acting on the warning signs by seeking help immediately can have a marked influence on their severity and duration. However, the nature of an eating disorder means that the signs might be discreet, and there may be ambivalence about seeking help.

There are physical, psychological and behavioural warning signs that can signal the onset or the presence of an eating disorder in a male or a female but these are some warning signs that are more likely to occur in males:

• Preoccupation with body building, weight lifting or muscle toning
• Exercising when sick or injured
• Lowered testosterone
• Anxiety/stress over missing workouts
• Muscular weakness
• Decreased interest in sex, or fears around sex
• Possible conflict over gender identity or sexual orientation
• Using anabolic steroids

Our socio-cultural influences mean that over-exercising and the extreme pursuit of muscle growth are frequently seen as healthy behaviours for males and can even be actively encouraged. The truth is that these activities can indicate a significant disorder and lead to severe physical health problems.

• Males should only have one body type - the ideal physical body shape for men is now more prescribed with lean, muscular body types in fashion to the exclusion of other male body types
• You are what you look like - males are more at risk if they conflate having a ‘perfect body’ with success in other areas such as dating, getting a good job, and social desirability
• Males need to be in control – males can be expected to ‘take charge’ and be ‘in control’. When coping with particular issues beyond their control, males can sometimes displace these anxieties onto their bodies, manifesting in control over the body through excessive exercise and dieting
• Eating disorders and other mental illnesses are not masculine – males can be expected to conceal personality traits and vulnerabilities that have traditionally been associated with females. A desire not to appear weak or vulnerable has led to a stigma around mental illness that has delayed treatment and support for many males with eating disorders. This stigma has been further exacerbated by the popular misconception that eating disorders are a ‘female’s disease’.

These negative cultural messages do not reflect the realities of mental and physical health in males.

What are the warning signs of eating disorders in males?

Being aware about eating disorders and acting on the warning signs and symptoms can have a marked influence on the severity and duration of the illness. Seeking help at the first warning signs is very important in this respect. However, the very nature of an eating disorder means that the sufferer will try and ensure any warning signs are concealed.

There are physical, psychological and behavioural warning signs that can signal the onset or the presence of an eating disorder in a male or a female but there are some warning signs that are more likely to occur in males:

• Preoccupation with body building, weight lifting or muscle toning
• Weight lifting when injured
• Lowered testosterone
• Anxiety/stress over missing workouts
• Muscular weakness
• Decreased interest in sex, or fears around sex
• Possible conflict over gender identity or sexual orientation
• Using anabolic steroids

Further, our socio-cultural influences mean that over-exercising and the extreme pursuit of muscle growth are frequently seen as healthy behaviours for males and can even be actively encouraged. The truth is that these activities can indicate a significant disorder and lead to severe physical health problems.

Find out more about recognising warning signs.

Is it possible for a male to recover from an eating disorder?

Yes. It is possible for males to recover from eating disorders. Evidence shows that the sooner someone starts treatment for an eating disorder, the shorter the recovery process. Unfortunately, it is not uncommon for males to go untreated longer and to receive less professional care than females.

Commonly males only seek treatment or receive a correct medical diagnosis when symptoms become severe and few services are designed to meet the specific needs of males with eating disorders. The stigma associated with having a ‘female disease’ also contributes to a delay in seeking help.

Getting help

If you suspect that you or someone you know, male or female, has an eating disorder, it is important to seek help immediately. Your GP is a good ‘first base’ and can refer you to a practitioner with specialised knowledge in eating disorders.

Find help in your local area.