Eating Disorders

Anorexia

People suffering from anorexia feel desperate to keep their weight as low as possible. They do so by not eating enough or exercising excessively and sometimes both. Because starvation becomes a reality, they can become life-threateningly ill. They often have a distorted body image, believing themselves to be fat even when they are dangerously underweight. While most common in young women, for whom it typically starts in the mid-teens, men and women of any age can develop anorexia.

Bulimia

People who develop bulimia go through periods where they consume large quantities of food in a very short space of time. They then induce vomiting, use laxatives or exercise excessively (called ‘purging’), sometimes combining these behaviours, to try to prevent gaining weight. Bulimia is most common in young women, typically beginning in teenage years.

Binge Eating Disorder

Binge Eating Disorder is characterised by eating large amounts of food at one time until the person becomes uncomfortably full, at which point they are likely to feel upset, guilty or ashamed. Binges, which are often pre-planned may include “special” binge foods. Binge Eating Disorder can afflict men and women of any age, although it typically starts in the late teens or early 20s.

Signs of a Binge Eating Disorder

At the core of a Binge Eating Disorder is a vicious circle. Uncomfortable psychological states lead to a person seeking relief through binge eating which results in uncomfortable psychological states, to which binge eating is the now reflexive response. After a bingeing episode, people with Binge Eating Disorder often feel depressed, guilty, ashamed and disgusted with themselves. They sometimes describe a sense of being detached from the behaviour, as if on autopilot. The feeling of being unable to control the urge to binge only exacerbates any existing symptoms of depression and despair.

Indications that a Binge Eating Disorder may have taken hold include:

• Buying large quantities of food
• Hoarding food
• Thinking all the time about food
• Organising time around binge eating
• Eating large amounts of food in a short space of time
• Eating when not hungry
• Eating until becoming uncomfortably full
• Avoiding eating when other people are present
• Eating in secret
• Reducing social activity and compromising personal plans and ambitions

A variety of harmful consequences

Binge eating is experienced by both men and women and usually starts in teenage years or soon after. Ritual plays a part as binges are often planned in advance and involve specific foods. Besides the psychological impact, there are usually physical consequences, which may (although not always) include putting on excessive weight with its associated harmful effects. Dieting is not advised as it can lead to a worsening of the condition.

General fitness is likely to deteriorate, with sleep disturbance and chronic tiredness common. Problems with digestive organs may be experienced. The disorder commonly also impacts other areas of life as sufferers may avoid social interaction out of embarrassment or depressed mood. Low self-esteem may be an underlying factor in the development of a Binge Eating Disorder but the condition helps to perpetuate and reinforce that mental state too.

Recovery from Binge Eating Disorder is possible

Happily, most people suffering from Binge Eating Disorder can recover, although it may take some time. Recovery involves a real and lasting commitment to self-help in order to change the mood-altering relationship with food. Given the challenge faced, this is probably best achieved with the professional support.

Specialist psychotherapy in a well-structured Program is one option, with Cognitive Behavioural Therapy a widely endorsed model. Other people are drawn to a mutual aid approach involving a suitable 12-Step fellowship, while on-line support groups have also emerged more recently. It is important that what is on offer makes sense to the person seeking help and is one with which they feel they can fully engage.

A therapeutic Program should include:

• Monitoring eating patterns
• Drawing up realistic meal plans
• Recognising the situational and emotional triggers for a binge eating episode
• Identifying and addressing underlying issues
• Preparing alternative actions to bingeing in response to stress
• Finding positive ways to cope with negative feelings

Eating Disorders and Addiction

Eating disorders have much in common with addiction to substances and to behavioural addictions. But there are also significant differences. These will be taken into account within the context of an addiction treatment centre. However, this will not be a suitable setting for every person with an eating disorder.

The characteristics eating disorders have in common with addiction are:

• Regulation of feelings/a coping mechanism
• Control – Loss of control – Attempt to regain control
• Obsession
• Compulsion
• Shame and Guilt
• Isolation and Secrecy
• Self-perpetuating
• Life threatening

A relationship that threatens wellbeing and even life

As with addiction, it helps to see eating disorders as the manifestation of an unhealthy relationship – in this case with eating or with food. What makes it problematic is the nature and quality of the relationship. At its root lies the more or less conscious urge to regulate feelings in order to better cope with the experience of life. This relationship paradoxically ends up threatening mental health, physical wellbeing and sometimes even life itself.

The question of abstinence

The obvious difference with other behavioural addictions such as gambling and addiction to substances like alcohol, heroin, cocaine etc., is that food is essential to sustain life. This critical factor has particular implications for the care of patients in an addiction treatment and recovery Program that has abstinence as its starting point.

The question of abstinence in the treatment of eating disorders is inevitably more nuanced. The patient is helped to abstain from the behaviours which are symptomatic of the problematic relationship such as purging, weight loss, bingeing, orthorexia or restriction. This gives patients the chance to become aware of the feelings which threaten them when they do not resort to the behaviour. Some patients will need to understand that an obsession with self-image rather than enhancing self-esteem is likely to undermine it.

They can be helped to recognise the self-defeating nature of their coping response and with close support acquire and practice new, positive behaviours to deal with these feelings. This will open the path to resolving them in time.

The benefits of inpatient treatment for eating disorders

The characteristic tendency to isolation and secrecy can be addressed by the treatment centre’s capacity to monitor the patient around the clock. A person with an eating disorder can benefit greatly in a community of people aiming at recovery, such as in an addiction treatment centre. The support of the members of the group will be particularly encouraging, especially if the others undergoing treatment understand the necessary difference in the application of abstinence.

That food is served in a residential treatment centre provides the scope to observe eating, as well as weight and self-image related behaviours. Staff can work closely with the patient to establish a healthier relationship with food; one that focusses on balanced nutrition and sustenance rather than as a means of controlling mood. The range of complementary therapies and other activities available offers other opportunities to loosen the restrictions of the obsession.

Eating disorders are treatable, but as with any serious condition with significant consequences, it is essential to seek help as soon as possible. Because there are often both mental and physical health complications, the involvement of medical expertise at an early stage is strongly advised. So-called talking therapies, mutual aid, as well as both in-patient and out-patient services may have a role to play in recovery from eating disorders.