What are eating disorders?
Eating disorders are often described as an outward expression of internal emotional pain and confusion. Obsessive thoughts about, and the behaviour associated with, food are maladaptive means of dealing with emotional distress which cannot be expressed in any other satisfactory way. The emotional distress is often to do with a negative perception of self, a feeling of being unable to change "bad" things about oneself: food is used as an inappropriate way of taking control.
Perhaps due to cultural ideas of what constitutes perfection, people often feel a strong desire to be thinner than their bodies naturally tend to be - "when I am thin everything will be alright". They confuse who they are with what they look like. As a result they change their eating patterns and may as a consequence be at risk of developing an eating disorder.
An eating disorder involves a distorted pattern of thinking about food and size/weight: there is a preoccupation and obsession with food, as well as an issue of control or lack of control around food and its consumption.
There are several recognised eating disorders which can be described as follows:
Anorexic people starve themselves with the aim of losing weight to a point which others would consider to be very thin (although the sufferer is unlikely to perceive themselves as such). The longer the condition continues, the more difficult it can be to tackle, and in severe cases can necessitate hospitalisation and can even prove fatal. Sufferers are typically in their teens or twenties and most are women, although around 10% are male. The following are symptoms:
- distorted perceptions of one's weight, size and shape
- behaviour which results in a marked weight loss
- a morbid fear of gaining weight or becoming fat
- excessive exercising (while starving)
- cessation of periods in women.
Bulimic people may well maintain their normal weight. The condition is characterised by:
- bouts of eating followed by purging
- distorted perception of own weight, size and shape
- a powerful urge to overeat, leading to binge eating and a resultant feeling of being out of control
- compensatory behaviour such as self-induced vomiting; misuse of laxatives, diuretics or other medication; fasting; or excessive exercise
- a morbid fear of gaining weight or becoming fat.
- recurrent episodes of binge eating and consequent feeling of being out of control
- marked distress about binge eating and the attempts to control it
- during a binge may: eat more quickly than normal; eat until uncomfortably over-full; eat large amounts when not hungry; tend to "graze" rather than eat meals; eat alone in secret; feel disgusted and guilty with oneself.
- weight-loss accomplished primarily through extreme dieting, fasting or excessive exercise
Other, but related difficulties with food include:
- anorexic behaviour though still menstruating
- anorexic behaviour where, despite significant weight loss, current weight is still normal
- someone of normal weight inducing vomiting or purging after small amounts of food
- chewing and spitting food rather than swallowing
What characterises eating disorders?
Apart from the characteristics described above, there are other fairly common features which are often present. Some are more likely to be recognised by friends rather than the person with the problem.
- preoccupation with thoughts of food so that diet and food become the central focus of one's life
- a reliance on behaviour associated with food to deal with difficult emotions, stresses and tasks
- a desire for control over at least one aspect of one's life
- low self esteem from failing to meet expectations, which is then reinforced by the behaviour associated with the eating disorder, resulting in more self-disgust, shame and guilt, leading to lowered self-esteem
- distorted thinking - e.g. when I am thin I will be able to cope with ..
- secondary disorders caused by the behaviour - eg dental and digestive system damage, depression
- more women than men are affected
- sometimes, difficulty in adapting to being adult and to being sexual.
How to help yourself
The earlier help is sought the easier it is likely to be to change, but people do get over even very serious difficulties in time. The suggestions below may sound rather simplistic - in practice it usually helps considerably to talk about these with someone who is trained - and it may take some persistence!
- Acknowledge that the problem exists!
- Rather than just trying to tackle the unhelpful behaviours connected with food, try to identify what the eating disorder is disguising or helping you avoid - for example, are there difficulties in relationships, or within the family, or events in your past that have hurt you and changed how you feel about yourself?
- Challenge the distorted thinking! Although you may still think of yourself as overweight, at least allow yourself to recognise that others may see you quite differently, or even that they may be disinterested in your weight and just see you for who you are.
- Develop a pattern of eating that suits you and keeps you healthy. This isn't the same as saying develop a rigid routine of eating that cannot be varied! Maintaining a generally balanced diet is important, but allowing yourself to party (and break the rules') is also OK sometimes!
- Accept your body, i.e. respect your body regardless of it's current shape or size; set realistic expectations for changing it; recognise and understand its strengths and limitations. Recognise, too, that your body is not the same as your identity - confidence and personal contentment can be present however you look!
- Don't keep it a secret any longer - and it is unfair to expect a friend to keep secrets for you! Rather, seek support in dealing with the disorder from a professional helper or a self-help group.
How to help a friend whom you suspect has difficulties with food
- Remember that your friend is a person first, and someone who has difficulty with food second. So continue with whatever activities you would normally engage in together, and don't let issues of food dominate the friendship.
- Tell them of your suspicions - and be prepared for them to deny it
- Be supportive and encourage your friend to seek professional help. Ultimately, the problem is your friend's; if they won't seek help the consequences will be their's. Your responsibility is only to encourage them to seek help, or, in more extreme circumstances, to alert others - even against your friend's wishes.
- Don't nag about food, spy on your friend or get inveigled into imposing some form of external monitoring or control.
- Be available to listen when your friend can express his/her distress, but don't take on more than you can comfortably cope with. We all have limits - of knowledge, ability to help, understanding, time, etc. - so offer the level of support you feel able to sustain. If you try to offer more than that, you are likely to feel burdened and in time, perhaps, annoyed or angry, which is unlikely to help either of you, or the friendship.
- Look after yourself! Maintain your normal range of friendships and balance in your activities. Don't let this one issue take up all your time.
- If you are unsure whether your style of supporting your friend is actually helpful, or are quite concerned for your friend, you can seek out a professional (such as a counsellor) yourself, just to check out these things.
Local sources of help
University Counselling Service, 2-3 Bene't Place, Lensfield Road, Cambridge CB2 1EL.
CUSU, Old Examination Hall. Free School Lane, Cambridge.
Tel. network 33313 or (01223)356454.
National sources of help
Eating Disorders Association, 103 Prince of Wales Road, Norwich NR1 1DW
Helpline: 0845 634 1414
National Centre for Eating Disorders, 54 New Road, Esher, Surrey KT10 9NU
Tel: 01372 469493
Some useful books
- Overcoming Anorexia Nervosa - a self-help guide using Cognitive Behavioural techniques
- Freeman, (Constable and Robinson, 2002)
- The Food and Mood Handbook
- Amanda Geary, (Harper Collins, 2001)
- How to Cope with Bulimia
- Joan Gomez (Sheldon Press, 1995)
- The Art of Starvation
- Sheila McLeod (Schocken, 1982)
- Fat Is A Feminist Issue 1
- Susie Orbach (Arrow Books, 1988)
- On Eating
- Susie Orbach (Penguin, 2002)
- Getting Better Bit(e) by Bit(e) - a survival kit for sufferers of bulimia nervosa and binge eating disorders
- Schmidt & Treasure (Psychology Press, 1993)
- Anorexia Nervosa: a survival guide for families, friends & sufferers
- Janet Treasure (Psychology Press, 1997)
For a list of other relevant self-help books consult our: Self-help Booklists.