”Dead girl walking”, the boys say in the hall
”Tell us your secret”, the girls whisper. One toilet to another
I am that girl. I am the space between my thighs, daylight shining through.
I am the bones they want, wired on a porcelain frame.
Laurie Halse Anderson, Wintergirls
Eating disorders describe illnesses characterized by irregular eating habits and severe distress or concern about body weight or shape. Eating disorders can develop during any stage in life but typically appear during the teen years or young adulthood.¹ Anorexia Nervosa has the highest mortality rate of any psychiatric disorder (Arcelus, Mitchel, Wales & Nelson, 2011).²
Eating disorders along the continuum
In the United States, 84 per cent of young women want to be thinner than they are. To diet is the most common way people deal with body dissatisfaction. On the far end of the continuum are people who become so obsessed with their body image that they develop an eating disorder. (Nolen-Hoeksema, 2014).
Thousands of teens develop eating disorders every year, or problems with weight, eating, or body image. An eating disorder is more than just going on a diet to lose weight or exercise every day. They’re extremes in eating behaviour – the diet that never ends and gradually gets more restrictive.
What are the different types of eating disorders?
Bulimia nervosa– is recurrent binge eating, following by self-induced vomiting.
Anorexia nervosa– is the starvation of oneself by eating less or as little as possible.
Binge eating disorder – is eating a considerable amount of food at one time.
Other lesser-known disorders are:
Pica – is an unusual craving for eating, licking or chewing on food or non-food with no nutritional value, for example, chalk, paper, sand, plastic.
EDNOS – is an eating disorder that does not fall in any of the above categories – a combination of the symptoms of anorexia, bingeing and bulimia.
What causes eating disorders?
Eating disorders are complex illnesses with a genetic component that can be affected by various biological and environmental variables.
Though the exact cause of eating disorders is unknown, it is generally believed that a combination of biological, psychological, and environmental abnormalities contributes to developing these illnesses.
Examples of biological factors include:
· Eating disorders, like most psychological disorders, runs in families.
· Bodily systems that regulate appetite, hunger, satiety, initiation of eating, and eating cessation can be causes of eating disorders.
· Nutritional deficiencies
Examples of psychological factors include:³
- Negative body image
- Poor self-esteem
Examples of environmental factors that would contribute to the occurrence of eating disorders are:
- Dysfunctional family dynamic
- Professions and careers that promote being thin and weight loss, such as ballet and modelling
- Aesthetically oriented sports, where an emphasis is placed on maintaining a lean body for enhanced performance. Examples include rowing, diving, ballet, gymnastics, wrestling, long-distance running.
- Family and childhood traumas: childhood sexual abuse, severe trauma
- Cultural and/or peer pressure among friends and co-workers
- Stressful transitions or life changes
What are the signs & symptoms of an eating disorder?
It is important to know the warning signs of an eating disorder. These may indicate that an eating disorder is developing or is being experienced in full.
Physical warning signs
- Sudden or rapid weight loss
- Frequent changes in weight
- Sensitivity to the cold (feeling cold most of the time, even in warm environments)
- Loss or disturbance of menstrual periods (females)
- Signs of frequent vomiting – swollen cheeks/ jawline, calluses on knuckles, or damage to teeth
- Fainting, dizziness
- Fatigue – always feeling tired, unable to perform normal activities
Psychological warning signs
- Increased preoccupation with body shape, weight and appearance
- Intense fear of gaining weight
- Constant preoccupation with food or with activities relating to food
- Extreme body dissatisfaction/ negative body image
- Distorted body image (e.g. complaining of being/feeling/looking fat when actually a healthy weight or underweight)
- Heightened sensitivity to comments or criticism about body shape or weight, eating or exercise habits
- Heightened anxiety around mealtimes
- Depression or anxiety
- Moodiness or irritability
- Low self-esteem (e.g. feeling worthless, feelings of shame, guilt or self-loathing)
- Rigid ‘black and white’ thinking (viewing everything as either ‘good’ or ‘bad’)
- Feelings of life being ‘out of control’
- Feelings of being unable to control behaviours around food
Behavioural warning signs
- Constant or repetitive dieting (e.g. counting calories/kilojoules, skipping meals, fasting, avoidance of certain food groups or types such as meat or dairy, replacing meals with fluids)
- Evidence of binge eating (e.g. disappearance of large amounts of food from the cupboard or fridge, lolly wrappers appearing in the bin, hoarding of food in preparation for bingeing)
- Evidence of vomiting or laxative abuse (e.g. frequent trips to the bathroom during or shortly after meals)
- Excessive or compulsive exercise patterns (e.g. exercising even when injured, or in bad weather, refusal to interrupt exercise for any reason; insistence on performing a certain number of repetitions of exercises, exhibiting distress if unable to exercise)
- Making lists of ‘good’ and ‘bad’ foods
- Changes in food preferences (e.g. refusing to eat certain foods, claiming to dislike foods previously enjoyed, the sudden interest in ‘healthy eating’)
- Development of patterns or obsessive rituals around food preparation and eating (e.g. insisting meals must always be at a certain time; only using a certain knife; only drinking out of a certain cup)
- Avoidance of all social situations involving food
- Frequent avoidance of eating meals by giving excuses (e.g. claiming they have already eaten or had an intolerance/allergy to particular foods)
- Behaviours focused around food preparation and planning (e.g. shopping for food, planning, preparing and cooking meals for others but not consuming meals themselves; taking control of the family meals; reading cookbooks, recipes, nutritional guides)
- Strong focus on body shape and weight (e.g. interest in weight-loss websites, dieting tips in books and magazines, images of thin people)
- Development of repetitive or obsessive body checking behaviours (e.g. pinching waist or wrists, repeated weighing of self, excessive time spent looking in mirrors)
- Social withdrawal or isolation from friends, including avoidance of previously enjoyed activities
- Change in clothing style, such as wearing baggy clothes
- Deceptive behaviour around food, such as secretly throwing food out, eating in secret (often only noticed due to many wrappers or food containers found in the bin) or lying about the amount or type of food consumed
- Eating very slowly (e.g. eating with teaspoons, cutting food into small pieces and eating one at a time, rearranging food on a plate)
- Continual denial of hunger
References & resources
¹ Eating Disorders | Dr Kerryn Armstrong. https://www.drkerrynarmstrong.co.za/eating-disorder
² Anorexia Death Rate – Highest Mortality Rate of Mental …. https://www.eatingdisorderhope.com/information/anorexia/anorexia-death-rate
³ Orthorexia nervosa definition, causes, symptoms, test …. https://healthjade.com/orthorexia/
4 Warning Signs of Eating Disorders | Eating Disorders Victoria. https://www.eatingdisorders.org.au/for-family-and-friends/warning-signs-of-eating-disorders/
5. Abnormal Psychology. Susan Nolen-Hoeksema. Sixth Editon. McGrawHill. 2014