Understanding Eating Disorders
Eating disorders are common illnesses that typically begin during adolescence. They can occur in both males and females, of any age and from any cultural background. People experiencing an eating disorder may be underweight, normal weight or overweight. They may also appear to be eating a ‘normal’ amount.
A person experiencing an eating disorder will change the way they interact with food, and/or be dissatisfied with their body shape and size. These changes will have significant impact on their life. Eating disorders are serious mental illnesses that can have severe medical complications. Eating disorders have a high mortality rate. However, most young people who receive treatment early will recover.
A specific trait of eating disorders is that they often cause people to become secretive about food and weight control behaviours. Frequently, sufferers deny any problem, or avoid certain situations, people or conversations. Another characteristic of the illness is that it is often difficult for the individual to understand that they are unwell and require help. As a result, not all people who experience an eating disorder get the treatment they need.
Parents are instrumental in identifying whether their child may have an eating disorder. They can usually determine that something is wrong and can ensure their child sees the right health professionals to access treatment. Evidence shows that parents are often crucial in helping their child recover from an eating disorder, so they should always be involved in treatment.
There are a number of different types of eating disorders. The most common types are outlined below.
What is Anorexia Nervosa?
A person experiencing anorexia nervosa restricts their food intake. This results in weight loss and a body weight that is too low for their age, sex, stage of development and physical health. The person is terrified of gaining weight and will engage in various behaviours to avoid this. There may also be a disturbance in the way they experience their body weight, shape or size, and they may experience very low self-worth as a result.
There are two different sub-types of anorexia nervosa. The ‘restrictive’ type is where a person will significantly reduce their intake of food (and/or increase their amount of energy output through means such as excessive exercise). The second type is ‘binge/purge’, where a person may not have such a high level of food restriction, but will try to control their weight through excessive exercise or purging (e.g. by self induced vomiting, using laxatives).
Another variation of this illness, atypical anorexia nervosa, occurs when a young person displays the features of anorexia nervosa, without the low weight classification. People experiencing atypical anorexia nervosa may have lost weight quickly, but still be classified within the normal or overweight range. Recently, there has been a significant increase in the number of young people presenting with atypical anorexia nervosa.
What is Bulimia Nervosa?
A person experiencing bulimia nervosa will have repeated occurrences of binge eating (for example once a week or more over a few months). When binge eating, a person feels ‘out of control’ and eats an amount of food that far exceeds the amount another person would eat in the same period. Often the foods consumed in a binge episode are high in sugar or fat.
In order to compensate for the binge episodes, a person experiencing bulimia nervosa will use weight control behaviours also known as ‘compensatory behaviours’. The aim of these behaviours is to reverse the effect that the binge may have had on their weight. People may use methods such as excessive exercise, self-induced vomiting, or laxative use. Bulimia nervosa is different to anorexia nervosa (binge/purge subtype) as a person experiencing bulimia nervosa is not classified underweight for their age, sex, stage of development and physical health.
What is Binge Eating Disorder?
People experiencing binge eating disorder have repeated occurrences of binge eating (at least once a week for three months). However, they do not use any compensatory behaviour/s to counteract the binges.
A person experiencing binge eating disorder will eat an amount of food in a given period that far exceeds the amount another person would eat in the same period. Binges are characterised by:
- feeling out of control
- eating very fast
- eating until uncomfortably full
- eating when not physically hungry
- eating alone because of embarrassment about the amount of food being eaten
- feeling depressed or guilty afterwards
- a high level of distress
What is Other Specified Feeding and Eating Disorders?
This diagnosis is used when people are experiencing severe eating disorder symptoms that do not quite ‘fit’ any other eating disorder diagnosis. The illness may have characteristics similar to anorexia nervosa, bulimia nervosa, binge eating disorder, or a combination of these.
How do people get an eating disorder?
It’s no one’s fault that a young person develops an eating disorder. Parents do not cause eating disorders and young people do not choose them.
Individual personality traits, genetics and environmental factors can contribute to a person developing an eating disorder. These are known as predisposing factors. A combination of factors is usually involved in triggering the development of an eating disorder.
The most prominent risk factor for an eating disorder is dieting. Dieting includes eliminating food groups, fasting or missing meals. In young people, food provides the nutrition required for healthy growth and development. Dieting can be dangerous. Dieting can also trigger a tendency to binge eat.
Genetics can contribute to a person developing an eating disorder, but this isn’t well understood. For example, genetics may influence the way people perceive food (reward-pleasure responses), and their internal responses such as appetite and metabolism.
Certain personality traits are associated with an increased risk of developing an eating disorder. These traits include perfectionism, low self-esteem, rigidity, anxiety and/or being driven and high acheiving, avoidant or impulsive. Obsessive-compulsive tendencies may also be a factor.
Societal ideals and cultural norms may also have a negative impact.
Do people get better?
There is effective treatment available for those experiencing an eating disorder and their families. Research tells us the sooner a person receives the right treatment for their eating disorder, the more likely they are to have a positive outcome.
There is effective treatment available for eating disorders. There are varying levels of research evidence supporting the different types of treatments available, and treatment approaches differ depending on diagnosis or age. Professional opinion and advice should be sought in order to understand which opinion is the “right fit” for your child.
Ideally, treatment should be supported by a care team. A care team can have any number of people but should consist of at least one mental health clinician, and one medical professional.
Treatment for eating disorders is provided in the community, in an outpatient setting. Hospital admissions are usually only required if a young person is medically unsafe.
The most common treatment approaches for eating disorders in young people are briefly outlined below.
Family Based Treatment (FBT)
FBT is considered the preferred treatment for a young person with anorexia nervosa, and may be useful for young people experiencing bulimia nervosa. FBT is an intensive outpatient treatment that involves weekly appointments for the entire family with an FBT clinician. Parents have an active role in ensuring the young person begins eating sufficiently in order to restore weight to a healthy level. The subsequent phases involve the family working together to gradually return more control of eating back to the young person and finally support the young person to return to the expected level of development for their age.
Cognitive Behavioural Therapy Enhanced (CBT-E)
There is good evidence for cognitive behavioural therapy (CBT) in bulimia nervosa and binge-eating disorder. Cognitive Behavioural Therapy Enhanced (CBT-E) is a version of CBT developed specifically for eating disorders. CBT-E is an individual therapy, and focuses on identifying and challenging the abnormal thoughts about food and body image that are associated with problem behaviours. The therapist works with the person to provide strategies to monitor their actions and reduce problematic behaviours such as binge eating and purging. There is also evidence for CBT adapted for internet delivery, or in guided self-help form.
Dialectical Behavioural Therapy (DBT)
DBT can be helpful for people with bulimia nervosa or binge eating disorder. It provides young people with coping strategies to manage their emotional distress. DBT aims to help people work through their emotions in a healthy and productive way.
Where to seek treatment
It is important to seek help immediately for a suspected eating disorder.
GP’s are usually the first point of contact. Parents may find the FYI GP report a helpful document to take to this appointment, as not all GP’s have expertise in this specialist area. If parents are not satisfied with the outcome of their GP appointment, it may be necessary to seek another opinion.
It is imperative for parents to persist seeking help if they suspect their child may have an eating disorder as it is a severe mental illness that can have serious medical complications.
If a young person appears to have bulimia nervosa or binge eating disorder, Headspace could be a helpful place to start.
Headspace is the National Youth Mental Health Foundation providing early intervention mental health services to 12-25 year olds. Headspace aims to make it as easy as possible for a young person and their family to get the help they need for problems affecting their mental health and wellbeing. Headspace centres can be located via the Headspace website, which can be accessed in FYI resources.
For suspected anorexia nervosa in young people, intensive support is required. Child and Adolescent Mental Health Services (CAMHS 0-18 years of age), or Child and Youth Mental Health Services (CYMHS up to age 25 years) across Victoria can provide eating disorder assessment and treatment. CAMHS and CYMHS are state funded mental health programs that provide support for children and young people with mental health difficulties, including eating disorders. Referral to a local CAMHS or CYMHS is through the area mental health service triage, which can be contacted by phone 24 hours a day, 7 days a week. Details for your local CAMHS / CYMHS and triage numbers can be located via the Better Health Channel website. This can be accessed via FYI Resources.
Some mental health services have specialist eating disorder teams. Parents will be informed if there is a specialist eating disorder team in their local area when they contact mental health triage.
If parents require immediate help for their child, they can contact 000 or go to the nearest Hospital’s Accident and Emergency Department.