We all need to eat to live. Thinking about food and eating are an inevitable and necessary part of our day. However, some people end up developing unhelpful thoughts about food and unhelpful behaviours around food too. Sometimes these unhelpful thoughts and behaviours can get to the point where they would be categorised as an eating disorder. An eating disorder is a mental health condition that involves unhelpful attitudes, thoughts and behaviours around food (and sometimes body image and weight too). Eating disorders can involve obsessive thoughts about food, engaging in unhelpful food-related behaviours such as food restriction or binge-eating and feeling anxious or low about food choices. If severe and left untreated, eating disorders can cause very serious physical and mental health issues.
Anyone can be affected by an eating disorder. Someone struggling with an eating disorder can be any weight (they can be overweight, underweight or a healthy weight), they can be male or female, they can be any age and they can come from any background. It’s estimated that, in the UK, around 25% of those suffering from an eating disorder are men. However, men may be more unlikely to recognise the signs and symptoms of eating disorders and hesitant to seek out help or treatment, so there could be more men struggling with eating disorders than we realise. It’s important that you know what the signs and symptoms of an eating disorder are so that you can seek out help and treatment if you start to exhibit any of them. Below, we explore the most common eating disorders, the warning signs that you may be developing the condition and also the harmful effects of the disorder:
1. Binge eating disorder (BED)
Binge eating disorder is an eating disorder in which someone eats a lot of food in a short period of time (binges) and finds it difficult to stop eating (even though they’re full). Often a binge will involve eating very quickly, eating in secret or when alone, eating to the point of feeling uncomfortably full and also feeling guilty, low or ashamed after eating. BED is usually diagnosed when someone’s bingeing on average 1 day a week for 3 months or more frequently than this.
You may be struggling with BED if you notice that you’re bingeing. You may be bingeing if you have occasions where:
- You feel completely out of control around food and eat much more than one portion of food in a short period of time (e.g. within 2 hours).
- You eat to the point of getting uncomfortably full and feel intense feelings of guilt or shame after doing so.
- Once you start eating, you find it difficult to stop, you eat very fast and eat even though you’re not feeling physically hungry or enjoying the food anymore.
- You find yourself eating these large volumes of food when you’re alone or in secret and may try to hide what you have eaten from others e.g. by hiding food wrappers or re-buying and replacing foods you’ve binged on.
- You overeat in a way that makes you feel very low or disgusted about your eating behaviours.
Often people with BED will find that they are quite disciplined with their food intake during the day but then experience an uncontrollable urge to overeat in the late afternoon or evenings. Binges can be spontaneous or they may be planned in advance. Binges may also involve eating specific “binge foods” which are often foods that the individual restricts themselves from eating day-to-day. Many people with BED will just seek out weight loss help such as choosing a new meal plan or diet to follow, however, binge eating requires psychological treatment from an eating disorder specialist. It’s important to be aware that many of the strategies used for weight loss such as following a meal plan, calorie counting, intermittent fasting or cutting out food groups, can all make binge-eating disorder much worse.
Harmful effects: Individuals with BED can be any weight but if the condition is left untreated over the long term, an individual with the disorder may end up putting on a lot of weight and dealing with the complications associated with being overweight or obese such as having mobility issues, high blood pressure or type 2 diabetes. Binge-eating disorder can also have a very negative effect on someone’s mood, causing them to experience anxiety, depression and also feelings of guilt and shame around their eating behaviours. Individuals suffering from binge eating disorder may also lack confidence and have low self-esteem or poor body image. There’s a danger that those struggling with this eating disorder choose to withdraw from things that they previously enjoyed or from seeing friends and family and this can also worsen their low mood.
Bulimia is a condition, similar to binge-eating disorder, where someone will find themselves bingeing (as described above). However, someone suffering from bulimia (unlike someone suffering from BED) will also use strategies to try and “compensate” for their binges such as:
- making themselves sick (purging);
- using laxatives or diuretics;
- fasting or crash dieting; and/or
The warning signs of bulimia include all of those warning signs listed for BED above, however, they also include signs of the compensatory behaviours such as:
- Making yourself sick after eating.
- Fasting or putting yourself on a very restrictive eating plan or crash diet after you’ve had a binge.
- Using laxatives or diuretics regularly and even though these have not been prescribed by your doctor.
- Spending over an hour a day exercising and/or exercising to “burn off” the food you have eaten after a binge.
- Using weight loss pills or drugs to try and compensate for bingeing.
Bulimia carries all of the risks of BED, however, it also carries many additional risks due to the use of compensatory behaviours. Regular vomiting can cause issues such as tears in the lining of the throat, dental problems and bad breath. The regular use of laxatives can cause issues such as constipation and difficulty ever having bowel movements. Other harmful effects of bulimia can include heart and kidney problems, skin issues, fatigue, fits and muscle spasms and bone problems.
Anorexia is the mental health condition with the highest mortality rate. It’s an extremely dangerous condition which involves individuals restricting their food intake and starving themselves until they become very unwell. In order to be diagnosed with anorexia you would have to be underweight (i.e. have a BMI under 18.5). However, as anorexia is such a serious condition, if you notice any of the warning signs listed below, it’s helpful to seek out help or treatment even if you’re a healthy weight, to ensure that you don’t get to the point where you’re seriously unwell.
You may be struggling with anorexia (or are at risk of developing anorexia) if:
- You regularly skip meals or feel anxious about eating certain foods which you perceive as fattening.
- You have lots of food rules and feel unable to eat a lot of different types of food.
- You’ll only eat very small bites of food or feel the need to cut food up into very small portions or bites in order to be able to eat it.
- You lie to others about having eaten food that you haven’t.
- You feel nervous about eating food that other people have prepared or about eating in restaurants because you don’t know what is in the food or how many calories it contains.
- You’ve been consistently losing more than 1-2kg a week.
- You think about food or obsess over food a lot but feel unable to eat this food, perhaps instead cooking food for others, scrolling through food-related accounts on social media or watching cooking shows on TV to satisfy that obsession.
- You often feel light-headed or dizzy or have noticed your hair falling out as you’ve started to lose weight.
- You believe that you’re fat or need to lose weight even though other people tell you that this isn’t the case.
- You take medicine to suppress your appetite or aim to eat under 1200 calories a day.
Anorexia is a very dangerous mental health condition and the sooner you seek out treatment for it, the more likely you are to fully recover. Anorexia can cause a range of very harmful effects including fertility issues, low sex drive, issues with muscles and bones, kidney and bowel problems, heart problems and a weakened immune system. If left untreated and allowed to get worse, it can ultimately lead to death. If you suspect that you may have anorexia or are showing any of the signs or symptoms above, seek out immediate medical help.
4. Avoidant restrictive food intake disorder (ARFID)
A lesser-known eating disorder is something called avoidant restrictive food intake disorder or ARFID. This is a condition in which someone restricts their food intake or doesn’t feel able to eat certain foods due to the food’s taste, texture, “freshness”, colour or smell or because they just have a low interest in eating. Many people with the condition will find themselves just eating “safe”, highly-processed or beige foods and will find it difficult to eat fresh foods such as vegetables and fruits. However, for other people, the condition may just show up as eating feeling like a chore and them lacking an appetite to eat. Whatever the cause of the condition, ARFID often means that an individual has very limited food choices and can feel anxious about going out to eat or eating at people’s houses, they may also just find themselves eating the same few foods or small portions of foods every day.
You may be struggling with ARFID if you notice any of the following:
- You’re unable to try or eat certain food due to the texture, taste or smell of these foods.
- You worry about vomiting, gagging or choking when you think about eating certain foods.
- You tend to stay away from “fresh” foods such as fruits and vegetables and prefer “safer” foods such as processed foods, cooked meat and potatoes.
- You don’t really remember to eat often or feel that eating has become a chore.
As ARFID can involve eating a very restrictive diet there’s a risk of macronutrient and micronutrient deficiencies as someone with ARFID is probably not eating a very balanced diet. For those that have a low interest in food, ARFID can also present the same risks as anorexia.
5. Other eating disorders include Orthorexia, Bigorexia and Purging Disorder
Many people have unhelpful thoughts and behaviours around food that don’t fit into the categories described above or that aren’t currently recognised in their own right as an official eating disorder. These unhelpful thoughts and behaviours would fall under the category of “other specified or feeding disorder” (OSFED). OSFED is an official disorder and the majority of people suffering from an eating disorder have OSFED. Some examples of conditions that may fall within this category can include:
- Bulimia or BED of limited frequency: this is where someone is bingeing (or bingeing and compensating) but less frequently than once a week or has been bingeing for less than 3 months.
- Atypical anorexia: this is where someone is showing the signs and symptoms of anorexia and is restricting their food intake but is not underweight.
- Purging disorder: this is where someone engages in compensatory behaviours such as purging or using laxatives but without bingeing (they may do this just after a regular meal).
- Orthorexia: this is similar to anorexia in that someone will restrict their food intake. With anorexia someone will usually restrict foods that they think will make them gain weight or that are fattening, however, with orthorexia, someone will typically restrict foods that they don’t think of as “healthy”. The definition of what is “healthy” can become more and more narrow over time.
- Bigorexia: this is a disorder driven by the need to increase muscle mass. It’s often viewed as a type of body dysmorphia rather than a type of eating disorder, however, it can lead to unhelpful food-related behaviours too. As it involves the belief that the body is too small and more muscle mass is needed, it can lead to some very unhelpful behaviours such as food restriction, over-consumption of protein/ protein-containing products, use of steroids and over-exercising. Bigorexia can have a very negative effect on someone’s mental health, confidence and self-esteem.
If you’ve noticed that you’re struggling with any of the symptoms described above, it’s important that you seek out medical help as soon as possible. Eating disorder treatment is much more likely to be successful when the treatment is sought early and before the unhelpful thoughts and behaviours become too entrenched. Some people may not feel that they are “bad enough” or “unwell enough” to get help or because they don’t yet meet the diagnostic criteria for an eating disorder, however, often these patterns would fall into the OSFED category. Eating disorders also tend to worsen the longer they’re left untreated so seeking help and treatment as soon as you can is key. Places you can access help and support can include:
- your GP or a private medical doctor who may refer you for talking therapy such as CBT (cognitive behavioural therapy) or prescribe medication to support you;
- the eating disorder charity BEAT;
- the charity CALM (Campaign Against Living Miserably);
- the Samaritans who offer a support service if you’re having suicidal thoughts;
- on the BACP or UKCP website, which lists places and people with whom you can access private psychotherapy for eating disorders; and/or
- in-patient/residential treatment for your eating disorder if it’s making you seriously unwell, either from a private clinic, a public hospital or accessed via your GP.
Eating disorders are caused by a very complex range of different factors. The range of factors that may underlie and cause eating disorders to develop include:
1. Poor body image. Read this post on ways to work on improving your body image.
2. Genetics and exposures. There are genetic factors that can contribute to the development of an eating disorder and things that we are exposed to such as media representations of “ideal” body types can influence our thoughts, behaviours and attitudes to food and our body.
3. Crash or fad diets. Extreme dieting can create unhelpful thoughts and behaviours around food. Read this post to explore why crash diets are a bad idea.
4. Perfectionism and perfectionist traits. Perfectionist traits can make you more likely to develop an eating disorder.
The bottom line
Eating disorders are very serious mental illnesses. If you’re worried that you’ve started exhibiting any of the symptoms of an eating disorder described above, it’s important that you seek out medical help as soon as possible. We all need to eat to live. However, worries about food, your body and eating shouldn’t end up taking over your life.