The word disorder conjures up chaos and untidiness. So if we have an eating disorder does it mean that we eat chaotically or untidily. The term disorder, is now widely used when referring to an illness of the mind or body. So what is an Eating Disorder and what is normal eating?
We are constantly reminded that we should be eating our five a day. Government bodies recommend that we should eat a varied diet, preferably in small quantities, frequently, five or six times a day. These guidelines are considered to be the ideal, and maybe considered to be the normal! However, no two people necessarily eat the same foods or quantities in any given day. In a modern society, we are able to choose the type of food we eat and when we eat. We might think we are normal eaters, because we are not chaotic eaters and that we are in control of the food we eat. Our eating habits however, are driven by many factors. In the western world, we have an extensive range of foods to choose from and our selections may be based on our cultural experiences, our individual tastes and our budgets. Our food selection may also be affected by our home environment, whether it be an individual or family meal that is required. Mealtimes maybe habitual, or may vary from day to day, affected by our working day. Our social commitments, play an important part on our eating habits. Whether we are an occasional social diner or somebody who dines out frequently, and maybe we regularly choose meals so that we appear to be a healthy eater. Daily life can interfere with our eating habits, whether adjusting to work shift patterns or by simply not having enough time to stop and eat. Illness, anxiety and stress alter our routines and thus affects our eating habits, changing what and when we eat. So are we all, abnormal eaters?
Abnormal eating could be used to describe the eating habits of somebody who does not adhere to the government guidelines. We may restrict ourselves to a diet of foods that we know we like, that enables us to maintain our budget and therefore avoid our fear of waste. We may choose sugary, fatty foods to eat , just because we can! We may perceive unhealthy eating to be a social standard and we could be more likely to conform to it! We may eat larger portions of foods knowing we shouldn`t, but because we can and it has become a requirement to enable satiety. As a result of these behaviours, we may begin to experience feelings of guilt and shame and try to put right our overeating instantly, by purging or by laxative taking. We may not introduce corrective behaviour for some months to come and we may then decide to diet! We may take the diet further still and begin to eat very little, skip meals or just not eat at all.
The extension of supermarket hours has also enabled us to extend the times that we can choose to eat. We may experience cravings for particular foods that need to be satisfied, and we may also feel the need to finish a meal even though we are full, or eat a whole packet or box of food. Our food selections may be a constant, almost a ritual. However unusual or chaotic, our eating habits may seem, whilst we are in control of them they are simply abnormal! But when the balance of control changes, and the eating habits control us, they can start to affect our daily routines, the habits intrude upon our working , home and social commitments.
When our abnormal eating habits are in control, we have now developed an Eating Disorder. We are no longer able to choose what, how and when we eat, but feel compelled to eat what we must. If we do not succumb, we may feel unable to cope. These habits are now driving our daily rituals and initially we may feel that we are quite normal. They may only be considered strange or excessive to the outsider. Our behaviour is now affected, forcing us to deny our habits or to hide them and develop secrecy tactics, for fear of criticism or exclusion. We may become preoccupied with food and we may have developed concerns about our weight and body shape which are now
driving our eating habits. These can affect our feelings and emotions but it is true to say that our feelings can also be driving our eating! If our habits have become unbreakable and are in control it is likely we have developed an Eating Disorder.
Binge Eating Disorder
There have been a large number of reports lately concerning Obesity. Reports suggest that the number of obese people has more than trebled in the developing world since 1980 and it is being called an epidemic. The most recent report by the National Obesity Forum estimates that 50% of the UK population will be obese by 2050. There are a number of Eating Disorders by definition and we will look firstly at the characteristics of Binge Eating. Deanne Jade of the National Centre for Eating Disorders defines the Binge Eating Disorder as requiring three of the following criteria:
- Recurrent problems with binge eating or episodic eating, where the amount of food is objectively large or excessive.
- Accompanied by a subjective sense of being out of control.
- Extreme concern and distress about eating behaviour, a sense it is abnormal.
- Binge eating at least once or twice weekly over a minimum period of 3 months.
- No purging strategies or excessive weight control methods such as fasting.
- The episodes will have at least three of the following traits:
- Eating faster than usual
- Eating past being full
- Eating when not hungry
- Eating alone or in secret
- Feeling guilty or upset after overeating
- A feeling of being taken over or driven in respect of eating
According to the National Centre for Eating Disorders, the criteria for Binge Eating Disorder (BED) differs from Bulimia Nervosa simply because of the absence of compensatory behaviours such as vomiting and laxative abuse. This is indicative of Binge eaters struggling incessantly with excess weight.
Bulimia Nervosa
Deanne Jade defines Bulimia Nervosa as an Eating Disorder characterised by recurrent episodes of Binge Eating followed by compensatory behaviours of vomiting, laxative or diuretic taking, in order to prevent weight gain. Bulimics have a tendency to be influenced by their weight and shape which has a significant effect on self esteem. A feature of this disorder is that a sufferer may be normal or overweight and usually tries to hide the problems of bingeing and purging for fear of shame. A sufferer may feel tension and the urge to eat reduces this feeling. Foods that are typically eaten during a binge may include biscuits, chocolates, crisps, cereal, chips, toast, cakes, tubs of ice cream but bulimics have been known to binge on lettuce! The food may on occasions be enjoyed but is mostly eaten so quickly without tasting. Following a binge, a sufferer may feel guilty, anxious and ashamed that they use compensatory behaviours in attempt to contain their weight. They may purge or use
laxatives or excessive exercise and other extreme weight control methods may be undertaken.
Research shows that the frequency of episodes of binge eating varies from once per week to 46 times per week. Deanne Jade reports that Bulimia is said to exist when some but not all of the following criteria exists:
- Episode of overeating.
- Feelings of guilt, shame, weakness and self hatred.
- Excessive fear of weight gain.
- Excessive concern with body shape and size.
- Secret behaviours.
- Eating maybe chaotic.
- Attempting to control weight by purging or laxative abuse.
Bulimia Nervosa can become an addiction with a need for secret behaviours to cope with feelings and emotions. It brings with it a loss of control and for both men and women today there is an increasing social status placed upon having a slim body shape.
Anorexia
Anorexia is defined by Deanne Jade as a condition whereby a person is preoccupied with body weight and has a fear of fatness and they continue to seek a low weight. Weight loss is desired and is attained by dieting or avoiding foods. In addition this may be accompanied by excessive exercising or purging.
Anorexia is said to exist when some of the following characteristics exist:
- Loss of weight BMI < 17.5
- Obsession with body weight loss
- Fears of being fat
- Disturbed perception of body shape
- OCD behaviours and rituals
- Secret behaviours
- Denial of illness
- Insomnia and restlessness
- Self hatred and low self esteem
- Avoidance of meals and social gatherings
- Refusal to eat
- Depression
- Anxiety
Anorexia occurs in both men and women and requires professional help to aid recovery. This is a serious illness and prolonged starvation can lead to other physical health problems such as Osteoporosis, Heart abnormalities, Hormonal problems, and loss of concentration to name just a few. Statistics show that female anorexics peak during adolescence between the years of 13 and 20 years. Whereas the onset of anorexia for males is still unclear. This may be affected by the onset of puberty which has different physical meanings for girls than boys.
Girls who reach puberty early experience a higher incidence of self abuse and low self worth. Whereas for boys, if they mature early they gain social status, self worth and emotional strength. This is an evolving illness with 1 in 5, 20% of anorexics succumbing to it. Statistics show that 30 to 50% of anorexics develop bulimic tendencies and 30% recover.
OSFED
This is a title that applies to Other Specified Feeding or Eating Disorders. It used to be known as EDNOS but has been changed in the DSM V to OSFED. It refers to diagnosis when a person`s symptoms do not meet the criteria of Anorexia Nervosa or Bulimia Nervosa, instead they are categorised as OSFED. Binge Eating Disorder is categorised under the heading of OSFED, as with the absence of purging it does not fall into the category of Bulimia Nervosa. The existence of this category is important, as it allows those suffering from an Eating Disorder of clinical significance, whereby they have significant concerns with food and behaviours around food, but do not fall into the category of AN or BN to be recognised. This allows these people who are diagnosed as having an eating disorder of clinical significance to receive treatment. In addition, many sufferers may move from one disorder to another and have partial symptoms of AN and/or BN but may not meet the full criteria of AN or BN. Some people may suffer from an Eating Disorder but their thoughts and behaviours may differ from those previously mentioned. They are classed as
atypical cases. This group may include people who do not binge, but for fear of weight gain may purge regularly. They may maintain a normal body weight as they may consume large amounts of alcohol. Other people may exclude food from their diet as they believe it to be impure or they believe they are intolerant or allergic. This group may be known as Orthorexic. Included in OSFED is a disorder known as Night Eating Syndrome. This came about when it was recognised that there were a group of people who were eating most of their calories following their evening meal. These people must not be confused with those who eat at night, due to work shift patterns. There is also still some debate as to whether Night Eating Syndrome is a variant of Binge Eating.
It is concluded that anybody suffering from an Eating Disorder will display characteristics as previously mentioned. But all will have significant concerns about body weight and shape which will drive the various eating behaviours.
If you need help or you know of anybody, who you believe may be suffering from an Eating Disorder, please do not hesitate to contact Angela or Sally here at Chrysalis by Email: a&s@chrysaliscounsellingservices.co.uk or by Tel: 01352 706280 for further information or advice.
We also run Eating Disorder Group Workshops for anybody needing help and if you would like to register for our next workshop please do not hesitate to contact us for further information or visit the NEWS section of the website.