- 10% of people with Anorexia Nervosa will die within 10 years of onset of the disorder.
- Approximately 30% of high school aged girls engage in weight loss related behaviours.
- 40% of high school aged girls view themselves as too fat regardless of if they are of healthy-bodyweight.
- Girls who diet moderately are 5 times more likely to develop an eating disorder within 6 months of dieting than non-dieters.
- Adolescent girls who diet are 324% more likely to become obese than those who do not.
- 20% of overweight females and 6% of overweight males report using laxatives, vomitting, diuretics and diet pills to try and lose weight.
- 20% of female elite athletes and 8% of male elite athletes meet the criteria for being diagnosed with an eating disorder.
These are all various stats from short term studies that show that eating disorders and disordered eating impact people of all walks of life in different ways. As prevalent as eating disorders are in our society they are often very misunderstood by most people – part of that is because a lot of the behaviours associated with disordered eating are considered culturally acceptable.
To better understand people who have eating disorders or engage in disordered in eating, we need to know: what is considered an eating disorder or disordered eating, what’s considered optimal eating in terms of physical and psychological health, how disorder eating effects the body, what needs disordered eating fulfills, who’s at risk for developing disordered eating patterns, different types of disordered eating, how disordered eating effects the active population and the role exercise plays, and how to effectively treat eating disorders.
When I say the word “Eating Disorder” you probably visualize an image of a frail emaciated woman who looks she hasn’t eaten in 4 years. It’s a common misconception that eating disorders manifest themselves in the form of an extreme visual. The majority of the time eating disorders and disordered can’t be identified just by looking at someone’s body.
In fact when it comes to eating disorders or disordered eating, for every person you see looking extremely frail with all of their bones protruding from their skin their are thousands who look very athletic, average and chubbier. Disordered eating / eating disorders can only be confirmed by analyzing behavioural patterns towards food, exercise, body-image, etc – not by aesthetic. And a lot of the time disordered eating behaviour slides under the radar due to the fact that a lot of disordered eating patterns are considered socially acceptable in our culture.
So what is disordered eating?
Well before we can understand what “disordered eating” is, we need to understand what is optimal. What’s considered optimal along the spectrum of eating is something called attuned eating.
In a nutshell, attuned eating can also be referred to as “internally regulated eating” or “non-restrained eating.” What this means is that person will eat simply by listening to their body, they are in tune with their hunger and satiety signals and know when it’s time to start eating and when to stop eating and act accordingly. Attuned eaters will use moderate constraint when eating but are non-restrictive in their food choices. Their food choices will vary in response to emotion, schedule, hunger and proximity to food. They include both “healthy” and “unhealthy” foods in their diet in order to maintain satisfaction over the long-haul. Their bodyweight has a way of self-regulating itself because they listen to their body in order to determine their energy needs.
When our behaviours start to deviate from this model we start to fall into what’s called “disordered eating” which can eventually transgress into eating disorders. Disordered eating is externally regulated – meaning there is cognitive control of food intake. This can often times be referred to as dieting. Essentially all variables are controlled in terms of determining when, what, and how much a person eats – eating is based on external guidelines. Hunger and satiety are often ignored or given minimal attention attention and the person actively resists the needs of the body. Some people are able to undertake dieting or disordered eating behaviours for short periods of time without it becoming an issue, however when done for prolonged periods of time the risks of developing an eating disorder increase significantly.
What’s the difference between an eating disorder and disordered eating?
Eating disorders are very misunderstood by anyone who isn’t going through one or anyone who isn’t a professional that deals with treatment of eating disorders. The main difference between disordered eating and eating disordered is the emotional and psychological factor. Eating disorders are symptoms of low self-esteem and powerlessness and are often accompanied with isolation, depression, and suicidal thoughts. Eating disorders can manifest in many different forms, such as Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder (BED) and Eating Disorder Not Otherwise Specified (EDNOS.) BED is the most common eating disorder in North America. And many people who are suffering from and eating disorder can experience symptoms of more than one eating disorder
An eating disorder will most likely develop after a prolonged time of disordered eating behaviours. Most commonly with prolonged disordered eating and eating disorders peope lose their ability to regulate their caloric intake and can lose the internal cues from the body for hunger and satiety.
Loss of Internal Cues
Despite the face the we develop the ability to regulate caloric intake at 6 weeks olds a lot of people lose the ability to respond to internal cues of of hunger and satiety. They may block them out or consciously ignore them and as a result lose the ability to respond to internal cues of of hunger and satiety. People who lose this ability do not know when to eat, when they are satisfied, nor do they know how much to eat. Sometimes people have ignored these cues for so long that they don’t know they exist. This creates a dependence on externally regulated eating and pulls people farther and farther away from attuned eating.
Who’s at risk of developing disordered eating patterns?
Some things that increase the risk of developing disordered eating patterns are:
- Having low self-esteem or depression
- Being exposed to media portrayal of unrealistic body standards
- Being unable to respond to or communicate emotional needs
- Being exposed to culture that places a high emphasis on “physical ideals”
- Having a history of abuse (emotional, physical, or sexual)
- Having a history of dieting behaviour
- Being a high achiever or perfectionist (academically, professionally, or physically)
- Being female
Functions of Disordered Eating
The reality is that people don’t pick up disordered eating habits because they want to. Generally they pick up disordered eating behaviours because it fulfills a need or a function for them. These are some of the functions that disordered eating can fulfill:
- Comfort and soothing
- Release of tension, anger or rebellion
- A sense of predictability, structure or identity
- Avoidance of intimacy
- Numbing and sedation
- Self-punishment or punishment of the body
- Cleansing or purification of self
- Creating of a large or small body to protect from abuse
It is important to understand the cause of the behaviour or what the disorder is fulfilling in order to treat it properly. The most neglectful thing a person can say to someone who is suffering from an disordered eating or an eating disorder is to change the way they eat. “Just eat more” or “just eat less” are commonly touted by misinformed people. The behaviours have nothing to do with food, the food is the expression, but everything causing it is psychological and emotional, hence the need for qualified professionals (psychologists, psychiatrists, and social workers) for proper treatment.
The behaviours will manifest differently in people based off of their behaviours, beliefs and attitudes surrounding food and eating despite any parallelisms between causes.
Disordered eating will usually manifest in one of two forms: deprivation eating or emotional eating.
Disordered Eating in the Active Population and the Role of Exercise
An often neglected population when it comes to recognizing and diagnosising disordered eating is the active population. The active population includes athletes, regular gym-goers, our beloved meatheads, weekend warriors, etc. It’s harder to recognize disordered eating patterns in these populations because we generally admire characteristics in pursuing athletic endeavors. Some of these people will try to hide disordered eating by saying they are doing it for performance. Disordered eaters of the active population will typically have skewed relationships with exercise in addition to food and eating. They will often fall into the category of being a compulsive exerciser (Note: someone can be a compulsive exerciser without exhibiting disordered eating.) A proper psychological analysis will usually indicate that compulsive exercisers are not exercising for performance or reshaping the body but because of not dealing with feelings. As a result this creates an exercise dependence in order to avoid dealing with unaddressed emotions.
Exercise Dependence is expressed as:
1.A stereotyped pattern of exercise; once or more daily
2.Giving up other aspects of life to maintain exercise
3.Withdrawal symptoms following a cessation to exercise
4.Relief or avoidance of withdrawal by further exercise
5.Subjective awareness of a compulsion to exercise
6.Rapid reinstatement of the previous exercise pattern after a period of abstinence
Treating Disordered Eating
Disordered eating needs to be addressed by qualified professionals meaning psychologists, social workers, nurses, doctor’s, dieticians, etc. Treatment of disordered eating does not focus on regulating food intake as dieting is generally at the root of the problem for most disordered eaters and needs to stop in order for the disordered eating to stop. In the active population, if compulsive exercise is an issue this also needs to stop for proper treatment to occur.
Counselling is the most appropriate and effective way to overcome an eating disorder and is a crucial part of the treatment – a large component of the disorder is psychological and without addressing that there will be little success in overcoming the disorder. Often times, challenging food fears is necessary as most disordered eaters develop phobias around certain foods. We want to challenge food fears because the fear of what people believe food can do to them underlies many eating problems. Dichotomous food labeling (Good vs. Bad, Clean vs. Dirty) discourages exploration, discovery and natural feedback from the body. Often reframeing the mindset around food with supportive vs. non-supportive eating is crucial. With supportive eating food should be emotionally and physically supportive, meaning it should attribute to your physical and mental well-being.
In addition to learning to eat supportively, people also need to relearn how to respond to hunger and satiety. And it’s important to answer the following questions:
- How do you know when you are hungry?
- How do you know when you are full?
- How do you know when you are satisfied?
- What is the difference between full and satisfied?
Being able to answer these questions will help you learn how to eat supportively. Learning how to eat supportively is crucial in overcoming disordered eating and is an important part of the treatment. Fortunately there are qualified and caring psychologists, social workers, dieticians, and nurses who specialize in treating eating disorders and can help implement the treatment.
If you or someone you know is a disordered eater or has an eating disorder, please encourage them to reach out and connect with professionals who specialize in treatment of eating disorders. I know it may be difficult, as I was once personally in the same position. There are caring professionals and excellent outpatient/inpatient treatment centres that want to help and have successfully helped others in the same position, myself included.
The NEDIC (National Eating Disorder Information Centre) – http://www.nedic.ca/
Sheena’s Place – http://sheenasplace.org/
Sudbury District Eating Disorders Program – http://www.mentalhealthhelpline.ca/Directory/Program/12703