Eating Disorders (eBook)

1 What are eating disorders?

Whoever you are, and whatever your reasons for buying this book, we are meeting here on this page because you have some kind of interest in eating disorders. If you read newspapers and magazines regularly, you will probably have come across the names of many different ‘eating disorders’. Some of these you might know a lot about; others may be new to you. In this chapter I want to make sure we have the same understanding of what eating disorders are and what I mean by all the terms and jargon I use.

Most eating disorders come from the same basic root belief. Someone who is struggling with difficult thoughts, experiences, feelings or memories comes to believe that things would be different if they were thinner. This may show itself as a hatred of their own body – a conviction that they are fat and disgusting. Or it may simply be a drive to be thinner. Some sufferers start out genuinely overweight. Others simply think they are, or may have been told that they need to lose weight, for example through bullying or teasing. Whatever the reason, they come to place their hopes and aims on that one thing: in order to change their life they need to be thinner. An eating disorder develops because someone believes that losing weight will help them to cope with whatever life is throwing at them.

What comes next for sufferers is a resolve to change what they eat, and often to exercise more. It is a common myth (among sufferers as well as other people) that only those with anorexia restrict what they eat. That’s not true though – most people with eating problems aim to restrict their food and set themselves strict diet plans. How well they manage to stick to this we will think about in a moment, but at this stage it is all about setting those plans. Most sufferers could give you a list of foods in their head that are ‘forbidden’ or ‘bad’. They will also probably have ‘good’ foods which they allow themselves to eat, although some people simply aim to eat as little as possible, or even to fast for a period of time.

The third stage in developing an eating disorder is the one in which sufferers start to split into the different kinds of eating disorder, such as anorexia and bulimia. This is because what happens next depends on lots of things, including personality and practical issues such as whether or not it is possible to skip meals.

One group of people manage to stick resolutely to their diet plan. They restrict their eating severely, often cutting down more and more as time goes on – adding foods to their ‘forbidden’ list, counting calories or fat grams obsessively, and always compulsively chasing the control they long for. These people are those suffering from anorexia nervosa. The term ‘anorexia’ actually means a loss of appetite, whereas the ‘nervosa’ clarifies that this is something to do with the sufferer’s mind. However, this is a bit misleading because in fact people with anorexia do not lose their appetite. Once they have suffered for a long time many do become so separated from the normal urges to eat that they no longer feel the sensation we would call hunger, but what causes them to stop eating is a tremendous act of will and self-control. Then, as the illness continues, the drive to keep restricting food starts to come from the fear of what will happen if they do allow themselves to eat.

People who suffer from anorexia lose dramatic amounts of weight. This can happen very quickly, or relatively gradually. Of course, if someone was overweight to begin with, this can take some time to show, so not all sufferers are very underweight. But one of the biggest risks of anorexia is the physical impact of someone effectively starving themselves over a long period of time.

However, it is a misconception that sufferers never eat. Very few manage to keep up the control all the time and most will eat sometimes. For some this loss of control may even trigger cycles of bingeing and purging, like those you will see in bulimia. But, overall, sufferers eat less than they need to, and so continue to lose weight.

Meanwhile, a key feature of anorexia is that although sufferers are underweight or losing weight, they do not see themselves as thin. In fact, many persist in thinking they are fat, even when their life is at risk because they are so thin. This, of course, is because being thinner does not actually make them feel better or solve the problems they are struggling with, so they continue to feel that they need to lose weight and be thinner. This is one of the things that make anorexia such a dangerous condition.

A second group of people, meanwhile, start off with very similar aims to those with anorexia, but practical things about their lives (for example, if they are living at home and cannot avoid meals) or their personalities mean that there are regular times when their control breaks down and they eat. These people struggle with bulimia nervosa or binge-eating disorder. During these times they typically start to eat the foods they had originally forbidden themselves – all those things on that list. Putting a food on a ‘forbidden’ list often means you immediately start to crave it, so when these people break down and allow themselves to eat, they tend to overeat and binge on large quantities of these foods. Binges tend to develop and worsen over time, and usually happen in secret. Some people will plan specifically for a binge. They feel a terrifying sense of being out of control, and may eat things they would never normally consider, such as uncooked food, food that does not belong to them or even dog or cat food. Binges are very frightening because they represent the thing the sufferer most wants to avoid.

People with binge-eating disorder live their lives struggling with episodes of binge-eating. They hate themselves and their weight, and are usually overweight or obese. Often they have been on every diet around and swing from one eating plan to another, but each time they are doomed to failure because their control eventually breaks down and another binge starts. Binges can be triggered by certain feelings and many sufferers would describe them as episodes of ‘comfort eating’. They may talk about their lack of self-control and even joke about it, but underneath it is anything but a joke.

Additionally, there are those who struggle with bulimia nervosa. The term ‘bulimia’ describes someone who eats ‘like an ox’, and this relates to the binge-eating part of the disorder. People who suffer with bulimia develop a fourth stage of this vicious eating and dieting cycle. After a binge, seized with terror, regret and frustration at what they have done and desperate to avoid putting on weight, they begin to do something to purge what they have eaten. What they do varies, but can include things such as making themselves sick, taking laxatives or excessive exercise. They think that the purging makes things better, but in fact it makes the bingeing worse because swallowing food is no longer the ‘point of no return’ of eating. Now they have something they believe will stop them putting on weight when they binge-eat, so the binges tend to become more frequent and worse, involving more and more food. Some people binge and purge several times a day. Others lurch between bingeing and purging, and then aim to fast for several days in a desperate attempt to stop what they are doing.

People suffering with bulimia are usually convinced they are overweight and hate their appearance. However, in spite of feeling so dissatisfied, most are actually at or near normal weight. You cannot tell if someone has bulimia just by looking at them. Bulimia often carries on for years in secret without even close family knowing anything about it. Sufferers endure a regular cycle of difficult and painful feelings as they struggle with the triggers for and the consequences of binges. Very often they will try to stop bingeing – most hate themselves for doing it and feel very ashamed of what they do. But in their effort to stop, they actually set themselves up to fail, developing a new resolve to restrict their eating and therefore starting the whole cycle again.

What I have just described are the three main eating disorders. Of course, there are many variations of these three diagnostic terms, and often people do not fit one or another precisely. Add to this the fact that doctors and psychologists have specific criteria that someone has to meet to be diagnosed with a specific eating disorder, and you can understand why another disorder is commonly diagnosed: something called EDNOS. This means Eating Disorder Not Otherwise Specified, and is used when someone is plainly suffering with an eating disorder, but for one reason or another doesn’t quite fit the criteria for anorexia, bulimia or binge-eating disorder. Perhaps they have anorexia, but have not yet lost enough weight to be clinically underweight. Or perhaps they are a man, or a younger girl, and so do not meet one of the criteria for anorexia, which is that a sufferer’s periods have stopped (something called amenorrhoea). Or maybe they are struggling with bingeing and purging, but it is not yet occurring often enough to be diagnosed as bulimia (the criteria require someone to binge and purge at least twice a week for a minimum of three months).

Some common questions – and answers

My friends/family/teachers say they think I am anorexic, but I am not thin. Could I be fat...