Image credit: Adobe Stock

What are eating disorders (EDs)?

Eating disorders are different types of unhealthy eating patterns. Statistics tell us that EDs happen more often in girls and young women, but we're learning that more and more boys and men experience EDs too. For the most part, they involve eating either too much or too little. Other behaviours can also come along with disordered eating, like exercising too much, obsessing about food, throwing up, or taking laxatives to get rid of food you've eaten.

What types of eating disorders are there?

The most common types are:

1. Anorexia Nervosa 

Also known as Anorexia. People living with anorexia are terrified of eating and gaining weight, and become obsessed with these worries. They usually restrict food intake to lose weight. They may also use exercise or vomiting after meals to control weight. Anorexia is a very dangerous illness. Anxiety and depression are common with anorexia.

People with anorexia: 

• Are extremely afraid of gaining weight; 
• Have a very negative image of their bodies; 
• May think they are too fat, or that a part of their body is too big, even when family, friends and doctors disagree; 
• Have a low body weight. 

3. Binge Eating Disorder (BED) 

Binge eating means eating a large amount of food, but without the purging behaviours (vomiting, laxatives, exercise) seen in bulimia. This is not the same as having a bad day and eating more ice cream than you usually would. People with a BED often describe feeling out of control during a binge, that they are often not aware of the food or the amounts they are eating. Binge eating is often triggered by an upsetting situation or difficult emotions. People often feel overwhelmed by negative emotions, and eating gives them a temporary feeling of comfort. But this feeling of comfort is followed by feelings of guilt and shame. People with BED are sometimes larger than an 'average sized' person, but not always. They usually suffer from low self-esteem. 

4. Other or 'Unspecified' Eating Disorders 

Many serious EDs don't fit perfectly into one of the above definitions. For example, someone may either: 

• Vomit after meals, but not restrict food or binge; 
• Not eat enough food to nourish the body, but without any medical condition explaining this or fear of gaining weight. 

These illnesses are still very serious, as our health depends on being able to eat (and keep down) regular meals with the right 'dose' of nutrition to fuel our bodies and minds. 

How do I know if I have an ED? 

Here are some signs linked to eating disorders: 

• Intense fear of gaining weight; 
• Obsession with dieting or your weight; 
• Being overly picky with the food you are eating; 
• Hiding or getting rid of food; 
• Losing an unhealthy amount of weight; 
• Skipping meals; 
• Refusing to eat with friends or family; 
• Missing 2 menstrual periods; 
• Binging (eating large amounts of food and feeling out of control while you do so); 
• Using diet pills or laxatives; 
• Throwing up after you eat; 
• Refusing to eat non-'diet' foods; 
• Refusing to let others prepare your food; 
• Cutting food in very small pieces; 
• Weighing and measuring food amounts; 
• Obsessing over calorie and carb content of foods; 
• Not gaining height when you should be growing; 
• Feeling you have to exercise even if you don’t need to. 

What are the differences between healthy eating and disordered eating? 

We live in a world that constantly bombards us with images and videos telling us how we should look, what we should wear and how we should act. As a result, we tend to care about our appearance and that isn't a bad thing. It can be fun to play around with the kind of clothes you wear, hair products, body art, makeup or jewellery. However, this becomes unhealthy when it takes control of our lives and starts to impact our thoughts about ourselves, our feelings, our body and our relationships. Disordered eating often begins by simple dieting and can quickly spiral out of control and take over our lives, with serious consequences. Untreated eating disorders may also cause death. Disordered eating often leads to more serious EDs. It's important to get help if you have serious concerns about weight along with eating disorder symptoms.

What causes EDs? 

Eating disorders often begin with worries about the food you are eating or your weight. Dieting can cause an eating disorder to develop. While many teenage girls and boys will try to diet, only a few go on to develop a disorder. Things that might contribute to eating disorders are feeling stressed or anxious, low self esteem, low mood or feeling badly about yourself or your appearance. 

1. Socio-cultural influences 

We are constantly bombarded with media messages that tell us that being thin is essential for love, success and happiness. It might be hard to imagine, but there were times in history when round hips, bellies and thighs were celebrated! The 'ideal' model is now impossibly thin, airbrushed and photo-shopped, giving us even more unrealistic images to compare ourselves to. Such images tell us (or construct for us) what is acceptable or beautiful. It can be hard to ignore these messages, because they are everywhere, and really do get 'under our skin'. Perhaps these messages are intended to make us all feel 'not good enough' so that we will spend more money on trying to improve our appearance! We need to work on constructing our own ideas of beauty that celebrate diversity of size, shape, colour and ability. Instead of seeing our bodies as 'ornaments', we need to think of them more as 'instruments'-for doing the stuff we need and want to do! 

2. Personality traits 

People dealing with EDs often struggle with low self-esteem, and can be overly concerned about how others see them. Some are considered "super feelers". This means they feel emotions very intensely, both their own, and those of others. This makes them highly sensitive to how others people perceive them. This can be a wonderful quality as it can make a person very kind and compassionate, but it can also cause a person to want to please everyone and to be perfect as much as possible. They tend to put pressure on themselves to always do better, but are rarely satisfied with the results of their efforts. For many people, the main feeling underneath an ED is feeling 'not good enough' in some way. 

3. Stress 

Any severe stress (like from bullying, conflict at home, trauma, abuse, or the stress of living with anxiety) can cause people to turn to disordered eating patterns as a way to try to cope. For many, EDs are a way to regain control when life becomes very stressful, unpredictable and threatening. Controlling your eating habits can temporarily reduce anxiety, but doesn't do anything about the cause of the anxiety. So things can quickly get out of control again. 

4. Genetics 

Like other mental health issues, your genes influence your risk of developing an ED. People with a family history of EDs, obsessive-compulsive disorder, depression or anxiety have a greater risk of developing an ED. Your genes also play a big role in the size and shape of your body. It's hard to fight against your genes. And fighting your natural body type through starvation or disordered eating is dangerous. It's healthier if we learn to love and accept our bodies. We need to practice giving our bodies what they need, taking good care of them so they can take care of us. 

How are eating disorders treated? 

• First, talk to someone you trust. There is no shame and certainly no blame in having an ED. It's important for you to build a support team that understands you so that you do not have to feel alone.
   

• Arrange a visit to your family doctor or nurse practitioner. Either one can help you explore options that make sense to you.

Treatment for EDs includes: 

Individual counselling (or therapy) 

Counselling without including your family is only a good option if your are at a normal weight and have mild symptoms. For more severe eating disorders, individual counselling should happen along with family therapy. This gives your family the chance to learn about eating disorders and the best ways to help you. 

Individual counselling will help you to cope with stress or difficult emotions without taking things out on your body through eating disorder symptoms. It can also be a chance to: 

• Work on improving your self-esteem; 
• Learn how to care for yourself and your body; 
• Develop strategies for having a whole and happy life. 

Your therapist can be a great ally to help keep you motivated towards your goal. It's important to find a therapist who is a good listener. 

Family therapy 

Family therapy or support will help your family team work together toward recovering from this illness. By talking together and sharing accurate information, your family can learn how the illness affects you, what your needs are, and the best ways to support you. Your family can also work out ways to decrease some of the major stresses at home.

Medications

Medications can be a useful option to consider when you are feeling very stuck and having great difficulty
reaching your goals, even with all of the other support options. Medications can also:

• Reduce some behaviours such as binge-eating and purging;
• Decrease overwhelming feelings and thoughts;
• Reduce the anxiety and depression that often go along with an eating disorder.

Hospital treatment or private residential programs
 

Going into the hospital may be necessary if you are medically unwell and need further care and monitoring. It may also be an option for people who aren't getting better at home, even with the support of family and professionals.

Helping yourself get better

While it's important to have professional and family support to recover from an eating disorder, there are a few things that you can do on your own too.
 

• Eating your way out of the ED. The only way out of an eating disorder is to 'eat your way out' by getting back to eating normal meals at regular times throughout the day. For those with anorexia, the only way out of the illness is to get back to your body's healthy weight (for girls with anorexia, this means getting your periods back). For those with bulimia, the only way to leave the illness behind is by forcing yourself to eat regular meals and snacks all day. This is the only way to end the cycle of hunger, bingeing and purging.
   

• Scheduled Eating. This is the most important element in recovering from an ED. It sounds simple, but when you have obsessive worries about eating too much or gaining too much weight, it can be incredibly difficult. Scheduled eating is a way of re-nourishing your body and training it back into healthy habits. It means eating at regular times, even when you don't want to. So you schedule, eat, and keep down 3 regular size meals a day, with snacks in between. Snacks are important, because they keep your metabolism at a healthy rate (when you don't eat enough, your metabolism slows down). At first, your brain might not 'feel' hungry or want to eat. You have to retrain or re-feed, so you and your body learn how to read natural hunger cues again. Giving your body the nutrients it needs will also help to clear your thoughts and feelings, because your brain won't be suffering from inadequate nutrition. When you have an ED, eating normally is not easy. It will take a lot of strength, determination and commitment to make it work.

Here are some tips that will help:

• Stand up to your eating disorder

  • Your ED is not you. Don't let it define you. It can help if you give it an identity of its own-like a bully who is trying to control and harrass you.
    
    1. Name the bully inside your head. Some people call it 'Ed' or 'Ana', but feel free to get creative. By giving your ED a name, you help to separate yourself from it. Your ED bully will try to manipulate you into believing that it has the answer to making you feel better about yourself. It will always make you feel that you are eating too much and gaining too much weight. It will always try to make you feel guilty and bad about yourself so it can control you and push you around even more.
    
    2. Don't let the bully talk trash about you. Fight back with thoughts and arguments that show you're just fine the way you are. Recovery means learning to stand up to the bully and not listen to it. And don't just focus on your appearance. You're so much more than that. Think about things you can do, things you like to do, things you're good at, things you're proud of or that bring you peace and joy. If it helps, write down the things it's saying about you. Then push back by writing down the reasons your bully is completely wrong about you.
     

• Plan meals. Set a fixed time when you will eat your breakfast, lunch and dinner. Plan ahead what you will be eating to help stay focused on the goal. For extra support, think of where you will eat and with whom. Take part in grocery shopping and pick foods you used to enjoy eating before the eating disorder. Don't avoid any foods or food groups-'everything in moderation' is the key!
   

• Look ahead. Take some time to think about what is most important to you. Ask yourself, what do I value the most in my life? Where do I want to be in 5 or 10 years? What kind of person do I want to be? What goals do I have? You might find there are many things that are meaningful to you. Think about the steps you need to take to be 'who' you want to be. Worry less about the things that aren't as important to you. Think about who and what can help you to reach your long-term goals. Invest your time and energy in taking care of yourself, focussing on positive relationships, and reaching your goals, instead of trying to be perfect in everything. Also, ask yourself, what makes a good friend? Who are the most important people in my life? Is it their weight that matters most to you? Would they want you to be obsessing about your weight?
   

• Be your own best friend. We often have great advice for our friends, but maybe we should sometimes take our own advice. If a friend was being treated badly by someone, what kinds of things would you tell them?
   

• Exercise your gratitude muscle. Noticing and paying attention to good things in your life is important. It's a habit, and we need to practice it. Take some time every day to think about things you're grateful for. They don't have to be big things. You'll be surprised at how nurturing an 'attitude of gratitude' will help you see more of the positive things in your world.

  • A warm smile
  • Your affectionate dog
  • A purring cat
     

• Accept yourself. Recognize that there is a weight that your body wants to be, called your natural set point. This is where your body is at it's healthiest, but is not always model-thin. There is also a healthy 'dose' of nutrition that is right for our bodies. Eating disorders develop when we try to change either of these things, and can spell disaster for our physical and mental well-being. Things don't usually go well when we try to fight Mother Nature. Recovery means learning to accept ourselves at the weight that our body wants us to be. If the vet told you that your puppy needed 1 cup of dog food 3 times a day, would you give your puppy only half that amount, and let your puppy go hungry? Of course you wouldn't. We need to be able to do the same for ourselves. We need to take the amount of nutrition our bodies need to be healthy.
  
  Battling an ED can be very tiring. This might feel like a tug of war, with your ED on one side, and you on the other. Instead of trying to overpower the ED, take another tactic and simply let go of the rope. Accept that the urge to binge, purge or avoid eating exists. Notice that these feelings are there, but don't act on them. You are coping without acting upon these urges. This will eventually allow you to let go of this power struggle altogether.
   

• Relax when feeling overwhelmed Find ways to calm yourself when you're feeling overwhelmed and having urges to engage in eating disorder symptoms. Try to focus only on the present moment and practice one of your favourite relaxation skills, like:

  • A breathing exercise;
  • Going out for a walk;
  • Reading a book;
     

• Make positive affirmations. It’s common to be self-critical, and we are often way too hard on ourselves. Positive affirmations are things you say to yourself to help change your thinking when you are hard on yourself. For example, when you are thinking “I’m such a loser, what's wrong with me?”, you may try saying instead “I’m being too hard on myself; I have a friend who likes me and that's good enough”. At first, you might find it difficult not believing all the self-critical thoughts, but with practice, you’ll notice the negative thoughts will be less frequent and intense. You can also find other ideas for positive affirmations on the internet simply by searching for them. Go a step further by writing your positive affirmations on a sheet of paper or journal and go over them every day. The secret here is focussing on what you do like about yourself. Make yourself smile-it will actually make you feel better.

Remember!

When you have an ED, you often don't have an accurate perception of how you really look. For example, many people with eating disorders think they are really overweight, when they're not. This is called 'dysmorphia'. This kind of warped image of your body can get worse when you're not getting enough calories and nutrients.