What are Eating Disorders

Eating disorders are illnesses that can adversely affect individuals both physically and psychologically. They involve severe disturbances in one’s eating behaviour and everyday diet such as extreme reduction in their food intake or overeating; or extreme measures to lose weight such as purging or over-exercising; all while feeling exceedingly distressed about their body shape and weight. Eating disorders, which occur more frequently during the adolescence stage or early adulthood, can affect both men and women.


There are many contributing causes to eating disorders, and in most cases, involve complex emotional and social issues. They stem from various biological, psychological and environmental risk factors such as the tendency to diet, low-self-esteem, poor body image, history of major life trauma or abuse, stressful life changes, professions that emphasize on image or appearance etc. A number of these factors often come together at some point of the person’s life to trigger the eating disorder.


These abnormal eating habits are often detrimental to the individual’s physical and mental health hence posing a serious threat to the individual’s life. In severe cases, it is life-threatening. Individuals who are affected may also suffer from depression, substance abuse as well as anxiety disorders. However, eating disorders are treatable. Therefore, people with eating disorders need to seek professional help as early diagnosis and treatment may promote recovery.

Common types of eating disorders include anorexia nervosa, bulimia nervosa and binge-eating disorders as well as eating disorders not otherwise specified (EDNOS).


Anorexia Nervosa


Anorexia nervosa consists of the following characteristics:
• Obsessive fear of gaining weight
• Refusal to maintain a normal, healthy body weight
• Extreme preoccupation with his or her body
• Distorted and unrealistic perception of body image and body weight
• Denial of low body weight
• Being extremely thin and emancipated
• Lack of menstruation in girls and women
• Restricted food intake/calories or starving
• Excessive exercising
• Weighing themselves constantly
• Lack of insight to the seriousness of the illness


Other physical symptoms may include:
• Low blood pressure
• Fatigue
• Thinning/brittle hair
• Bloated stomach
• Abnormal heart rhythms
• Brittle nails
• Dry skin
• Anaemia
• Low tolerance to cold temperatures
• Constipation
• Osteoporosis


For many who have anorexia nervosa, they consider themselves to be fat or overweight even though they are evidently underweight and malnourished. The fear of gaining weight leads them to try and maintain an extremely low weight. It is often an emotional turmoil associated with a distorted body image and self-esteem. They often equate a thin body to their self-worth.


Bulimia Nervosa


Those who have bulimia nervosa undergoes recurrent episodes of binge-eating – an overwhelming compulsion to overeat – followed by purging to avoid gaining the extra weight or calories. Some may secretly binge and purge by self-induced vomiting, consuming laxatives or diuretics, fasting, strict dieting or excessive exercising. These frantic, self-harming efforts are often accompanied by feelings of shame and unhappiness about their weight and body shape as well as harsh judgements of their perceived flaws.


However, unlike anorexia nervosa whereby the person can be seen as severely underweight, people with bulimia usually have healthy or normal body weight, therefore keeping their condition a secret for a long period of time. The vicious cycle of binge-eating and purging can go on from several times a week to several times a day depending of the severity of the condition. This condition affects both men and women.


Those with bulimia may suffer from these signs and symptoms:
• Excessive exercising
• Damaged tooth enamel and discoloured teeth due to exposure to stomach acid
• Dehydration
• Sore/inflamed throat or sores in the mouth
• Fluctuating body weight
• Swollen cheeks
• Acid refluxes
• Loss of menstruation
• Calluses or scars on knuckles due to forcing fingers down their throats to induce vomiting
• Feeling lack/out of control
• Inability to stop eating to the point of physical discomfort
• Eating in privacy or secrecy
• Frequent visits to bathrooms during mealtimes
• Feelings of guilt or ashamed or depressed after eating


Binge-eating Disorder


Binge-eating refers to recurring episodes of overeating unusually large amounts of food compulsively. Many who binge on their food employ this method as a way to cope with their emotions or stress. Those with binge-eating may also feel deeply embarrassed about being unable to resist the urge to binge thus, often doing it in secret. They often feel compelled to eat a lot even when they are not hungry. Often, after a bout of bingeing, he or she may feel a sense of disgust or guilt with themselves, and may form other problems such as depression. Other risks include obesity, diabetes and heart conditions.


A person with binge-eating disorder may not show obvious physical symptoms. They may be slightly overweight, obese or even be at a normal weight. However, they may display several behavioural and emotions signs and symptoms such as:
• Eating extremely huge amounts of food
• Consuming food even when full
• Eating rapidly
• Eating until it creates a discomfort
• Feeling out of control with eating behaviour
• Constant feelings of depression, ashamed and disgust or guilt about eating behaviour
• Experiencing anxiety
• Often eating alone and feeling isolated
• Difficulty talking about their emotions or feelings
• Frequent dieting, with or without weight loss
• Fluctuating weight


As binge eating is closely linked to negative emotions such as guilt, shame, low self-esteem, self-disgust as well as some other psychological issues, these concerns needs to be addressed.


If you want to travel swiftly, go alone. If you want to travel far, go together.
African proverb


Survivors & Supporters


First, let us share the story behind the terms used to refer to persons with eating disorders (ED) & persons who are concerned for them, ie. survivors & supporters respectively.


The founding members of the original ED self-help group chose to focus on the hopeful & optimistic aspects of the ED experience. The emphasis is on development & strengthening through overcoming difficulties – to strive, survive & thrive. Hence, they are the SURVIVORS.


While active agents in their own recovery & only they can do it, they can’t do it alone. Survivors sustain longer & recover better with encouragement & emotional support from important others. Hence, families, friends & other loved ones are SUPPORTERS.


The good news is that with the right help, recovery is very possible. With treatment, consistent effort and support, many survivors have recovered and reclaimed their lives again.


It may help to:
– Be a good friend to yourself — being kind and patient with yourself as you would with a friend in need. Cultivating a nurturing self especially for times when we are super vulnerable. Just as it’s not fair to hit someone when they are down, we can learn to stop self-bashing / hitting when we are down since at those times we’d appreciate support to get up.


– Seek help when you feel that something is not right – whether or not we are able to say that we’ve got ED, we can say that something is not quite ok. It may be painful to say that thinness is not the answer to every problem for quite a while & that we felt out of control for just as long. We can say that we wish to talk to someone so that we can start moving towards achieving a serene sense of self.


– Confide in somebody whom you can trust — friend, family member, relative, school counsellor, work colleague — sharing your concerns may bring a sense of relief. If your confidante or healthcare professional is unable to understand the significance of your sharing, just keep on searching for support – keep focus on recovery & not allow these hiccups to stop our getting better.
– Remember all this suffering & stress is temporary – our bodies are re-adjusting & returning to its pre-ED state. So expect that it’ll feel weird, out of shape, weight gain, uncomfortably bloated, water retention, etc … we wish we could be like Pokémon & finish morphing in seconds. However, human bodies & brain need bit more time before regaining the shape we feel comfortable with.


– Improve skills in dealing with ANTS (automatic negative thoughts, feelings & reactions) – it’s so easy to be caught in a never-ending cycle of one reaction triggering another reaction & another & another, such that by the time we realise it, it’s so difficult to extricate ourselves. It helps to train our awareness to stay focused on “here & now”. Mindfulness training can be helpful, as is learning to distract & engage in other things, eg. things we liked before ED obsessions took over.


– Re-training our digestive system — because of the disruptive eating habits, our bodies have forgotten how to feel hungry & /or full. Our stomachs will feel uncomfortable with regular “normal” balanced portions, as it’s different from what the ED was used to. Yet this is how our bodies learn to recognise the hunger & satiety signals again, so that we can eat “normally” & be free from ED.


– Address health problems — Physical wellbeing is just as important as emotional & mental wellbeing. However, if ED has brought physical health concerns that affect both your emotional & mental wellbeing, please make that a top treatment priority as physical discomfort & worries over them can derail our recovery efforts. In some life-threatening situations, hospitalization may help stabilise the condition. It can also be effective in helping you to return to normal weight and eating patterns.


– Plan your recovery — This can be achieved with the help of an eating disorder treatment team (a family doctor, psychologist, nutritionist, social worker and/or psychiatrist). You and your care team can come up with a personalised care plan that supports your needs.


– Support groups for persons with eating disorders — whichever phase of recovery you are in, support groups could provide a safe environment for you to talk freely about ED, give &/or receive suggestions and support from people with similar experience.


It may help to:


– Get to know about eating disorders — especially how they feel inside e.g. understand that they may be as terrified of food as a person with phobia (eg. heights). Listening to survivors, reading books or websites, discussing with other supporters are some ways of increasing our knowledge and understanding.


– Learn to separate the person from the illness – symptoms of ED could be stronger resulted in the survivor acting out their pain. Remind yourself that your loved one is still there and your support is essential for her/him to overcome the ED symptoms & regain control of themselves.


– Seeking professional help – family support is crucial to survivor’s recovery & family’s wellbeing, yet certain aspects of ED recovery is beyond what the family can provide. Hence, engaging professional healthcare support is often helpful.


– Be aware of our attitude towards food, size, shape & weight – our comments about these may unintentionally create more difficulties for the survivor. Eg. comments on people based on their appearance implies that what’s outside (eg. looks) is more important than what’s inside (eg. kindness).


– Be aware of our attitude towards getting results – our impatience may lead to unhelpful comments. Remind ourselves that any stable recovery takes much time & effort before getting noticeable improvements; that all are fighting ED in their own ways. Learn to be aware of nano-progress: they are the building blocks & foundation of steady recovery.


– Learn to listen without judging – we can be preoccupied by our concerns and react emotionally. Listening and responding with objectivity and taking their concerns and fears seriously are essential forms of support. We also need to accept that no matter how much we want to be supportive, it’s impossible to be supportive 24/7.


– Be direct, specific, kind and gentle in our approach – it can be difficult as the survivor is hurting deeply & react badly. So it’s even more important to be objective and calmly clarify communications. Agree to a time-out if discussion is not getting anywhere useful. Bear in mind that perception of support is subjective, so do check with the survivor, when all are calmer, about the helpfulness of the action and agree to adjust or disagree ….


– Seek support for ourselves – to survive the journey, we too, can help by improving our self-care, taking time out to recharge so that we can travel further together on the recovery journey. Learn to set aside our worries and engage in supportive activities for ourselves eg, being a part of a support group, or a hobby. Keep firmly in mind: it’s a temporary upheaval, a transition, before things settle down & get better.


SEDS is a support group for survivors of ED and supporters. The group meets once a month. Contact SAMH Insight Centre at 1800 283 7019 for more information on the support group.