Eating disorders whānau information — Canterbury

Eating disorders can have an impact on the whole family, not just the person living with the illness. This information is intended to help family members understand what we do at the South Island Eating Disorders Service.

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How our process works

Family based treatment requires active involvement of whānau throughout treatment.

At the South Island Eating Disorders Service we start with an assessment morning. This gives us the opportunity to:

  • gather information
  • discuss it as a multidisciplinary team
  • make any possible diagnoses
  • determine recommendations for treatment.

We encourage you to contribute to this process as your input is very useful. We will usually spend time with the person on their own also in order to assess them individually.

At the end of the assessment process, treatment recommendations will be discussed with the person being treated and you where appropriate.

Treatment

Treatment is evidence-based and in line with international research. Your whānau member will receive individual treatment or group treatment.

Each person offered treatment will be assigned a case manager who will coordinate their care and review process. Most treatment will be provided on an outpatient basis. Inpatient treatment is sometimes recommended for those not able to recover as an outpatient or if there is a significant medical risk requiring hospitalisation.

All treatment is based on a structured programme that addresses the specific features of the eating disorder.

It is important to understand that recovery from an eating disorder can take a long time and there may be periods of relapse alternating with time when your whānau member is doing well.

How you can help

The development of an eating disorder is not anyone’s fault. The causes of eating disorders are complex.

Recovery from an eating disorder is hard work. You have a key role to play in supporting your loved one. Eating disorders have both a psychological and a physical or medical component. Many of the symptoms which are so distressing are a consequence of starvation or malnutrition.

If you wish to speak to someone about your whānau member, you can call their case manager. We welcome these phone calls and they can be very useful. We are bound by the privacy law so there may be things we cannot discuss with you. If your whānau member does not want us to discuss things about them with you, you can still give information to the treatment team.

We can also provide you with a whānau education and support session. Speak to your whānau member’s case manager if you would like this.

Tips for whānau

You have a key role in supporting someone while they are attending treatment.

  • Learn as much as you can about eating disorders.
  • Have a conversation about how you can best support them. Different people like to be supported in different ways. Something that may seem supportive to one person may be unhelpful to another. Try to be honest about how you feel and listen when they communicate how they feel.
  • Be patient and empathetic with your loved one, no one sets out to have an eating disorder. Hold the hope of recovery, while accepting that some weeks will be better than others. Try not to feel discouraged if there are setbacks.
  • Look after yourself. It can be hard to watch someone you care about struggle and it can be easy to forget to look after yourself in the process. Taking time out and talking to others can be helpful to ensure you stay well.

Other people have found it helpful to:

  • eat regular meals and snacks together with a variety of food.
  • remain calm and encouraging. If you start to feel frustrated take some time out
  • suggest a fun activity that does not focus on their eating disorder. Connect with your family member in a fun way.

Try not to:

  • talk about or engage in diets, counting calories or excessive exercise
  • label food as “healthy/good” or “unhealthy/bad”.
  • comment about body, weight or shape, whether positive or negative (about anyone’s body, including your own).

If engaged in Family Based Therapy, review these tips with your therapist.

Understanding eating disorders

Eating disorders do not discriminate. They affect people of all:

  • genders
  • ages
  • ethnic groups
  • sexual orientations
  • socioeconomic statuses
  • body shapes
  • weights.

An eating disorder is a mental illness characterised by disturbances in behaviours, thoughts and attitudes towards food, eating, and body weight or shape.

Unhealthy behaviours someone may engage in include:

  • restricting food intake
  • binge eating
  • counting calories
  • excessive exercise
  • fasting
  • self-induced vomiting
  • using laxatives.

Eating disorders can seriously impact personal (physical, psychological and social) and family functioning. They are a serious illness, with the highest death rate of any psychiatric disorder.

No one chooses to have an eating disorder. The factors that contribute to the development of an eating disorder are complex, and involve a range of biological and genetic, psychological and environmental factors. Someone with an eating disorder may look well yet can be extremely unwell.

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Types of eating disorders (internal link)

Other specified feeding or eating disorder (OSFED)

A person diagnosed with OSFED has symptoms characteristic of other eating disorders but do not meet full criteria for another eating disorder. OSFED is commonly diagnosed in adults and adolescents and is as serious as any other eating disorder.

Starvation or “starvation syndrome” occurs when the body does not receive enough energy. This is commonly seen in people with eating disorders whose food intake is restricted, irregular or unbalanced. A person does not need to be underweight to experience symptoms of starvation.

The best information about the effects of starvation in humans has come from a study conducted by the University of Minnesota in the 1940s. The study included 36 mentally and physically healthy young men who took part in the experiment as an alternative to military service. The results can help us understand what your whānau member may be coping with.

The study involved:

  • 3 months where the men ate normally
  • 6 months where they were restricted to about half of their original caloric intake. Over this time they lost, on average, 25% of their original body weight
  • 3 months of rehabilitation, during which the men were gradually re-fed.

Throughout all 3 phases the men’s behaviour, personality and eating patterns were studied in detail. 

Food obsession

One result of starvation was a big increase in preoccupation with food. The men found it hard to concentrate on their usual activities as they could not stop thinking about food and eating. Food became a main topic of conversation, reading and daydreams. Many of the men began reading cookbooks and collecting recipes. Some developed a sudden interest in collecting kitchen utensils.

During starvation, their eating habits also changed. The men spent much of the day planning how they would eat their allocated food. They often ate in silence and devoted total attention to consumption. The study participants were often caught between conflicting desires to gulp their food down ravenously or consume it slowly so that the taste and smell of each morsel could be fully appreciated. The men often made unusual concoctions by mixing foods together and increased their use of salt and spices. The use of coffee and chewing gum increased dramatically.

During the rehabilitation phase, most of these attitudes and behaviours continued. For a small number of men these became even more marked during the first 6 weeks of refeeding.

Binge eating

During the starvation period, all of the volunteers reported increased hunger. Some appeared able to tolerate the experience fairly well, but for others it created intense concern.

Several men failed to adhere to their diets and reported episodes of binge eating followed by shame and guilt.

When presented with greater amounts of food during rehabilitation, many of the men found it difficult to stop eating.

Even after 12 weeks of rehabilitation, the men frequently complained that they experienced an increase in hunger immediately following a large meal. For some of them, the binge eating continued for months after they had free access to food.

Emotional changes

Although the men were mentally healthy before the experiment, most experienced major emotional changes as a result of starvation. These changes included:

  • periods of depression
  • irritability and angry outbursts
  • anxiety
  • mood swings.

These emotional changes continued for several weeks of the rehabilitation phase. Some men became more depressed, irritable, argumentative, and negative than they had been during the starvation phase.

Social and sexual changes

The men became more withdrawn and isolated throughout the study. Humour reduced and feelings of social inadequacy grew. The men became reluctant to:

  • plan activities
  • make decisions
  • participate in group activities
  • date or have sex.

Relationships became strained. During rehabilitation, sexual interest was slow to return. Even after 3 months, the men judged themselves to be far from normal in this area. However, after 8 months of refeeding, virtually all of the men had recovered their interest in sex.

Cognitive changes

During starvation, the men reported impaired:

  • concentration
  • alertness
  • comprehension
  • judgement.

Formal intellectual testing revealed no signs of diminished intellectual abilities.

Physical changes

During the starvation phase, the men had many physical changes, including:

  • reduced heart muscle
  • gastrointestinal discomfort
  • decreased need for sleep
  • dizziness
  • headaches
  • hypersensitivity to noise and light
  • reduced strength
  • fluid retention
  • hair loss
  • sensitivity to the cold
  • visual and auditory disturbances
  • tingling or prickling sensations in the hands or feet.

There were also decreases in body temperature, heart rate, blood pressure, and respiration, as well as in basal metabolic rate.

Physical activity

In general, the men responded to starvation with reduced physical activity. They became tired, weak, listless, apathetic, and complained of a lack of energy.

While eating disorders are a mental illness, they can cause health complications and reduced quality of life. It is important for everyone with an eating disorder to regularly consult with a healthcare provider.

Cardiovascular risks

Heart problems may cause a person to:

  • feel dizzy
  • faint
  • feel the cold
  • fatigue easily
  • have a slow or irregular heartbeat
  • have chest pains.

When a person loses weight, the size and strength of their heart may decrease.

Vomiting, use of diuretics and laxatives can cause fluid loss which can lead to fluctuations in electrolytes (potassium and sodium). These problems can be serious and may cause a heart attack or sudden death.

Bone risks

Loss of bone density is common in people with eating disorders. Damage can occur at any time during the eating disorder and could be irreversible.

Reduced growth or bone damage often occurs alongside malnutrition and low weight, which increases the risk of developing osteoporosis.

Dental risks

Regular vomiting can cause irreversible damage to tooth enamel, leading to brittle and sensitive teeth.

While stopping vomiting is the most effective solution, if someone is still vomiting, they should not brush teeth immediately afterwards. Instead rinse out the mouth with water to prevent further damage from stomach acid.

Gastrointestinal risks

People with eating disorders often experience:

  • nausea
  • reflux
  • constipation
  • diarrhoea
  • bloating
  • abdominal pain.

Many of these symptoms are not caused by a particular food group (such as gluten and dairy), but by the disordered eating.

Hormonal risks

Hormone levels can be negatively impacted when someone is:

  • not eating enough for their body’s requirements
  • engaging in excessive exercise
  • is below the weight that is healthy for their body.

Low levels of reproductive hormones can result in a higher risk of infertility and reduced bone density, regardless of gender.

Symptoms of low hormones can include low libido and irregular or loss of periods (amenorrhoea).

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