Ngā kaumingomingotanga kainga Eating disorders
Eating disorders are mental health conditions that lead to serious and unhealthy eating patterns. Eating disorders affect people of all ages and all social classes. They are also becoming more common and affecting people at a younger age.
On this page
Causes of eating disorders
We do not know exactly what causes anyone's eating disorder. But there are 3 general groups of risk factors:
- sociocultural factors (things to do with society as a whole)
- whānau factors
- individual factors, which includes a genetic component.
Most eating disorders are more common in women. But men are also affected, and can find it harder to ask for and get help.
Types of eating disorders
There are several different types of eating disorder. Some of the symptoms are the same and sometimes people can have more than one type.
Anorexia nervosa is a condition in which a person loses a lot of weight. They still think they are fat, even though others would describe them as very thin. People with anorexia are obsessed with controlling their weight and what they eat. Sometimes this can be to the point of starvation.
It is much more common in girls and women, although boys and men get anorexia too.
Men with anorexia are often preoccupied with bodybuilding, weightlifting or muscle toning. They may have lowered testosterone levels and lose interest in sex. They are likely to have thinning hair or serious hair loss and grow a type of downy body hair called lanugo.
Anorexia is a serious health issue that usually requires intensive ongoing treatment to overcome.
Patient.info have produced a video with more information about anorexia.
What is anorexia nervosa? — YouTube (external link)
People with avoidant restrictive food intake disorder (ARFID) refuse to eat most food. They eat so little they do not meet their energy or nutritional needs. It can be related to anxiety and hypersensitivity to certain textures and flavours.
ARFID usually starts in tamariki (children) or rangatahi (teens). But it can happen in people of all ages. Tamariki with ARFID may have delayed growth because they are not eating well enough.
ARFID is much more serious than normal fussy eating. ARFID can have serious health consequences. It is more common among males than females.
Avoidant restrictive food intake disorder — KidsHealth (external link)
Binge eating disorder is also called compulsive overeating.
People with the disorder go through periods of eating too much when they are not actually hungry. They often feel they cannot control their eating. Yet they constantly try to gain control through dieting or fasting.
The warning signs of binge eating disorder can include frequent weight fluctuations, weight gain and frequent dieting. They can include alternating between eating and fasting, rapid eating and eating until uncomfortably full. Also, eating alone or in secret and an obsession with food and eating.
For many people who binge, food provides comfort or a distraction from problems they are having. This can be linked with depression and anxiety.
Bulimia is when a person repeatedly restricts their eating, binges and purges.
Bingeing means eating a large amount of food, usually quickly. The person probably feels out of control while eating.
Purging is making yourself throw up, using laxatives, or using other ways to try to get rid of food. People do this so they do not gain weight.
Some people with bulimia also exercise excessively to avoid gaining weight.
These cycles of bingeing and purging often lead to feelings of failure and depression. People with bulimia believe they have lost control over their efforts to lose weight. They often feel disgusted about their purging. They also tend to dislike their bodies and have low self-esteem.
Bulimia is treated with talking therapies, including cognitive behaviour therapy.
Diagnosing eating disorders
There are several changes that can suggest an eating disorder. If you or someone you know has an eating disorder, you may notice some of these changes. Changes will depend on the person, and their eating disorder.
If someone has had an eating disorder for a long time, it can cause physical, psychological and social effects.
It is common for people with eating disorders to exercise too much and make frequent trips to the toilet. They may also:
- avoid snack foods
- have unusual eating habits
- weigh themselves a lot
- abuse alcohol or drugs
- make excuses to avoid social situations.
Eating disorders can cause changes such as extreme weight loss (anorexia) or constantly changing weight. People may also have:
- hair loss
- swelling, dry skin
- growth of downy body hair (lanugo)
- tiredness
- discoloured teeth
- scarring on the back of their hands from making themselves throw up.
Someone with an eating disorder may feel helpless, be depressed, and have an anxiety disorder. They may also show perfectionist tendencies or seem overly worried about their body size.
Men with anorexia are often preoccupied with bodybuilding, weightlifting, or muscle toning. This may lower their testosterone levels and cause them to lose interest in sex. It may also cause thinning hair, serious hair loss, and growth of downy body hair (lanugo).
Treating eating disorders
If you think that you, or someone you know, may have an eating disorder, get professional help as soon as possible. Treatment is more successful when people with eating disorders get help early. This is especially so for tamariki (children) and rangatahi (young people).
Rarely, someone with an eating disorder can become so malnourished that they need emergency treatment. If someone you care about with an eating disorder has collapsed, is having seizures or is confused, call 111.
If someone is having severe medical problems from their eating disorder, they may need to be admitted to hospital.
Self care with an eating disorder
Admitting you have a problem and accepting help are the first steps. The earlier you ask for help, the easier it will be to get better.
There are many things you can do to help yourself recover from an eating disorder.
- Learn more about eating disorders to help you understand what is happening to you — you may like to look at an online self-help programme.
- Try to be kind to yourself — seek support to learn ways to deal with difficult emotions and thoughts.
- Make time for things you enjoy, and spend time with people who make you feel good.
- Talk to a friend or whānau member — support from people who care about you is important.
- Try not to concentrate on your eating habits.
- Try to improve your communication, and build up your emotional confidence and security.
- Join a support group — this can help talk about your problem, and get advice and support from people who know what you are going through.
If you are a binge eater
- Try not to let yourself get so hungry that the urge to binge is overwhelming.
- Keep a diary to become aware of your eating patterns and the feelings that trigger binges.
Getting help with an eating disorder
Many people with eating disorders feel embarrassed, ashamed or guilty. They have often tried to treat their disorder without success. This can make them believe that nothing will work and stop them getting help.
Eating disorders are treatable. But the longer someone has an eating disorder (particularly anorexia), the more difficult it is to change their thinking and behaviour. So, it is best to get treatment as early as possible. Specialist treatment such as cognitive behavioural therapy, is essential.
Talking to your healthcare provider is a good first step.
Specialist eating disorder services
Specialist eating disorder services provide treatment and support to people suffering from an eating disorder. You can find providers on the Healthpoint website.
Eating disorder services — Healthpoint (external link)
Counsellors and therapists
Talking therapies with a counsellor or psychologist help many people. Cognitive behaviour therapy is a type that can help with eating disorders.
Accessing mental health services — Mental Health Foundation (external link)
Supporting someone with an eating disorder
Eating disorders like anorexia or bulimia are serious medical conditions. They can be fatal if left untreated.
If you suspect a friend has an eating disorder and want to approach them about it, be caring and non-judgemental.
Many people with eating disorders say they are fine and just want everyone to leave them alone. In reality they may feel scared and isolated. They may also be unsure how to stop the eating disorder from controlling their life.
They can put a lot of effort into hiding the condition, so it can be difficult to diagnose. But the earlier it is diagnosed, the better the chance that they will recover.
Here are 5 tips for supporting someone with an eating disorder:
- read up on eating disorders and know your facts before you talk to someone about their eating disorder
- be kind and do not judge them — use language that is not critical or judgemental
- be honest about your concerns — it is an important talk to have
- encourage them to seek professional help
- keep supporting them even if they become defensive or angry — when they seek professional help, continue to support them through their journey to recovery.
Medication abuse in eating disorders
People with eating disorders often try to get rid of food so they do not gain weight. This is called purging.
We often think purging means vomiting, but there are other ways to purge as well. Many people with eating disorders use drugs to help get rid of food from their bodies. Some drugs can also suppress a person's appetite, so they do not feel very hungry.
Purgatives are drugs or other substances. Purgatives make you vomit (emetics), wee (diuretics) or cause diarrhoea (laxatives).
Diuretics
Diuretics make you wee more. Most diuretics are either prescribed by a healthcare provider or available over the counter. Some other substances such as caffeine also act like diuretics.
Diuretics have no effect on calories or body fat. They just make you lose water, which changes the balance of electrolytes in your body. This can lead to serious medical problems, including heart problems. Too much caffeine can lead to restlessness, insomnia, irritability, nervousness and increased urination. It can also lead to gastrointestinal problems.
If you use a diuretic regularly, you may develop a tolerance for it and need more to get the same effect. And you may have problems with long-term water retention when you stop taking it.
Emetics
Emetics are substances that make you vomit. Around 30% of people with eating disorders have used emetics to make vomiting easier.
Some emetics build up and take a long time to clear from your body. This is especially true if you have been taking emetics regularly. You can become tolerant and need more of the drug to make you vomit. This is extremely dangerous, as these drugs are toxic above certain doses.
As well as making you feel sick (nausea) and throw up (vomiting), emetics can cause muscle weakness and shortness of breath. They can also cause gastrointestinal problems and heart problems.
Laxatives
Laxatives are substances that get rid of the food in your bowel. They do this by increasing the volume of poo or speeding up the time it takes for food to pass through your gut. Some laxatives act by making your muscles work more. This moves food through your intestines more quickly. Others coat the poo with oil, soften it or increase the amount of water or fibre in the poo. This also makes it move more quickly.
Many people with eating disorders use laxatives. They do this to try to counteract the effects of bingeing and to lose weight. They believe this will get rid of the food they eat, but it does not. This is because they only make you lose water and electrolytes, not calories. Laxatives also mainly affect your large intestine. But this is after your small intestine has already absorbed the calories from the food.
Regularly using laxatives can lead to medical problems, including:
- recurring diarrhoea
- weakness
- tummy pain
- nausea and vomiting
- dehydration and electrolyte imbalance (in particular, low levels of potassium)
- finger clubbing
- skin problems
- heart problems.
Many of these problems are caused by chronic dehydration.
Using laxatives regularly may also mean you need larger amounts to get the same effect.
Sometimes people who abuse laxatives for too long can no longer do poos without them. This is because laxatives affect the nerves that make the muscles of your bowel contract. These people need specialised retraining to help their muscles function again.
You can also get side effects when you try to stop using laxatives, including:
- water retention
- constipation
- feeling edgy, irritable, tense, and angry (increased anxiety)
- urges or cravings to take laxatives.
These side effects can be uncomfortable and distressing at first. But your body becomes used to not taking laxatives and the side effects start to go away within about 2 weeks.
People with eating disorders often take appetite suppressants to dull their appetite. Appetite suppressants include diet pills and some other medicines. This is so they feel like eating less and lose weight.
These appetite suppressants may be prescription drugs, over-the-counter medicines, or substances like caffeine. A quarter to half of people with eating disorders have used appetite suppressants. But there is very little evidence that they actually help you lose weight. Some appetite suppressants can cause serious medical problems, including:
- increases in blood pressure
- seizures
- bleeding in the brain
- cardiac irregularities
- respiratory problems
- psychosis.
These effects may be greater if you take appetite suppressants with other substances, including caffeine.
Long term effects of an eating disorder
Eating disorders can cause many changes to the way your body works. Being undernourished affects your organs, blood, skin, hair and bones. Binge eating, vomiting, abusing purgatives, dieting and too much exercise have many health effects. These can be both physical and psychological. They also have social and legal consequences.
Skin and hair
Changes to your skin and hair can include:
- skin breakdown and poor healing
- dry skin
- baggy skin caused by rapid weight loss
- bruising
- stretch marks caused by rapid weight gain
- wrinkles
- calluses on your hands (from using your fingers to make yourself throw up)
- irritation at the corners of your mouth
- growth of downy body hair (lanugo)
- dry brittle hair, hair loss, and blue skin caused by a lack of oxygen (cyanosis).
Heart and circulation
Your heart and circulation can suffer in many ways, including:
- heart failure, or a slowed or irregular heartbeat, which can make your heart stop
- dizziness when standing because of low blood pressure
- low body temperature and coldness caused by poor circulation
- fluid retention causing puffiness, weight gain, and weeing a lot
- low blood sugar (glucose) causing dizziness and shaking
- irritability and tiredness caused by too few red blood cells (anaemia).
Electrolyte disturbances
Electrolytes are minerals in your blood and body fluids. They affect the amount of water in your blood. You need to have the right balance in your blood to keep your organs (heart, brain and kidneys) working well. Vomiting, using laxatives or dieting, leads to low levels of potassium, chloride and sodium. This may cause:
- weakness
- tiredness
- muscle pain
- depression
- broken blood vessels under your eyes.
Serious electrolyte disturbances can cause seizures, and your heart may actually stop.
Dental problems
The gastric acid from throwing up can strip away your tooth enamel, and cause tooth decay and mouth ulcers.
Gastrointestinal problems
Frequently throwing up can cause tears in your oesophagus and stomach. It can also cause reflux and dehydration leading to constipation.
Using laxatives can cause loss of bowel function (you cannot control when you poo). It can also include irritable bowel syndrome, stomach cramps and bloating. Starvation can cause malnutrition and you may stop being able to tell when you are hungry. All eating disorders can lead to you no longer being able to know when you are full.
Dehydration
Using diuretics and laxatives can cause dehydration. This can lead to:
- intense thirst
- decreased weeing
- swelling and puffiness
- headaches.
Dehydration can also cause:
- dizziness and fainting
- chronic fatigue
- confusion
- increased body temperature
- kidney failure
- death (in severe cases).
Hormones and sex
If you are malnourished, it can affect your hormone levels.
- Periods can become irregular or stop altogether.
- Testosterone levels may fall.
- You may lose interest in sex or become sexually impulsive.
- If you are vomiting or have diarrhoea, you may not absorb oral contraceptives, and may become pregnant.
Other problems
- You may get more infections because your immune system does not work well.
- You may have difficulty sleeping and be tired from too much exercise.
- You may also lose muscle and bone density (osteoporosis). This means you are more likely to break bones.
Attitude to food
People with eating disorders have distorted attitudes to food, eating, body shape and size. Parents with eating disorders may pass on their attitudes and beliefs about food to their tamariki (children).
Attitude to other things
People with eating disorders often lose motivation and interest in other activities. They often develop depression.
An eating disorder affects the way a person behaves around other people and can lead to:
- isolation
- secrecy
- mistrust
- poor school and work performance
- a constant feeling of being watched by other people when you are eating.
People with eating disorders often spend large amounts of money on binge foods and diet foods. Also, healthcare provider appointments, and gym memberships. They also frequently take a lot of time off work. The legal consequences can vary from person to person. They may include having your tamariki (children) put into foster care if your disorder affects your ability to parent. It may also include being subject to compulsory treatment under the Mental Health Act 1992.
Clinical review
This content was written by HealthInfo clinical advisers. It has been adapted for Health Information and Services.