Demystifying Eating Disorders
Disordered eating is not often discussed. It carries a lot of stigma and is very misunderstood. Common misconceptions may include that the person is just a picky eater, they are just trying to lose weight, or it’s just a diet taken too far. Maybe they are a picky eater or maybe they are on a diet and trying to lose weight, but that is not always the case. Sometimes food becomes a source of serious psychological distress. Maybe it’s all they can think about, maybe they feel out of control around food. That is when it becomes problematic.
What is an eating disorder
Eating disorders are characterized by persistent disturbances in eating behaviours, accompanied by a wide range of distressing thoughts, behaviours, and beliefs related to food, eating, body weight and/or body shape. It is estimated that 5% of the population suffers from an eating disorder. It is also three times more likely to develop in women and is often seen beginning in teenage years into early adulthood. However, eating disorders can affect individuals at any age and of all genders. The three most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. Eating disorders can become quite severe with devastating health consequences, and can even become life threatening if left untreated.
What it means to have an eating disorder
At the root, eating disorders involve some kind of changed behaviour and views on food and eating related behaviours. However, each has its own features and ways in which they manifest.
Anorexia nervosa involves an intense fear of gaining weight, deliberate weight loss, and a distorted body image accompanied with a body mass index (BMI) of less than 17.5. There are two types. The restrictive type involves restricting food intake and excessive exercise, while the purging type involves self-induced vomiting and/or the misuse of laxatives, diuretics or enemas. Individuals with anorexia nervosa can become very preoccupied with food through restricting calories, having “safe” foods, rituals surrounding how food is eaten, intense exercise routines, etc. In many cases, self-worth is tied to a very thin body shape or specific number on the scale.
Bulimia nervosa is characterized by recurrent episodes of binge eating where individuals consume a significant amount of calories within a short period of time followed by behaviours to compensate for what they just ate, much like the purging type of anorexia nervosa. They may feel like they cannot stop eating, that they cannot control what they eat, and feel emotions such as guilt or shame for eating so much once the binge eating episode is done. Bulimia nervosa is seen by the pattern of binge eating and then trying to compensate for what was consumed.
Much like bulimia nervosa, binge-eating disorder involves periods of large amounts of food consumption over a relatively short period. However, this is not followed by compensatory behaviours. In addition to eating large amounts, the person may also eat a lot quicker than they normally would, eat until they feel uncomfortably full, eat large amounts of food when not physically hungry, feel embarrassed by how much they are eating, and/or may feel disgusted with themselves, depressed, or guilty afterwards.
Many individuals also present with mixed features in which they may move between restricting, binging and purging. When they move between different categories of eating disorders and involve mixed features, this is referred to as other specified feeding or eating disorders (OSFED). In fact, most eating disorder diagnoses would fall within this category. It is also important to note that some individuals may present with some eating concerns that affect their lives, even if they don’t fulfill all of the above criteria. These concerns can be equally distressing and warrant treatment.
There are evidence based psychological treatments for these eating disorders. One that has relatively wide applications for all three of these eating disorders includes eating-disorder-focused cognitive behavioural therapy (CBT-ED). With CBT-ED for anorexia nervosa, the focus is on healthy eating behaviours coupled with working towards building self-esteem and having a healthy body image. For bulimia nervosa, the focus of CBT-ED involves addressing the difficult thoughts and feelings that may lead to binge eating. For binge-eating disorder, working through the emotional triggers for the binge eating and addressing body-image concerns is central. CBT-ED is one of the treatment options for these eating disorders. With any of these conditions, changing behaviours, addressing the intrusive and repetitive thoughts, and working through the emotions associated with food and eating is a way towards positive change. These changes are especially helpful with OSFED. CBT-ED would also be as helpful in cases where eating concerns are present but do meet full diagnostic criteria.
Having an eating disorder can be extremely difficult and may feel overwhelming. It is much more than just being a picky eater or lifestyle choices. It is a mental illness in which the relationship with food and eating becomes disordered. It is not as simple as “getting over it” but recovery is possible. No matter what eating concerns are present and whether they meet full criteria, evidence-based psychological interventions such as CBT-ED can be helpful in moving towards improvement. If you suffer from an eating disorder or feel your relationship with food has become a source of distress, you are not alone. Feel free to reach out.
About the author
Kayla Doyle is a Registered Psychotherapist (Qualifying) at CMAP Health. She has her Master’s of Education in Counselling Psychology from the University of Ottawa as well as a Post-Graduate Diploma in addictions and mental health counseling. Kayla has experience working with adults and children presenting with a variety of mental health concerns including anxiety disorders, depressive disorders, Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), as well as childhood concurrent disorders.