Eating disorders are a serious, potentially life threatening problem that requires specialist care and attention.

First recognised more than 125 years ago Anorexia Nervosa is still not fully understood and is distressing for sufferers and their families alike.

Our understanding of Anorexia Nervosa has improved over the years, with increasing success at specialist inpatient centres which are becoming more effective in weight restoration, however, they are disruptive to the adolescent’s family, social and educational life, and so relapses can occur. Getting better is not just about putting on weight again. That is why The Maudsley family-based outpatient treatment has been shown to be a good alternative model to costly inpatient or day hospital programs.

Food plays a central role in all our lives and it is not unusual for us to have an emotional connection with what we eat.

At times we might change the types or amounts of food we eat, this may be for ethical reasons, to improve health or due to a lifestyle change.

When some people experience difficult emotions they sometimes use food to help them to manage these feelings. For some people this might be referred to as 'comfort eating' for others this can develop and dominate their life. When under stress or upset others may lose their appetite causing them to eat less for a short time. However, it is when the relationship with food becomes the main way of dealing with difficulties that things become more damaging. This may involve restricting food, binge eating, purging after eating or over exercising to compensate for what’s been eaten.

Eating disorders don't usually develop from one cause; they are often due to a number of events or pressures that are hard to cope with. Other factors include low self-esteem, relationship difficulties, bereavement, academic pressure and emotional, physical or sexual abuse.

Such events cause the person to feel bad about themselves and the difficulties are then internalised. This leads to feelings of not feeing good enough or not being important. When this happens they may then start to change their behaviour with food. By trying to control their weight they are then able to feel more in control.

Who do eating disorders affect?

Eating disorders can affect anyone regardless of their age, sex or background. The most widely affected group is females between 12-25 years of age. More recently research has shown that the incidence of eating disorders amongst males is on the increase.

Other research displays a link between an individual's genetic make-up and their chance of developing an eating disorder. Other factors may include their parent's view of food and the availability of food in the household.

Types of eating disorder

Not everyone diagnosed with the same type of eating disorder will have exactly the same symptoms. They differ from person to person and all the symptoms do not have to be present to have a diagnosis. Below is an overview of the types of eating disorders that are treated at Riverdale Specialist Eating Disorders Hospital.

Anorexia Nervosa

This eating disorder involves restricting the amount that is eaten usually to a dangerous level. The focus upon food and weight is an attempt to cope with other problems not an aim to starve to death. This can make the person feel in control of their body and diet when they may feel out of control in other areas of their life. Eventually the disorder takes over and the starvation affects the brain leading to distorted thinking. This altered thinking allows the disorder to keep a firm hold and the person is less able to think rationally. As more and more weight is lost the organs within the body are put under an increasing amount of pressure. Occasionally Anorexia Nervosa leads to death if the condition remains untreated.

Long term effects of Anorexia Nervosa

The long term effects of Anorexia can cause female sufferers to have difficulty conceiving and this may lead to infertility. Fortunately many of the physical affects can be reduced when the body begins to receive the correct nutrition. In all cases of the disorder the chances of developing Osteoporosis are increased.

Physical affectsPsychological signsBehavioural Signs
  • Extreme weight loss
  • Feeling dizzy
  • Constipation/stomach pain
  • Hair loss/thinning
  • Downy hair on the body
  • Feeling cold
  • Rough dry skin
  • Loss of periods
  • Loss of libido
  • Osteoporosis
  • Intense fear of weight gain
  • Obsessional thought about food/weight
  • Distorted view of body
  • Denial of existence of a problem
  • Mood swings
  • Irritability
  • Thoughts and rules about food
  • Rigid behaviour with food i.e. cutting it up
  • Restlessness
  • Wearing baggy clothing
  • Avoiding meals
  • Regularly getting weighed
  • Over exercising

Bulimia Nervosa

The term 'Bulimia Nervosa' means the nervous hunger of an Ox and this term was originally used to describe the bingeing behaviour that the condition presents. People with Bulimia have an emotional hunger that cannot be satisfied by food alone. A large amount of food is eaten during a binge as a way of filling that emotional need. There is then a strong urge to get rid of the food eaten to avoid weight gain. This is usually done by self-induced vomiting or taking laxatives (or both), by fasting or restricting food intake or by exercising off the calories eaten.

People around the person with Bulimia probably won't be able to notice that there is a problem as the person is usually a normal weight, although weight will fluctuate. This allows the illness remain undetected and continue for many years.

Bulimic behaviours may initially make someone feel as though they are in control, but as the bulimia takes hold the opposite becomes true. The ritual of bingeing followed by purging becomes the main way of coping making the cycle difficult to break. Sufferers can be desperate to break the routine which in turn leads to further stress that maintains the cycle.

The frequency of binges differs for each person and it may become more or less frequent during the course of the illness. Some people may have long periods where they do not binge and purge but may still be obsessed by weight and shape.

For a long time some people do not see that there is a problem which allows it to exist for many years. The binge/purge cycle can feel like just a habit they have and feel as though it helps to reduce stress. Most people become more affected by the problem as it takes over their life and affects relationships. They can often feel very ashamed and hide their behaviour as it becomes more of a guilty secret.

Bulimia usually develops between late teens and early twenties and can following a period of Anorexic type behaviours. People with Bulimia tend to be in demanding jobs which require a high level of confidence. However this self-confidence can be a façade which covers low self-esteem and low self-worth.

Long Term affects of Bulimia Nervosa

Like Anorexia, Bulimia can be life threatening. Bingeing and purging can cause a dramatic loss of fluids which puts the heart at risk of failure. This fluid loss causes an imbalance of the essential minerals that are vital for organ function. Due to these complications not being visible to those around the person with Bulimia this can put them at a greater risk than somebody with Anorexia who is visibly at a low weight.

Other dangerous effects include a stomach rupture, a tear in the throat and bowel problems where laxatives have been abused.

Physical affectsPsychological signsbehavioural signs
  • Fluctuations in weight
  • Increased risk of heart problems
  • Sore throat
  • Tooth decay
  • Problems with internal organs
  • Swollen salivary gland under the jaw
  • Possible hair loss
  • Poor skin condition
  • Irregular periods
  • Low libido
  • Tiredness
  • Strong urges to eat large amounts
  • Urges to eat foods high in sugar/carbs
  • Feelings of being out of control around food
  • Mood swings
  • Anxiety and depression
  • Feeling helpless
  • Bingeing often in secret
  • Buying large amounts of food
  • Food disappearing
  • Vomiting
  • Disappearing after meals
  • Avoiding meals
  • Period of fasting
  • Over exercising
  • Laxative use
  • Withdrawn from social settings

Eating Disorder Not Otherwise Specified (EDNOS)

Eating disorders are very complex and affect individuals differently. People diagnosed with the same disorder may have a different type or number of symptoms. A diagnosis of EDNOS is made where someone has some but not all of the symptoms of Anorexia or Bulimia. This does not mean that the difficulty they are experiencing is any less of a problem than those with a diagnosis of Anorexia or Bulimia.

People with EDNOS can switch between the symptoms of Anorexia and Bulimia during the course of their illness.

Examples of where a diagnosis of EDNOS might be made include:

  • Where someone has all the signs of Anorexia but still has their menstrual cycle
  • Where someone has episodes of binging and vomiting but these are not regular enough to determine a full diagnosis of Bulimia.
  • Where someone regularly chews food and spits it out after to avoid consuming calories

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