No one is to blame.

Eating Disorders Explained

 

Why do Eating Disorders (ED) develop in some people and not in others? Researchers have asked this question over the years and what we now know is that your genetics and biology play a considerable role. In fact, with over 40 genes now identified it is known an individual is born with a genetic predisposition  No longer do we think it is the parent's fault, or that someone chooses to have an eating disorder. With this knowledge, we can try to prevent the onset of an eating disorder, change treatment to suit the individual, and perhaps one-day medication can also be part of targeted treatment. Currently, no medicine can treat or cure an ED. However, some medicines can help with anxiety and depression that is associated with helping reduce some ED behaviours. 

How do you know if you or someone you love has an eating disorder? 

Identifying an Eating disorder can be tricky. You can't tell just by looking at someone that they have an ED. An ED can develop in any person. It does not discriminate against age, sex, race, socioeconomic status, or religion.

You may be in a larger body, yet severely restricting your food intake, while obsessing over food by watching cooking shows on youtube, cooking for your friends and family, feel guilt and shame if you eat, exercise obsessively, and have all the signs of anorexia apart from the BMI (see why BMI is BS click here). Equally, you may have binge eating disorder and be in a smaller body. Or suffer from the binge-purge cycle of bulimia nervosa and be in a "normal weight" that could signify to doctors, family or other health professionals that you are not sick enough for the help. Yet all of these disorders are dangerous and life-threatening and all worthy of treatment. 

Mental health or physical health illness?

What comes first?

So like I said earlier, we now know it is your genetic makeup that sets a person up for developing the ED. Personality traits are hereditary, and a part of who we are. Anxious, perfectionists, obsessive, compulsive, worriers, prone to depression, and sensitive to criticism are common with EDs, yet so are kind, caring, loving, smart, creative curious personality traits.

It is said the genetic traits are like a loaded gun, and the environment pulls the trigger.

Environmental triggers could be trauma, diet culture, pressures at school or work, pressures to look a certain way, or bullying, to name a few. There are many other triggers also. 

So the ED becomes a coping tool to deal with the triggers. And very quickly it can become out of control affecting what a normal life was. Leading to despair, disgust, guilt, shame, anxiety, depression, and emotional loneliness. Physical symptoms and complications start to manifest, and the body tries to adapt to the new normal leading to devastating consequences. 

An eating disorder is a genetic disease, causing a mental health illness leading to a physically compromised body. 

Sound complicated? 

Well, it is. EDs are very tricky to treat. The treatment team need to be at least a GP, a dietitian and a psychologist. 

When food becomes the enemy. 

Anorexia nervosa is a very dangerous illness where the quality of life is compromised and often, unfortunately, resulting in death. Very quickly a happy kind caring individual can become trapped by the lure of the eating disorder and lose everything that made that person happy. Anorexia steals your life, one by one the things you loved disappear. First, it could be your activities you loved to do, like going to play sports. You might not have the energy to go out and skateboard anymore. Then school or work is taken away and then there is less motivation to eat because you are stuck at home not really able to do anything because everything is too much of an effort resulting in severe emotional loneliness. The pathophysiology of being malnourished leads to not making hormones that can result in the loss of periods, but some complications that are less obvious can include not making other hormones including testosterone, or growth hormone resulting in poor growth,  neurotransmitters such as serotonin are compromised, hunger hormones are switched off also, bone density is compromised also resulting in osteoporosis. Metabolism slows down resulting in cold fingers and toes, the brain slows, and the lack of nutrition making it hard to create new thought pathways. The list of complications is long and can be read about in Dr Jennifer Gaudiani's book called "Sick Enough" which I would highly recommend parents purchase to help understand the medical complications of starvation. 

It is so important that when you see the warning signs of anorexia that it gets treated ASAP. Before it takes away too much of the individual's life. Anorexia is a bully, to the sufferer and the friends and family. It will lie and manipulate to convince you they are ok. It is a very tricky illness to treat, and the longer the anorexia is in the person's head, the harder it is to fight it. 

The nutrition rehabilitation and physical complications of rebuilding a starved body are so hard and complex you would not wish it on anyone. It hurts physically and mentally, it is uncomfortable and it takes a team of people, not just health professionals, but friends and family have to support the individual also.

If you think someone you love is struggling to eat please seek help. 

The scary cycle of binge and purge

Bulimia Nervosa is an eating disorder characterised by binging on large amounts of food then purging due to feelings of guilt and shame of eating the food. The amount of food that is considered a binge is different for each individual, but the thoughts, feelings and behaviours are similar. 

You cannot tell if someone sufferers from bulimia by looking at them, it affects males and females of all shapes, sizes and ages. The binge-purge cycle can go on for years causing serious damage to the person's teeth, digestive tract, from the esophagus to the large bowels. Electrolyte disturbances can affect hydration status and become dangerous when potassium levels are low from purging. other physical complications can include reflux, rumination, Barret's esophagus, face swelling and parotid glands swelling, kidney failure, and thyroid dysfunction.

This is a serious illness that does need medical attention and support to stop the binge-purge cycle in a safe way. 

Eating to cope

Binge Eating Disorder (BED) is characterised by eating large amounts of food in an uncontrolled way for periods of 2 hours or more. As with all eating disorders, you will not know if someone has this illness by simply looking at their appearance as this does affect anyone in any shape weight or sex. 

Binges can be triggered by a range of things, including restricting because of extreme hunger due to starting a new diet, or by coping at the end of a stressful day, or some more traumatic issues sparked from trauma. 

The main problem with people seeking help for BED is weight stigma. Because diet culture praises dieting, thinness, and the ability to restrict food for hours at a time people are often praised for their disordered eating behaviours. 

In my clinical experience, I have unfortunately seen people in larger bodies not eat much more than a piece of chicken breast for months on end have all the signs and symptoms of an anorexia diagnosis and severe malnourishment yet so culturally accepted for their ability to exercise obsessively and restrict so intensely. 

An eating disorder needs to be treated as such, and not with a diet or weight loss. Learning to address the psychological issues associated with the binging and learning to have a healthy relationship with food should always be the first and foremost treatment for anyone with BED. Bariatric surgery should not be an option until the binging is has ceased, because it does not address the eating concerns from the start. and when the eating disorder has been addressed the bariatric surgery may not even be an option any more. 

2020 Victoria Schonwald The Eat Clinic