Eating disorders are often not well understood in society, but with around 1 in 25 people in Scotland affected, Cumbernauld Community Health Information Hub is spotlighting the issue with a view to raising awareness and removing stigma.
This week is Eating Disorders Awareness Week (1-7 March 2021), a campaign which takes place every year to increase knowledge about eating disorders and provide resources and support for those who are interested in seeking treatment.
Eating disorders are a spectrum of mental illnesses which are generally defined by abnormal eating habits that negatively affect a person’s physical and mental health. They are most common in teenage girls and young women, although they can affect both men and women of all ages and body types.
Research has shown that body image, poor self-esteem, dieting fads, and fat-shaming all contribute to the development of eating disorders. Manifestation of eating disorders varies according to the specific condition, but generally it can include weakness, fatigue, frequent vomiting, binge eating, sensitivity to cold, reduced libido, weight loss and growth failure.
These physical symptoms are difficult enough to battle on their own, but if you add in the psychological effects and root causes (such as depression, anxiety disorder, obsessive compulsive disorder (OCD) and addiction), as well as the negative stereotypes that are often associated with eating disorders, it is clear to see how serious and tormenting being affected can be.
It can also be easy to understand why many people do everything they can to conceal that they have an eating disorder. Indeed, the biggest challenge for those affected can often be acknowledging that there is a problem and deciding to seek the appropriate help. Mary McNeil, Development Manager at Cornerstone House Centre, commented:
“Eating disorders can affect anyone, no matter their age, gender, ethnicity or background. They can be both serious and highly distressing for people experiencing them and their loved ones.
“In the same respect, people of all sizes can struggle with an eating disorder and this particular mental illness is often not recognisable just by looking at someone.
“The stigma that accompanies eating disorders can strip an individual of their quality of life and cause them to have low self-worth resulting in isolation.
“This cycle can lead to additional insecurities which can potentially result in a detrimental escalation of symptoms and issues, preventing someone from seeking proper support and help.
“Notably, someone who struggles with an eating disorder may be fearful of negative perceptions by family and friends as well as having embarrassment about their behaviours regarding the disorder.
“What most people don’t realise is that the stigma disguises the fact that eating disorders do not discriminate and that they can cause anyone to try and change themselves to match the unrealistic western cultures appearance ideal.
“This appearance ideal is not the same as the healthy ideal. The goal of the appearance ideal is to attain thinness that is neither realistic nor healthy.
“With all this in mind, it is really important that people are compassionate, non-judgemental and supportive towards those who have an eating disorder. Remember, eating disorders are not lifestyle choices, they are mental health conditions with socio-biological influences.”
Despite the complexities, with the right treatment and interventions, a high proportion of people with eating disorders fully recover and go on to live healthy lives.
A number of charities provide bespoke support, information and resources to help those with eating orders in their recovery, most notably the national intermediaries Beat and Anorexia and Bulimia Care.
Twelve months ago, Scottish Government underlined its commitment to improving the lives of those affected by eating disorders by announcing a national review of eating disorder services. Speaking during Eating Disorders Awareness Week 2020, Mental Health Minister Clare Haughey said:
“More people lose their lives from eating disorders than any other psychiatric condition, therefore it requires a specialist and dedicated response. The national review will build on the work of the Mental Welfare Commission for Scotland who are currently visiting eating disorder services in Scotland.
“Direct investment in mental health has been increased to £117 million in this year’s budget. This will help us ensure better access to services. This review is a crucial first step in a programme of work to improve services for people living with an eating disorder.”
The outcome of the review, which is expected to be published this year, will provide a full picture of the current support available for those with an eating disorder as well as offering a number of recommendations to inform improvement work.
EATING DISORDERS: A KEY INFORMATION GUIDE
What Are Eating Disorders and Who Are At Risk?
Anorexia nervosa and bulimia nervosa (often simply referred to as anorexia and bulimia) are two of the most common types of eating disorder, although there are others too. Not every person affected displays all the symptoms of one eating disorder alone, but may have different characteristics of different disorders.
Whilst the causes of eating disorders are not entirely clear, both biological and environmental factors appear to play a role. Cultural idealisation of thinness is believed to contribute to some eating disorders, although there can be a whole range of implicating factors.
One frequent misconception is that eating disorders only affect young white women who are underweight. In actual fact, studies suggest that around a quarter of people with eating disorders are male, and that up to one in five people affected are aged 40 or over. Equally, it is known that around 85% of people with eating disorders are not underweight.
It is recognised, however, that certain groups of people may be more prone to developing an eating disorder than others. Those believed to be more at risk include dancers and other athletes, individuals who have experienced sexual abuse, people with learning difficulties, people with issues managing their weight and people experiencing depression or anxiety.
What Is Anorexia and What Are The Signs and Symptoms?
Anorexia is an illness in which people keep their body weight low by dieting, vomiting or excessively exercising. Central to the illness is anxiety about body shape and weight that originates from a fear of being fat or from wanting to be thin.
How people with anorexia see themselves is often at odds with how they are seen by others, and they will usually challenge the idea that they should gain weight. People with anorexia usually see their weight loss as a positive achievement that can help increase their confidence and self-esteem. This can contribute to a feeling of gaining control over body weight and shape.
Anorexia is, however, a serious condition that can cause severe physical problems because of the effects of starvation on the body. It can lead to loss of muscle strength and reduced bone strength. In older girls and women with anorexia, their periods often stop, and men with anorexia can suffer from a lack of interest in sex or impotency.
Moreover, the illness can affect a person’s relationships with family and friends, causing them to withdraw, and it can also have an impact on how they perform at school or in the workplace. The seriousness of the physical and emotional consequences of the condition is often not acknowledged or recognised, and people with anorexia often do not seek help.
Anorexia in children and young people is similar to that in adults in terms of its psychological characteristics. However, children and young people may, in addition to being of low weight, also be smaller than other people their age and slower to develop.
What Is Bulimia and What Are The Signs and Symptoms?
Bulimia is an illness in which people feel that they have lost control over their eating. As in anorexia, those affected evaluate themselves according to their body shape and weight. Indeed, in some instances (although not all), bulimia develops out of anorexia.
People with bulimia are caught in a cycle of eating large quantities of food (called ‘binge eating’) and then taking drastic or unhealthy action in order to prevent them from gaining weight. For example, after eating those with bulimia may vomit, take laxatives and / or diuretics (called ‘purging’), exercise excessively or fast.
This behaviour can dominate the daily life of person with bulimia, and lead to difficulties in relationships and social situations. More often than not, those affected hide their actions from others and their weight is often normal. People with bulimia tend not to seek help or support very readily.
In many cases, people with bulimia experience mood swings, anxiety and tension. They may also have very low self-esteem, and may try to hurt themselves by scratching or cutting. Physical symptoms can include tiredness, feeling bloated, constipation, abdominal pain, irregular periods and occasional swelling of the hands and feet. Other health issues can be caused by excessive vomiting, laxative misuse and over-exercising.
In contrast to anorexia, bulimia in children and young people is rare, although young people may have some of the symptoms of the condition.
What Other Eating Disorders Are There?
Other eating disorders may affect more than half of people with an eating disorder. These conditions are often categorised under Other Specified Feeding or Eating Disorders (OSFED) because they do not exactly fit the description of either anorexia or bulimia.
For instance, people may have some of the symptoms of anorexia or bulimia (such as dieting, binge eating, vomiting and a preoccupation with food), but not all of them. Alternatively, they may have symptoms that fall between anorexia and bulimia, or they may move from one set of problems to another over time.
Many people with OSFED have suffered with anorexia or bulimia in the past. Of the other eating disorders, most is known about binge eating disorder (BED). With this, people have episodes of binge eating but do not try to control their weight by purging.
What Should I Do If I Think I May Have an Eating Disorder and What Help is Available?
Generally, the best first step to take if you think you may have an eating disorder is to schedule an appointment with your GP. If your GP suspects you have an eating disorder, they will arrange a referral for you to receive treatment through a specialist eating disorder service.
Speaking to a GP can be a very difficult step for many people with eating disorders to take, however. If you are unsure about communicating with your GP in the first instance, one option is to talk to a trusted friend, family member, teacher, pastor or someone else you know who will take the time to listen and be understanding. You could ask them to visit the GP with you if you are worried about going on your own.
If talking to someone you know is too much to face, another option is to contact the Eating Disorder Helpline anonymously and confidentially. The Helpline, which is run by the charity Beat, is operational 365 days per year and can be accessed by telephoning 0808 801 0677 from 9am-8pm (weekdays) and 4pm-8pm (weekends). If chatting on the phone is not really your thing, specialist online chat rooms and message boards are also available through Beat.
There are several different treatment options which can be effective for many eating disorders. Treatment often varies by disorder and may involve counselling, cognitive behavioural therapy (CBT), dietary advice, medication and specific interventions to reduce efforts to eliminate food.
Ignoring symptoms of an eating disorder is not recommended under any circumstances. In fact, it can be highly dangerous to do so. Hence, it is important that you tell someone as soon as possible if you are struggling. Advice on how to tell someone you have an eating disorder can be obtained by clicking here.
To show your support during Eating Disorders Awareness Week, you can donate to, fundraise for or volunteer with organisations such as Beat, Anorexia and Bulimia Care, Supported Scotland or Diabetics With Eating Disorders, to name just a few.
Further information about eating disorders, including support with any concerns in relation to eating disorders and coronavirus (COVID-19), can be obtained by clicking on NHS’s Eating Disorders web page or visiting Beat online at www.beateatingdisorders.org.uk.
Support is also available from the Tier 3 Eating Disorder Specialist Service (TESS), which provides a Lanarkshire-wide provision for people requiring community-based treatment for eating disorders. The team, which can be contacted on 01236 703402, provides assessment and care of the medical, nursing, dietetic and occupational therapy needs of those with anorexia, bulimia and other eating disorders.