Mental Health

Eating disorders: understanding the signs

Eating disorders often go unrecognised and untreated, but increased awareness and understanding can drive positive change.

Jo Stratmoen
March 2017

Eating disorders are often perceived as adolescent girls’ obsession with their weight or a lifestyle choice in the age of social media. The reality is that they’re serious mental illnesses, with serious consequences.

More people die from health complications resulting from an eating disorder than any other mental illness, and young people with eating disorders are 10 times more likely to die prematurely than their peers. And yet many sufferers aren’t getting the help they need – it’s been suggested that fewer than one in four do.

According to Christine Morgan, CEO of The Butterfly Foundation and National Director of the National Eating Disorders Collaboration (NEDC), people with eating disorders often feel high levels of shame, embarrassment and denial, which may prevent them from seeking what could be life-saving treatment.

“This is a concern because the sooner treatment is started the more successful it’s likely to be,” she says. Morgan says that reducing the stigma around eating disorders through education is a key factor in promoting early identification and treatment.

Eating disorders explained

There are three main types: binge eating disorder, bulimia nervosa, and anorexia nervosa. Two further categories are a catch-all for the 38% of people who may have some of the behaviours seen in the above, but not enough for a diagnosis.

  • Binge eating disorder: This is most common type, at 47%. It’s characterised by repeatedly eating an excessive amount of food within a short period of time – as little as 2 hours – at least once a week. Although people with this disorder can be normal weight they’re more likely to be overweight or obese and experience many of the same problems, including high blood pressure and cholesterol levels, heart disease and type 2 diabetes.
  • Bulimia nervosa: Bulimia accounts for 12% of eating disorders. People with bulimia also experience repeated episodes of binge-eating, but they may also force themselves to vomit, misuse laxatives or other medications, or exercise excessively to avoid gaining weight. Their weight may fluctuate but they’re usually within the normal weight range or are overweight. Health issues can include irregular heartbeat, and even heart failure, inflammation and rupture of the oesophagus.
  • Anorexia nervosa: Less common (3%) is anorexia. The hallmarks are an intense fear of gaining weight and severely restricting calorie intake. As a result, their weight is way lower than it should be. Some people also indulge in binge-eating and purging and, as with bulimia, their self-worth is built to a large extent on their perception of how they look. Complications can include abnormally slow heart rate and low blood pressure, potentially leading to heart failure, dry, brittle bones and muscle loss and weakness.

Who gets eating disorders?

“At any one time nearly one million Australians have an eating disorder,” says Morgan. They’re most common in girls and women, but boys and men aren’t immune. As many as 15% of Australian females and 3% of males will experience an eating disorder in their lifetime.

Why does it happen?

There are no easy answers. We know eating disorders are more common in developed countries where the “thin ideal” prevails. Girls involved in activities like athletics and modelling, where body image is all-important, tend to be at higher risk.

Low levels of self-esteem are found across the eating disorder spectrum. People with anorexia tend to be perfectionists and those with binge eating disorder and bulimia tend to be impulsive in nature.

It has been suggested that childhood unhappiness can play a part, with parental separation or divorce increasing the risk. Sexual abuse during childhood and fear of social rejection have also been associated with eating disorders.

Morgan says that as the behaviours associated with an eating disorder become ingrained the brain starts to change, hardwiring the behaviours into the brain. “Once this occurs, successful treatment becomes that much harder.”

Signs to look for

Eating disorders can be hard to spot. In many cases people with eating disorders aren’t extremely overweight or thin. They may also hide their behaviour or be in denial.

“A reluctance to eat with other people, change in clothing size, mood swings, negative comments about body shape, compulsive exercise, frequent trips to the bathroom, and social withdrawal are all red flags that something is going on,” Morgan says.

Physical warning signs include rapid weight loss or frequent weight changes, menstrual disturbances, decreased libido in men, lethargy and disturbed sleep, and damage to teeth and bad breath from induced vomiting.

Starting the conversation

The worst thing to do when broaching the subject with a loved one is to comment on behaviours such as restrictive eating or excessive exercise, says Morgan. “One approach is to gently observe that the person doesn’t seem overly happy and to ask if anything is troubling them.”

The most important thing is to let them know you care about them and want to help. “Listen respectfully and let them know that you won’t judge or criticise them,” she adds.

Treatment and recovery

Seeing a GP is the first step to building a treatment team, which will include an eating disorder specialist and possibly a psychologist, social worker, and dietician. Successful treatment means overcoming physical, mental, and emotional barriers to get back to normal eating habits, thoughts, and behaviours.

It’s not uncommon to falter or relapse on the road to recovery. Although this can be frustrating, with the right interventions, a good support network and a high level of personal commitment, it’s possible to recover.

“Unfortunately, the current rate of recovery is under 50% because of reluctance to seek help on the part of people with eating disorders, the lack of understanding about the neuropsychological nature of the conditions among primary care practitioners, and the lack of appropriate resources,” says Morgan. “With early recognition and treatment as many as 85% of people could make a full recovery.”

Getting help

If you think you or a family member may have an eating disorder, there are a number of places you can turn to:

The Butterfly Foundation is an advocacy group for people with eating disorders. It operates a national helpline staffed by experienced counsellors: 1800 334 673.

The Foundation also coordinates The National Eating Disorders Collaboration, which brings together health professionals to create recommendations and guidelines.

The Headspace National Youth Mental Health Foundation provides early intervention mental health services to 12-25 year olds. Use their confidential online chat tool or call 1800 650 890.


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