EATING DISORDERS

Eating disorders are abnormal patterns of eating and exercising that

severely interfere with a person’s everyday life. These patterns can include
eating extremely small amounts of food or eating in an uncontrolled way.
The person may also be very distressed, anxious or worried about food, body
weight and appearance. The most common eating disorders are anorexia
nervosa, bulimia nervosa and binge eating disorder. Eating disorders are not
a function of will but are, rather, unhealthy eating patterns that “take on a
life of their own.” The voluntary eating of smaller or larger portions of food
than usual is common, but for some people this develops into a compulsion
and the eating behaviours become extreme.
Types of eating disorders
Anorexia nervosa
People with anorexia nervosa usually set themselves the goal of losing
weight, and lose so much that they become very underweight for their age
and height and become unwell. Most are also overly concerned or distressed
about their body shape and weight. Some people with anorexia nervosa
severely restrict their eating, and may also exercise excessively. Others may
binge-eat (eat a large and excessive amount of food in an uncontrolled way),
and then make up for overeating by purging (vomiting or using laxatives or
diuretics).
Bulimia nervosa and binge eating disorder
People with bulimia nervosa or binge eating disorder regularly binge-eat.
Most people with these conditions are overly concerned or distressed about
their weight and body shape. People with bulimia nervosa compensate for
their binge eating by repeatedly trying to control their weight in extreme
ways, such as purging or exercising excessively. People with binge eating
disorder do not display these behaviours regularly, so they can either have a
normal weight or be overweight, even obese.
Binging and purging can be a symptom of both bulimia nervosa and anorexia
nervosa. However, people with bulimia nervosa are not extremely
underweight like people with anorexia nervosa.
Avoidant/restrictive food intake disorder (ARFID)
Avoidant/restrictive food intake disorder (ARFID) is another eating disorder
that occurs mainly in children. People with ARFID have food phobias and
avoid some
foods, although they are not worried about their body shape and weight.
They lose a lot of weight or develop nutritional deficiencies, and some people
with this condition cannot eat food at all. When this happens, they might
need supplements or need to
be fed through a nasogastric tube (a tube passed through the nose and into
the stomach). Both children and adults can develop ARFID. Children
with ARFID usually have medical problems similar to children with anorexia
nervosa.
Causes of eating disorders
There is not just one simple reason why eating disorders occur.
Researchers think that eating disorders happen because of a combination of
factors. These factors are:
 biological (the way the brain works
 genetic
 (familial)
 psychological (how one thinks)
 social (relationships with other people)
 cultural (the customs and values of the people around).
Symptoms of eating disorders
If one thinks they might have an eating disorder, they should speak to their
doctor/ the general practitioner (GP). The only way to be sure that one has
an eating disorder is to be diagnosed by a health professional.
Early signs and symptoms
One does the following:
• Is afraid of putting on weight, or weighs oneself all the time
• thinks about food all the time, or feels anxious at meal times
• starts restricting how much food they eat
• overeats uncontrollably
• feels out of control around food
• hoards food to binge on later
• makes oneself vomit after eating
• takes laxatives to make them lose weight
• worries too much about how they look
• checks oneself in the mirror constantly
• does not like eating around other people
• starts to lie about what they eat or how much they eat
• exercises too much
• feels cold all the time, weak or light headed
• for girls and women, their periods have stopped, or have not begun by age
16.
One does not have to have all these symptoms to be diagnosed with an
eating disorder. If one is, they should speak to a doctor who can make an
initial assessment, and then refer them to an appropriate eating disorder
specialist or service. As well as these signs and symptoms, one may feel bad
about themselves or that they are not good enough, feel sad, anxious or
irritable, or not feel like spending time or getting involved in activities with
other people.
Risk factors
Generally, girls/women are at higher risk of developing an eating disorder
than boys/men. Some other things that may make one more at risk of
developing an eating disorder are:
• having feelings of low self-esteem or worthlessness
• living in a western culture in which being thin is considered the ideal body
shape
• living in an urban area
• participating in activities in which body image is a concern (e.g.
professional or competitive dancing, gymnastics or fashion modelling).
• having a history of strict dieting and body dissatisfaction
• having lived in an environment in which leanness or obesity has been a
concern
• experiencing depression or loneliness
• being a perfectionist, or impulsive, or have difficulty managing emotions
• migrating from a developing country to a western culture
• experiencing stressful life changes (e.g. leaving home to go to university, a
relationship breakup or the physical bodily changes of puberty)
• having experienced physical, emotional or sexual abuse.
Who gets eating disorders
All eating disorders can occur in both males and females of any age.
People used to think that only young women and teenage girls could have
eating disorders. Eating disorders occur in both males and females, but girls
and women are twice as likely as boys and men to have an eating disorder.
People of any age can have any of the eating disorders, although some
disorders are more common in particular age groups. Some people have an
eating disorder for many years before it is diagnosed or treated. Even adults
in late middle age sometimes ask for treatment for an eating disorder that
started earlier in life.
Anorexia nervosa
Anorexia nervosa most often starts at around age 15–19 years but it can
occur at any age, including in childhood. About 1% of women and less than
0.5% of men experience anorexia nervosa during their life.
Bulimia nervosa
Bulimia nervosa usually starts in the late teenage years or young adulthood.
About 2% of women and 0.5% of men experience bulimia nervosa during
their life.
Binge eating disorder
Binge eating disorder usually starts in the late teenage years or young
adulthood. People in mid-life are more likely to develop binge eating disorder
than other eating disorders. Around 3.5% of women and 2% of men
experience the condition during their life.
Children and eating disorders
There are some differences between eating disorders in children younger
than 12 and eating disorders in teenagers and adults. Children are:
• less likely to say that they are afraid of weight gain or being fat.
• less likely to make themselves vomit or use laxatives.
• less likely to understand that their condition is serious.
• more likely to have physical symptoms.
• less likely to have symptoms that fit the pattern of anorexia nervosa,
bulimia nervosa or binge eating disorder, but more likely to have ARFID.
Why get treatment
If eating disorders are not treated, they can result in serious medical
problems. Eating disorders can become medical emergencies, so some
people with an eating disorder will need to go to hospital to get life-saving
treatment, or treatment for long-term problems caused by malnutrition.
Having an eating disorder can interfere with home life, education, work and
social life. People with an eating disorder can also have
other mental health conditions, such as anxiety disorders and depression.
Severe malnutrition due to starvation or purging can cause life-threatening
heart conditions, osteoporosis (weak bones that fracture easily) and liver
disease. When the body is starved, the brain is also starved. This can
interfere with ability to think clearly
and concentrate. It can also make it harder for one to understand situations
clearly and judge actions and those of other people properly. The effects of
brain starvation can only be reversed by restoring the body to a safe weight
that allows the body to
function normally. About one in 20 people with anorexia nervosa die from
this disease. The risk is highest when a person has had anorexia nervosa for
several years.
Risks of eating disorders in children
Malnutrition in children with eating disorders can slow down normal growth,
delay puberty, and cause brain problems such as an inability to learn and
think normally.
Girls may not start having their periods at the normal age. Children with
eating disorders can also have psychological problems, such as depression,
anxiety and obsessive-compulsive disorder. Having an eating disorder in
childhood increases a
person’s chance of developing obesity, high blood pressure and heart
disease in later life. Low bone density and osteoporosis (having porous,
fragile bones that are prone to fractures) is a risk, especially for girls with
anorexia nervosa who become malnourished in early adolescence and who
do not have normal periods. Even if they recover from anorexia nervosa,
they may not build up normal bone mass.
Why it is important to get treatment
Anorexia nervosa can lead to severe malnutrition (from starvation).
Starvation can cause changes in the brain and could have long-term effects
on health. Starvation can also cause heart failure and sudden death.
The first step is to speak to the doctor general practitioner (GP).
Recovery from eating disorders
With treatment, most people with an eating disorder make a good recovery,
so it is important to have a positive attitude to the recovery journey. At least
50% of people with bulimia nervosa or binge eating disorder fully recover
with treatment.
It can take some time to get better – perhaps up to five years for someone
with anorexia nervosa. For some people, the eating disorder might return for
a time (e.g. during a time of stress). Because it takes time to recover, it is
important to establish an ongoing relationship with a trusted health
professional.
Assessment
This is the first step in treatment. Before they can work out how to help the
health-care team will need to do an assessment. The assessment is a
consultation in which a health-care professional will speak to one about
things like their medical history, thoughts and feelings, and eating habits.
Treatment of eating disorders
The medical team will also check physical health and arrange tests if
needed. They will use the assessment to gain a thorough understanding of
the patient and their individual circumstances, so that they can:
• make sure the diagnosis of an eating disorder is correct
• find out if one has any other medical or mental health conditions
• understand which treatment may be best for them.
The health-care team will usually ask for permission to talk to the family or
carers, and to the GP and other health professionals who are involved in
one’s care. During the assessment, one may be asked about:
• their thoughts and feelings about their body
• any concerns or fears one may have about weight gain
• exercise
• whether one has times when they cannot control their eating and eat large
amounts of food at a time
• whether one has times when they avoid eating or restrict the amount they
eat
• whether one takes any medications or other substances to avoid putting on
weight (e.g. laxatives, diuretics, diet pills or stimulant drugs)
• whether one has had an eating disorder in the past
• whether one has had other mental health problems (e.g. depression,
obsessional thinking, or anxiety).
• whether one has had other psychological symptoms (e.g. finding it hard to
concentrate or solve problems).
• one’s early life, including their relationships with their parents or other
people who looked after them, and how they developed.
• one’s family and relationships
• one’s general health, including any health conditions they have or have
had in the past.
Collecting this information may take time and might continue over several
sessions.
The health-care team will also need to check physical health. This will involve
measuring weight, height, pulse rate, blood pressure and temperature. If
they are underweight or purge (or both), they will need blood tests and an
electrocardiogram (to measure the speed and rhythm of heartbeat).
They may also need a scan to measure bone mineral density.
These tests are necessary to check if one has any serious or urgent medical
problems and need to be seen by other medical services or specialists.
After assessment is complete, the next step is to put together a treatment
plan.
Treatment plan
After assessment, the health-care team will work with the patient and family
and carers to make the treatment plan. The treatment plan is a written
document that lists the goals for recovery, and the treatments that will be
used to help one achieve those goals. They will be given information about
which available treatments are suitable for them. If there is more than one
option, the doctors will help them decide what is best for them. The
treatment plan will be guided by the patient’s wishes and choices, as well as
their health needs. The goals should be reasonable and achievable. Some
aspects of the treatment may have a higher priority than others; for
example, if there is need to be
admitted to hospital for medical care to keep safe, this will be the first
priority.
For people with long-term anorexia nervosa, the first aims of treatment may
be to improve their quality of life, keep them safe, and deal with crises when
they happen.
How well one responds to treatment will determine the length of the
treatment. Treatment may last for several years.
Aims of treatment
Aims of treatment differ between individuals, but usually include:
• preventing medical problems, including life-threatening conditions
• overcoming dehydration
• getting enough nutrients and fluids to become healthy again
• preventing your health getting worse
• learning to eat without stress or anxiety
• overcoming unhealthy ways of thinking and acting
• overcoming depression or other mental illness
• enabling the body and mind to develop normally (for a child or a young
person)
• learning to think and act for oneself, to keep themselves safe in future
• helping one to get back to work or school or helping them not to miss days
because of illness
• helping one to get involved in the community
• helping one to cope with their eating disorder and still live a full and
meaningful life
• supporting one’s family or carers.
Adjusting the treatment plan
After one has begun treatment, the health-care team will regularly review
the treatment plan and adjust it, if needed. the treatment will depend on the
progress one is making towards recovery. This is generally measured by
whether they have a healthier eating pattern, whether they are less
distressed, and whether they are able to participate in everyday activities
more easily than before treatment.
For people with anorexia nervosa, progress towards recovery is also
measured by medical checks such as blood glucose levels, blood pressure,
and brain and heart function. For women and girls with anorexia nervosa, the
return of periods is a good sign that they are getting better. If they are not
making progress towards recovery, the health-care team will talk to them
about changing your treatment.
Where to have treatment
Whenever possible, one will be able to choose where they have treatment,
and it should restrict their life as little as possible. Usually there is a range of
options, including:
• outpatient treatment (live at home and go to a clinic or hospital for regular
appointments)
• a day program (sleep at home but go to a clinic each day)
• inpatient treatment (stay in hospital during your treatment).
Most people with eating disorders have mainly outpatient treatment, but one
may need to go to hospital if they:
• are at immediate risk of serious medical problems (e.g. if the tests show
that one has, or could develop, a heart condition, even if they feel well)
• have suddenly lost a lot of weight
• have had no food or nourishment for several days
• cannot control purging or excessive exercise
• are feeling suicidal or have thoughts about harming themselves
• are pregnant.
If one needs to go to hospital, it is best if they go to one that has a
specialized eating disorders unit. If specialist beds are unavailable, they may
be offered treatment in a general mental health inpatient unit.
If one is very unwell physically, they may need to be admitted to a general
adult medical ward or general children’s medical ward until they are
physically stable.
For children with anorexia nervosa, it is usually best to have treatment in a
children’s medical ward. Hospital stays for eating disorders are usually not
long, even if one has had the illness for a long time. Even for adults with
long-term anorexia nervosa, hospital stays should only be arranged when the
person’s health needs to stabilized, or to achieve goals agreed between the
person and their health- care team.
Sometimes people with eating disorders are so distressed that they refuse
life-saving treatment. They are given treatment without their consent if it is
needed to save their life and they are unable to make decisions for
themselves (e.g. they are too sick to think clearly or to give their consent).
This is called involuntary treatment.
Involuntary treatment can only continue for as long as is needed to keep the
person safe. The patient and their family or carers have the right to have the
decision reviewed by an independent authority, such as a court or tribunal.
If there is not a specialized eating disorder service close to where one lives,
the health-care professional (GP, or clinical psychologist) can contact
someone who specializes in eating disorders for advice about their care.
Treatment
Treatment for eating disorders involves healthy eating together with medical
care and psychological treatment. Some people might also be prescribed
medications. The healthcare team will work with the patient to decide which
combination of treatments is right for them.
Healthy eating
For people with anorexia nervosa, effective treatment must always include
regular and adequate nutrition. The health-care team will talk this over with
them in detail, but these are some key points:
• Adequate nutrition is a non-negotiable part of the treatment plan. Getting
back to a healthy weight and getting the nutrients the body needs to stay
healthy are essential to treatment. The health-care team will help them to do
this.
• Usually, a dietitian experienced in the treatment of eating disorders will
plan a tailored diet for one to make sure one gets all the essential proteins,
carbohydrates, fats, vitamins and minerals the body needs. The dietitian’s
role is to help them make healthy eating part of their everyday life. Habits
will not change overnight, but over time one can learn to have a healthy and
stress-free relationship with food.
• The health-care team will do their best to make sure one eats enough,
either by staying with them at mealtimes if they are in hospital, or by asking
them to agree to their family or carers being with them at mealtimes if they
are at home. When they are well enough, you can record what they eat at
each meal and discuss this with the health-care team during outpatient
appointments.
• If one is are unable to eat, or refuse food, they will be given balanced food
substitutes – drinks that are high in energy and protein. Food substitutes are
generally avoided because the key goal is to get them to eat normal foods
again.
• If one is seriously unwell and unable to eat food or drink food substitutes,
they may need nasogastric feeding (where a feeding tube is passed through
the nose and into the stomach).
When adults with severe or long-standing anorexia nervosa start to eat or be
fed after a long period of not eating enough, there is a risk of a serious
reaction known as ‘refeeding syndrome’. Because of this risk, the process
should be supervised by a specialized team with skills and experience in
working with people with severe long-term anorexia nervosa.
People with bulimia nervosa or binge eating disorder may need to lose some
weight to avoid or to overcome medical problems. The healthcare team may
recommend a supervised and appropriate weight loss program in the short
term. In the long term,
the most effective way to manage weight is to change thinking and
behaviour. Psychological treatment will help you do this.
For children, it is best to work on eating healthy food at the usual mealtimes,
sitting at a table with their family (or in a situation that is like a family meal).
Even after children and teenagers have reached a healthy weight, they will
still need their eating patterns checked regularly. The doctor will also
regularly measure their growth, do blood tests
for hormones, and check their temperature, pulse and blood pressure.
Medical care
One may need treatment for medical complications caused by starvation,
vomiting, or laxative use. They may also need general medical and dental
care.
Medical complications due to starvation can include serious and even life-
threatening problems such as:
 Dehydration
 low blood glucose levels
 anaemia (lack of red blood cells)
 low blood pressure
 an extremely slow or irregular heartbeat
  low white blood cell count (which reduces ability to fight infection),
 liver and kidney problems.
Starvation can also cause changes in the structure of your brain,
osteoporosis (weak, porous bones that break easily and heal slowly), and
constipation or abdominal
(gastric) distress. If one is female, periods may stop (or not start).
Very rarely, a person who has been starving or severely malnourished for a
long time can have a serious reaction when they start eating again (known
as refeeding syndrome). If one is at risk of this, doctors will check the levels
of phosphate, potassium and magnesium in the blood every day for the first
one or two weeks. If they find any dangerous changes, the doctors will treat
them with oral supplements or by intravenous fluids (via a drip).
Making oneself vomit too often can cause ulceration or tearing of the
oesophagus (the tube that connects the mouth and the stomach) or swelling
of the salivary glands. They may need to see a specialist for oesophageal
problems. The stomach acid in the vomit can damage the enamel of the
teeth, so one may also need regular dental visits.
Losing too much potassium by vomiting can cause an irregular heartbeat,
which can be life threatening. The doctor may test blood and arrange
treatment, if needed.
Over-use of laxatives can upset the normal bowel function. Sometimes this
damage can be permanent.
One may need specialist treatment for bowel problems. People with bulimia
nervosa or binge eating disorder who have put on a lot of weight may have
(or be at
risk of) cardiovascular disease because of abnormally high levels of
cholesterol or triglycerides in the blood, high blood pressure or high blood
glucose. They may also be at risk of developing diabetes. The health-care
team can arrange the usual tests and treatments for these conditions.
Most people with an eating disorder need treatment from a team of health
professionals (GP, psychiatrist, psychologist and dietitian). The team will
work with them to find out about their symptoms, understand their eating
disorder and work out if they have other mental health conditions
(e.g.depression). They will agree on a treatment plan. One will be given
information about which available treatments are suitable for them. If there
is more than one option, the doctors will help them decide what’s best for
them.
Most people with an eating disorder can have effective treatment while living
at home – but if they are very unwell, they may need to go to hospital for a
short time. To maximize chances of a full recovery, they will need medical
care, good nutrition, and psychological treatment.
Their family, or people who are close to them, can be involved in their care.
Their private information will not be shared with anyone else unless they
agree, or it is really necessary to help them get well and stay safe.
Medications
Medications (medicines) are not part of the standard treatment for anorexia
nervosa because there is not strong enough evidence that they are effective.
For people with bulimia nervosa or binge eating disorder, if they also have
another mental health condition such as depression, anxiety, impulse control
or substance use disorder, doctor may prescribe antidepressant or mood-
stabilizer medications. These medications may also be useful alongside
psychological treatment, even if does not have one of these conditions.
Research shows that antidepressant medications can help people with
bulimia nervosa reduce their uncontrolled overeating, as well as improve
their mood. The doctors may suggest a low dose of an antipsychotic or
antidepressant medication if one has symptoms of anxiety or obsessive
thinking.
People with a very low body weight have a higher risk of unwanted side
effects from these medications, so they are prescribed only when necessary.

Psychological treatment
In addition to nutrition and medical treatment, to recover and stay well you
must also make changes in their thinking and behaviour. Psychological
treatment is an essential part of treatment for everyone with an eating
disorder. It provides a chance to find out what triggers a person’s eating
problems and to work out how to deal with them.
There are many different types of psychological treatments, but all involve
talking with a therapist (a psychologist or psychiatrist). These treatments are
designed to help one understand their thinking, actions and relationships, so
that they can make changes that will make them less distressed and make
everyday living easier.
Some of the main psychological treatments used to help people with eating
disorders are:
• family therapy (family members work together as a team to directly
manage a child’s behaviour)
• cognitive behavioural therapy (works by teaching one to recognize their
negative thoughts and beliefs and to challenge them, so that they can
change their behaviour)
• interpersonal psychotherapy (focuses on the link between when and how
the symptoms started and on problems they have relating to other people)
• psychodynamic psychotherapy (focuses on uncovering what is on their
mind that they are not normally aware of).
For children and teenagers with anorexia nervosa, family therapy is usually
the best choice. Other types of psychological treatment are considered if
family therapy is not possible or has not been successful.
If one is severely underweight, they will need to begin their physical recovery
before they start psychological treatment, so they are strong enough and
their brain is working properly.
Whichever therapy decided on, three things will always be true:
• One will play an important role in their own treatment.
• One will need to be patient and keep persisting.
• One must be committed to the treatment.
Challenging the way one thinks, feels and behaves is very hard work. This
may be distressing as they work through issues and problems with their
therapist, and
begin to make changes that affect the way they live their life.
It takes time and persistence to achieve real change. Learning new ways of
thinking, feeling and behaving will involve trial and error, and may be very
frustrating. This process may take many months before one discovers subtle
changes in the way they
think about themselves and the world around them. The goal for is to be in
control of their thinking and feeling – and therefore in charge of their
behaviour.
It is important for everyone involved in your treatment to be committed to it.
For example, family therapy would not be the best choice of treatment if a
key person in the family is not supportive or is not always available.
Other practical help
Adults with long-term anorexia nervosa may need help with nutrition,
housing, financial issues, and recreational and occupational activities. If
substance use is a problem, the health-care team will arrange treatment.
A doctor may refer the patient to an appropriate eating disorder specialist or
service.
Most services that care for people with eating disorders bring together a
team of healthcare professionals that includes doctors (such as
psychiatrists), clinical dietitians and psychologists. Ideally, each team
member will have special knowledge, skills and experience in eating
disorders. Each has a different kind of expertise, and together they can help
you work through the treatment plan to get well.
For children and teenagers, the team should include people with special
experience and training in managing eating disorders in these age groups.
Psychiatrists’ role in treating eating disorders
Many people who are treated for eating disorders will see a psychiatrist
during their treatment.
Psychiatrists are medical doctors who are experts in mental health. To
become a
Psychiatrists often lead a health care team. Some psychiatrists completely
specialize in the care of people with eating disorders. Because they are
doctors, they can prescribe
medication, develop treatment plans and monitor physical health. They can
also provide psychotherapy (also called talking therapy or psychological
treatment).
When working with the health care team one should do the following:
• Tell them if anything is worrying or frightening them.
• Try to be honest with them.
• If they say anything one does not understand, ask them to explain.
Making decisions
The patient should make decisions about their treatment based on
information from the health-care team (unless it is a medical emergency).
Normally, Involving family and carers in assessment, treatment and care is
advisable as other people’s understanding of the situation is very important;
since on their own, they may not be aware of how severe their symptoms are
or how serious their condition is – or may be struggling to admit it.
Confidentiality
Information about treatment should be is kept confidential. Sometimes it is
necessary to share information with other health professionals, to keep the
patient safe and to support them better. It is important for family and carers
who support them to be given enough information to be able to help them
effectively. This does not mean that everything about them will be shared
with other people – only the information that is really necessary to provide
safe care and support to them.
Like adults, children and young people have the right to have information
about themselves kept private. However, it may be a good idea for the
child’s school,
child-care centre or sporting group to be told about their condition to help
keep them safe.
For people with anorexia nervosa, the risk of going back to the pattern of
starving and losing weight is highest at about 4–9 months after successful
treatment. People who have recovered from bulimia nervosa or binge eating
disorder also find it very hard
to resist going back to their old habits. One needs to stay in touch with the
health-care
team and keep working very hard on staying well, especially if binging or
purging has been a problem for them in the past.
Helping oneself. One should:
• Keep talking about their problem with the people who love and support
them, even if this is hard to do.
• Surround oneself with people who support them and want to see them
healthy and happy.
• Join an eating disorder support group. These groups provide a safe
environment where one can talk freely about their eating disorder and get
advice and support from people who know what they are going through.
• Try to keep information flowing freely between the health-care
professionals who manage their care and their family or carers.
• Stick with their eating disorder treatment plan. They should not neglect
therapy or other parts of their treatment, even if they are doing better. They
need to follow the recommendations of the health-care team.
• Do everything, they can to make sure their brain and body are getting the
regular and adequate nutrition they need to recover.
• Get treatment for other mental health problems (e.g. anxiety and
depression) if these are a problem for them.
• Ask the health-care team to help you make a relapse prevention plan and
an advance care directive.
• Work out what triggers their symptoms (e.g. certain times of year or
stressful life events). They should make a plan to deal with them, such as
going to therapy more often during these times or asking for extra support
from family and carers.
• Avoid people that drain their energy, make them feel bad about
themselves or encourage their symptoms. If they cannot avoid them, they
need to work out a way
to protect themselves.
• Fill their life with activities that they enjoy or make them feel fulfilled. They
should try something they have always wanted to do, such as learning a skill
or a hobby.
When one is busy doing something worthwhile, they will focus less on food
and weight.
Remember that recovery is possible. Believe in yourself – that you can and
will get better and stay well.
Support for people with disorders
Family members, friends or carers of someone with an eating disorder,
should do the following things to help:
• Offer ongoing support to the person, including reassurance, listening,
comfort and assistance to get help.
• Give the person hope for recovery by reassuring them that people with
eating disorders can and do get better.
• If the person has not responded to treatment for eating disorders, reassure
them that this does not mean that they will not succeed in the future.
• Encourage the person to be proud of the positive steps they are taking
toward recovery.
• Suggest to the person that they surround themselves with people who are
supportive.
Things that do not help
• Do not let issues of food dominate your relationship with the person and try
to avoid
conflict or arguments over food.
• Try not to give advice about weight loss or exercise.
• Try not to reinforce the idea that physical appearance is vital for happiness
and success.
• Try to avoid comments about the person’s weight or appearance.
Having a loved one with an eating disorder does not mean that one is a ‘bad’
parent, partner, brother, sister, child or friend. There is no evidence to
suggest that any family dysfunction is the cause of eating disorders.
One will probably feel some pain, suffering, sadness, guilt or despair of their
own. Being the main support person can be hard work and it may sometimes
feel that they are getting nowhere. One should ever blame themselves.
It can be very hard to understand a person’s eating disorder.
Helping someone with an eating disorder
One should get medical help immediately if the person:
• has deliberately injured themselves
• is expressing thoughts of suicide or of killing someone else
• is disorientated (does not know who they are, where there are, or what
time of day it is)
• has delusions (false beliefs) or hallucinations (seeing, hearing, feeling or
smelling things that do not exist)
• has a pulse that is very slow (less than 50 beats per minute) or very fast
(more than 120 beats per minute), or an irregular heartbeat
• is confused or not making sense
• is complaining of chest pain
• has collapsed or is too weak to walk
• is experiencing fainting spells
• has blood in their bowel movements, urine or
vomit
• has cold, clammy skin or a very low body temperature (less than 35°C)
• is vomiting several times a day
• seems to be dehydrated
• has painful muscle spasms.
If the person has any of these symptoms, call 999 or visit the emergency
department at the nearest hospital.
Summary
• Eating disorders affect girls and women more than boys and men.
• Factors believed to contribute to eating disorders include biological and
personal factors as well as society's promotion of the thin body image.
• Eating disorders carry with them a high risk of other mental and physical
illnesses that can lead to death.