Introduction to eating disorders…

What is an Eating Disorder ?

An eating disorder is an illness which manifests itself in a variety of unhealthy eating and weight control behaviours that become obsessive, compulsive, and/or impulsive in nature. Eating Disorders almost always start out as diets, but these disorders are not about food and weight

The food serves as a stress reliever and in many cases initially the person is not aware of what they are doing. In this day and age of dieting, health and
fitness, it is difficult to sometimes ascertain the difference between someone who has an eating disorder and a person who is simply weight conscious.

The main ingredient present In a person with an eating disorder is the use or abuse of food to cope with, distract from, numb, control, and comfort from Negative feelings, whereas a weight conscious person may simply want To lose weight for a wedding, Christmas, an occasion, to fit into an outfit, or simply to look and feel better. It is the psychological and emotional implications that separate the weight conscious person from the person with an eating disorder. Unfortunately some embarking on the weight loss trail start out innocently to lose a few pounds, however over a period of time a persons brain and body chemistry can be affected By the diet they have chosen and the result is the brain and body functioning become impaired.

When embarking on a weight loss trail always seek professional help with getting a nutritionally sound eating plan that you can maintain for life. Start as you plan to go on!

POSSIBLE CAUSES
There is no single cause for eating disorders, as there are many factors pertaining to them. The common thread seems to be a supersensitive nature, low self esteem, and an inability to respond appropriately to uncomfortable Feelings. The good news is recovery is
possible, and a person can restore their relationship with themselves

1 and with food. All individuals have their own unique personal issues that contribute to their eating disorder, so treatment has to be tailored to the individuals specific needs, personality, and Lifestyle.

WHO DEVELOPS EATING DISORDERS?
Anyone can develop an eating disorder regardless of age, sex, cultural background, etc. and it is not unusual for an eating disorder to surface in middle age. Research suggests that there may be a genetic disposition to eating disorders and a link to certain personality
types. However, there are many factors pertaining to eating disorders, and anyone can develop a disordered pattern of eating. A traumatic event, distorted perception, being abused, being bullied, a long term illness, a death, negative influence from a family member or a friend, depression etc. can all have their part to play in the symphony that
can create issues around food.

WHAT ARE THE VARIOUS CATEGORIES OF EATING DISORDERS ?
There are several categories of eating disorders, however the main culprits are Anorexia Nervosa (anorexia), Bulimia Nervosa (bulimia), Binge Eating Disorder (compulsive overeating), and other related disorders. These disorders centre around extreme or potentially dangerous eating and weight control behaviours which include binge eating, starving, purging, chewing and spitting and over exercising. There are two less well known eating disorders, The Night Eating Syndrome and Orthorexia Nervosa (extreme rigidity in eating healthily). Night Eating Syndrome was first named by Albert Stunkard in 1955 and refers to A type of binge eating generally more common among overweight individuals, where over half of total calories for the day are eaten during the period following the evening meal. Stunkard noted that the syndrome became particularly prominent
during periods of weight gain and life stress, and there was a correlation between NES and failure to diet. Care must be taken not to identify NES among people whose lifestyle or culture predisposes evening eating and there are no other problems with the classification of night eating syndromes.

ANOREXIA - THE FACTS
Anorexia Nervosa means Ôloss of appetite for nervous reasons. The first case of anorexia was in 1694 in france and the first paper written on anorexia was by Sir William Gull in 1874. Anorexia is the relentless pursuit of low body weight ether by curtailing food Intake or restricting particular foods thought to be fattening. This can result in emaciation
and the risk of collapse or death.

Some anorexics also exercise compulsively to burn off the perceived excess of calories from the small amount they do manage to eat. The focus placed on food is an attempt to cope with, control, and get a sense of power in the persons life. It is not about simply wishing to be slim like models in magazines. Starvation causes the disorder takes control and this alters brain and body chemistry that results in further distortions in thinking and emotional reasoning. As the illness takes more of a hold, a person starts to become exhausted as their energy levels are compromised due to lack of food; this together with an increase in negative Energy may account for the heaviness they feel. In all cases this heaviness is mistaken for fatness , hence they engage in a constant struggle to keep losing weight, a war on food that must be maintained despite the already severe weight loss that the person has incurred. Anorexia affects the body and mind in several different ways.

ANOREXIA CHECKLIST
- Weight loss in a short space of time
- Loss of periods for women
- Feeling cold all the time
- Dizziness
- Dry, rough pale discoloured skin
- Severe restriction of food
- Food rituals such as playing with food on plate, chopping into small pieces counting bits of food, preparing food but not eating, cooking for others.
- Bloated stomach (which is mistaken for fat)
- Loss of bone mass
- Mood swings
- Perfectionistic attitudes
- Insecurity
- Self worth becomes based on what is eaten or not eaten
- Intense fear of gaining weight
- Distorted perception of body shape, weight, personality, and amount of food eaten
- Rigid and obsessive behaviour with food, people, self.
- Wearing baggy clothes
- Avoiding company
- In some cases people also take laxatives.
- Buzz from starving - sense of power and worth.
- Conviction that they are OK despite the concerns of others.

As you can see the above can and do have far reaching effects on a persons Health and well being, and as such left untreated can be fatal. The long term effects for women can lead to the development of infertility or a difficulty in becoming pregnant. However once the
body receives proper nutrition these effects can be reduced. As for men and women there is a high risk of developing osteoporosis (see leaflet osteoporosis and eating disorders for more information.)

TREATMENT
Most people with anorexia can be managed on an outpatient basis, however for very severely low weight individuals an inpatient hospital/institution programme may need to be implemented in order that the individual may be able to respond to therapeutic interventions. The earlier the eating disorder is detected the better it is for the individual's response to therapy. There is great controversy about how to approach this illness In terms of what do you work on initially. First do you restore a regular eating pattern as to allow the
body to return to health so the underlying psychological issues can be dealt with, or do you work on the underlying psychological and emotional issues so the individuals behaviour with food becomes obsolete? Many of the symptoms of the anorexia are due to Nutritional
deficiencies suffered by the brain and body and once The individual is made aware of this, then mental, emotional and physical interventions can and need to be used concurrently in order that treatment can be effective. Severely low weight individuals, would need nutritional intervention first in order to handle therapeutic interventions. I believe the individual needs to be educated and empowered to take responsibility for their mind and their body, and with information, advice, support, help, knowledge, and new perspectives this can be achieved. The initial assessment will determine the severity of the case and the next Step that needs to be taken. While weight gain needs to be achieved, it should not be made the primary focus. It needs to be addressed through educating the client to make more nutritionally sound food choices to improve the status of brain and body chemistry. This seems less daunting on the individual, and long term the focus is not weight gain but alleviating the symptoms of nutritional deficiencies that are present. Addressing the underlying issues that caused the person to turn to food in the initial stages will result in a fresh perspective on things. Medication should not be used for the sole treatment of Anorexia or indeed any type of eating disorder.

Separating the person from the anorexic illness is helpful right from the start of therapy, so the person has a fighting chance to deal with this Ôinner voice' that they think is them. Cognitive behavioural therapy, a treatment intervention which challenges characteristic
unhelpful thinking patterns that help maintain The illness, is a very effective recovery approach with anorexia and other eating disorders.

BULIMIA - THE FACTS
It was only in 1979 that doctor's first recognised bulimia nervosa as an eating disorder. The term bulimia nervosa literally means Ôox hunger of nervous originÔ. This hunger is driven by an emotional need that food cannot alone fill. Usually the person feels this void or
gap or emptiness and they seek to use food to fill it. Unfortunately, as many find out, this emptiness cannot be filled by food, as it is emotional, physical and spiritual. Sufferers characteristically binge eat or over eat; end up feeling bloated, worse, too full, after their
eating episode and then vomit and/or take laxatives in a bid to prevent themselves from gaining weight. Others over-exercise in an attempt to burn unwanted calories. As with anorexia, control and the abuse of food to cope are also present. Bulimia usually follows dieting, and starts later than anorexia, in late adolescence, and may follow anorexia although most bulimics have not been anorexic. It can continue for many years if left untreated, thus many older women have the illness. The period after childbirth is another time when women are at risk. People become bulimic because they believe that purging will help them get rid of unwanted calories and stop them from gaining weight, as other weight loss attempts have resulted in failure. Bulimia is also associated with low self esteem, lack of confidence, an over-evaluation of shape and weight, and a need to control weight. Bulimic behaviour is very addictive as, while vomiting or exercising the brain releases endorphins, chemicals which are the body's natural pain killers. The ritual confers a sense of emotional release, so what starts off as a way of controlling calories, becomes a way of getting this emotional release, and will be repeated whenever a person feels emotional stress.

BULIMIA CHECKLIST
- Frequent Weight Changes
- Sore Throat, swollen glands, tooth decay, bad breath
- Preoccupation with overestimation of body shape and weight
- Vomiting
- Laxative abuse
- Rigid and harsh exercise regimes
- Fear of putting on weight
- Depression
- Mood Swings
- Electrolyte and fluid imbalances
- Poor skin conditions and hair loss
- Lethargy and tiredness
- Heart palpitations
- Internal organs damage
- Uncontrollable urges to eat vast amounts of food
- Anxiety, guilt, shame attached to self and behaviour
- Feelings of Isolation
- In some cases, shoplifting
- Buzz from vomiting, sense of release/relief.
- Buzz from perceived weight loss
- Easy weight gain

Again, like anorexia, the above can and does have a far reaching effect on mental, emotional, physical and spiritual well being. In extreme cases, bulimia causes heart failure as when a person induces vomiting they lose potassium from the body. Potassium is a mineral regulates the adrenal glands, the nervous system, the heart and energy levels in the body. Note the adrenal glands in the body are responsible for handling stress effectively. Other dangers include rupture of the stomach, choking, tooth enamel erosion, swollen glands and the drying up of salivary glands.

TREATMENT
As with all eating disorders, bulimia is curable in most cases and very manageable in other cases, so a much better relationship with self and food can be attained. Again as with anorexia, cognitive behavioural therapy is a successful therapeutic Intervention which challenges the thoughts, values, and beliefs which maintain the illness example beliefs about shape and weight, and assumptions that normal eating will make them gain weight. In time, this therapy will help sufferers to develop new automatic behaviours around food. Also, emotional resilience or the development of appropriate responses to feeings
Needs to be addressed. Appropriate medication can alleviate bulimic symptoms in the short term; however this should be only used short term if at all. There is strong evidence that therapeutic interventions are more effective in the long run and protect against
relapse. Experience suggests that along with therapeutic interventions, alternative medicine has a valid presence. Acupuncture, bio energy, reflexology, reiki, meditation, all aid the mind/body connection to become more harmonious, and in the long term, this has a very positive affect on the recovery process. As bulimia (and the other eating disorders) are born out of lack of awareness and understanding of the real effects of purging, it is imperative that education Is a vital component of any treatment plan? An effective treatment plan would also need to be adapted to the individual's specific needs, personality, lifestyle, and Symptoms.

BINGE EATING DISORDER - THE FACTS
Like bulimia, binge eating disorder has only recently recognised as a distinct condition. It was in 1992 that it was first acknowledged as an eating disorder in its own right. (BED) is very similar to bulimia in all respects, except that the person does not purge to dispose of
unwanted calories. It is believed that there are more people suffering from BED than anorexia or bulimia. People who binge or overeat and who do not purge usually struggle With their weight, although not all are overweight if the restrain successfully when they are not eating compulsively. Overweight, of course brings with it the risk of a host of other physical illnesses and most sufferers feel miserable, out of control and ashamed of their Behaviour.

BINGE EATING DISORDER CHECKLIST
- Bingeing in secret
- Eating very rapidly
- Emotional eating
- cant stop when had enough
- sensing the eating behaviour is not normal
- Eating despite feeling very full sometimes
- Feeling out of control with eating
- Shame, depression, guilt
- Compulsive eating when not hungry
- Fantasies about being a better person when thin.

TREATMENT
As many people with weight are judged by society, a supportive and nurturing environment needs to be put in place for the individual to feel safe in order to deal with the emotional issues that drives the uncontrollable behaviours with food. Here again, education, is a vital
component of recovery from (BED) therapeutic interventions work at both physical and emotional levels to deal with the urges and cravings, to change eating habits and foster weight loss. The first priority to be addresses is the whole relationship with Food and not weight loss, as many come into therapy with weight loss as a priority.

OTHER EATING DISORDERS (NOS - NOT OTHERWISE SPECIFIED)
These eating disorders come with some of the diagnostic signs of anorexia, or bulimia but don't necessarily qualify as a full blown eating disorder with the same psychological, emotional or physical implications.

Night Eating Syndrome refers to a type of eating where most of the Total Amount of calories ingested in a day is actually taken in during the night time after the evening meal. This is common among overweight Individuals. Care must be taken not to identify NES among
people whose lifestyle or culture predisposes evening eating and there are no other problems. NES is associated with feelings of loss of control and an inability to sleep without eating or drinking something. Orthorexia is a term coined by Dr. S Bratman and it describes eating Patterns that are very rigid and pertain to only Ôhealthy' foods. The rigidity can give rise to feelings of deprivation which may result in binge eating at some stage. The term orthorexia comes from the greek word orthos (straight, proper) And orexia (appetite). It is
characterised by the pathological obsession for biologically pure food, which leads to important dietary restrictions. Orthorexic patients exclude foods from their diets that they consider to be impure because they have herbicides, pesticides or artificial substances and they worry in excess about the techniques and materials used in food elaboration. Thos obsession leads to loss of social relationships and affective dissatisfactions which, in turn favours obsessive concern around food. In orthorexia, the patient initially wants to improve his/her health, treat a disease or lose weight. Eventually the diet becomes the most important part of their lives. If you have an orthorexic client you must carry out a differential diagnosis with chronic delusional disorder, anorexia nervosa and obsessive - compulsive disorder.

Within each category of eating disorder there are sub categories such as Anorexia - acute anorexia, stable long term anorexic, bulimic subtype not necessarily underweight.
Bulimia - normal weight to obese, normal weight history of anorexia chaotic Bulimic.
Binges Eating Syndrome - obese binge eater, non obese binge eater, failed dieters, Yo-yo dieters. Self worth, self esteem, weight and shape issues transcend all forms of Eating disorders.

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Suzanne Horgan director & founder Certified Trainer in Practitioner Skills for Eating Disorders and Obesity Contact Us today..........info@eatingdisorders.ie

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