Eating Disorders (ED’s) – how to recognise the signs and what to do.

Since the first COVID-19 lockdown, diagnosed eating disorders have been on the increase and they come with a number of high co-morbidties. It is estimated that there is a 3-4 times increase on diagnosed cases since this time last year as food, either as restriction of over-consumption, is used a method to control the anxiety that has come from the fear and uncertainty that has accompanied Covid-19.

The numbers quoted for recognised ED’s of course takes no account of those who are undiagnosed of which there are many either through lack of support, lack of knowledge on who to go to, lack of desire to change (because of course the ED provides benefits…) or simply the strict ED criteria are not met.    Those who may slip by unnoticed are perhaps someone who is just thought of a fussy-eater or someone who ‘eats too much’ is just thought of as someone who ‘needs to get more control’ but actually there may be something much deeper going on.

ED’s are most common in individuals between 14 and 25 but can be seen much younger and older and 25% of those categorised are men.   For some, ED’s can morph into a compulsion for exercise and they cross-over with the definition of monomania which is defined as the an excessive mental preoccupation with one thing.  

Eating disorders and disordered eating should also be distinguished.  There are strict criteria to fulfil (DSM -V) for an Eating Disorder to be ‘diagnosed’  which can then result in a GP referral to CAMHS for children/adolescents or other psychological support for adults.  If you don’t meet these criteria, you may then be dismissed but actually disordered eating habits are very common and can be quite distressing for many individuals and their families.  In today’s society where food messages are confusing – we are surrounded by large food manufactures and the government providing mixed messages along with the inescapable influence of social-media – it is not hard to see how disordered eating can begin and develop into something more sinister.

Eating Disorders can range from food restriction resulting in anorexia nervosa ( AN – persistent restriction of eating followed by significant weight loss with intense fear of weight gain), bulimia nervosa (uncontrolled binge eating with subsequent compensatory behaviour), binge eating disorder (BED), orthorexia (obsession with healthy foods) and other atypical behaviours or defined as OSFEDs (Other Specified Feeding and Eating Disorders).   Common features amongst many are an over-reliance on self-evaluation based on body shape and weight, usually a lack of flexibility in behaviour and a limited ability to feel emotions, thus using food in some way to suppress them, a feeling of powerlessness, OCD family traits,

There are risks associated with these conditions – for example, CVD is strongly associated with both anorexia nervosa and binge eating disorder, but also seen are long-term digestive dysfunction, lack of menstruation (particularly in AN), weight fluctuations, fatigue, sleep disturbances and altered heart rate/dizziness/electrolyte imbalances.  For anorexics, the list is much longer.

Individuals who may be more at risk are those who may have perfectionist personality traits, a history of trauma, high performers – in life and particularly sport where there is an emphasis on body shape and weight.  Trauma is not just the more often thought of sexual abuse but can be where there has been a tragic event or lack of nurture during childhood.

What to look out for:

• A change in usual eating behaviours, such as finding reasons to skip meals, often accompanied by more secretive behaviour.
• A change in mood, often more withdrawn and a withdrawal from social situations.  Enhanced anxiety due to neurotransmitter imbalances with lack of protein and digestive dysfunction is common – albeit anxiety may be a pre-existing condition.
• Obsession over body appearance, own and those on social-media, and excessive body-checking.
• Weight loss but this may not always be obvious at first.  Not everyone looks like a skeleton.
• Obsessive use of exercise in an attempt to manage weight.
• Dental erosion of teeth and calluses on hands (bulimics).
• Poor/deteriorating quality of hair, skin and nails.
• Distorted body image.

What to do:

Support and progress is most effective if a multi-disciplinarian approach is offered which can include psychological, nutritional and conventional medical support to monitor health.  Success in overcoming the ED is also much more successful if addressed early on.  If you have concerns over a child, other loved one or want support for yourself, the earlier help is sort, the better the recovery prognosis.   I strongly recommend where support is sought that you ensure the health care professional has specific additional training in eating disorders – be it a Nutritionist, Dietician or Psychologist.  Some good resources to find out more are:

• Beat Eating Disorders – Help Finder
• CAMHS – Child and Adolescent Help
• Where trauma is involved, this may need to be worked on as a priority.

Katherine is a degree qualified Nutritional Therapist (BSc First Class) with additional training in Eating Disorders from the National Centre for Eating Disorders and is a NLP Practitioner.  She is also training in EFT (Emotional Freedom Technique) in 2021 to help with trauma directly in clinic.  To find out more how Katherine can help you please contact her on info@kch.degreesabovezero.net.