What are some of the most common types of Eating Disorders?
- Anorexia Nervosa – Characterised by extreme food restriction, intense fear of gaining weight, and a distorted body image. People with anorexia often see themselves as overweight even when they are underweight.
- Bulimia Nervosa – Involves cycles of binge eating followed by purging behaviours, such as vomiting, excessive exercise, or using laxatives, to prevent weight gain.
- Binge-Eating Disorder (BED) – Characterised by episodes of excessive eating, often in a short period, without purging behaviours. People with BED may feel a loss of control and experience guilt or distress after binges.
- Avoidant/Restrictive Food Intake Disorder (ARFID) – Involves avoiding certain foods due to sensory issues, fear of choking, or lack of interest in eating, leading to nutritional deficiencies or significant weight loss. Unlike anorexia, it is not driven by body image concerns.
- Other Specified Feeding or Eating Disorders (OSFED) – A category for disordered eating behaviours that don’t fit neatly into the above diagnoses but still cause distress and health risks. Examples include atypical anorexia (weight remains in a normal range despite severe restriction) and purging disorder (purging without binge eating).
What are some early signs or warning signs of an eating disorder that friends, family, or loved ones should look out for?
Recognising the early signs of an eating disorder is crucial for early intervention and recovery. Here are some key warning signs to look out for:
Behavioural Signs:
- Obsession with food, dieting, and weight which can involve constantly talking about calories, food restrictions, or body image.
- Avoiding meals or eating in secret, this could involve skipping meals, making excuses not to eat, or only eating alone.
- Excessive exercise, this could involve working out compulsively, even when tired or injured.
- Frequent trips to the bathroom after eating, possible sign of purging (vomiting or laxative use).
- Rigid food rules; labelling foods as “good” or “bad” and feeling guilt after eating certain foods.
- Social withdrawal often avoiding social situations involving food.
Physical Signs:
- Sudden weight changes, rapid weight loss or gain, though not always present.
- Dizziness and fatigue, feeling weak, faint, or exhausted.
- Hair thinning or loss, lack of nutrients can lead to hair falling out.
- Cold sensitivity, feeling cold all the time due to low body fat.
- Gastrointestinal issues, stomach pain, bloating, or constipation.
Emotional and Psychological Signs:
- Intense fear of gaining weight, even if underweight.
- Low self esteem, linking self-worth to weight or body shape.
- Mood swings or irritability, malnutrition can affect emotions.
- Perfectionism, setting extremely high standards, often linked to control over food.
How do eating disorders affect someone’s mental health?
Eating disorders can have a profound impact on a person’s mental health, often creating a vicious cycle of emotional distress and disordered eating behaviours. Here are some key ways they affect mental well-being:
- Increased anxiety and depression, many people with eating disorders experience heightened anxiety and depression, often due to negative body image, low self-esteem, and the stress of maintaining disordered behaviours.
- Obsession and preoccupation with food and weight, constant thoughts about food, weight, and body shape can consume a person’s mind, making it difficult to focus on daily tasks, relationships, or personal goals.
- Social isolation, many individuals withdraw from social situations to avoid eating in front of others, fear judgment, or because they feel misunderstood. This isolation can worsen feelings of loneliness and depression.
- Cognitive impairment due to malnutrition, common in restrictive eating disorders, can lead to trouble concentrating, memory problems, and difficulty making decisions. This can affect work, school, and daily life.
- Emotional dysregulation, people with eating disorders often struggle with regulating their emotions, experiencing intense mood swings, irritability, or emotional numbness.
- Increased risk of self harm and suicidal thoughts, the emotional distress associated with eating disorders can lead to self harm or suicidal thoughts, especially if the person feels hopeless about recovery.
- Co-occurring mental health disorders, eating disorders often exist alongside conditions like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or substance use disorders, making recovery more complex.
Why is it so important to address the emotional aspects alongside the physical ones?
Addressing the emotional aspects of an eating disorder is just as important as treating the physical effects because the disorder is often deeply rooted in psychological and emotional struggles. If only the physical symptoms such as weight loss, malnutrition, or digestive issues are treated, the underlying emotional triggers remain, increasing the risk of relapse. Emotional healing is therefore crucial, where recovery is focused on breaking the cycle of disordered eating by restoring a healthy relationship with food alongside aiming to improve overall well being and self esteem.
What are some common misconceptions about eating disorders that we should be aware of?
There are many misconceptions about eating disorders that can contribute to stigma, misunderstandings, and barriers to seeking help. Here are some of the most common myths:
Myth: “Eating disorders are just about food and weight.”
While eating disorders involve disordered eating behaviours, they are primarily mental health conditions rooted in deeper issues like anxiety, trauma, perfectionism, and low self-esteem. Food is often a coping mechanism for emotional distress.
Myth: “You can tell if someone has an eating disorder by looking at them.”
Eating disorders affect people of all body sizes. Not everyone with an eating disorder is underweight, and many individuals struggle with disorders like binge eating disorder (BED) or atypical anorexia.
Myth: “Only young women get eating disorders.”
Eating disorders affect people of all ages, genders, and backgrounds. Men, older adults, and even young children can develop them, but they are often underdiagnosed in these groups due to stereotypes.
Myth: “Anorexia is the only serious eating disorder.”
While anorexia is life-threatening, other disorders like bulimia, binge eating disorder, and ARFID (Avoidant/Restrictive Food Intake Disorder) can also have severe physical and psychological consequences.
Myth: “Eating disorders are a choice.”
No one chooses to have an eating disorder. They are complex mental health conditions influenced by genetics, brain chemistry, trauma, and societal pressures.
Myth: “People with eating disorders are just seeking attention.”
Most people with eating disorders go to great lengths to hide their struggles due to shame, fear, or stigma. It’s not about seeking attention but rather about coping with deep emotional pain.
Myth: “Parents or society are to blame for eating disorders.”
While societal beauty standards and family dynamics can be risk factors, eating disorders are complex illnesses with multiple contributing factors, including genetics, biology, and personal experiences. Blaming parents or culture oversimplifies the issue.
How does society’s portrayal of body image and beauty standards contribute to the development of eating disorders?
Society’s portrayal of body image and beauty standards plays a significant role in the development of eating disorders by promoting unrealistic and often unattainable ideals. These standards create pressure that can contribute to body dissatisfaction, low self-esteem, and disordered eating behaviours. The media often promotes a narrow definition of beauty, photoshopped images can be heavily edited leading to compare and despair. Social media platforms can show case idealised body image which can exacerbate low self esteem and create the illusion of unrealistic attainability. Women can feel pressure to be thin but curvy, while men can feel pressure to be muscular with low body fat. LGBTQ+ individuals may experience additional body image pressures related to gender identity and societal norms. Constant exposure to these pressures can lead to body dissatisfaction, working therapeutically to shift the focus from appearance to overall well being aims to foster healthier relationships with food and body image.
What are the potential long-term effects of untreated eating disorders, both physically and mentally?
Untreated eating disorders can have serious long-term effects on both physical and mental health. The longer they go unaddressed, the more damage they can cause, sometimes leading to irreversible complications or even life-threatening conditions.
Physical effects of untreated Eating Disorders
- Heart Problems; malnutrition, electrolyte imbalances, and extreme weight loss can weaken the heart, leading to irregular heartbeats (arrhythmias), heart failure, and even sudden cardiac arrest. Purging behaviours (vomiting or laxative abuse) can cause low potassium levels, which increases the risk of heart complications.
- Gastrointestinal Issues; restrictive eating or binge purge cycles can damage the digestive system, leading to chronic constipation, bloating, acid reflux, or gastroparesis (delayed stomach emptying). Frequent vomiting can erode the oesophagus and cause oesophageal tears or rupture, which can be life-threatening.
- Bone Loss and Osteoporosis; lack of essential nutrients like calcium and vitamin D can lead to weakened bones and early-onset osteoporosis, increasing the risk of fractures. This is particularly concerning for young individuals, as bone density loss can be permanent if not treated in time.
- Hormonal Imbalances and Infertility; in women, severe weight loss and malnutrition can cause amenorrhea (loss of menstrual periods), affecting fertility and increasing the risk of early menopause. In men, eating disorders can lead to low testosterone levels, reduced libido, and reproductive issues.
- Kidney and Liver Damage; severe dehydration from purging or restricting fluids can lead to kidney failure over time.
- Dental and Oral Health Problems; frequent vomiting exposes teeth to stomach acid, leading to tooth enamel erosion, cavities, and gum disease.
Mental and emotional effects of untreated Eating Disorders
- Chronic Anxiety and Depression; many people with eating disorders experience persistent anxiety, depression, and mood swings, which can worsen over time without treatment. The obsessive nature of eating disorders can lead to heightened perfectionism and social withdrawal.
- Cognitive impairment; malnutrition affects brain function, leading to poor concentration, memory problems, and difficulty making decisions. Chronic starvation can shrink brain matter, which may take years to recover, even after weight restoration.
- Increased risk of substance abuse; many individuals turn to alcohol, drugs, or stimulants (like diet pills or caffeine) as a way to suppress appetite or cope with emotional distress.
- Self-harm and suicidal thoughts; eating disorders have one of the highest mortality rates of any mental illness, with a significant number of deaths resulting from suicide rather than physical complications.
- Social isolation and relationship struggles; many individuals isolate themselves to avoid eating around others or facing judgment, deepening feelings of loneliness and alienation.
How would you go about treating somebody with an eating disorder? Which types of treatment might you use? Which therapies are relevant?
Psychologically treating someone with an eating disorder involves a multifaceted approach that targets both the underlying emotional issues and the disordered behaviours surrounding food and body image. The treatment plan is typically individualised, as each person’s experience with an eating disorder is unique.
Typically, we begin the process with initial assessment and evaluation, this helps me to gather a comprehensive understanding of the person’s eating habits, emotional state, history, and mental health and of course any medical concerns that need immediate attention. A focus here will be on understanding triggers, patterns of behaviour, and the role food plays in coping with emotions or stress. I feel it is important to pace this process so that it feels manageable, many individuals with eating disorder’s feel a deep sense of shame, guilt, or fear around their behaviours, so creating a safe, non-judgmental space is essential.
There are many different psychological interventions for treating eating disorders. I personally utilise an integrative approach, combining Cognitive Behavioural Therapy (CBT), Compassion Focused Therapy (CFT) and if appropriate trauma focused intervention such as Eye Movement Desensitisation Reprocessing (EMDR). Here is an overview of these approaches.
Cognitive-Behavioural Therapy (CBT) is a widely-used, evidence-based therapy that focuses on identifying and changing negative thought patterns and behaviours. CBT helps the client to recognise unhelpful thinking patterns and develop healthier behaviours. Some of the goals of CBT in treating eating disorders include:
- Understanding the clients personal experience through developing a historical formulation, enhancing awareness and insight.
- Exploring and challenging unhelpful patterns in thoughts and beliefs.
- Cognitive restructuring to replace unhelpful thoughts with healthier, more realistic beliefs about food, body image, and self worth.
- Helping clients to develop alternative coping strategies, alongside recognising and managing emotional triggers that lead to binge eating or purging.
- Improving emotional regulation, helping clients to learn how to manage intense emotions like anxiety, sadness, or shame without resorting to disordered eating behaviours.
- To develop techniques designed at helping the client to experiment with and test out unhelpful beliefs and to develop more beneficial and empowering behaviours alongside aiming to improve overall self confidence.
Exposure Therapy can be useful for people with Avoidant/Restrictive Food Intake Disorder (ARFID) or those who have extreme fear around gaining weight or eating certain foods, exposure therapy may be used to gradually confront food-related anxieties. Gradual Exposure can be used to work on exposure to feared foods in a controlled gradual way, helping individuals to reduce anxiety and discomfort around eating. This can be paired with breathwork and relaxation techniques to reduce distress.
Compassion Focused Therapy (CFT), is a therapeutic approach particularly close to my heart. It is particularly useful for individuals who struggle with shame, self-criticism, or low self-esteem. By fostering self-compassion, CFT helps you to respond to yourself with kindness and understanding rather than harsh judgment, which can be particularly beneficial in addressing psychological aspects of eating disorders often linked to feelings of shame. At the core of compassion focused therapy is an understanding of innate human suffering, utilising CFT can help to facilitate emotional healing, helping the client to enhance mindful awareness, while simultaneously taking steps to alleviate emotional pain and suffering through development of techniques specifically tailored towards building a compassionate mind, enhancing attributes such as strength, warmth and non judgment. Typical Techniques often utilised in compassionate mind training involve guided practice, compassionate reframing, imagery exercises and mindfulness.
Eye Movement Desensitisation and Reprocessing (EMDR) is a structured therapy that helps individuals process and recover from traumatic memories or distressing life experiences. This type of approach is used to process and reframe traumatic memories that contribute to emotional distress and eating disorder behaviours. Through guided eye movements or other forms of bilateral stimulation, EMDR helps your brain process and integrate traumatic memories, reducing their emotional impact. When treating a client for an eating disorder, it is important to consider that unresolved trauma may actually show up as eating disorder behaviours. For example, restrictive eating and or binge eating can be used in an attempt to numb and avoid feelings associated with traumatic experiences. Intense emotions such as guilt, shame, and anger can give rise to unhelpful relationship with food where the individual will turn to food to regain a sense of control. These factors will be continually considered and reviewed throughout the course of therapy to ensure the treatment approach is appropriate and meeting with the goals of the client.
Mindfulness-Based Cognitive Therapy (MBCT) combines cognitive therapy with mindfulness strategies to help the client manage negative thought patterns and prevent relapse. During therapy I often utilise a range of mindfulness strategies aiming to help individuals stay in the present moment, to notice thoughts and emotions without judgment, and avoid acting on urges to engage in disordered eating behaviours. The aim here is also to improve distress tolerance and to learn healthy coping strategies therefore reducing the likelihood of resorting to harmful behaviours like purging or binge eating.
When finalising therapy, relapse prevention and establishing routes for long term support is an important area to consider. This may include; building resilience, affirming self-care practices, stress management, and heightened self awareness in relation to potential triggers that could cause relapse. It is important to create awareness of and increase access to support systems including possible ongoing therapy, support groups and communication with loved ones which can be key to sustaining recovery.
Psychologically treating an eating disorder requires a comprehensive, individualised approach that combines therapy, support, and education. By addressing the emotional roots of the disorder, improving coping strategies, and involving family or support networks, individuals can gradually recover and develop a healthier relationship with food and their body.
What are some strategies or tips for someone currently struggling with disordered eating to begin their journey toward recovery?
Starting the journey toward recovery from disordered eating is often difficult, but with the right strategies and support, it is entirely possible. If you or someone you know is struggling, the following tips can help begin the process of healing, though professional help is always recommended for the most effective recovery.
Acknowledge the Struggle, acceptance is the first step. Recognising that disordered eating is a problem is often the hardest part. It may feel overwhelming or even shameful, but understanding that it’s okay to ask for help is crucial.
Remind yourself that you are not alone in this journey, and eating disorders are not a sign of weakness or lack of willpower, they are complex mental health conditions that deserve care and attention.
Seek professional support; this may involve psychological therapy, medical and nutritional support, alongside support groups to connect with others who have similar experiences.
Start with Small, manageable goals. For example, if restricting food is an issue, try adding a small snack each day and gradually increasing the variety and quantity of meals.
Celebrate each step you take toward recovery, no matter how small it may seem. Every positive action counts.
Practice self compassion and patience, recovery is a nonlinear process, there will be ups and downs, and that’s okay. Be kind to yourself during difficult times and recognise that setbacks don’t mean failure.
Challenge the inner critic, replace self criticism with self compassion. Treat yourself as you would a close friend who is struggling.
Practice mindfulness and stress management, mindfulness practices such as meditation, yoga, or deep breathing can help manage stress and difficult emotions.
Starting the recovery journey from disordered eating is about taking one small step at a time and being compassionate with yourself throughout the process. While the path can be challenging, healing is possible with the right support, mindset, and commitment to your well being.
How can loved ones best support someone with an eating disorder, both during and after treatment?
Supporting a loved one through the journey of recovery from an eating disorder can be both challenging and deeply rewarding. Loved ones play a critical role in providing emotional support, offering encouragement, and helping to create an environment conducive to healing.
Education can play a hugely helpful role; learn about the specific eating disorder your loved one is dealing with, including its symptoms, triggers, and treatment options. Understanding the complexities of eating disorders helps reduce misconceptions and allows you to offer informed support.
Offer non judgmental support, create a safe and non-judgmental environment where your loved one can feel comfortable discussing their struggles without fear of criticism or shame. Avoid making comments about their appearance, weight, or eating habits.
Encourage professional help and treatment, encourage your loved one to seek professional treatment if they haven’t already, or to continue with treatment if they’re in the process of recovery. Be supportive, not pushy, and recognise that seeking help is a personal decision.
Be patient and understand recovery takes time, recovery is a long-term process that involves setbacks, progress, and everything in between. Be patient and understand that healing may not always follow a linear path.
Set boundaries and practice self care, set healthy boundaries for yourself while being supportive. It’s important not to sacrifice your own well-being while helping your loved one.
Supporting a loved one with an eating disorder can be a delicate balance of offering love, encouragement, and boundaries while also maintaining self care. Being patient, empathetic, and understanding throughout their recovery journey is essential for their healing. It’s important to remember that healing from an eating disorder is not just about changing eating habits but also about building emotional resilience, self-compassion, and a healthy relationship with food and body image.
Written by Victoria De-Petro – Psychotherapist
