Every day, we are surrounded by different messages from different sources that impact the way we feel about the way we look. For some, poor body image is a sign of a serious problem: an eating disorder. Eating disorders are not just about food. They are often a way to cope with difficult problems or regain a sense of control. They are complicated illnesses that affect a person’s sense of identity, worth, and self-esteem.
When someone has an eating disorder, their weight is the prime focus of their life. Their all-consuming preoccupation with calories, grams of fat, exercise and weight allows them to displace the painful emotions or situations that are at the heart of the problem and gives them a false sense of being in control.
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The signs of an eating disorder often start before a person looks unwell, so weight should never be the only consideration. There are three main types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder.
- Anorexia nervosa – A person who experiences anorexia nervosa may refuse to keep their weight at a normal weight for their body by restricting the amount of food they eat or exercising much more than usual. They may feel overweight regardless of their actual weight. They may think about their body weight often and use it to measure their self-worth. Symptoms include refusal to keep body weight at or above the normal weight for one’s body type, dieting to extremes, usually coupled with excessive exercise, feeling overweight despite dramatic weight loss, loss of menstrual periods and extreme preoccupation with body weight and shape. Anorexia nervosa can cause heart and kidney problems, low blood iron, bone loss, digestive problems, low heart rate, low blood pressure, and fertility problems in women. As many as 10 per cent of people who experience anorexia die as a result of health problems or suicide.
- Bulimia nervosa – Bulimia nervosa involves periods of uncontrollable binge-eating, followed by purging (eliminating food, such as by vomiting or using laxatives). People who experience bulimia nervosa may feel overweight regardless of their actual weight. They may think about their body weight often and use it to measure their self-worth. As well as a preoccupation with body image, symptoms include repeated episodes of bingeing and purging, usually by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics – methods which are both ineffective and harmful and eating beyond the point of fullness. Health problems caused by bulimia nervosa may include kidney problems, dehydration, and digestive problems. Vomiting often can damage a person’s teeth, mouth, and throat.
- Binge-eating disorder – Binge-eating disorder involves periods of overeating. People who experience binge-eating disorder may feel like they can’t control how much they eat, and feel distressed, depressed, or guilty after bingeing. Many people try to keep bingeing a secret. Binge-eating can be a way to cope or find comfort, and it can sometimes develop after dieting. Some people may fast (not eat for a period of time) or diet after periods of binge-eating. Binge-eating disorder can increase the risk of Type 2 diabetes, high blood pressure, or weight concerns.
Eating disorders can affect anyone, but some people may be at higher risk. People who experience lower self-esteem or poor body image, perfectionism, or difficulties dealing with stress may be more likely to experience an eating disorder. A lack of positive social supports and other important connections may also play a big part. In some cases, eating disorders can go along with other mental illnesses. Our beliefs around body image are also important. While the media may often portray thinness as an ideal body type, this alone doesn’t cause an eating disorder. How we think about those messages and apply them to our lives is what affects our self-esteem and self-worth.
When someone has an eating disorder, their weight is the prime focus of their life. Their all-consuming preoccupation with calories, grams of fat, exercise and weight allows them to displace the painful emotions or situations that are at the heart of the problem and gives them a false sense of being in control. Warning signs include:
- Low self-esteem;
- Social withdrawal;
- Claims of feeling fat when weight is normal or low;
- Preoccupation with food, weight, counting calories and with what people think;
- Denial that there is a problem;
- Wanting to be perfect;
- Intolerance of others;
- Inability to concentrate.
Our society’s preoccupation with body image is reflected in the fact that, at any given time, 70 per cent of women and 35 per cent of men are dieting. More seriously, a 1993 Statistics Canada Survey reported that in women between the ages of 15 and 25, one – two per cent have anorexia and three – five per cent have bulimia. Eating disorders have the highest mortality rate of all mental illnesses, with 10-20 per cent eventually dying from complications. Eating disorders can be difficult to detect. The media glamourization of so-called ideal bodies, coupled with the view that dieting is a normal activity, can obscure a person’s eating problems. It can be difficult for a person with an eating disorder to admit they have a problem. Knowing how to support someone with an eating disorder is also a challenge.
Clearly, these potentially life-threatening conditions are a growing problem. Despite their collective label, these disorders are not about food. Eating disorders are a way of coping with deeper problems that a person finds too painful or difficult to deal with directly. They are complex conditions that signal difficulties with identity, self-concept and self-esteem. Eating disorders cross cultural, racial and socio-economic boundaries, and affect men and women.
The possibility of biochemical or biological causes is being studied. Some people with eating disorders have been found to have an imbalance of chemicals in the brain that control hunger, appetite and digestion, possibly as a result of the disorder.
Treatment is available – it can be a long process, but an eating disorder can be overcome. If you think that you, or someone you know, has an eating disorder, it is important to learn the facts. Gaining an understanding of these conditions is the first step in the journey to wellness. The sooner someone seeks help, the sooner they will benefit from treatment. However, people with an eating disorder usually work very hard to keep it secret, and find it very difficult to acknowledge that they have a problem. Diagnosis can be difficult, since the symptoms of eating disorders often occur in combination with depression, anxiety and substance abuse. A multi-disciplinary approach is the most effective treatment route. This involves a thorough medical assessment, nutritional guidance, support, medical follow-up, individual, group and family therapy.
You may have a lot of difficult feelings around finding help—it isn’t always an easy step to take. Many people who experience an eating disorder are scared to go into treatment because they may believe that they will have to gain weight. Many also feel a lot of shame or guilt around their illness, so the thought of talking about very personal experiences can seem overwhelming. Some people find comfort in their eating behaviours and are scared to find new ways to cope. Restricting food, bingeing, and purging can lead to serious health problems, but eating disorders are treatable and you can recover. A good support team can help you through recovery and teach important skills that last a lifetime. Treatment for an eating disorder usually involves several different health professionals. Some people may need to spend time in hospital to treat physical health problems. Counselling helps people work through problems and develop skills to manage problems in the future. There are different types of counselling, including Cognitive-behavioural therapy, dialectical behaviour therapy, and interpersonal therapy.
It can be very helpful to connect with support groups. They’re an opportunity to share experiences and recovery strategies, find support, and connect with people who understand what you’re experiencing. There may also be support groups for family and friends affected by a loved one’s eating disorder. There are many self-help strategies to try at home. Skills like problem-solving, stress management, and relaxation techniques can help everyone cope with challenges or problems in a healthy way. You’ll find many different skills like these in counselling, but you can practice them on your own, too. And it’s always important to spend time on activities you enjoy and connect with loved ones. A dietitian or nutritionist can teach eating strategies and eating habits that support your recovery goals. This is also called ‘nutritional counselling.’ While there are no medications specifically for eating disorders, medication may help with the mood problems that often go along with an eating disorder. Eating disorders can cause physical health problems, so you may need regular medical care and check-ups.
Supporting a loved one who experiences an eating disorder can be very challenging. If you think someone you know has an eating disorder, learn what you can about these conditions. Express your concerns calmly and in a caring way. You can’t force someone to change their behaviour, but you can let them know that you care and want to support them. Encourage the person to seek professional help. Don’t lay blame and focus discussions on feelings, not food. Examine your own issues around food and weight. Be supportive, but do not enable the behaviour. Here are some tips to help you support a loved one:
- Remember that eating disorders are a sign of much bigger problems. Avoid focusing on food or eating habits alone.
- Be mindful of your own attitudes and behaviours around food and body image.
- Never force someone to change their eating habits or trick someone into changing.
- Avoid reacting to a loved one’s body image talk or trying to reason with statements that seem unrealistic to you.
- If your loved one is an adult, remember that supporting help-seeking is a balance between your own concerns and their right to privacy.
- If your loved one’s experiences are affecting other family members, family counselling may be helpful.
- Don’t be afraid to set boundaries and seek support for yourself.