who we helpEating Disorders
Eating disorders are far from a lifestyle choice. Over one million Australians are experiencing an eating disorder at this current moment.
They are non-bias towards gender, age and ethnicity and are caused by a multitude of factors. Personality traits that have been associated with eating disorders include low self-esteem, neuroticism, perfectionism and harm avoidance. Negative body image and eating disorders go hand in hand. What can start as dissatisfaction in your body or just a strategy to improve mood, can develop into severe disordered eating and with medical complications.
Identifying whether someone has an eating disorder is based on much more than appearance. Note that warning signs vary from individual to individual.
Some Signs That Should Raise Alarm Include
Dieting behaviours, for example, restricting food or water intake
Rules or ‘black and white’ thinking regarding food. For example, ‘Because I ate a cookie today, I am an unhealthy person’.
Lying about how much food you have consumed
Obsessive exercise routines
Fainting, lacking energy and concentration
Sensitivity to cold despite warm weather
Menstrual changes
Avoiding meal time or social occasions where food will be present
Obsessive worrying and thinking about food
Body checking or avoidance
Losing a large amount of weight in a short period of time
Excessive exercise or engaging in other compensatory behaviours
Types of Eating Disorders
Anorexia Nervosa
Anorexia is characterised by a restriction of dietary intake leading to low body weight. Anorexia can consist of only restrictive behaviour or can include some binging and purging behaviours.
A significantly low weight may mean an individual has a low BMI. It may also occur if an individual has failed to achieve expected weight gain and growth, or they may have lost a significant amount of their original weight since restricting.
Individuals have a disturbance in the way their body is perceived. There is an overevaluation of shape and weight for their self-worth and/or a lack of insight into the seriousness of their low body weight.
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Anorexia has serious consequences for both physical and mental health. Changes in the brain due to malnutrition can make it difficult for a person to recognise how unwell they are. Restriction can lead to increased depressive and anxiety symptoms, increased shame, social withdrawal, self-harm and suicide, increased ritualised behaviour and preoccupation with food and body. Physical complications include fatigue, deficiencies, heart problems including low blood pressure, low heart rate and heart failure, gastrointestinal changes, bone loss and infertility.
There are a number of treatments for anorexia. For adolescents, family-based therapy (FBT) currently has the highest level of evidence base and is preferred by the Sydney Children’s hospital. Other treatments include Adolescent Focused Therapy, Specialist Supportive Clinical Management (SSCM), Cognitive Behavioural Therapy - Enhanced for eating disorders (CBT-E), and Maudsley anorexia nervosa treatment for adults (MANTRA).
Bulimia Nervosa
Bulimia is characterised by episodes of binge eating followed by compensatory behaviours. Episodes are once per week or more. There is an over-evaluation of an individual’s shape of weight for their self-worth.
A binge is defined by eating a more than what most people would eat in a discrete period of time e.g. 2-hour period along with a sense of loss of control over the eating. Compensatory behaviours could be vomiting, laxative abuse or other medications, diuretics, fasting, or excessive exercise.
Binging and compensatory behaviours can often trigger intense shame and guilt. Individuals with bulima often have weight fluctuations. They may be at a healthy weight, or their behaviour may cause them to gain or lose some weight.
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Physically, bulimia can have severe consequences. Repeated vomiting can lead to dental erosion, dehydration, and electrolyte imbalances. Chronic misuse of laxatives can result in gastrointestinal issues and damage to the digestive system. Additionally, the emotional toll of bulimia can be profound, contributing to feelings of isolation, distress, and a disrupted relationship with food.
Binge Eating Disorder
A person with binge eating disorder will engage in binge eating once or week on average or more without any compensatory behaviours.
A binge is defined by eating a more than what most people would eat in a discrete period of time e.g. 2-hour period along with a sense of loss of control over the eating.
People with binge eating disorder often eat rapidly, eat alone, or in secret. They may feel disgusted in themselves or guilty afterwards.
Other Specified Feeding and Eating Disorders
A person with Other Specified Feeding and Eating Disorder (OSFED) present with many symptoms of anorexia nervosa, bulima nervosa or binge eating disorder but don’t meet the full criteria. The key characteristic of OSFED is that the behaviours result in distress or impaired functioning, yet they don't align with the specific diagnostic criteria of other eating disorders.
frequent dieting, disordered eating patterns, extreme concerns about body weight and shape, or unhealthy behaviours like binge eating, restriction or purging.
OSFED is the most common diagnosed eating disorder. It can be just as debilitating and dangerous as more well-known eating disorders, and it often goes undiagnosed because people may not fit the "classic" symptoms.
Avoidant Restrictive Food Intake Disorder
Individuals with ARFID avoid eating or restrict their intake of food. This can be due to having low appetite or lack of interest in food, sensory sensitivity or a fear of an undesired consequence of eating such as chocking, nausea or vomiting.
Weight and shape concerns are not characteristic of ARFID however individuals may also present with mixed symptoms which are similar to other eating disorders.
Onset of ARFID after a period of normal eating can often be attributed to a traumatic incident around eating, swallowing or digestion.
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ARFID is more complex than “fussy eating”. It is a serious eating disorder with significant physical and psychological consequences. Because ARFID often leads to malnutrition, individuals with this condition may experience physical symptoms like fatigue, growth delays, and weakened immunity.
Treatment involves a cognitive behavioural approach (CBT-AR) addressing triggers behind food avoidance and nutrition counselling to ensure a client’s nutritional needs are met. Trauma focused approaches such as Eye Movement Desensitisation and Reprocessing (EMDR) can address fear of eating stemming from a traumatic incident.
Eating Disorders and Neurodivergence
When it comes to eating disorders, risk factors such as poor body image, societal pressures, and genetic predispositions may come to mind. Recently however, more attention has been given to the compelling correlation between neurodivergence and disordered eating behaviours.
Neurodivergence is an umbrella term for anyone who falls outside of typical mental functioning. It includes autism, ADHD, and also diagnosis such as tourettes, dyslexia, and dyspraxia.
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Research indicates that individuals with neurodivergent traits may be at higher risk for developing eating disorders. It appears that up to 20-35% of women with anorexia nervosa meet the diagnostic criteria for autism. The prevalence of ADHD in eating disorders is similarly high, with estimates between 18-37% in those with an anorexia or bulimia diagnosis.
There are many factors which drive this correlation. For instance, the heightened sensitivity to sensory stimuli in autism spectrum disorder (ASD) can influence food preferences and aversions, leading to restrictive eating patterns. Similarly, the executive function deficits observed in ADHD may contribute to impulsivity around food choices and binge eating episodes.
Interoception, the perception of internal bodily sensations, plays a crucial role in regulating eating behaviours and emotional responses. Neurodivergent traits can impact interoceptive awareness, influencing individuals' relationships with food.
Moreover, the social and emotional challenges experienced by neurodivergent individuals can exacerbate feelings of isolation, anxiety, and low self-esteem—factors known to fuel disordered eating behaviours.
By acknowledging the impact of neurodivergence on eating behaviours, we can foster greater understanding and support for individuals navigating these complex challenges.
Eating Disorders and Trauma
Eating disorders are not entirely about food and body image. There is a profound impact that traumatic experiences can have on one's relationship with food and body image.
Trauma is associated with a greater incidence of eating disorders. Some studies have reported up to 90% of individuals with eating disorders as having a history of trauma preceding the onset of their eating disorder.
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For many individuals, eating disorders serve as maladaptive coping mechanisms to deal with the aftermath of traumatic experiences. They may attempt to regain control in their lives by obsessively controlling their food intake. Eating disorders may become a distraction or focus away from emotional pain. Eating disorder behaviours such as restricting, bingeing or purging may be used as an escape from overwhelming emotions. Attempts to control one’s body or perfect eating habits may also be a way of reclaiming self-worth.
Recognizing the connection between eating disorders and trauma is crucial for effective treatment and recovery. A holistic approach that addresses both the trauma and disordered eating patterns is essential for lasting recovery.