Understanding Eating Disorders and Their Treatment
It can be very difficult to cultivate a comfortable relationship with food. Pressures to be thin, the pleasures of eating, and the tension between restraint and indulgence can be powerful forces capable of drawing a person into a compelling battle with food. For some people this battle is intermittent and may vary in its intensity and impact. For others it can be persistent and intense, and may come to exert a dominating influence in their life.
When a battle with food interferes with your wellbeing or impacts negatively on your life, it can be considered to be an eating disorder. Eating disorders are generally classified into four main types, although in reality there is considerable overlap between the eating disorders and people often move between one and the other. The main categories of eating disorder are:
- In Bulimia people experience recurrent episodes of uncontrolled overeating or binges
- These alternate with efforts at weight control, such as stringent dietary restriction, purging through self-induced vomiting or laxative use, excessive exercise, or all of these
- Fuelling the efforts at weight control is a strong tendency to evaluate self-worth in terms of weight and shape
- Bulimia is more common in women than men, and usually first appears during adolescence or young adulthood
Binge Eating Disorder
- In Binge Eating Disorder people experience recurrent episodes of binge eating, but without the same excessive weight control behaviour (such as purging or strict dieting) seen in Bulimia
- This usually occurs against a general tendency to overeat, particularly at times of stress
- Dissatisfaction with weight and shape is common, but is generally less severe than in Bulimia
- People with Binge Eating Disorder are often older than those with Bulimia, for instance in their 30s or 40s
- Although more women than men experience Binge Eating Disorder, there is less of a gender discrepancy than in Bulimia
- Anorexia differs from Bulimia mainly in that it involves a very low body weight
- Anorexia also primarily involves dietary restriction and excessive exercise rather than uncontrolled eating and purging, although some people do binge and purge to some degree
- It is important to note that anorexia can cause serious adverse health consequences due to malnutrition which need to be addressed as a priority in any treatment
Atypical Eating Disorder or Eating Disorder Not Otherwise Specified
- In many instances a person experiences aspects of one or more eating disorder without meeting all criteria for a single specific diagnosis. This is known as Atypical Eating Disorder or Eating Disorder Not Otherwise Specified. Paradoxically, atypical eating disorders are thought to be at least as prevalent as other eating disorders.
Causes of eating disorders are different for different people. Common factors that contribute to eating disorders are:
- Using food as a way to cope with emotions such as depression, anger, stress or anxiety
- A drive to be thin
- Body image dissatisfaction and / or excessive focus on weight and shape
- A self perpetuating cycle of dieting and rebound
- Using food to switch off or zone out
- Using food as a way to comfort, soothe or pamper yourself
- Using food as a form of rebellion or self-punishment
- Rigid rules around food and eating
- An attempt to experience a sense of control
- Messages about food, eating, weight, or body image acquired over the course of a person’s life
Often, a person’s eating habits end up exacerbating the underlying causes, creating a self-perpetuating cycle. For example, someone who is seeking to gain a sense of control through dieting makes themselves vulnerable to binges by restricting their eating excessively, causing irresistible urges to eat. After bingeing they feel more out of control and experience an even greater need to exert control through dieting. This sets them up for more bingeing and so on, in a self-perpetuating loop. A similar cycle occurs for someone who uses food to deal with difficult feelings such as depression or stress. Although binge eating may bring a temporary sense of relief, after a binge people often feel more depressed and guilty and self critical, which exacerbates their negative feelings, increasing the desire to binge and so-on. These cycles can become very difficult to break, and can cause considerable distress.
Effective treatment is based on a good understanding of the factors driving a particular person’s eating disorder. With each person’s specific makeup in mind, therapy addresses the causal factors underlying your eating patterns as well as providing you with new skills that enable you to respond in a different way to your triggers, to yourself, and to food.
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