For this year’s Eating Disorders Awareness Week (EDAW) I am putting together a series of short blogs about eating disorders. To begin with, would you be able to recognise the signs of a potential eating disorder in a friend or loved one? This list is far from comprehensive, however here are some: – being very stressed around food and mealtimes – being secretive about food and eating – restricting or cutting out food types or food groups (such as ‘carbs’ or dairy) – frequent dieting or calorie counting – food refusal – being rigid and inflexible about food as well as in general – rituals around food – avoiding social eating – over-exercising – excessive walking: choosing to walk rather than drive/use public transport even for long distances – spending long periods of time in the toilet or bathroom – frequent vomiting and/or use of laxatives – unable to stop eating – eating large quantities of food in one go – frequent night time eating – grazed knuckles – sudden changes in weight (loss or gain) – weakness, dizziness, fainting – feeling cold in warm temperatures – loss or change in menstrual periods (females) – always tired – preoccupation with body size or shape – distorted body image – fear of weight gain – irrational thinking – social withdrawal – increased anxiety, depression, paranoia, irritability, anger
Of course, many of these symptoms can be present for reasons other than eating disorders, so it’s important not to jump to cocnclusions. However if someone you know is displaying more than one of these and recently seems to have changed the way they behave around food in a way that is worrying you, you may want to consider the possibility of an eating disorder and encourage them to seek help.
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Working with eating disorders and body image issues is an area of therapy that requires specialist training and knowledge. I am very proud to hold the Master Practitioner for eating disorders and obesity qualification from the National Centre for Eating Disorders to work with the following conditions:
Binge Eating Disorder
Night Eating Syndrome
Feeding or Eating Disorders Not Elsewhere Classified (FEDNEC – which is a catch-all term for other eating related disorders that don’t fit into the above categories)
Eating disorders are classified as:
Restriction of food/energy intake relative to needs (anorexia and sometimes bulimia)
Compensatory behaviours, including self-induced vomiting, excessive exercising, misuse of laxatives (anorexia and bulimia)
Fear of weight gain and/or food and eating (anorexia and bulimia)
Disturbances in and preoccupation with body image (all eating disorders)
However, there are cross-overs between the conditions and sometimes behaviours can change over time meaning that a different type of eating disorder can develop. In fact, it’s not always helpful or relevant to have a diagnosis, as what matters is how the individual is affected.
Eating disorders and eating distress have an enormous psychological impact on sufferers and can dominate their lives. At times it may feel as though the eating disorder is in charge. Effects can be long term, recovery can be challenging and sadly, eating disorders have the highest death rate of all mental health conditions, often through suicide. But people do recover and go on to develop healthy relationships with food and with themselves.
The condition may also have a dramatic effect on the sufferer’s physical health. Abnormal food absorption – either too little or too much, or poor food choices – affects the body’s metabolic balance which can result in negative physical consequences, such as osteoporosis, diabetes, metabolic syndrome, thryroid imbalance, infertility and physical damage to the digestive tract or teeth.
In short, eating disorders of all types seriously impair the physical and psychological health of the sufferer, and significantly affect their daily life, so specialist support is recommended to help the sufferer move towards recovery.
What sort of help do eating disorder sufferers need?
Firstly they need to be able to fully understand their condition, so treatment for eating disorders should have a psycho-educational component, which looks at the whole picture of what is going on for them, both physically and mentally.
Whilst there is seldom a single ’cause’ to an eating disorder, there are often predisposing and precipitating factors – the eating disorder specialist can help the sufferer to recognise and understand them. We also look for perpetuating factors that have been keeping them stuck.
Nutritional rehabilitation is very important when addressing eating disorders as many of the symptoms and behaviours are caused or perpetuated by dietary distress. An eating disorder specialist should be familiar with the nutritional basis of eating disorders as well as for recovery, and in some cases should work alongside a dietician or nutritionist to best support their client. I have studied nutritional basics as part of my eating disorders and obesity qualification.
I have continued to keep my skills and knowledge in this area up to date, attending courses run by Kings College IoPPN and the Maudsley Hospital among others.
While undergoing treatment for an eating disorder, medical monitoring is essential, which can be carried out by the client’s GP or by a specialist eating disorder service. A good eating disorder therapist will be in contact with the client’s GP. An eating disorder specialist must know when medical intervention is indicated and should be trained to look out for the signs and symptoms.
An eating disorder specialist will also be mindful of the systemic factors affecting their client, such as family situation and background, social situation, school, college or work. These factors are all part of the complexity of an eating disorder. In some cases it may be necessary to work with the client’s family.
In summary, there is no ‘quick fix’ therapy for eating disorders so it is important that good rapport develops between the client and the therapist, and that the work is thorough, courageous and supportive.
Please contact me if you feel that you or one of your loved ones may benefit from finding out how I can help with eating disorders or eating distress, or to book a confidential free assessment.