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Eating disorders

08 Apr 2022 / Wellbeing Print

Mirror, mirror

Eating disorders have one of the highest mortality and morbidity rates of all mental-health conditions and are often misunderstood. Ellen Jennings debunks the myths and points you to where you can find help.

Eating disorders are complex mental-health conditions that can be life-threatening. They have one of the highest mortality and morbidity rates of all mental-health conditions. According to the Health Service Executive’s Model of Care for Eating Disorders (2017), it is estimated that 188,895 people in Ireland will experience an eating disorder at some point in their lives.

Historically, eating disorders have been seen as affecting mainly women. However, this is an illness that does not discriminate – it can occur in men, women, boys and girls. A person can develop an eating disorder for a number of reasons, and there is usually an accumulation of ‘risk factors’ that are identified as the person progresses through treatment.

It is not always the case that something significantly traumatic has happened in a person’s life that has caused the eating disorder, although sometimes this can be the case. 

Risk factors

When we consider risk factors, we can think of these in two groups – the first applying to those factors that are ‘internal’ to the person, including factors that arise out of the personality type and genetic makeup of the person. Low self-esteem, perfectionism, a difficulty managing emotions, and a tendency towards all-or-nothing thinking can all play a role.

The second group includes factors that are ‘external’ to the person – including our experiences of the world we live in and the environment we work in. This is where certain sociocultural factors and stressful life events can play a role.

The competitive and demanding nature of modern-day working life can make it difficult to find a work/life balance. Long working hours and hectic schedules can mean that eating and sleeping patterns can become disrupted. It’s important that work commitments do not come at the expense of our mental health and family life.

Our relationship with food and our body is something that is deeply personal, and it can change throughout our lives. Although the average age of onset of an eating disorder is adolescence (coinciding with the physical changes of puberty and increased focus on body image), there are other periods throughout our lives where our self-esteem can be affected: for example, the breakup of a relationship, media influences, and traumatic events can all present challenges to our self-esteem.

Relieving distress

To cope with these perceived pressures and difficult emotions, a person may turn to control over food and their body as a way of relieving distress and achieving some degree of control over their life. Their world feels like an unsafe place, and, for many complex reasons, an eating disorder provides them with a sense of safety.

Control over food and our body can serve to distract, numb, or overpower other emotions. Paradoxically, eating-disorder thoughts and behaviours can further perpetuate emotional distress, leading to a cycle that can be difficult to break.

Once trapped within the eating disorder, people often feel that they need to maintain it to survive. They don’t know who they are, or how they might cope without it.

Eating disorders can occur quite gradually, at any stage in our lives, and can be difficult to recognise or acknowledge. They affect a person on an emotional, physical, cognitive, and behavioural level.

All four aspects interact and influence each other in various ways, at any time. This is why it’s not only difficult for those on the outside to understand this complex disorder, but it is also very difficult for the person themselves to be able to understand why they are feeling compelled to do what they are doing.

Behavioural and physical changes are a symptom of what might really be going on for the person. Skipping meals, excessive exercise, restricting food, avoiding socialising around food, or visiting the bathroom at unusual times are behavioural clues.

Physically, there might be a lack of energy, digestive problems, and menstrual issues in females. There can be a marked change in weight or a significant weight change in a short period of time, although this is not always the case.

Internal dialogue

The cognitive and emotional aspects can be more easily hidden – rigid rules around food and exercise and what we ‘should’ or ‘should not’ do become prominent thoughts. There is an internal dialogue that promotes eating-disorder behaviours, rules, and secrecy. The rules are often unrealistic, demanding, harsh, and critical.

It can seem as though life is not possible unless these expectations are fulfilled. This creates a distorted logic that conflicts with a person’s rational thoughts and, in turn, contributes to emotional distress.

From the outside, this might look like a sudden change in personality or mood, a difficulty coping with a change in routine, becoming stressed or upset easily, and not taking an interest in things they used to.

This complex web of factors makes an eating disorder extremely individual and personal, with different aspects serving a different function for the person. In this way, the support and treatment that the person requires will also be individual and personal.

At one point or another in our lives, we might relate to some degree of disordered eating behaviours. Where a person crosses over from ‘normal’ disordered eating into an ‘eating disorder’ is where compulsion comes into play. When a person feels that they have no choice but to engage in disordered eating behaviours, or they will feel out of control, panicky or anxious, this is in the realm of an eating disorder.

Long-term effects

The long-term effects of experiencing an eating disorder can include heart problems, issues with bone health, muscle weakness, malnourishment, electrolyte imbalances, and problems with fertility.

Early detection and intervention are important to prevent the behaviours becoming more entrenched and destructive over time.

Reaching out for help can be really challenging – it means acknowledging that something is not quite right about our relationship with food and our body. Letting go of this control over food can bring up difficult feelings, and it can often feel like things are getting worse before they get better. If you are concerned about yourself or someone you know, the first step might be voicing these feelings and opening up a conversation with someone you trust.

Bodywhys (the Eating Disorders Association of Ireland) provides a range of non-judgemental listening, information, and support services for those affected by eating disorders, and their families.

A diagnosis is not required to avail of this support. If the person feels ready to do so, there are several support services available via email, phone, and online chat groups for both teenagers and adults.

Bodywhys also offers a free family-support programme called PiLaR (peer-led resilience) for those who may be supporting someone with an eating disorder. This is a free four-week structured programme, incorporating both psycho-education and support, as well as practical advice and skills to help support your loved one towards recovery.

The programme covers topics like understanding eating disorders, communication, active listening, mealtime support, triggers, and dealing with relapse.

Offering support

When supporting someone with an eating disorder, it is important to do so from a non-judgmental place and to avoid trying to problem-solve.

The focus should be on feelings rather than specific behaviours. In this way, it allows the person to think through what might really be going on for them, and what the next steps might be.

Just as the development of an eating disorder can be gradual, treatment and recovery can also be a gradual process of unlearning the eating disorder behaviours and finding alternative coping mechanisms. This process usually begins with a visit to the GP, who will look after the physical aspects and can then refer on to a dietician or therapist, if necessary.

Just as no two eating disorders are the same, treatment will be unique for everyone and can be a process of trial and error to find what works. Similarly, there is no one definition of what recovery means – it involves a sense of internal awareness and trust in oneself to live without the eating-disorder rules and behaviours.

This might look like recognising black-and-white thinking, and being open to seeing the middle ground; it might be feeling less self-critical and more self-compassionate. It can involve routines around food and sleep, recognising triggers and eating-disorder thoughts.

Although the road to recovery can be challenging, with many steps forwards and backwards along the way, people can – and do – get better with appropriate treatment. Life without the eating disorder is possible, and you are not alone. If you are concerned about yourself or someone you know, links to support services are included below.

Look it up

Read and print a PDF of this article here.

Ellen Jennings
Ellen Jennings is communications officer at Bodywhys, the Eating Disorders Association of Ireland.