Eating Disorders

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What are eating disorders?

An eating disorder is a term used to describe a problematic relationship with food, eating and your weight.

There are several types of eating disorders with very different symptoms. Each type of eating disorder involves having an unhealthy relationship with eating and diet.

Eating disorders can cause both physical and mental health problems, and are often associated with mental health conditions like anxiety and depression.

young woman with an eating disorder sitting on the floor in distress, hugging her knees to her chest.

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False beliefs about eating disorders

False belief: “All people with an eating disorder are underweight”

It is not true that all people with eating disorders are underweight. In fact, many people have a normal weight, or are even overweight. The same is true in reverse. Just because somebody is underweight, it does not mean that they have an eating disorder.

False belief: “Only young women have eating disorders”

Although it may be true that eating disorders are more common in young women, they can actually affect anybody at any age.

What is the difference between an eating disorder and dieting?

Many people choose to diet to change their weight and body shape at some point during their lifetime. This is a conscious choice in order to look or feel better, and it is usually temporary. However, some people become obsessed with looking a certain way, and they develop fixed beliefs and fears relating to food and image which take over their lives. This is called disordered eating, and these people may be said to be suffering from an eating disorder.

Although it is possible for someone to start off just wishing to diet and then going on to develop an eating disorder, this does not usually happen for the majority of people who go on diets.

Why is it important to be aware of eating disorders?

Eating disorders can have serious consequences for both physical and mental health. It is important to be aware of eating disorders and their symptoms so that you can help yourself or people around you who may be suffering from one.

Some people may not even realise they have an eating disorder, or they may not understand how dangerous it can be.

Eating disorders can be complicated and are often linked to other psychological issues. This means that they can cause a lot of distress, and sufferers may need support from a friend, relative or colleague to seek the treatment that they need.

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What are the different types of eating disorders?

There are a large range of conditions which fall under the category of eating disorders.

These conditions have dramatically different features, but they all revolve around an unhealthy obsession with food, diet or body shape.

Often, people with one of these eating disorders will also have psychological problems such as anxiety or depression.

Anorexia nervosa (commonly known as anorexia) is one of the most common  eating disorders worldwide. It is the eating disorder that most people think of when the phrase ”eating disorders” is mentioned, even though it appears to be less common in Iraq.3 

People living with  anorexia are generally underweight, and they struggle to have a healthy relationship with their food and weight. This ends up causing them to starve themselves. 

Person stepping on a weight measure and tape measure.


Having anorexia  involves obsessively losing weight, or constantly trying to maintain a low weight. It is associated with the following signs and symptoms:

 

  • Only eating certain foods, eating small amounts of food, or skipping meals altogether
  • Hiding or lying about food intake
  • Excessive exercise
  • Using medications to try and lose weight 
  • Fear or anxiety about eating and weight gain
  • Fixed patterns of eating and exercise
  • Not accepting that you are underweight
  • Irregular or no periods in women
  • Physical symptoms such as constipation, headaches, dizziness and hair loss
  • In severe cases, some people develop a layer of fine hair all over the body (this is called lanugo hair)

Bulimia nervosa (commonly known as bulimia) is another type of eating disorder. In contrast to anorexia, bulimia sufferers can be a normal weight, or even overweight. 

 

The key feature that defines bulimia is the repeated process of eating a lot of food in a short amount of time, and then vomiting, exercising or using medications to remove that food from the body. This process is referred to as “binging” and “purging”, and it is often done in secret, which makes bulimia difficult to spot in some people. 

 

Young woman with bulimia staring at herself in the bathroom mirror after purging.


The symptoms and signs of bulimia  include:

 

  • A lack of control around food and eating, leading to binges 
  • Being afraid of gaining weight
  • Obsessively thinking about food and body weight
  • Eating and exercising in private
  • Anxiety around food
  • Physical symptoms such as abdominal pain, tooth damage from vomiting and fatigue 

Some people with diabetes who use insulin suffer from a subtype of bulimia referred to as ‘diabulimia’. This is when someone binges on food, then alters the dose of insulin they give themselves in order to avoid gaining any weight. Diabulimia can have very serious effects on the body as it can cause problems with the body’s regulation of blood sugar. 

 

Bulimia is also linked to a higher rate of self-harm than other eating disorders. 

 

There are many different ways in which people cause harm to themselves, not all of which are visible. Some people cut or burn themselves which may leave scars on the arms or legs, but other injuries may be less obvious. 

Bulimia can be a condition on its own, but sometimes people who have recovered from anorexia go on to develop bulimia.

Binge eating disorder shares one of its main features with bulimia, which is the need to eat a large amount of food over a short period of time. 

Someone with binge eating disorder feels compelled to binge on food, even though they understand it is unhealthy and are not hungry, and they do not even want to eat the food. 

People with binge eating disorder often feel like their eating habits are out of control, and they feel both physically and psychologically unwell after binging. 

The difference between binge eating disorder and bulimia is that people with BED do not purge or vomit after they binge. That is why people with this type of eating disorder are often overweight.

Orthorexia nervosa (which is also called orthorexia) is an eating disorder which was recognised much later than the others and was first described in 1997.4

This eating disorder involves having an overwhelming obsession with healthy eating and exercise, often taken to extreme lengths. 

Young woman with Orthorexia Nervosa running in the park.


People with orthorexia are aiming to be as healthy as possible, and are not purposely trying to lose weight like those with anorexia. However, because people with orthorexia eat a very restricted diet and often exercise intensely, they tend to lose weight or become underweight. 

Many orthorexics participate in periods of fasting, often if they feel they have eaten too much, or have had something that they see as unhealthy. 

Unlike the other eating disorders, people with orthorexia are often happy to share their thoughts and ideas around healthy food and tend not to eat in secret.

EDNOS stands for Eating Disorder Not Otherwise Specified, and is a term used to describe an eating disorder that does not clearly match the description of one of the recognised eating disorders. For example, somebody may experience a lot of the symptoms of anorexia and have lost a large amount of weight, but still be a healthy weight for their height and age. 

It is important to be aware of EDNOS in order to understand that eating disorders can affect people in different ways, and may not always fit exactly with our perception of what people suffering from eating disorders are like.

Pica is a disorder which causes people to eat things which are not food sources and do not have nutritional value. 

There is a huge range of items that people with pica may ingest, but the most common are:

  • Hair 
  • Soil 
  • paper
  • Ice 
  • Sharp, often metallic, objects

In some rare cases, the cause for this compulsion is due to a low level of minerals in the body, such as zinc or iron. However, the majority of pica cases have no medical cause, and appear to be purely psychological. For this reason, pica is generally treated as an eating disorder. 

In some cases, the non-food items can cause serious damage to the body such as:

  • Internal injuries
  • Poisoning from a toxic ingredient
  • A blockage of the bowel 

All of which need to be treated as a medical emergency.

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Who usually gets an eating disorder?​

Anybody of any age, gender or race can get an eating disorder. 

An eating disorder may develop at any stage from childhood to old age. 

Women are twice as likely to be affected than men, but we should all be aware that men can suffer from these issues too. 

There are however, some groups of people who seem more likely to suffer from an eating disorder based on current research and statistics. This includes:

  • Teenagers and young adults
  • Women
  • People who were overweight during childhood
  • People who need to look a certain way (such as models and athletes)

In Iraq, there is not a lot of data on eating disorders and who they affect. Rates of eating disorders are low compared to other countries, but this is likely due to underdiagnosis and a lack of research in this area, so the true prevalence is not known.

Eating disorders support group comforting one of the male members

What causes eating disorders?​

There are many different reasons why people may suffer from an eating disorder.

Generally, an eating disorder develops because of a combination of several factors which first cause people to develop a problematic relationship with food and their body, and then lead to the development of a full blown eating disorder. 

Some of the risk factors for developing an eating disorder are:

  • Genetics – although the exact cause is still unclear, close relatives of those with eating disorders are more likely to develop one themselves.

  • Childhood abuse – suffering from any kind of abuse as a child appears to increase the likelihood of developing an eating disorder, possibly because of a link with having low self-esteem. 

  • Family issues – the children of parents who comment negatively about their or their child’s weight are much more likely to develop an eating disorder. Children who have experienced family stress such as divorce, parental addictions or bereavement are also at higher risk.

  • Childhood obesity – people who were overweight as children are more likely to go on to have an eating disorder later in life.

  • Personality disorders – these are a separate psychological problem to eating disorders. Personality disorders can cause people to develop low self-esteem and difficulty in controlling their emotions, which in turn can cause an eating disorder to develop.

  • A stressful event – any sort of trauma or stressful event can trigger the beginning of a problem with food, even in adulthood.

  • Diet culture – this is a controversial cause, but in recent years, many eating disorder sufferers have stated that unrealistic and altered pictures of celebrities on magazine covers and on social media sites, and the desire to be thin, maybe one of the reasons their illness developed.

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What are the complications of an eating disorder?​

All eating disorders can have significant impacts on both physical and mental health. In fact, eating disorders are the psychological disorder with the highest death rate, due to their combination of physical and psychological complications.

The physical damage caused by eating disorders varies depending on the type of eating disorder, as well as its severity.

The psychological effects of eating disorders tend to be similar for all of the different types of disorders. These include issues such as anxiety, depression and related symptoms such as insomnia and low self-esteem. Almost all sufferers of an eating disorder will recognise at least one of these problems.

The physical complications of eating disorders can be different for different people, and they can be severe, and even life threatening.

Some of these issues only develop if someone has had an eating disorder for years, whilst others can develop more quickly.

Although many of these problems can be reversed if the eating disorder is overcome, some can require medication or may even end up being permanent, life-long problems.

Which physical problems can eating disorders cause?

The physical problems that are commonly associated with eating disorders include:

This develops when the body does not receive the right amount of healthy nutrients. The body needs certain minerals and vitamins in order to function properly. In many eating disorders, either too little food is eaten, or the range of food eaten is restricted, so the body is unable to get the nutrients it needs.

In disorders like bulimia, purging, either by vomiting or using laxatives, is common. This causes the body to lose fluids. If these fluids are not replaced, it can cause dehydration which can lead to dizziness, fainting, and acute kidney problems.

This is caused when someone does not take in enough fibre or fluids. Constipation is usually more uncomfortable than it is serious, but in rare cases, it can cause more serious bowel problems.

This is the medical term for slow stomach emptying and digestion. Gastroparesis can be caused by both undereating, and purging after overeating. This can lead to chronic nausea, vomiting and bloating, and once it has developed, is difficult to treat.

This is associated with bulimia and purging by vomiting. It can cause indigestion and in the long term, it can damage the oesophagus and lead to a pre-cancerous condition called Barrett’s oesophagus.

Vomiting frequently and acid reflux can also cause erosion of the teeth because of the repeated contact between the teeth and acidic stomach contents when vomiting.

Kidney problems are thought to be caused by chronic malnutrition and dehydration. Long term kidney problems can develop due to eating disorders, leaving the kidneys permanently damaged.

In severe cases of anorexia, the body is so starved of fuel that it starts to break down muscle tissue in order to survive. If heart muscle tissue is broken down, it can cause heart failure. Persistent vomiting in bulimia can also cause heart failure. If heart failure does develop, it can cause severe, unpleasant symptoms and even sudden death.

This is the medical word to describe low bone density, and it can be caused by malnutrition as seen in eating disorders. It is associated with a higher risk of fractures, and may be semi-permanent if it is not found and treated early.

Can eating disorders cause infertility?

Eating disorders can cause hormone imbalances, especially in people who are outside of the healthy weight range. These imbalances make becoming pregnant and carrying a healthy pregnancy to term much more difficult. 

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How can an eating disorder affect quality of life?​

There are many ways in which having an eating disorder can affect somebody’s quality of life. 

Having an obsession with your weight and body image can cause problems with your self-esteem and in your ability to build relationships.

Restrictions that an eating disorder sufferer puts on themself, such as not being able to eat in public or only eating food that they have prepared themselves, can also have a negative impact on their life.

This behaviour is immensely stressful for the sufferer as well as their friends and family and can cause lots of friction and arguments. 

Most people with eating disorders do not feel positively about themselves or their appearance. This can have a huge effect on many aspects of daily life, and can prevent them from reaching their potential in school, university or work. 

The physical issues caused by eating disorders also have a toll on the body, and are likely to leave someone feeling tired, weak and generally unwell. They may not speak openly about their problems because they either do not realise they have an eating disorder, or do not wish to talk about it. 

Unfortunately, there is also an association between eating disorders and substance misuse. If someone with an eating disorder is abusing alcohol or drugs, it can further impact quality of life and cause a whole new set of problems.

Which other conditions have similar symptoms to an eating disorder?​

Most of the eating disorders that are currently recognised have fairly strict criteria that have to be met before a diagnosis can be made. However, there are a couple of other conditions which may mimic an eating disorder. 

Certain features of autism may be confused with an eating disorder. This is because some autistic people are fussy eaters, and they may create rules about what, where and how they eat. 

 

However, in autism there is not generally any significant weight loss or purging behaviour, and there are also other symptoms such as communication difficulties and unusual behaviours which are not found in an eating disorder alone.

Some other mental health problems may also appear in a similar way to an eating disorder, or may co-exist with one.

Specifically, personality disorders can cause somebody to behave unusually, have difficulties in forming relationships and have low self-esteem, all of which are also seen in eating disorders. If there is no obsession with food or weight, and no weight loss or purging, then there is unlikely to be an eating disorder present. However, it is possible for somebody to suffer with both problems at the same time.

Disclaimer

The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.

How do you treat eating disorders?​

Eating disorders can be extremely difficult to treat as they have both physical and psychological elements, and are often deeply ingrained in the sufferer’s personality.

In general, treatment for eating disorders focuses on psychological therapy and building a better relationship with food. For some people, medications are also used.

The physical issues caused by eating disorders are treated in the same way as they would be in anybody else.

Anorexia treatment is mainly psychological. 

This treatment can be delivered via:

  • Self-help 
  • In a clinic 
  • Over the phone
  • In severe cases, in a psychiatric hospital. 

Cognitive Behavioural Therapy (CBT)

The most popular form of talking therapy used in the treatment of anorexia is cognitive behavioural therapy (CBT). This type of therapy works on changing the way a person feels about themselves and about food, and helps them develop coping mechanisms to try and overcome those negative feelings. CBT is a technique used in many psychological problems and is not specific for anorexia.

Specialist Supportive Clinical Management (SSCM)

There are some other specific types of therapy used specifically for anorexia such as SSCM (specialist supportive clinical management). 

This combines therapy and dietary advice with a target weight to aim for, and focal psychodynamic therapy, which is more reflective on why this person’s habits began and what they mean. 

Medications for anorexia

 

Sometimes, medications are also used in the treatment of anorexia. These are usually a type of antidepressant and when they are used in combination with therapy, they can be an effective way of improving someone’s mood and outlook on life. Examples of medications used to treat anorexia are:

  • Fluoxetine 
  • Sertraline 
  • Paroxetine 
  • Escitalopram
  • Citalopram

Advice on diet & nutrition

Of course in addition to therapy and medication,  advice on diet and nutrition is also incredibly important. It is important that weight is gained slowly and that the new eating habits that develop are healthy and sustainable. 

This advice might be given by a doctor, dietician, or nutritionist. It may also involve keeping a food diary, attending cooking classes, or aiming to reach a certain goal weight over time.

Therapy & Cognitive Behavioural Therapy (CBT)

 

The treatment for bulimia is similar to that of anorexia in many ways. Both involve therapy to help understand why someone eats in the way that they do, and how it makes them feel. The main type of therapy that is used in bulimia is CBT

 

In bulimia treatment, there is also more of a focus on what causes binges, known as triggers, and how these triggers can be avoided or overcome. Focusing on ways to overcome and avoid triggers can help to prevent the feeling of being out of control. This in turn can help reduce the frequency of binges, until they stop altogether.

Advice on diet & nutrition

 

Some people with bulimia may also be offered dietary advice, although there is less of a focus on this in bulimia treatment. This is because the issue in bulimia is related to the binge-purge cycle, rather than what is, or is not, being eaten. 

 

Medications for bulimia

 

Antidepressant medications are also sometimes used to treat bulimia, but they should not be used on their own without any CBT

 

Breaking the habits people with bulimia have can take a long time. Bulimia recovery is a gradual and difficult process, but it rarely requires admission to a psychiatric hospital.

Binge eating disorders are sometimes simpler to treat than other eating disorders. This is because they have more obvious triggers and fewer associated physical issues. 

 

Many people with binge eating disorders are able to get better using self-help alone and the rate of people requiring CBT and medications is lower than in other eating disorders. 

 

However if they are required, both the CBT and choice of medications is similar to that for anorexia and bulimia, just with a different focus during therapy.

 

Some people with binge eating disorder are actually overweight or even obese, and they may struggle to lose weight. For these people, advice on healthy eating and encouragement to exercise can also be helpful alongside either self-help or CBT. This helps people with binge eating disorder get to the root of why they binge eat, and this can help them develop strategies to cope with difficult emotions. 

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Is there a cure for eating disorders?

There is not a quick and easy cure for any eating disorder. The treatments that have been described for each eating disorder can take a long time to be effective and require a lot of engagement and motivation from the sufferer in order to work.

However, recovery is definitely possible, and many people are able to live a full and happy life after treatment.

For many people, the new appreciation for life and the ability to enjoy something as simple as a family meal is hugely rewarding and helps them to understand why recovery is so worthwhile.

Sometimes, people who have recovered can relapse and develop signs of an eating disorder after treatment. If this happens, they may require further treatment in future.

Relapsing after recovery appears to be more significant in anorexia, with some research suggesting that the lower someone’s body weight is at the start of treatment, the higher the risk of relapse is.10 To prevent this, other methods can be used alongside the treatments that have been described already, such as group therapy, family therapy and online support groups.

 

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  7. Nobis S, Morin A, Achamrah N et al. Delayed gastric emptying and altered antrum protein metabolism during activity-based anorexia. Neurogastroenterology & Motility. 2018;30(7):e13305. doi:10.1111/nmo.13305 (Access here)
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  10. Lemberg R, Cohn L. Eating Disorders. Phoenix: Oryx Press; 1999:10. 

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