Portfolio of Hope

  1. What is an eating disorder?

An eating disorder is a serious mental health condition whereby the individual struggling uses food to try to reclaim control over their feelings and otherwise uncontrollable situations they may find themselves in.

2. What are the different types of eating disorders?

The most common eating disorders are Anorexia Nervosa, Bulimia, and Binge Eating Disorder.

Anorexia nervosa is diagnosed in individuals who try to control their weight by not eating enough food, exercising too much, or as is often the case, a combination of the two. In trying to keep their weight as low as possible, several severe complications can arise, making Anorexia Nervosa a mental illness with the highest mortality rate.

Bulimia is diagnosable in people who experience a lack of control over how much they eat. They will typically eat a lot of food in a very short amount of time. To reverse the ‘damage’ they have done after a binge, people with bulimia will take drastic action to avoid putting on any weight, whether that be by making themselves sick, taking laxatives, engaging in excessive exercise, or a combination of all three of these drastic interventions.

Binge Eating Disorder, commonly referred to as BED, is characterised by the consumption of excessively large portions of food over a short period of time. People with this condition generally only stop eating when they feel uncomfortably full/sick, due to their compulsion to eat being so strong.

If an individual’s symptoms are not an exact fit to the diagnostic criteria for either Anorexia, Bulimia or Binge Eating Disorder, they might be diagnosed with OSFED, or ARFID.

The former diagnosis, OSFED, which stands for ‘Other specified feeding or eating disorder’, accounts for the highest percentage of all eating disorder sufferers. It incorporates several less common eating disorders, including; atypical anorexia (individual has all the symptoms associated with anorexia nervosa except a low weight), purging disorder (bulimia without the binge. People with purging disorder make themselves sick/use laxatives to control their weight), and night eating syndrome (seen in people who eat to excess at night, either after waking up from sleep, or after their evening meal.) People may also be diagnosed with OSFED if they have all the symptoms of either bulimia nervosa or binge eating disorder, but of a low frequency/limited duration.

The latter diagnosis, ARFID (Avoidant/restrictive food intake disorder), is prevalent in people who avoid certain foods, limit how much they eat of said food, or do both. They might do this for a variety of different reasons, the most common being; having a sensitivity to taste, texture, smell, appearance, or temperature of certain types of food, having had a negative experience concerning food in the past (e.g., choking/vomiting), and having a lack of appetite meaning that, to them, eating is nothing more than a ‘chore’-something they know that they have to do, though they don’t really want to do.

3. What are the possible causes of eating disorders?

  • Psychological factors- Many people with an eating disorder state that their diagnosis was largely fuelled by their drive for perfectionism, of which the standards they set for themselves are often unachievable. Poor body image and subsequent low self-esteem is another psychological factor that can have a big impact on the development of eating disorders, as is demonstrating behaviour that is ‘inflexible’ in nature. For example, people diagnosed with Anorexia, when asked, said that when they were younger, they always followed the rules and felt that there was only one ‘right way’ to do things. This obsessive behaviour overlaps with OCD and anxiety in many ways, therefore people who have other anxiety related mental illnesses are more likely to develop an eating disorder, compared to people with no existing anxiety disorder.
  • Environmental factors- There are many experiences that can happen in one’s life that can lead to the development of an eating disorder in those affected, these can be referred to as ‘environmental factors.’ Examples of such factors include; traumatic experiences such as bullying or abuse, feelings of pressure/high expectations to look/act a certain way (largely driven by diet culture and the media), sports performance requirements, and family dynamics, all of which can lead to weight stigma arising.
  • Biological factors- There have been several studies into the causes of eating disorders, with evidence suggesting that they can be caused as a result of biological factors, such as a genetic link being present amongst family members with eating disorders, or the copying of behaviour (children mirroring their parents disordered tendencies.) It is for this reason that it is not uncommon to see eating disorders span generations. In fact, a recent study has highlighted that inherited biological and genetic factors contribute approximately 56% of the risk for developing an eating disorder. What is more, it has been found that individuals who have either a mother or a sister with an eating disorder are 12x more likely to develop Anorexia than other individuals without a family history of eating disorders.

4. What are the signs and symptoms associated with eating disorders?

The signs and symptoms of eating disorders can vary massively due to the sheer number of different eating disorders that exist. Common symptoms that seem to be present in the majority of eating disorders, however, include; pre-occupation with weight/body shape and food/calories, difficulty socialising with and eating in front of others, restricting food intake/certain food groups, using compensatory behaviours after eating (e.g. being sick- going to the toilet a lot after eating- or taking laxatives), exercising excessively, having very strict habits/routines around food (e.g. cutting food into small pieces, excessively chewing, eating very slowly), and extreme changes in mood.

Whilst the above symptoms are all associated with mental health, eating disorders also have several physical symptoms that can have an adverse effect on one’s health. Examples of such symptoms are; feeling cold and tired, dizzy and faint, poor circulation, digestion problems (e.g. bloating, constipation, diarrhoea), extreme fluctuations in weight (either up or down), delayed signs of puberty/menstrual irregularities, muscle weakness, impaired immune functioning, dry skin/hair, and brittle nails. Dental problems can also be an issue in certain eating disorders, such as bulimia.  

5. What feelings might an individual with an eating disorder experience?

Many people with an eating disorder, regardless of the specific type, focus on food and their bodies (the key characteristics of eating disorders), in an attempt to feel in control of their lives.

Eating disorders allow the unwelcome thoughts of the past to be ignored as people have something else to focus on. Whilst this might seemingly help them to handle their emotions, it in fact causes them to intensify. This is because eating disorders come attached with a whole host of additional complications, all of which make the old feelings even worse. The feelings, instead of being worked through and resolved, or at the very least, accepted, are instead buried beneath fresh shame and guilt, to be uncovered in the future. This can cause many people with eating disorders to experience a sense of hopelessness and powerlessness, believing that they will never be able to control their thoughts. Thinking discouraging thoughts such as these can impact upon their motivation to recover, causing it to dwindle and potentially leading to the development of further mental health conditions, such as depression, in already vulnerable individuals.

Other feelings that people with eating disorders might experience are ones associated with how ‘good’ or ‘bad’ they are. People with eating disorders commonly hold the belief that ‘being fat=bad, and ‘being thin=good.’ It is harmful beliefs such as these that induce their negative sense of self, affecting their body image and overall self-esteem. It is also what leads to many eating disorder thoughts, such as food being either ‘good’ or ‘bad’, self-indulgence being a sign of ‘weakness’ and having a larger body being a sign of ‘failure.’ Such feelings can lead to further feelings of worthlessness arising in individuals with eating disorders.

6. How might an eating disorder affect the individual and their life?

Eating disorders take over a person’s life and make them very unwell, profoundly impacting upon their physical health, education, and general daily living.

Individuals with eating disorders might find what were once enjoyable activities (e.g., socialising) difficult, leading them to refrain from going out, particularly if food is involved, which, it often is in social situations. Socially isolating themselves in this way by turning down invitations and withdrawing from friendship groups could, in turn, lead to the breakdown of relationships. This might contribute to them developing feelings of loneliness as a result. Thinking that they are alone in their struggles is likely to intensify their negative emotions and subsequent disordered behaviour.

Aside from having an adverse impact on relationships, eating disorders can also have a negative effect on an individual’s daily obligations, a result of the immense amount of time eating disorder sufferers devote to controlling their food intake and physical activity.

In the context of eating disorders impacting upon one’s work, individuals with an eating disorder diagnosis might find themselves in unemployment, causing their stress levels to rise as their financial difficulties mount up.

Furthermore, the lack of energy that the majority of eating disorder sufferers experience, combined with their mind being ‘on other things’, means that they will often lack in concentration, therefore negatively affecting their attention span. This can lead to issues, not just with work and relationships, but with every area of their life. They might struggle to drive, look after their family, and do everyday tasks such as cleaning.

Another way in which eating disorders effect individuals is because of what the disorder does to their physical health. The health repercussions from their eating disorder behaviour can be severe. Whilst physical symptoms can initially manifest themselves in ways such as fainting spells, muscle weakness, weakened hair/nails etc, over time symptoms can considerably worsen, with the potential for lasting damage to occur, such as damage to the heart, kidneys, and/or liver. This can cause severe complications for several reasons, such as effecting their ability to have children in the future, and weakening their immune system putting them at risk of contracting viruses/infections that their body might be too weak to fight. Eating disorders can therefore be described as a ‘life or death’ illness, with this description backed up by the fact that eating disorders have the highest mortality rate of any mental illness.

7. How might an individual’s eating disorder affect others?

The physical and mental health concerns associated with eating disorders can cause their loved ones to worry and stress about them. This might lead to increased arguments and disagreements around food, with mealtimes becoming tense rather than enjoyable as they perhaps used to be.

An eating disorder sufferers loved ones are likely to experience feelings of powerlessness, as they have no choice but to watch on as their loved one inflicts harm upon themselves. Loved ones might also question why they are struggling, wondering if they are to blame for any reason. Feelings such as these can cause immense feelings of guilt to arise and can lead to them developing mental health problems of their own, such as depression. They might also experience feelings of resentment towards their loved one, because although they love them, they cannot understand why they are putting themselves and others through so much turmoil. To people who lack experience in eating disorders such as Anorexia, the solution is simple; ‘just eat’, the reality however is far from simple. It is most definitely not so easy, and assuming that it is, can cause further conflict.

8. What are the different approaches to the treatment of eating disorders?

  • Psychotherapy- Psychotherapy involves one-to-one counselling with a therapist. It is designed to aid an individual’s understanding of the causes and thought processes behind their eating disorder, helping the patient to learn new skills and techniques to replace their unhealthy coping mechanisms.

There are various therapies which come under the umbrella term of ‘psychotherapy’, including CBT (cognitive behavioural therapy), DBT (dialectical behaviour therapy), and family therapy.

The former, CBT, assists individuals with the process of learning to recognise and transform their disordered thoughts rather than letting them control their life.

DBT uses mindfulness techniques such as meditation. This approach supports individuals to better understand the thoughts/emotions which they experience. In DBT, individuals are encouraged to acknowledge their disordered thoughts as a separate entity to themselves, therefore giving them the sense of freedom to dismiss their unhelpful thoughts rather than responding to their urges.

The latter therapy type, Family therapy, gives the family members of eating disorder sufferers an opportunity to learn how to help their loved one throughout their journey to recovery.

  • Medication- Medication, usually taking the form of anti-depressants, is often prescribed to people with eating disorders, though it is often used in combination with psychotherapy. Antidepressants help to reduce the symptoms of depression and anxiety, which are commonly experienced alongside eating disorders.

9. What could others do to help an individual recover from a specific eating disorder?

It is common for people with eating disorders to fail to see that there is a real problem. They may not understand why others are concerned for them. This can cause loved ones to feel frustrated and upset, but it is important that they emphasise how much they care about them.  

In every eating disorder, it is only when the person is able to find healthier means of taking care of themselves and generating internal sources of self-esteem that they can see a way out of their eating disorder. Family and friends of someone struggling can help them by encouraging them to engage in the activities which they enjoy, whether that be socialising with friends, or partaking in sport.

People should be encouraged to eat regularly (3 meals + snacks), also being encouraged to eat all food groups, and keep up with adequate hydration. Offering support and supervision at mealtimes can be of great help to an individual with an eating disorder.

10. What local resources are available to an individual experiencing an eating disorder?

  • SYEDA (South Yorkshire Eating Disorders Association)– SYEDA is an independent charity who provide non-judgemental support to people affected by eating disorders. With a team comprising of people who have personal experience of eating disorders themselves, SYEDA provide service users with helpful information and guidance, aiding them on their ‘road to recovery.’

Aside from their one to one therapeutic and practical support offer for those directly experiencing an eating disorder, they also facilitate support groups and deliver education and training to the wider community, helping to combat some of the stigma and misconceptions surrounding eating disorders, and therefore removing potential barriers to treatment.

  • CEDS (The Rotherham Doncaster and South Humber NHS Foundation Trust’s Community Eating Disorder Service)-CEDS is a specialist face-to-face service working with children and young people who have an eating disorder in the Rotherham and Doncaster region.

CEDS’ multidisciplinary team consisting of specialist nurses, cognitive behavioural therapists, family therapists, dieticians, psychologists, and psychiatrists, all work together to offer assessments and treatment in community settings.

Their service strives to ensure that all service users experience the best level of care possible, with their overarching aim being to give patients the absolute best chance at recovering from their eating disorder.

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