Eating disorders: how much do you really know?

How much do we really know about eating disorders such as anorexia, bulimia and binge eating? Big White Wall spoke to Susan Ringwood, eating disorders expert and chief executive of the UK’s leading eating disorder charity Beat, to uncover the facts

What is an eating disorder?

Susan Ringwood: There is a big debate at the moment as to what the diagnostic criteria should be. At the moment, an eating disorder is described as a serious mental illness. There are three main types of eating disorders:

• anorexia nervosa is the rarest, representing only 10% of eating disorder cases. This is someone who is unable to maintain a normal body weight for their age and is driven by a fear of gaining weight and a morbid dread of being fat
• bulimia nervosa represents around 30% cases and is found in somebody who doesn’t necessarily loose a lot of weight or restrict their diet, but might eat large amounts of food and then rid themselves of the food either by vomiting, abusing laxatives or sometimes through excessive exercising
• binge eating disorder is the last category and is less well known. This accounts for about 10% of all cases and these are people who eat uncontrollably, but don’t purge themselves of food

The other 50% are the ‘not otherwise specified’ group, and these are people who have features of all of these conditions,  or who move between them; perhaps by having periods of really restricting their diet in the way an anorexic does, and then binging uncontrollably.  

Are eating disorders really all about body image?

Susan Ringwood: No. A person with an eating disorder comes to believe in a dangerously unhelpful way, that the weight and shape of their body is the thing that is causing the problems in their life; their pain or their anguish. And if they were able to control, and even reduce, their weight and shape then their problems will go away.  

Is the media to blame for eating disorders?

Susan Ringwood: The pressure of society and an increasingly image conscious media are factors which add to the risk, but don’t cause it. It’s not about wanting to look like people in the magazines or having bad parents as some might suggest.  Research at the moment is looking at a number of factors, and it seems that those factors need to combine to increase the risk to an individual, it is rarely just one cause.

What personality traits or factors increase the risk to eating disorder?

Susan Ringwood: A person who is a perfectionist, who has a need to be in control of their life, is at increased risk. If, as well as feeling a need to be perfect and in control, you also have low self esteem - you don’t feel very worthy – that becomes a particularly risky combination.

Also, a person with an eating disorder seems to have a brain that is particularly sensitive to adrenaline, between 100 and 1000 times more sensitive which makes the person extremely prone to anxiety. Because hormones, such as adrenaline, are carried to our brains in fat, by reducing or controlling the amount of fat in the blood you turn that anxiety switch down. This suggests that people with eating disorders are ‘self medicating’ by starving themselves to stay calmer.

Why is it so common for someone with an eating disorder not to acknowledge that there is a problem?

Susan Ringwood: An eating disorder doesn’t feel like an illness, it feels like the answer. That is what is so challenging for others to accept, because sufferers describe the experience as a place of safety and of calm. They are no longer tormented with the awful fears that they had without realising that they have simply turned down a switch to their anxiety. Another reason is that there is a huge sense of shame and guilt; particularly for bulimics because of the vomiting and laxative abuse that often comes with the illness, which encourages secretive behaviour because it makes them feel disgusted and ashamed.

What are the emotional symptoms of an eating disorder?

Susan Ringwood: Whether you are starving yourself or your food intake is very chaotic, it dulls your emotional response. It can look a bit like depression, they struggle to feel any emotion at all or feel distant. So they can become very withdrawn from family life or don't want to socialise.

How do you best approach someone who you think might have an eating disorder in order to help?

Susan Ringwood: The first thing is to know you can’t make it worse. It’s a bit like bereavement when people don’t know what to say; it’s about showing the love for a person, not challenging arguing or rowing with them at meal times, but showing that you love them, and that you want them to get better. The sooner they get professional care the better and the more likely they are to make a full recovery.  You must go to your GP first and be persistent so that you get the best specialist as soon as possible.

What about people you don’t know so well, a colleague at work for example?

Susan Ringwood: It depends on the relationship and how close you are to that person, but it is always worth asking ‘is there anything you are worried about? I have noticed you seem to be really anxious’. Do not make it about food because it is actually about their emotional life. More often than not you will have noticed that their behaviour is not solely focussed on food intake anyway - they may also get very anxious when there is a change in routine, or be overly precise about every single thing they do.

Can men have eating disorders too?

Susan Ringwood: More men are coming forward to get treatment now; about 15% of diagnosed cases are men, but we think many more go undiagnosed.  When the British MP John Prescott admitted to having an eating disorder in the press, we had 10 times the amount of calls to our helpline, all from men, many of whom had no idea that what they did was an eating disorder and that they could receive treatment for it.

What sort of treatment is available for people with eating disorders?

Susan Ringwood: Talking therapy is shown to be working. This involves psychological therapies that help a sufferer to understand how their brain is wired and why it is causing them to behave in this way.

For younger people family therapy has been shown to be really effective. This doesn’t mean the families themselves need therapy, but is more about helping the family as a whole understand what is going on and become part of the recovery.

Hospitalisation is usually only appropriate in very serious cases when someone has become medically unstable. Although a mental illness, the most serious consequences of eating disorders are the effects the disorder has on physical health, particularly pressure on the heart.

Also, a person with an eating disorder is 200 times more likely to commit suicide than one without, particularly those who have enough insight to know that they are ill, and can't imagine how they can stop being the way they are. Eating disorders have the highest mortality rate of any mental illness, so it can be an incredibly risky condition.

Are eating disorders for life, or can you be ‘cured’?

Susan Ringwood: You can make a full recovery, particularly if you seek help early, and fortunately young people now are getting really good treatment. We know from data that about 40% of people will make a complete recovery. Another 40% may still be at risk or have times when they are ill and times when they are well, depending on their circumstances. And around 20% will have an enduring condition, and these sadly are the ones most likely to die prematurely. So it is important that people receive treatment as early as possible as this will improve their chances of making a full recovery.

For more information on eating disorders, visit http://www.b-eat.co.uk/Home