Eating disorders are complex with significant medical, psychological and social impacts for both the person and their family members. People who have eating disorders often have anxiety and/or depressive disorders in addition to their eating problems, and these disorders may add to the distress of other family members.
Eating disorders most commonly have an onset in adolescence – anorexia nervosa commonly has an onset at 14 years of age, and bulimia nervosa a little later at 16 years of age. However there has been an increase in younger children aged under 12 years developing eating disorders over the past decade.
Eating disorders can be life threatening, and are particularly concerning in younger children because the symptoms can escalate quickly, and left unmanaged can cause growth retardation. Eating disorders are not the same as fussy or picky eating or eating difficulties associated with other issues such as Autism.
What are the signs of an Eating Disorder?
Behaviours
An eating disorder is a serious mental illness which is characterised by eating, exercise and body weight or shape becoming a significant concern in a person’s life. Eating disorders are not a fad or lifestyle choice – the consequences are severe and have significant impacts on the person’s physical health and emotional wellbeing affecting their day-to-day life.
A person with an eating disorder may not be aware of the significant harm that is occurring to their health and well being or may go to some lengths to hide the problem. While any number of the following signs may be present, it is also possible for someone to have these behaviours but not have an eating disorder.
Other behavioural signs:
- Constant dieting and avoidance or restriction of food groups such as fats, sugar and protein
- Changes in food preferences – refusing to eat certain foods or claiming to dislike foods previously enjoyed
- Sudden development of a strong focus on healthy eating
- Frequently avoiding eating meals – claiming to have already eaten or developing an intolerance or allergy to certain foods previously enjoyed
- Skipping meals or replacing meals with fluids or fasting
- Strong focus on food preparation and planning – shopping, preparing and cooking food for others but not eating it themselves
- Development of rituals around food and eating – only using a certain cup or knife, cutting food up into very small pieces, not allowing different foods to touch on the plate or mashing all the food together, eating very slowly or rearranging food on the plate but not eating
- Counting calories/kilojoules
- Avoidance of social situations that involve eating
- Change in clothing styles – baggy clothing
- Evidence of purging – vomiting or laxative abuse – going to the bathroom shortly after meals
- Excessive or compulsive exercise – refusal to interrupt exercise for any reason, becoming distressed if exercise is interrupted
- Strong focus on body shape and weight – interest in weight-loss websites, dieting tips in magazines, images of thin people
- Development of repetitive body checking behaviours – spending a long time looking in the mirror, pinching wrists or waist, constantly weighing self
- Evidence of binge eating – large amounts of food from the cupboard or fridge “disappear”, sweet wrappers appearing in rubbish, hoarding of food in preparation for a binge
- Deceptive behaviours around food – eating in secret (wrappers and food containers found in rubbish), secretly throwing food away, or lying about the amount or type of food eaten
- Constantly denies hunger
Physical Signs
- Sudden or rapid weight loss
- Sensitivity to the cold (feeling cold even when it is warm)
- Loss or disturbances of menses (girls)
- Fainting or dizziness
- Fatigue – always tired and unable to perform usual activities
- Signs of frequent vomiting – swollen cheeks/jawline, calluses on knuckles
Psychological Signs
- Preoccupation with body shape, weight and appearance
- Intense fear of gaining weight
- Extreme body dissatisfaction/negative body image
- Distorted body image – feeling that one is fat when actually a healthy or low weight
- Heightened anxiety around meal times
- Moodiness or irritability
- Low self-esteem – feeling worthless, guilty or self loathing, feelings of shame
- Depression or anxiety
- Feelings of life being “out of control”
- Feelings of being unable to control behaviours around food
Treatment
If you think that your child or adolescent has an eating disorder taking action can seem very overwhelming.
A medical assessment is the first step to seeking help. For most people their General Practitioner is the first point of contact, however it is preferable that your doctor has some experience in the area of eating disorders. It is important to assess the severity of the eating disorder and to have a thorough physical examination. Your General Practitioner can provide you with a Mental Health Care Plan to help you access therapeutic treatment services with allied health clinicians (See Rates & Billing for more information).
For children and adolescents under 18 years of age, Family Based Treatment for Adolescent Anorexia Nervosa (also called the Maudsley Model after the hospital where it was developed) is the recommended first line of treatment. Central to this approach is the view that the family does not cause an eating disorder, rather the focus is on helping the family to mobilise its resources to take action to overcome the illness. For those in older age groups or if you have undertaken FBT and have had limited success there are other options for treatment, (See Clinical Services). Dr. Ingrid Wagner, has had over 30 years of experience in child and youth mental health and has specialised in family treatments, and eating disorders. You can arrange an appointment time for an assessment at a time that suits your family.