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Eating Disorders (and Disordered Eating)

Counselling in Perth

 

Eating disorders (ED) are serious mental health conditions that have physical and emotional consequences as well as an increased risk of mortality.  Mortality rates are estimated to be almost twice as high for people with ED compared to those without1.  Many people with an eating disorder also have other mental health and substance use issues which need to be recognised and addressed with treatment.

An eating disorder can be defined as a mental illness characterised by eating habits that are abnormal or disturbed, and require specific criteria in order to be diagnosed as such.  Eating habits and patterns that do not meet criteria for an eating disorder may be considered “disordered eating” and can often be the precursor to an eating disorder later on.

Eating disorders are often misunderstood to be an issue that only women experience.  This is not true – although the majority of people with eating disorders are female, men have eating disorders too! Statistics estimate that in 2012 approximately 4% of the Australian population had an eating disorder, of which 64% were female.  This 4% total was comprised 47% Binge Eating Disorder, 12% Bulimia Nervosa, 3% Anorexia Nervosa, and 38% with other types of eating disorders1.  Bear in mind, that these figures only represent the people with a diagnosed condition, with estimates of up to 20% remaining undiagnosed3.

Although the criteria for each eating disorder are different, there are some similarities that are present across all of them:

  • Chaotic dietary behaviours with a history of dieting
  • Issues with body image
  • Weight control strategies that are detrimental to person’s health
  • Secrecy attached to the under- or over-eating and compensatory behaviours (such as purging or excessive exercise)

 

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5)2 lists the following eating disorders:

 

Anorexia Nervosa

A

Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than minimally expected.

B

Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.

C

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

 

Bulimia Nervosa

A

Recurrent episodes of binge eating. An episode of binge eating is characterized by both:

 

1

Eating in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

 

2

A sense of lack of control over eating during the episodes (e.g. a feeling that one cannot stop eating or control what or how much one is eating.

B

Recurrent inappropriate compensatory behaviours to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

C

The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.

D

Self-evaluation is unduly influenced by body shape and weight.

E

The disturbance does not occur exclusively during episodes of anorexia nervosa.

 

Binge Eating Disorder

A

Recurrent episodes of binge eating. An episode of binge eating is characterised by both:

 

1

Eating in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

 

2

A sense of lack of control over eating during the episodes (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

B

Binge eating episodes are associated with three or more of the following:

 

1

Eating much more rapidly than normal.

 

2

Eating until feeling uncomfortably full.

 

3

Eating large amounts of food when not feeling physically hungry.

 

4

Eating alone because of feeling embarrassed by how much one is eating.

 

5

Feeling disgusted with oneself, depressed, or very guilty afterwards.

C

Marked distress regarding binge eating is present.

D

The binge eating occurs, on average, at least once a week for 3 months.

E

The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

 

Pica

A

Persistent eating of non-nutritive, non-food substances over the period of at least one month.

B

The eating of non-nutritive, non-food substances the inappropriate to the developmental level of the individual.

C

The eating behaviour is not part of a culturally supported or socially normative practice.

D

If the eating behaviour occurs in the context of another mental disorder (e.g. intellectual disability, autism spectrum disorder) or medical condition (e.g. pregnancy), it is sufficiently severe to warrant additional clinical attention.

 

Rumination Disorder

A

Repeated regurgitation of food over the period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

B

Not attributable to an associated gastrointestinal or other medical condition (e.g. reflux).

C

Does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

D

If symptoms occur in the context of another mental disorder (e.g. intellectual disability), they are sufficiently severe to warrant additional clinical attention.

 

Avoidant/Restrictive Food Intake Disorder

A

A feeding or eating disturbance (e.g. lack of apparent interest in eating food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating)as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

 

1

Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

 

2

Significant nutritional deficiency.

 

3

Dependence on enteral feeding or oral nutritional supplements.

 

4

Marked interference with psychosocial functioning.

B

The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

C

The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

D

The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

 

Additionally, there are a number of other clusters of symptoms that are characteristic of a feeing or eating disorder, and that cause clinical distress or impairment in social, occupational, or other important areas of functioning predominate, but DO NOT meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.  For example: Night Eating Syndrome.

 

Risk factors for developing an eating disorder include:

Age

Eating disorders are start in adolescence, although they can occur anywhere from childhood to older adulthood.

Gender

Anorexia and bulimia are more common in females than males, although males do experience eating disorders also.

Family History

Eating disorders are more likely to happen in families when there has been a parent or sibling with an eating disorder.

Dieting

Someone with a history of dieting is at an increased risk of disordered eating or an eating disorder.  Dieting and a desire to lose weight is often the start of an eating disorder for females.

Sports

Sports coaches, parents and peers can often reinforce the “need” to lose weight or have a better body shape by making comments relating to eating or body shape.

Obesity

Obesity and over-eating type disorders often go hand-in-hand.  Binge eating can lead to obesity, and obesity can lead to binge eating and purging.

Mental Health

People with mental health issues such as depression, anxiety, obsessive compulsive disorder (OCD), and personality disorders are more likely to have an eating disorder than those people who do not.

 

How can a psychologist or counsellor help with an eating disorder or disordered eating?

A psychologist can provide counselling to deal directly with the emotional and behavioural aspects of the ED, as well as other co-morbid issues such as depression and anxiety often associated with ED.  The most common forms of psychological therapy for ED is Cognitive Behaviour Therapy (CBT) and Dialectical Behaviour Therapy (DBT).

Cognitive Behavioural Therapy

CBT specifically for Eating Disorders (CBT-E) has been shown to be an effective treatment in adults when emotional dysregulation is the precursor to the ED.  This type of therapy addresses thoughts (cognitions), feelings, and behaviours directly, with treatment focussing on:

  • Normalising eating – set up a regular eating routine
  • Reducing or eliminating abnormal eating behaviour
  • Reducing or eliminating any avoidance of specific foods or strict dieting
  • Reducing eating due to mood or event triggers
  • Exploring core beliefs about body image and the self
  • Exploring fears relating to weight (loss) and body shape
  • Exploring self-esteem
  • Increasing a sense of self-control
  • Increasing self-awareness of normal, healthy appetite cues

 

Dialectical Behaviour Therapy (DBT)

DBT for binge eating teaches skills for emotional regulation and distress tolerance – alternatives to abnormal eating.

 

If you think you have an eating disorder or even issues with disordered eating (emotional or comfort eating, obesity etc.) and you are seeking the services of a psychologist or counsellor in Perth to assist you, please contact me directly on 0406 033 644 or This email address is being protected from spambots. You need JavaScript enabled to view it.

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References

  1. Butterfly Foundation. (2012). Paying the price: the economic and social impact of eating disorders in Australia. Melbourne: Butterfly Foundation.
  2. American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. The National Eating Disorders Collaboration. (2012).Eating disorders in Australia. Sydney: NEDC.