WHAT ARE EATING AND BODY CONCERNS?
Eating disorders are at the severe end of the continuum. These are common but very serious illnesses that can occur in people regardless of gender, age or cultural background. People who have an eating disorder may be underweight, normal weight or overweight. They may also appear to be eating a 'normal' amount.
These changes have a major impact on their life. Eating disorders are serious mental illnesses that can have severe psychological and medical complications. Eating disorders have a high mortality rate. It is often difficult for people with eating disorders know that they are unwell and require help. As a result, not all people who have an eating disorder get the treatment they need. However, most people who receive treatment early will recover.
A person who has bulimia nervosa has occurrences of binge eating and also tries to control their weight by using ‘compensatory behaviours’. The binge eating behaviours occur often, for example once a week or more over a few months or longer. When binge eating, a person feels 'out of control' and eats an amount of food that is far more than the amount another person would eat in the same time. Often the foods eaten during binge eating are high in sugar or fat.
‘Compensatory behaviours’ are weight control behaviours that a person who has bulimia nervosa uses to try and compensate, or reverse the effects on their weight of binge eating. Methods such as excessive exercise, self-induced vomiting, or taking laxatives are used. A person with bulimia nervosa will also have concerns about their body weight and shape, and the way they feel about their body tends to have a strong influence on how they think about and judge themselves.
Bulimia nervosa is different from anorexia nervosa (binge/purge subtype) as a person who has bulimia nervosa is not necessarily underweight for their age, sex, stage of development and physical health. Bulimia nervosa is also different from binge eating disorder. For more information on binge eating disorder and anorexia nervosa, see below.
BINGE EATING DISORDER
A person who has binge eating disorder also has repeated occurrences of binge eating (at least once a week for three months). When binge eating, a person feels 'out of control', as though they cannot stop eating or control how much they are eating. They eat an amount of food that is far more than the amount another person would eat in the same time.
In binge eating disorder, people feel very distressed about their binge eating. The binge eating may also have features like:
Unlike bulimia nervosa, people with binge eating disorder do not use compensatory behaviours to try to compensate or reverse the effects on their weight of their binge eating.
A person who has anorexia nervosa restricts how much they eat. The restriction causes severe weight loss and leads to a body weight that is too low for their age, sex, stage of development and physical health. The person is terrified of gaining weight and will use various behaviours to avoid this. There may also be a disturbance in the way they experience their body weight, shape or size, or they may not realise the seriousness of their eating restriction and low weight or weight loss.
There are two types of anorexia nervosa. The 'restrictive' type is where a person will reduce their intake of food a great deal (and/or increase their amount of energy use through things like excessive exercise). The 'binge/purge' type is where a person may not have such a high level of food restriction, but will try to control their weight through excessive exercise or purging (e.g. by self-induced vomiting, using laxatives).
Another variation of this illness is called atypical anorexia nervosa. This occurs when a person has the features of anorexia nervosa, but their weight is not really low. People with atypical anorexia nervosa may have lost weight quickly, but still be within the normal or overweight range.
Weight, shape, and body size control behaviours include things like dieting, excessive or compulsive exercise, self-induced vomiting, laxative and diuretic use, intake of diet pills and supplements, including meal Replacements, protein powders, and creatine supplements, and anabolic steroid use. These are used deliberately to try to lose weight, gain weight, alter body size or shape to be smaller, larger, or more muscular, or to prevent weight gain or weight loss. They are described as ‘unhealthy or extreme weight control behaviours’ because they cause psychological and physical health problems. Unhealthy weight control behaviours are not mental illnesses in and of themselves, but may occur as part of an eating disorder or other mental health illness.
Under some circumstances, trying to look after one’s health through diet and exercise can become unhealthy. This occurs when people are really rigid, or inflexible about the way they eat or the way they exercise. It is also unhealthy when people diet or exercise to an extreme degree. Examples of unhealthy dieting would be things like having a strict limit on how much food one can eat, like a calorie limit, or forbidding oneself to eat between meals or for long periods of time, or having strict rules about eating a lot of protein and very little fat. Examples of unhealthy or extreme exercise would be things like exercising for many hours in the day and even if it interferes with work, family, or socialising, or continuing to exercise even when injured or ill. When eating and physical activity start to be more for purposes of weight, shape, or size control, rather than pleasure and a relaxed and flexible attitude to health, it is a sign that there may be a problem.
Body dissatisfaction refers to negative thoughts and feelings about body weight, shape, or size. It is more typical for women to express concerns about being too large and wanting to lose weight or be smaller. Men typically are concerned about being too small and want to become larger and more muscular. But, some men may also want to be thinner, and some women may want to be more muscular and toned.
Body dissatisfaction is not trivial. It causes difficulties at the time it is experienced, and also has the potential to cause problems in the future. People who experience body dissatisfaction often feel distressed and have low quality of life. They may also have feelings of low self-worth because the way they value themselves is tangled up with how they feel about their body. People with body dissatisfaction describe feeling ashamed or embarrassed about their body. Some people also experience intense dislike or loathing of their body that intrudes on many aspects of their lives. For example, people may be fearful and anxious about trying to control or change their body. They may avoid social occasions because they are very worried about others’ judging how they look. They may also spend a lot of time checking their body to make sure they have not gained weight or lost muscularity. Body dissatisfaction also places people at greater risk of developing other problems like eating disorders, depressed mood, and weight gain.
People with muscle dysmorphia are highly concerned that their body is too small and not muscular and lean enough. But, they may not actually be small. They may in fact be average sized or even very muscular. To try to fix their perceived problems with their body size and muscularity, people with muscle dysmorphia often spend a lot of time working out and lifting weights. They are also often very focused on what they eat to try to promote muscle growth and keep their body lean.
Muscle dysmorphia can cause distress and may interfere with other aspects of a person’s life, including their social life and work life. They may give up important activities because of a need to work out and maintain a particular diet. They may also continue to work out, or use muscle building substances, including anabolic steroids, even if they know those behaviours are causing them harm.