Understanding Types of Eating Disorders and How to Treat Them
There is more than one type of eating disorder, but all involve issues related to your relationship with food as well as the psychological distress that accompanies those issues. It’s not about not liking food or eating, but more about having control over your body – or sometimes it involves a lack of control.
The Mental Health Foundation defines eating disorders such as anorexia nervosa and bulimia nervosa as mental health problems where a person experiences issues with their body weight and shape and engages in behaviour that will disturb their everyday diet and attitude towards food – for example, controlling the amount of food they eat.
But however, you describe it, if you’re affected by any type of eating disorder – or eating problem, as it’s sometimes referred to – it can have a significant impact on your life.
According to the eating disorders charity Beat, approximately 1.25 million people in the UK are affected by eating disorders, the majority of whom are women (estimates suggest anything between 11 and 25 per cent of eating disorder cases are found in men) (i).
Eating disorders often develop during adolescence, but you don’t have to be a teenager to be affected. In fact, Beat says some cases have developed in children as young as six years old, as well as in adults in their seventies (i).
And while many people imagine people with eating disorders as being very thin, you can’t always tell someone is affected by looking at them. Indeed, according to Beat, one study suggests up to 85 per cent of people with eating disorders aren’t underweight (ii).
What causes them?
As for what causes eating disorder, however, nobody really knows. But it’s thought that it might be a mix of genetic, biological and environment factors, often combined with a trauma or life event that acts as a trigger. For instance, you may be more likely to develop an eating disorder if any of the following apply:
You or someone in your family has a history of eating disorders, addiction or depression
You’re a perfectionist
You have low self-esteem or an obsessive personality
You suffer from a lot of stress and/or anxiety
You have a job that puts pressure on you to be slim
You’ve been sexually abused
The good news is eating disorders can be treated successfully. However, it’s important to get treatment and support as soon as possible – your GP is the best person to see if you need help for an eating disorder – as the earlier you’re diagnosed and treated, the more likely you are to make a full recovery.
If you’re worried or nervous about speaking to your doctor about an eating problem, you can try calling the Beat adult helpline on 0808 801 0677 or youth helpline on 0808 801 0711. There’s also a helpline specifically for students: 0808 801 0811.
Anorexia and bulimia
Even if you don’t know anything about eating disorders, you’ve probably heard of two of them: anorexia nervosa and bulimia nervosa.
According to Beat, the latest statistics suggest 10 per cent of eating disorders are caused by anorexia. This is a serious mental illness that tends to cause low body weight when someone doesn’t eat enough to give their body what it needs to stay healthy and produce energy (depending on their situation they may hide food or try to throw it away in secret).
Someone with anorexia may also find other ways to keep their weight low, such as vomiting or using laxatives. They often see themselves differently to how others see them, and may have a highly distorted body image, often thinking they’re much bigger than they really are. They may also develop an intense fear of gaining weight and may appear unusually defensive if anyone suggests that they should.
What are the signs?
Someone with anorexia may eat very little food or even stop eating altogether. And as they are often – though not always – underweight, they may feel cold and weak, and find it hard to concentrate.
Someone with anorexia may have hair that’s starting to thin or fall out. And while they may lose a noticeable amount of weight, it’s not always easy to spot because they may wear baggy clothes to hide their shape.
Other symptoms include depression, tiredness, low self-confidence, anxiety, loss of interest in sex, reduced bone density and muscle strength, and even if they have been diagnosed with anorexia they may underestimate how serious it is or even deny they have a problem at all. Women with anorexia may also have irregular periods or periods that have stopped altogether.
Someone with anorexia may also spend a lot or even most of their time thinking about food. They may count calories obsessively, and some also spend excessive amounts of time at the gym working out.
How is it treated?
Most cases of anorexia are treated in outpatient facilities – only severe cases where there’s a risk of physical and psychological harm or those where outpatient treatment hasn’t been successful are treated in hospital.
Talking therapies are often used to help those affected to find healthy ways of coping with whatever thoughts or feelings are behind their anorexia, and to encourage healthy eating. The most well-known of these therapies is cognitive behavioural therapy (CBT), which aims to help people manage problems by changing the way they think and behave.
Bulimia is thought to be the second most common eating disorder, with the latest statistics suggesting it causes 40 per cent of eating disorders (i). Anyone of any age can be affected, though bulimia often develops during the teenage or early adult years.
Typically, bulimia involves eating large amounts of food at the same time – called bingeing – usually when you’re feeling anxious or upset. However, this isn’t the same as overindulging every now and then, as most of us tend to eat a bit more than we should occasionally. According to Beat, people with bulimia don’t feel in control of how much or quickly they’re eating when they’re having a binge, and some even say they feel they’re disconnected from what they’re doing (iii).
With bulimia, bingeing is often followed by making yourself sick or taking laxatives – called purging – because you feel guilty or ashamed about bingeing. Other methods of purging include fasting and exercising excessively.
And as with anorexia those affected by bulimia are often obsessed with their body weight and shape, and can also have a distorted body image, seeing themselves as much bigger than they really are.
What are the signs?
People with bulimia aren’t usually underweight, and because they’re often reluctant to get any help and tend to be good at hiding their problem from others (they often eat in secret, for example), their condition can be tricky to spot. However, they often may seem low, depressed, anxious and upset, and sometimes have sudden mood swings.
People with bulimia may also get frequent sore throats or may have oral health problems if they use vomiting as a purging method, or they may complain about having stomach or digestive problems – such as irritable bowel syndrome – if they use laxatives too often. Women with bulimia may have irregular periods or periods that have stopped altogether. Other symptoms can include tiredness, feeling bloated, constipation and sometimes swelling of the hands and feet.
How is it treated?
Most treatment for bulimia takes place in outpatient services, with only those at risk of suicide or severe self-harm admitted to hospital. As with anorexia, talking therapies are often recommended, including CBT (a form of CBT has been developed specifically for bulimia cases, called cognitive behavioural therapy - bulimia nervosa, or CBT-BN).
Other eating disorders
As well as anorexia and bulimia, binge eating disorder is a common eating disorder. It can affect anyone, but the condition tends to be more common in adults than in younger people, and middle-aged people are often affected.
As the name suggests, binge eating disorder involves eating large amounts of food very quickly over a short period of time. But unlike those with bulimia, people with binge eating disorder don’t usually use purging methods after a binge.
According to Beat, binges are usually planned like a ritual and can involve special binge foods, usually eaten in private (iv). But because they have little to no control over their eating, those affected can feel guilty or disgusted with themselves. This can lead to low self-esteem, lack of confidence, depression and anxiety.
Someone with binge eating disorder may also feel stressed, anxious, embarrassed, worthless or unhappy about their body. They may eat without thinking – such as snacking in front of the TV – and regularly eat food high in sugar, fat or salt, including when they’re not hungry. They are also typical comfort eaters, turning to food when they feel stressed, upset or unhappy.
Because of the large amounts of food they eat, people with a binge eating disorder may gain a lot of weight, high blood pressure, nausea, joint and muscle pain, breathlessness and may have one or more health problems associated with being overweight (diabetes, for instance).
However, according to Beat, you may notice things like changes in behaviour and feelings in someone with binge eating disorder before any physical symptoms start to appear (iv).
Binge eating disorder treatments
The National Institute of Health and Care Excellence (NICE) recommends a treatment called guided self-help as the first step to treat binge eating disorder. According to the NHS, this often involves working through a self-help book as well as having sessions with a therapist or other healthcare professional (v).
Self-help books for binge eating disorder are designed to help you monitor what you’re eating as well as to help you find out what’s causing your binge eating behaviours. You may also learn about the things that trigger a binge eating episode, as well as how to regulate your eating and to learn how to manage your weight in a healthy way.
Other specified feeding or eating disorder (OSFED) According to the NHS this is the most common type of eating disorder, and your symptoms don’t exactly fit with the exact diagnostic criteria for anorexia, bulimia or binge eating disorder (vi). Despite this, OSFED is as serious as anorexia, bulimia and binge eating disorder.
There are different types of OSFEDs, including the following as suggested by Beat (vii):
Atypical anorexia (this presents all the symptoms of anorexia except weight remains within a normal range)
Bulimia nervosa (of low frequency and/or limited duration) (all the symptoms of bulimia, except the binge/purge cycles don’t happen as often or over as long a period of time)
Binge eating disorder (of low frequency and/or limited duration) (all the symptoms of binge eating disorder, except the binges don’t happen as often or over as long a period of time)
Purging disorder (purging to affect your weight or shape, but not a part of binge/purge cycles)
Night eating syndrome (eating repeatedly at night, either after waking up from sleep, or by eating a lot of food after your evening meal)
Signs of OSFED include preoccupation with food, eating in secret, low self-confidence and self-esteem, poor body image, irritability, mood swings, tiredness, concentration difficulties and social withdrawal.
Since there are many variations of OSFEDs, there’s no specific treatment plan, but talking therapies are often used.
Meanwhile, other less common types of eating disorder include the following:
Orthorexia (an unhealthy obsession with eating ‘pure’ food – this hasn’t yet been officially classed as an eating disorder, but it is becoming more common)
Avoidant/restrictive food intake disorder (restrictive eating but not for the purpose of losing weight or related to body image issues)
Rumination disorder (regurgitating food repeatedly before swallowing it or spitting it out – this isn’t a symptom of digestive tract disorders that cause food regurgitation)
Pica (a compulsion to eat non-food substances such as coal, earth or chalk)
If you think you may have an eating disorder, it’s important to see your GP as soon as you can. Other organisation that may provide essential support and information include:
Anorexia and Bulimia Care
Mental Health Foundation
Royal College of Psychiatrists
Eating disorders myths
Eating disorders are subject to more than their fair share of misinformation, with many myths believed to be facts. According to Beat, here are some of the most common ones:
Myth Eating disorders are just a faddy diet gone too far.
Eating disorders are serious mental illnesses that require prompt, appropriate treatment. Anorexia is the illness where people restrict the food they eat to a harmful extend. People with bulimia are rarely underweight.
You can tell by looking at someone that they have an eating disorder.
Eating disorders come in all shapes and sizes and not everyone affected will be very underweight or look ill. They are mental illnesses, so your thoughts, feelings and emotions are involved.
Eating disorders only affect impressionable girls from privileged backgrounds.
Eating disorders can affect people of any age, gender, culture, ethnicity or background. Girls and young women aged 12 - 20 are most at risk, but up to 25 per cent of cases are thought to be boys and men.
Eating disorders are a modern phenomenon.
Eating disorders were first observed and written about during the 1680s.
Eating disorders are a lifestyle choice.
People with eating disorders do not choose to be ill and they are not trying to seek attention. They can find it very difficult to believe that they are ill, and equally hard to acknowledge it once they do know.
No one ever really recovers from an eating disorder – you’ve got it for life.
Eating disorders are treatable and full recovery is possible. There can be serious long-term consequences to physical health if the conditions are not treated quickly. Some people do develop a long-term or recurrent eating disorder, but treatment is improving all the time.
People with eating disorders are just trying to look thin like their celebrity idols.
People with eating disorders typically have very low self-esteem and feel worthless. They are more likely to wish to disappear and not be noticed than want to draw attention to themselves.
Natural support for eating disorders
If you think you have an eating disorder, it’s essential to get help from a medical professional who specialises in the disorder affecting you. However, some experts believe nutritional supplements may have a part to play in the treatment of eating disorders alongside conventional treatments such as CBT.
This is because some eating disorders may cause nutritional deficiencies. According to a study by scientists in Madrid, nutrients found to be deficient in those with eating disorders include the following (viii):
Vitamin B1, B9 and B12
All of these vitamins can be found in a good-quality multivitamin and mineral supplement.
The same study suggests people with eating disorders may also be deficient in long-chain polyunsaturated fatty acids, including omega-3 fatty acids (such as those found in fish oils).
An earlier small-scale trial found some people with eating disorders may have a deficiency in vitamins B2 and B6 (ix). However, after successful treatment, their B2 and B6 levels went back to normal, the researchers claim.
Meanwhile, experts from the Vincent Square Eating Disorder Service in London recommend that people with eating disorders who are in the anorexic weight range – that is, if they have a BMI of 17.5 or less – should be prescribed a multivitamin supplement, a vitamin B1 supplement and a combined calcium and vitamin D supplement (x). This, they say, is because people who are underweight have, in general, a poor nutritional status.
Available online: https://www.beateatingdisorders.org.uk/types/bulimia
Available online: https://www.beateatingdisorders.org.uk/types/binge-eating-disorder
Available online: https://www.nhs.uk/conditions/binge-eating/treatment
Available online: https://www.nhs.uk/conditions/eating-disorders
Available online: https://www.beateatingdisorders.org.uk/types/osfed
Diaz-Marsa. M., Alberdi-Paramo. I., Niewll-Galmes. L. Nutritional supplements in eating disorders. Actas Esp Psiquiatr. 2017 Sep. 45(Supplement):26-36. Available online: https://www.actaspsiquiatria.es/repositorio//suplements/19/ENG/19-ENG-678040.pdf
Rock. C.L., Vasantharajan. S. Vitamin status of eating disorder patients: relationship to clinical indices and effect of treatment. Int J Eat Disord. 1995 Nov. 18(3):257-62. Available online: https://www.ncbi.nlm.nih.gov/pubmed/8556021
Information for healthcare professionals – Advice for GPs regarding supplement prescription in anorexia nervosa. Available online: https://www.cnwl.nhs.uk/vincent-square/further-information-resources/information-sheets
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.