Eating Disorders

Eating disorders are complicated illnesses that are not ‘simply’ about food. They can be a way for people to cope with feelings that they find too difficult to deal with directly. They can also begin as a result of trying to meet societal pressures to look a certain way. Eating disorders are a serious threat to mental and physical wellness.

• What are the different types of eating disorders?
• What are some warning signs of an eating disorder?
• Who can develop an eating disorder?
• What causes eating disorders?
• Are there other mental health issues that accompany eating disorders?
• What are the effects of eating disorders?
• Can eating disorders be prevented?
• Where can I find out more about eating disorders?
• Where can I get treatment for myself and/or my family members?

What are the different types of eating disorders?

The most commonly known eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder/compulsive overeating. Click here for definitions of these disorders.

However, you may be struggling with feelings about your body or your use of food even if you don’t ‘fit’ into these descriptions. There is overlap between various disorders and it is common for people to have different types at different times. In fact, the most frequent diagnosis is for Eating Disorders Not Otherwise Specified (ED-NOS), which is for eating disorders that don’t fit neatly into a specific category. Click here for information on the less well known eating disorders.

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What are some warning signs of an eating disorder?

Warnings signs of an eating disorder include:

• cycles of gaining or losing large amounts of weight
• preoccupation with food, dieting, weight and shape
• avoiding food even when hungry
• feeling guilty and ashamed of eating
• being secretive about eating
• feeling out of control when eating
• feeling better when restricting eating
• feeling fat even though others disagree
• feeling worthless when thinking about body and weight
• feeling that happiness will not be achieved without reaching ‘ideal’ weight
• not liking to eat with other people
• irregular menstrual periods, cessation of menstruation or notable changes
• “getting rid” of food by using laxatives, exercising vigorously or self-induced vomiting
• abrasions on knuckles from self-induced vomiting

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Who can develop an eating disorder?

Anyone can develop an eating disorder. While teenage girls are particularly at risk, these disorders also occur in younger boys and girls, teenage boys and adult men and women. In fact, professionals who work in this area are reporting an increase in the number of middle aged women and men of all ages who are struggling with eating disorders.

General information on who can get eating disorders:
Anorexia Nervosa and Related Eating Disorders, Inc.

Articles on Eating Disorders and Men:
Eating Disorders Association (Note: this document is in pdf format. You must have Adobe Acrobat installed on your computer to read this document. If you do not have Adobe Acrobat, click here for a free download.)

Articles on Eating Disorders and Mid-Life Women:
Canadian Women's Health Network
Eating Disorders Resources
Mayo Clinic

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What causes eating disorders?

No one is sure about exactly what causes eating disorders, and experts agree that there is no one cause. Rather, there are a whole range of factors (ex: individual genetics and psychological make up, social pressures and family/individual stresses) that combine to result in an eating disorder for some individuals. Eating disorders are also widely viewed as ways that people cope with painful underlying emotions.

The following are some of the factors that may combine to make certain people vulnerable to the onset of an eating disorder.

Dieting

Dieting is the number one contributing factor to the development of an eating disorder. While not everyone who diets will develop an eating disorder, almost every eating disorder begins with a diet. When individuals do not allow themselves to eat certain foods or enough food, this creates physiological and emotional responses which often lead to feelings of being out of control. Typical responses to this feeling are to either binge or to be afraid to begin eating due to a fear of not being able to stop.

Personal factors

There are a number of personal factors that tend to be present in individuals who have eating disorders. These include:

• having low self esteem and being very self-critical
• experiencing depression and/or anxiety
• being very self-conscious and sensitive to others opinions
• having high expectations of self and others, or the tendency to be a perfectionist
• struggling with fears about sexuality
• feeling unprepared for adulthood
• having difficulty with problem-solving, coping and decision-making
• experiencing relationship problems
• dealing with trauma (ex: death of a loved one, abuse issues)
• having difficulty adjusting to body changes (ex: puberty, pregnancy, menopause)
• experiencing difficulties with life transitions (ex: puberty, parenthood, midlife, divorce)

Social/cultural factors

There are a number of social factors that may combine with other factors to place pressure on individuals to pursue an unrealistic body type. For example:

• We live in a society where ‘thinness’ is equated to happiness and life satisfaction – and conversely, any amount of overweight is equated with negative personality traits such as laziness and a lack of self-discipline.
• Many of the diagnostic criteria for eating disorders are normalized in our culture through media, the diet and exercise industry, and peer groups. (ex: fear of weight gain, extreme weight loss diets that omit food groups, binge eating, exercising excessively).
• There are a number of sports and other activities where weight and shape are central concerns for coaches/instructors and participants (ex: dance, gymnastics, competitive swimming, weightlifting, wrestling, team sports, modeling).
• As a society, we have lost our instinctive understanding of the connection between hunger and food. We have replaced this with other connections (ex: social times and food, emotions and food).

Biological/genetic factors

Recent research suggests there may be biological or genetic factors that affect the risk of developing an eating disorder. It is not uncommon for individuals with eating disorders to have a family history of:

• eating disorders
• depression
• anxiety
• obsessive compulsive disorder
• addictions

This evidence strongly suggests that there is a biological or genetic component to the illness, and researchers are currently studying this.

Family factors

There are several family characteristics that, in some individuals, may contribute to the development of an eating disorder. For example:

• Family members may place a high value on appearance and have a preoccupation with their weight, and they may model dieting behaviour and/or restrictive eating in the home.
• In striving to be the perfect family, family members may engage in conflict avoidance and/or the denial of conflict.
• The presence of family conflict or trauma may contribute to an individual’s vulnerability of developing an eating disorder.
• A history of emotional, physical or sexual abuse has also been identified in the family background of some individuals who have developed an eating disorder.
• Parental difficulty encouraging and facilitating their children’s shift to independence may trigger a pre-existing vulnerability.

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Are there other mental health issues that accompany eating disorders?

Individuals who have an eating disorder may have at least one other mental health issue, including:

• major depression
• anxiety disorders
• substance abuse/dependence
• obsessive and compulsive symptoms
• personality disorder

In order to be effective, treatment needs to address all mental health issues.

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What are the effects of eating disorders?

Eating disorders may result in physical damage. Left untreated, they may even be life threatening.

Individuals with anorexia can damage their heart, liver and kidneys due to not eating enough.

Physical effects may include:

• swollen joints
• Brittle bones/osteoporosis (risk to bone fractures)
• Seizures do to hypoglycemia (low blood sugar)
• Brain tissue loss (memory and attention altered)
• Hormone shifts (loss of fertility)
• hair can fall out and fingernails break off
• Drop in core body temperature
• soft hair called lanugo grows all over the skin (attempt of body to keep warm)
• cessation of menstrual periods
• abdominal pain/cramping
• irregular bowel patterns
• severe malnutrition
• increased risk of cardiac problems
• death due to medical complications (ex: sudden cardiac arrest)
  

Physical issues associated with bulimia may include:

• lesions and/or perforations of the esophagus
• damage to the stomach and kidneys due to vomiting
• damage to the intestinal tract and kidneys from habitual laxative use
• constipation and bowel paralysis from laxative abuse
• tooth decay due to the acids that come up into the mouth while vomiting
• cessation of menstrual periods (risk to osteoporosis)
• loss of the potassium which can contribute to heart problems and death
  

Individuals with Binge Eating Disorder/Compulsive Overeating may often be significantly overweight because of the amount of food eaten. Physical difficulties include:

• menstrual irregularities
• diabetes
• high blood pressure
• high cholesterol
• osteoarthritis
• decreased mobility
• shortness of breath
• heart disease
• liver and kidney problems
• cardiac arrest and/or death

There are also emotional difficulties that result from living with an eating disorder. Because of the secretive nature of the illness, individuals may:

• become withdrawn and less social
• experience severe mood swings
• have trouble with sleep disturbance
• experience feelings of guilt
• feel depressed or suicidal

Also, while eating disorders frequently begin as a way of alleviating anxiety and feeling more in control, the obsessive nature of rituals around food and eating or not eating may increase anxiety levels and feelings of being out of control.

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Can eating disorders be prevented?

While there is no ‘magic solution’, there are definitely preventive measures that parents, coaches and other adults can take to alleviate the weight and shape pressures children face as they grow up. For example:

• avoid equating thinness with happiness, competence and success
• avoid linking attractiveness with body size
• promote and celebrate diversity
• praise your children for what they do, not how they look
• celebrate and praise children’s strengths, abilities and talents
• encourage involvement in activities that help children to feel good
• ask your children to make a list of their positive attributes not related to body or appearance
• avoid comments on weight, shape and size
• do not allow teasing or nicknames that are related to weight
• avoid focusing too much on weight, calories or food
• encourage healthy food choices that will provide energy
• allow children to eat when they are hungry and to stop eating when they are full
• do not make children keep eating until every bite is gone
• do not talk in terms of losing weight or being thin, but encourage a healthy body image by focusing on helping children feel strong and energetic
• help children to become good problem solvers, and to make their own decisions and choices wherever possible
• increase children’s critical awareness of the unrealistic images that are often provided in the media, and monitor what media messages your children are reading and hearing

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Where can I find out more about eating disorders?

The following are some websites that provide information on body image, disordered eating and eating disorders:

• National Eating Disorder Information Centre (NEDIC) or toll free 1-866-633-4220
• Anorexia Nervosa and Related Eating Disorders Inc. (ANRED)
• Eating Disorder Association (UK)
• Mirror-Mirror

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Where can I find information about preventing eating disorders?

Assiniboine Body Image Network (Southwestern Manitoba, outside of Brandon)
The Assiniboine Body Image Network is made up of professionals from a variety of backgrounds. The network shares resources and is involved in health promotion, education and prevention programs regarding weight and body image concerns to various audiences in the Assiniboine Regional Health Authority. For more information, phone 1-204-571-2950.

Boundary Trails Public Health Department (Winkler/Morden)
Lending library accessible to individuals and family members seeking information on disordered eating/eating disorders. For more information call 1-204-331-8832.

Canadian Mental Health Association – Eating Disorders Self-Help Program (Winnipeg)
The Eating Disorders Self-Help Program offers public awareness, education, advocacy and self-help groups for individuals and family members. They also have print resources available on the prevention and intervention of eating disorders/disordered eating. For more information, go to www.eatingdisordersselfhelp.ca or phone 1-204-953-2358.

Committee on Disordered Eating (Winnipeg)
The Committee on Disordered Eating (CODE) provides public education and awareness around disordered eating and eating disorders, and is involved in health promotion/prevention strategies for all age groups. For more information, e-mail ewatson1@wrha.mb.ca or phone 1-204-940-2653.

Klinic’s Teen Talk Program (Across the province)
Teen Talk delivers 14 different workshops throughout Manitoba, all of which include the themes of body image, self-esteem and identity – and one workshop that is specifically about body image and self-esteem. For more information, go to www.teen-talk.ca or phone 1-204-784-4010.

Women’s Health Clinic (Winnipeg and some rural areas)
The Women’s Health Clinic (WHC) provides community education for Grades 4-S4 on healthy body image/weight preoccupation and self-esteem. WHC also provides information packages on Eating Disorders and Health At Every Size. For more information, go to www.womenshealthclinic.org or phone 1-204-947-1517.

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Where can I get treatment for myself and/or my family members?

Manitoba Health has compiled an inventory of treatment resources in Manitoba, organized by regional health authority.