Eating disorders

Key points about eating disorders

  • An eating disorder is an overall term for a number of conditions that involve eating in a disordered way.
  • The most common eating disorders are anorexia, bulimia and binge eating disorder.
  • Women are more likely to develop an eating disorder, but anyone of any age may develop one.
  • The causes of eating disorders are complex and don't involve just one factor.
  • Getting support is crucial to recovery, so seek help sooner than later.
  • With treatment, most people with an eating disorder make a good recovery, although it may take several years. 
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An eating disorder is one of a number of conditions that involve disordered eating patterns. The person affected tends to be focused on their weight and body shape.

The most common eating disorders are anorexia, bulimia and binge eating disorder. 

A new category of eating difficulties is avoidant restrictive food intake disorder (ARFID)(external link)(external link). This is different from other eating disorders as it involves a disinterest in food for reasons other than a preoccupation with weight and shape. 

There are lots of myths about eating disorders such as:

  • Myth # 1: You can tell by looking at someone that they have an eating disorder
  • Myth # 2: Families are to blame
  • Myth # 3: Mothers are to blame
  • Myth # 4: Eating disorders are a choice
  • Myth # 5: Eating disorders are the province of white upper-middle class teenage girls
  • Myth # 6: Eating disorders are benign
  • Myth # 7: Society alone is to blame
  • Myth # 8: Genes are destiny
  • Myth #9: Eating disorders are for life

Disordered eating refers to when you no longer have the usual habits of eating that most people have. This can affect how often you eat, how much you eat, the type of food you eat, how flexible you are around your eating habits and whether you experience pleasure in eating. Depending on the eating disorder, it may involve severe avoidance of eating or purging (getting rid of) food you have eaten.

If you no longer have a sense of what is normal eating, you can read about healthy eating basics.

Eating disorders happen because of a combination of factors. These factors can be biological (the way your brain works), genetic (things your inherit), psychological (how you think), social (your relationships with other people) or cultural (the customs and values of the people around you). 

Eating disorders can affect any age or gender; however, women are more often affected, particularly younger women.

Anorexia and bulimia can develop at any stage in life, but most often occur during adolescence and early adulthood. Binge eating disorder can occur at any time, but can often start in mid-adulthood. Avoidant restrictive food intake disorder is likely to start in childhood. Any of these disorders can have a serious impact on your health.

People at risk of an eating disorder often have experienced the following:

  • having feelings of low self-esteem or worthlessness
  • living in a western culture in which being thin is considered the ideal body shape
  • living in an urban area
  • taking part in activities in which body image is a concern (eg, professional or competitive dancing, gymnastics or fashion modelling)
  • having a history of strict dieting and body dissatisfaction
  • having lived in an environment in which leanness or obesity has been a concern
  • experiencing depression or loneliness
  • being a perfectionist or impulsive, or having difficulty managing emotions
  • migrating from a developing country to a western culture
  • experiencing stressful life changes (eg, leaving home to go to university, a relationship breakup or the physical bodily changes of puberty)
  • having experienced physical, emotional or sexual abuse.

Self-care and getting support from others is vital in recovering from an eating disorder and feeling happy again. If eating disorders are not treated, they can result in serious medical problems, so seek help sooner than later. 

Start by talking to your GP as they can refer you to an eating disorder specialist who understands what you are going through and knows how to help you. Find out more about eating disorder services in New Zealand(external link).

It also helps to learn about your condition. Read more aboutanorexia, bulimiabinge eating disorder(external link) and avoidant restrictive food intake disorder(external link).

Video: Disorder, is an M-rated intimate insight into the perspectives of people who have lived with disordered eating.

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The Outlook for Someday(external link), NZ, 2018

If your doctor thinks you most likely have an eating disorder, they will refer you to an eating disorder specialist or service. Most services that treat people with eating disorders bring together a team of different healthcare professionals, including psychiatrists and other doctors, psychologists and dietitians. Some treatment is publicly funded.

Treatment for eating disorders involves healthy eating, together with medical care and psychological treatment. You may need to learn how to manage your feelings in a different way. Some people might also be prescribed medications.

Most people with eating disorders have mainly outpatient treatment, but you may need to go to hospital for treatment if you are at risk of serious medical problems. With treatment, most people with an eating disorder make a good recovery, although it may take several years.

Learning how to take good care of yourself and manage your emotions is key to recovering from an eating disorder. The following steps can help you on your road to recovery. 

  • Learn about eating disorders to help you make sense of how you feel.
  • Seek help early. The longer you leave it, the harder it is to get well.
  • Make a decision to recover: see your doctor and get the treatment you need.
  • Don’t be so hard on yourself – seek support and learn strategies to help you deal with difficult emotions and thoughts.
  • Learn about nutrition and develop a healthy relationship with food.
  • Learn ways to improve your body image – self-acceptance and kindness to yourself are important to help you recover.
  • Feeling good about yourself is key – make time for pleasurable activities and spend time with people who can boost your mood.

Are you concerned a friend may have an eating disorder? How can you be sure and what can you do or say?

Eating disorders such as anorexia or bulimia are serious medical conditions, which can be fatal if left untreated. If you’re approaching a friend about a suspected eating disorder, remember to do so in a caring, non-judgemental way. 

Many people with eating disorders say they are fine and just want everyone to leave them alone. However, in reality, they may be feeling scared and isolated and unsure how to stop the eating disorder from controlling their life. They can put a lot of effort into hiding the condition, so it can be difficult to diagnose. But the earlier a diagnosis is made, the better the chance is of recovery.

Here are our top five tips for supporting a friend with an eating disorder.

1. Know your facts

Before you talk to your friend, it's helpful to have read up on eating disorders and know your facts. For example, there are different types of eating disorders, symptoms and possible causes.

2. Be kind and non-judgemental

The last thing a person with an eating disorder wants is to feel judged. They may already be feeling alone, confused and ashamed. Knowing they have a friend who cares and who will listen is often the first and most important step in helping them on the road to recovery. Try to use language that isn’t critical or judgemental and be compassionate.

3. Be honest

Being honest about your concerns shows your friend you care. While it may be a conversation you are nervous to have, it’s an important one that may be life-saving. It helps to pick a time and location where you can talk face-to-face in private and your friend is feeling comfortable and relaxed.

4. Encourage them to seek professional help

The most important thing you can do, apart from letting your friend know you’re there to help, is to encourage them to seek professional help. The longer an eating disorder is left untreated, the harder it is on their body and mind to recover. Encourage them to see their GP, who can provide a diagnosis and advice on where to get further help. 

5. Keep supporting them

Be aware your friend may become defensive or angry and even try to deny they have a problem. You can’t force somebody to seek help, especially if they’re an adult, so just keep letting them know you’re there to support them. And once they do seek professional help, keep supporting them throughout their journey to recovery.

Remember, if your friend’s health or life is at risk, then seek medical advice immediately. 

EDANZ(external link)(external link) Help, support and understanding for people with eating disorders and their families
FEAST(external link)(external link)  For parents of children with eating disorders
Eating Disorders Carer Support(external link)(external link) (Facebook page) EDCS supports and represents parents/whānau and carers of people who have eating disorders
Just a thought(external link)(external link) NZ
Togetherall(external link)(external link) UK
Eating Disorders Anonymous(external link)(external link) US

Disordered eating(external link)(external link) Centre for Clinical Interventions, Australia
Body Image and Body Dissatisfaction(external link)(external link) Centre for Clinical Interventions, Australia
Self Help Resources for Mental Health Problems(external link)(external link) Centre for Clinical Interventions, Australia
Eating disorders(external link) Mental Health Foundation, NZ
Maudsley Parents(external link)(external link) US (for parents of children with eating disorders)
Information for parents, caregivers, family and whanau(external link)(external link) Tupu Ora Starship Inpatient Eating Disorders Service

Resources

Note: Some of these resources are from overseas so some details may be different. In New Zealand, ring 111 for emergencies, or Healthline 0800 611 116.

References

  1. Eating disorders(external link) Royal Australian & NZ College of Psychiatrists, 2015
  2. Normal eating vs disordered eating(external link) Centre for Clinical Interventions, Australia, 2018

Clinical guidelines

Hay P, Chinn D, Forbes D, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders(external link). Aust N Z J Psychiatry 2014;48:977–1008
Managing frequently encountered mental health problems in young people – non-pharmacological strategies(external link) BPAC, NZ, 2015

See our page Long-term conditions for healthcare providers

Other resources

Management of eating disorders(external link) Starship Children’s Hospital, NZ, 2021
Eating disorders – recognition and treatment(external link) NICE, UK, 2017
Classifying eating disorders – DSM 5(external link) Eating Disorders Victoria, Australia, 2016
Eating disorder services(external link) Healthpoint, NZ
Scoff questionnaire, Inside Out(external link) The SCOFF Questionnaire is a brief five-question screening tool validated for use in specialist and primary care settings.

Continuing professional development

E-learning

Professional development(external link) National Eating Disorders Collaboration, Australia
Eating disorder core skills – eLearning for GPs(external link) National Eating Disorders Collaboration, Australia
Eating disorders(external link) Goodfellow e-Learning, 2019
Eating disorders – core skills for GPs' e-learning(external link) Whāraurau, NZ

Webinar

Does your patient have an eating disorder?(external link) (Goodfellow Unit Webinar, NZ, 2018)

Brochures

what are eating disorders

What are eating disorders?(external link)

Centre for Clinical Interventions, Australia, 2018

normal eating vs disordered eating

Normal eating vs disordered eating(external link)

Centre for Clinical Interventions, Australia, 2018

eating disorders what are the risks

Eating disorders – what are the risks?(external link)

Centre for Clinical Interventions, Australia, 2018

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Michelle Meiklejohn, Clinical psychologist

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