Eating disorders: key facts

What are eating disorders?

Many ‘eating styles’ can help us to stay healthy - but some are driven by an intense fear of becoming fat. These can damage our health and are called eating disorders. The two most common problems are Anorexia Nervosa and Bulimia Nervosa. We describe them separately here, but the symptoms are often mixed.

Who gets eating disorders?

They are 7 to 10 times more common in women than in men.

What causes eating disorders?

We do not know for certain, but important factors include: 

• Control - losing weight can make us feel good and in control.
• Longstanding unhappiness which may show itself through eating.
• Puberty - anorexia reverses some of the physical changes of puberty. You can see it as putting off some of the challenges of becoming an adult.
• Family - saying “no” to food may be the only way you can express your feelings.
• Depression - binges may start off as a way of coping with unhappiness.
• Low self-esteem.
• Social pressure - Western culture, particularly the media, idealises being thin.
• Genes may play a part.

Types of eating disorders

• Anorexia Nervosa - signs and symptoms

• increasingly worrying about your weight
• eating less
• exercising more
• being unable to stop losing weight, even when you are below a safe weight
• using laxatives or other tablets to help you lose weight 
• smoking and chewing gum to keep your weight down
• losing interest in sex.

In women, periods become irregular or stop.

In men and boys, erections and wet dreams stop and testicles shrink.

When does it start? Usually in the teenage years, but it can start at anytime.

Anorexia nervosa is a dangerous condition which can lead to serious ill health and even death.

• Bulimia Nervosa - signs and symptoms

• worrying more about your weight
• binge eating
• make yourself vomit and/or use laxatives
• have irregular periods
• feel guilty about your eating pattern, but stay a normal weight.

When does it start?  Often in the mid-teens. But people don't usually seek help for it until their twenties because they are able to hide it.

• Binge Eating Disorder

This involves dieting and binge eating, but not vomiting. It is distressing, but not as harmful as bulimia. Sufferers are more likely to become overweight.

Treatments that can help

Your GP may refer you to a specialist counsellor, psychiatrist or psychologist. Your eating disorder may have led to physical problems and some physical illnesses can mimic anorexia - so get a physical health check.

• Treatments for anorexia

Psychotherapy or counselling -  talking to a therapist about your thoughts and feelings can help you to understand how the problem started, and how you can change the ways you think and feel about things. It can be upsetting to talk like this, but a good therapist will help you to do this in a way which helps you to cope better and to feel better. They will also help you value yourself more, and rebuild your sense of self-esteem.

Advice and help with eating -  a dietician may talk to you about healthy eating. They are experienced in talking about these experiences sensitively and will discuss them with you when you are ready. They may also advise you about vitamin supplements.

Psychiatric support - a specialist will discuss with you when the problem started and how it developed. You will have your weight measured and will have a physical examination. Although this can be difficult for someone with anorexia, it will only be done with your permission and with time for you to prepare for it. With your permission, the specialist might want to talk with your family or a friend to see what light they can shed on the problem. Medication is not usually prescribed for anorexia alone, but it may be given for other symptoms, such as obsessive compulsive disorder and depression.

Hospital admission - this may be an option if you have lost so much weight that it is making you ill.

Compulsory treatment - this only happens if someone is so unwell that their life or health is in danger or they cannot make proper decisions for themselves and need to be protected.

How effective is the treatment? More than half recover well, although it can take a long time.

• Treatments for bulimia

Psychotherapy

• Cognitive Behavioural Therapy (CBT) - this can be done with a therapist, a self-help book, in group sessions, or with a computer programme. CBT helps you to look at the links between your thoughts, feelings and actions.
• Interpersonal Therapy - this is usually done with an individual therapist. This treatment focuses on your relationships with other people.

Eating advice - this helps you to get back to regular eating, without starving or vomiting.

Medication - antidepressants can reduce the urge to binge. Unfortunately, without the other forms of help, the benefits wear off after a while.

How effective is the treatment? About half of sufferers recover. Recovery usually takes place slowly over a few months or many years.

How to help yourself

• Keep a diary of what you eat, your thoughts and feelings. This can help to identify links between how you feel, think and eat.
• Try to be honest with yourself and with others. Remind yourself that you don’t always have to be achieving things – let yourself off the hook sometimes.
• Know what weight is best for you and why that is.
• Challenge eating patterns and look to ways you can improve how you look at your body.
• Think about joining a self-help group and contact Beat, the eating disorders association which helps adults and young people in the UK beat their eating disorders.

How other people can help you

• Talking with your family and friends can help them to understand what you are experiencing.
• Having support from people around you will help and you may want to monitor your behaviour to make you more aware.

For more in-depth information see our main leaflet: Anorexia and Bulimia

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Dr Sophie Swinhoe

© March 2016. Due for review: March 2019. Royal College of Psychiatrists.

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