Eating disorders

Written by Christine Webber, psychotherapist and lifecoach

What are 'eating disorders'?

The common eating disorders are:

anorexia (often called 'anorexia nervosa')

bulimia (often termed 'bulimia nervosa')

Binge eating disorder.

In the first decade of the 21st century, they appear to be getting steadily commoner in Britain. But why do they occur? The reasons are complex, and they are connected with our rather curious and ambivalent attitude to food …

Mixed messages about food

At a medical conference in 2005, one of the speakers said that 'the majority of women have a slightly odd relationship with food'. Although this seems a rather sweeping statement, most of the females in the audience promptly nodded.

Certainly, many adult women have a 'love-hate' relationship with their food. Furthermore, a lot of them manage (quite unintentionally) to pass on mixed messages about food to their children.

Listen, for example, to two female friends lunching together. If they succumb to the delights of the dessert trolley one will almost certainly say to the other: 'I shouldn't be having this.' In other words, she is indulging her pleasure, her palate and her hunger, but she's punishing herself as she does so. Most probably, her friend will say something like: Oooh yes, I shouldn't be having this either – but isn't it lovely!'

Recently, we eavesdropped on a group of three women in a pub.

The first woman - Katherine - was telling her colleagues, Suzie and Caroline, that she'd had a tummy bug the previous weekend.

'It was awful' she said. 'I felt like death. Still...'

'Yes...' encouraged Suzie.

'Well - usual compensations...'

'I bet,' agreed Caroline. 'You look great, how much weight did you lose?

'Four pounds,' said Katrina, not even bothering to conceal the note of pride that crept into her voice.'

'Gosh. Fantastic. Four pounds...' Her two companions looked and sounded envious.

Let's face it, most women understand that conversation because deep down they subscribe to the view of the late Duchess of Windsor when she said: 'You can never be too thin or too rich.'

Even those women who know how dangerous this kind of thinking is, still cling to it. And it is that very type of thought - constantly, if unwittingly, being passed on to children - which has helped to increase the feelings of ambivalence about food among women in today's society.

Skinniness means success

We live in a very 'beautiful people' kind of world where television, magazines and newspapers continually bombard us with images of extremely slim people. This is undoubtedly a bad thing, because it makes women and girls feel deep down, that slimness equates with success. Small wonder then that there is an increasing number of children as young as 11 who are on some sort of diet.

And we in Britain are not alone in our unnatural obsession with food and weight. It's interesting to note - and very sad too - that as our kind of 'civilisation' spreads to the farthest corners of the world, so the desire for the perfect body spreads too. One study found that when television reached the Fiji islands, it wasn't long before the young women there became so concerned about their figures - for the first time ever - that 15 per cent of them began to induce vomiting as a means of controlling their weight.

When does dieting become an eating disorder?

But where does dieting stop and an eating disorder begin?

Well, plenty of people who occasionally go on a diet are psychologically healthy and certainly don't have eating disorders. And there are vast numbers of adults who are carrying a stone or two more than they should, and who have nothing wrong with them except for the fact that they take in more calories than they use up.

What about the countless women who have a funny kind of love/hate relationship with food? Well, their attitudes are certainly unhelpful, but most of them don't actually develop full-blown eating disorders.

So what is an eating disorder? In a nutshell it is an outward sign of inner problems. As BEAT (formerly known as the Eating Disorders Association says: 'An eating disorder occurs when eating or not eating is used to help block out painful feelings.'

BEAT also says that without appropriate help and treatment, such difficulties may persist throughout life.

How widespread is the problem?

There is no doubt that eating disorders are on the increase. The BEAT believes that 1.15 million people in this country have a significant problem and that between 60,000 and 90,000 of those are having treatment.

Indeed the scale of the problem is such that every GP in the land is likely to have one or two anorexics among his or her patients, and no less than 18 bulimics. However, most GPs don't identify all these people as having eating disorders because of the secret nature of these conditions.

One GP told us recently: 'I have never had anyone come into my surgery and actually complain of bulimia. So it's hard work making the diagnosis.'

Quite apart from anorexia and bulimia, there is also 'binge eating'. Compulsive or binge-eating is also classed as an eating disorder but far fewer studies are done about these people. And when compulsive eaters – who are sometimes extremely overweight – do visit their doctors they are likely to be given a diet sheet rather than offered any kind of counselling which might get to the root of the problem.

But does counseling help eating disorders? In fact during the last few years, cognitive behaviour therapy (CBT) has been shown to be very useful – particularly in the treatment of bulimia nervosa and overeating.

In CBT, the person with the eating disorder is helped to address the issue behaviourally – in that he or she is asked to eat regularly and not to ban any foods and so on – but also to look at the thinking behind why they eat. There is much emphasis on addressing the thoughts that persuade us to eat. For example, if someone eats because they're miserable, she will be encouraged to challenge the idea that eating makes her happy and to find other ways of comforting herself that does not include food.

There are a number of excellent books written by CBT practitioners that are of great help to bulimics and to overeaters and some of them are listed at the end of this article.

Female or male?

When we talk of eating disorders we tend to think 'female'. But it's important to recognise that nowadays about 1 in 10 people who have an eating disorder is male. And it appears that of those men with eating disorders, 25 per cent of them are gay. It's also been discovered that the vast majority of these males, if not all of them, were bullied at school.

Causes

But why do so many people now have eating problems?

One reason appears to be poor self-esteem. Certainly many eating disorders begin when young people become convinced that if only their bodies were more perfect, they would feel better about themselves.

There are also issues of control. If young people are bullied, or even just living in bossy or super-achieving households, they can easily feel that everyone else controls them. To counter that, they seek out some way in which they can be certain of exerting some real control of their own. And many of them choose to have ultimate control of their own bodies by rigidly governing how much food they'll allow to pass their lips. The sense of power can be very elevating – at least initially – and having had this kind of excited 'fix', most young people are reluctant to relinquish it.

Another cause of eating disorders is undoubtedly media pressure at a time when a young person is feeling vulnerable and awkward. But there is some suggestion that a person's genetic make up may make them more prone to eating disorders than other folk are.

Unfortunately, some young people suffer traumatic events such as bereavement or sexual abuse in their early years and there is substantial evidence that such episodes can trigger problems with food.

Also, households where there are high academic expectations are well-known breeding grounds for eating disorders.

Finally, many young women between the ages of 14 and 25 develop an eating disorder when they are not only under stress at school or college but also uncertain of their sexual orientation or sexual attractiveness.

It's important to note however that eating disorders are not the sole province of the young and to acknowledge that there may be people well into mid-life who are seeking answers to eating difficulties.

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