Physical health is connected to mental and emotional health.
Taking care of your body is a powerful first step towards mental and emotional health. The mind and the body are linked. When you improve your physical health, you’ll automatically experience greater mental and emotional well-being. For example, exercise not only strengthens our heart and lungs, but also releases endorphins, powerful chemicals that energize us and lift our mood.
The activities you engage in and the daily choices you make affect the way you feel physically and emotionally.
- Get enough rest. To have good mental and emotional health, it’s important to take care of your body. That includes getting enough sleep. Most people need seven to eight hours of sleep each night in order to function optimally.
- Learn about good nutrition and practice it. The subject of nutrition is complicated and not always easy to put into practice. You will feel better if you learn about what you eat, how it affects your energy and mood, and practice healthy eating habits.
- Exercise to relieve stress and lift your mood. Exercise is a powerful antidote to stress, anxiety, and depression. Look for small ways to add activity to your day, like taking the stairs instead of the elevator or going on a short walk. To get the most mental health benefits, aim for 30 minutes or more of exercise per day.
- Get a dose of sunlight every day. Sunlight lifts your mood, so try to get at least 10 to 15 minutes of sun per day. This can be done while exercising, gardening, or socializing.
- Limit alcohol and avoid cigarettes and other drugs.
What are Eating Disorders?
The term ‘eating disorder’ refers to a complex, potentially life-threatening condition, characterised by severe disturbances in eating behaviors.
Eating disorders can be seen as a way of coping with emotional distress, or as a symptom of underlying issues.
- Eating disorders are not primarily about food
- People can and do recover
- Eating disorders can affect anyone
Eating disorders are characterised by a variety of disordered eating behaviors such as:
- Self-starvation - by fasting and/or food restriction
- Purging - by self-induced vomiting, over-exercising, or laxative abuse
- Bingeing - by consuming quantities of food beyond what the body needs to satisfy hunger
An eating disorder can be very destructive, both physically and emotionally, and people can get trapped into the destructive cycle of the eating disorder without knowing how to cope with it.
An eating disorder is not just about food and weight, but also about a person’s sense of who they are.
Treatment of an eating disorder will require attention to both the physical and the psychological/emotional aspects of the person. Treatment must always include respect for and sensitivity for the overall well-being of the person.
The distress of a person experiencing an eating disorder, whether or not it is acknowledged, may have a considerable impact on family and friends.
What Is Anorexia Nervosa?
Anorexia Nervosa is an eating disorder characterised by the deliberate refusal to eat enough to maintain a normal body weight. As a result, both the body and the mind are starved of the nutrients needed for healthy, balanced functioning. Though anorexia is a serious illness which can be fatal, full recovery is possible with appropriate support and treatment.
Although the word 'anorexia' literally means loss of appetite, this does not accurately describe what a person experiences. Appetite is suppressed rather than lost and an intense interest in food is retained. Self-starvation and weight loss/control represent an attempt to feel more in control of one's life and gives the person a much needed sense of effectiveness and achievement. Restriction of food intake often begins with the gradual elimination of high calorie foods from the diet. A sudden preference for a vegetarian diet may form part of the pattern. At first, this can resemble a normal diet or lifestyle choice but the relentless drive behind the behaviour becomes more and more obvious as the disorder progresses. Other means of maintaining low body weight might include fasting, excessive exercise, self-induced vomiting, the use of laxatives, diuretics or appetite suppressants.
Anorexia nervosa can affect both males and females of all ages. It is most common amongst girls and young women. Around 10% of people with anorexia are male (see Eating Disorders in Men). Many factors combine to make any one person more vulnerable to anorexia than another and these factors vary from person to person. Anorexia is not primarily about food and weight issues or about 'slimming'. As with all eating disorders, the psychological issues and emotional distress underlying the physical symptoms must be addressed for long-term recovery to be possible.
- Restriction of food intake.
- Intense fear of putting on weight. This fear is not lessened by weight loss.
- Preoccupation with body weight, size and shape. Self-evaluation and self-esteem become increasingly linked to these.
- Perception of body shape and size are disturbed (body image distortion). Even an obviously emaciated body is experienced as fat.
- Disruption of hormonal balance. In women and adolescent girls the menstrual cycle is upset: periods become irregular and eventually cease (amenorrhoea). In men there can be a loss of libido. In pre-pubertal children growth can be disrupted and sexual development can be delayed.
Other Signs & Symptoms
Physical signs and symptoms:
- Over-activity and excessive exercising.
- Increased sensitivity to cold.
- Poor circulation.
- Bloating of stomach, fluid retention.
- Constipation and abdominal pain.
- Restlessness, inability to settle.
- Difficulty sleeping, tiredness.
- Dry, thinning hair.
- Dry, discoloured skin.
- Growth of fine, downy hair (lanugo) on the face and body resulting from the body's efforts to keep warm.
- Loss of periods.
- Decreased interest in sex.
Psychological and social signs and symptoms:
- Low self-esteem.
- Irritability and mood swings.
- Difficulty resolving conflict.
- Social isolation.
- Difficulty coping with change and frustration.
- Inflexible 'black or white'/ 'right or wrong' thinking.
- Obsessive and/or compulsive behaviour.
Food related signs and symptoms:
- Rigid, limited diet.
- Frequent weighing.
- Excessive thinking and talking about food and related issues.
- Lying about food intake, claiming to have already eaten or to have plans to eat elsewhere.
- Chasing food around the plate, taking a long time over meals.
- Cooking for others.
- Reading and collecting recipes.
- Rituals around food and eating.
- Increased use of spices, condiments, chewing gum.
- Increased consumption of fluids.
- Episodes of bingeing or perceived overeating.
- Secret disposal of food.
Most symptoms will reverse with weight gain and normalisation of diet and eating habits.
Health Consequences of Anorexia Nervosa
In order to deal with the effects of starvation, the body is forced to slow down all its processes and to find ways of conserving energy. The physical effects of starvation include:
- Dehydration -> risk of kidney failure.
- Muscle weakness -> risk of muscle loss.
- Tiredness and overall weakness -> risk of fainting.
- Abnormally slow heart rate and low blood pressure produces changes in the heart muscle -> risk of heart failure.
- Loss of bone density resulting in dry, brittle bones (osteoporosis) -> risk of postural problems and risk of fracture.
Starvation also affects a person's thinking and behaviour. Poor nutrition and dehydration produce changes in brain chemistry. It is thought that these changes in brain chemistry contribute to sustain the distorted thinking, disturbed perception and obsession with food associated with anorexia. Intellectual ability can also be affected resulting in reduced concentration, poor memory, difficulties with abstract thinking, problem solving, decision making and planning. In some cases, these changes can also increase vulnerability to depression, anxiety and other psychiatric disorders such as obsessive-compulsive disorder. If the depression is severe, there is a risk of suicide.
Other means of weight control such as self-induced vomiting, use of laxatives or diuretics and excessive exercise can also have very serious health consequences and can have a significant impact on a person's capacity to function effectively.
Bone health needs to be monitored and advice should be sought from a professional on how best to manage nutrition and exercise to facilitate the restoration of bone health. A DEXA scan will give a clear assessment of bone density and indicate what kind of treatment is required and how best to protect oneself against further loss.
Anorexia is a serious disorder and should not be left untreated. Both the physical and the psychological aspects of the disorder should be assessed and monitored. Treatment will vary according to the individual. See our Treatment Options & Medical / Counselling sections for further information. A GP can assess and monitor physical aspects of the disorder. Individual psychotherapy and family therapy can be useful in addressing the psychological problems relating to personal effectiveness and interpersonal problems that may be underlying the disorder. Nutritional counselling can increase a person's understanding of how their diet and eating patterns are affecting them physically, mentally and socially. Support groups and other support services can help to break social isolation and encourage recovery.
Some people may require hospitalisation.
The time needed for recovery from anorexia nervosa varies according to each individual.
Because of the nature of the disorder, a person with anorexia may have difficulty admitting to the seriousness of the risks to their physical and their mental health. The prospect of recovery can be very frightening and resistance to treatment is normal. This may have the effect of delaying appropriate treatment and can cause severe distress for carers and family members. Carers should seek information and support for themselves to increase their understanding of the disorder and their ability to help. Attending a support group for family and friends can be helpful.
Further information can be found in the books listed on our Booklist and from other websites for eating disorders and related issues. See our list of Websites or contact the Bodywhys Helpline: lo call 1890 200 444
What Is Bulimia Nervosa?
Bulimia nervosa is characterised by repeated episodes of binge-eating followed by behaviour aimed at compensating for the out of control eating. These compensatory behaviours can include fasting, self-induced vomiting, the use of laxatives and diuretics or appetite suppressants and excessive exercising.
In many cases, bulimia begins with a diet but the preoccupation with food and weight becomes obsessive and can take over the person's life. Eventually, they will become locked into a compulsive cycle of bingeing and purging (getting rid of the food) or resorting to other ways of preventing weight gain. Attempts to break the cycle often fail. The person begins to feel more and more out of control. Self-esteem is very low as it is measured against the ability to control one's eating, weight, shape and size. On the outside, a person with bulimia may seem very capable, positive, successful and on top of things. However, on the inside, they may be struggling desperately with feelings of guilt, shame, self-loathing and ineffectiveness.
For some people, bulimia develops after a period of anorexia. In such cases, diagnosis is not always clear-cut and treatment can be more complex.
Many people with bulimia maintain a normal body weight. As a result, the disorder can sometimes go unnoticed and untreated for a long time. The longer the binge-purge cycle remains in place, the harder it becomes to overcome it.
- Repeated episodes of binge eating, i.e. eating larger than normal quantities of food in a short space of time.
- Compensating for binges - this can take the form of purging or getting rid of the food by vomiting or using laxatives. Other means of trying to ensure there is no weight gain include periods of fasting or dieting, exercising and using diuretics.
- Preoccupation with body weight, shape and size.
- Self-evaluation is influenced significantly by body weight, size and shape.
- Hormonal disturbance including irregular menstruation.
Other Signs & Symptoms
Physical signs and symptoms:
- Frequent changes in weight.
- Lethargy, tiredness and insomnia.
- General digestive problems (cramps, wind, constipation, diarrhoea)
- Poor skin condition.
- Headaches, tension.
- Sore throat and mouth ulcers, husky voice.
- Calluses on fingers.
- Irregular periods.
- Enlarged salivary glands.
- Erosion of tooth enamel, tooth decay.
Psychological signs and symptoms:
- Feeling emotional, irritability, mood swings.
- Dissatisfaction with body image.
- Feeling out of control.
- Feelings of inadequacy and worthlessness.
- Feelings of guilt and shame.
- Depression and related symptoms.
Other behavioural signs:
- Preoccupation with dieting.
- Regular binges (uncontrollable overeating).
- Being sick after meals.
- Disappearing to the lavatory after meals in order to get rid of food.
- Secret hoarding of food.
- Secret disposal of vomit (e.g. bags of vomit hidden in bedroom).
- Abuse of laxatives.
- Excessive exercising.
- Risk-taking behaviours such as alcohol or drug misuse, shoplifting, promiscuity, self-harm.
- Problems dealing with social situations and interaction with others
Health Consequences of Bulimia
Frequent vomiting and the use of laxatives in particular can lead to dehydration and to the depletion of electrolytes (body salts). When this occurs, it can seriously affect the body's ability to function properly. All organs can be affected. The heart is particularly at risk.
Getting a medical check up is an essential part of treatment as the effects of bingeing and purging are not obvious and need to be properly assessed. A simple blood test will indicate the level of dehydration and electrolyte depletion. Dietary advice can then be sought to help correct these problems
If a person is severely dehydrated or depleted of essential nutrients, hospitalisation may be required.
Depression and high levels of anxiety and periods of emotional overwhelm often accompany bulimia. Addressing these and other psychological aspects of the disorder is crucial to recovery.
Frequent vomiting can cause erosion to tooth enamel and dental decay. Your dentist will advise you on how best to care for your teeth and reduce the risk of further damage as dental damage is not reversible.
The misuse of laxatives also has dangerous health implications. Coming off laxatives can be difficult. Laxatives are used under the misguided belief that they are an effective means of controlling weight. In fact, the use of laxatives offers no benefits and contributes only to exacerbating physical symptoms and feelings of dependency
What Is Binge Eating Disorder?
Binge Eating Disorder or Compulsive Overeating is characterised by periods of compulsive binge eating or overeating. There is no purging (getting rid of the food) but there may be sporadic fasts or repeated diets. Weight may vary from normal to significantly overweight.
In an eating disorder, food is not used to nourish the body. It is used to take care of emotional needs. Eating to meet psychological needs in this way is often referred to as emotional eating. Binge eating disorder is a form of emotional eating in which overeating has become a way of coping. A person with binge eating disorder becomes caught up in a vicious cycle of bingeing and dieting or restricting their food intake.
- People with binge eating problems often experience some of the following:
- Eating is out of control.
- Eating much more quickly than usual during binges.
- Eating until uncomfortably full.
- Eating large amounts of food, even when not hungry.
- Eating alone due to embarrassment about the amount eaten.
- Feelings of disgust, guilt, self loathing and shame after overeating.
- Depression and anxiety.
What Causes Binge Eating Disorder?
The causes of binge eating disorder (BED) are still unclear. As with other eating disorders, many factors (biological, psychological, familial and socio-cultural) combine together to contribute to the development of the disorder. Many people with BED also experience depression from time to time. Whether depression causes BED, or whether BED causes depression is not known. Many people say that being angry, sad, anxious or worried can cause them to binge eat. Low self esteem and dieting are seen as significant risk factors.
The relationship between dieting and binge eating is complex. Many people with BED report that they had episodes of bingeing before they started to diet. However, once a cycle of bingeing and dieting is established, it is the dieting that maintains and perpetuates the urge to binge.
Binge eating disorder is almost as common among men as it is among women. It is thought to affect up to 4% of the general population.
Complications Of Binge Eating Disorder
Binge eating puts a lot of stress on the digestive processes and on the metabolism which can become chaotic. Digestive problems such as bloating, stomach cramps, constipation or diarrhoea can be experienced. Disordered eating patterns can also affect the body's capacity to absorb the nutrients it needs for healthy functioning and can have a significant effect on energy levels.
The medical complications associated with binge eating disorder tend to be the same as those associated with obesity:
- High blood pressure
- High cholesterol levels
- Heart disease
- Gallbladder disease
- Depression and anxiety can become severe and may require specialist intervention.
How to Get Help
People with BED often try to control it on their own. More often than not, they will need the help and support of a healthcare professional. Consultation with a General Practitioner is an important first step towards self-care. The GP will look at the physical effects of binge eating and, if necessary, can make a referral to a dietician or to a psychologist or therapist. There are several different ways to treat a person with BED. Cognitive Behavioural Therapy helps a person to examine their thoughts and belief systems and to understand how these are linked to their feelings and behaviours. This can help a person to work out what changes they need to make in order to be able to break free of the compulsive patterns that are keeping them trapped in the disorder. Individual psychotherapy tends to concentrate more on a person's way of relating to themselves, to others and on how a person copes with the challenges of life. It aims to help a person to identify problem areas and work through them at a pace that they find tolerable.
Some addiction treatment centres offer programmes for people with binge eating disorder.
In general, people respond well to treatment and can overcome binge eating. Having access to support along the journey to recovery is important.
Some weight management clinics also offer programmes. However, alongside management of lifestyle and diet, it is important that any underlying psychological issues are also addressed.
The building of self esteem and the nurturing of self acceptance is an essential part of recovery.
Many people find that attending a support group can make a huge difference. Attendance at a support group is often an integral part of after care programmes. Support groups can provide much needed encouragement and understanding especially when a person is having a relapse and at other difficult times during recovery.
There are many self help books available which can be used on their own or under the guidance of a therapist and/or nutritionist. The Bodywhys booklet "Binge eating - Breaking the Cycle: a self help guide towards recovery" is aimed at anyone looking to find out about binge eating and how to take back control. It suggests practical steps that can be taken to facilitate sustainable, healthful change.
Some online self help programmes offer suggestions and strategies to help with managing feelings and behaviour and to support a person during periods of relapse (see website list below for examples).
Binge Eating - Breaking the Cycle: a self help guide towards recovery, 2006. Available from Bodywhys.
Overcoming Binge Eating, Fairburn C.G., The Guilford Press, 1995.
Getting Better Bite by Bite, Treasure J. and Schmidt U., Psychology Press, 1996.
Eating Your Heart Out, Buckroyd J., Optima, 1994.
Overcoming Overeating, Hirschman J.R. and Munter C., Cedar, 1996.
Breaking Free from Compulsive Eating, Roth G., Signet, 1986.
The Forbidden Body, Bovey, Pandora, 1994.
Depression and the Way out of your Prison, Rowe, Routledge, 1986.
Stress and Relaxation, Self-help Techniques for Everyone, Madders, Optima, 1993.
The Successful Self, Rowe, Harper Collins, 1996.
(Specifically for men) Making Weight: Men's Conflicts with Food, Weight, Shape and Appearance, Anderson A., Cohn L. and Holbrook T., Gurze, 2000
Binge/Compulsive eating workbook for Kids and Teens, downloadable from www.growthcentral.com
www.myselfhelp.com - offers information and self help programmes for binge eating, bulimia, depression and other aspects of mental health
www.aweighout.com - Offers information on emotional eating and self help programmes to overcome compulsive patterns and build self esteem and resilience
www.aso.org.uk - Website of the Association for the Study of Obesity: many helpful links and covers a wide range of related topics.
www.obsessiveeatersanonymous.org - Website of Obsessive Eaters Anonymous: displays information about support group meetings. Tel. 01 2891599
Eating Disorders In Males
Contrary to public opinion, eating disorders are not exclusive to women. Although fewer in number, men also experience eating disorders.
Up until recently much of the literature on males and eating disorders suggested that 10% of people with eating disorders are men. It is now thought that this figure no longer reflect the reality of males and eating disorders and in some more up to date research figures ranging between 15% and 25% have been quoted.
Health professionals working in the field of eating disorders see many more females than males, partly because of the lower incidence of eating disorders in males, but also because eating disorders tend still to be regarded by many as a female issue. As a result, boys and men may find it harder to seek help, and if they do, they may fear that they will not be met with understanding. Health professionals may be less likely to look out for eating disorders in males and this may also lead to under-diagnosis of eating disorders in the male population.
Some experts believe that there has been a significant increase in eating disorders in males in recent years and this is seen to be linked to media messages about men. Media emphasis on a lean, muscular ideal for males can create or exacerbate body image issues and low self esteem, increasing a person's vulnerability to developing an eating disorder. Men as well as women are affected by society's prevailing messages about physical appearance, and about what is and is not perceived as attractive and desirable. Media content, influenced by the fashion and cosmetics industries devoted to making men "look good" has become much more prevalent in recent years. A trim and fit aesthetic for men is increasingly represented as the norm. When this message is internalised, it can result in a person measuring their worth against unrealistic standards.
Risk Factors For Males
There are many reasons why a person might develop an eating disorder.
There may have been a traumatic event or a series of events, feelings of pressure and/or an accumulation of stress with which the person feels unable to cope.
For males the following may be triggers:
- Being overweight for their height and age as children and/or having been teased or bullied about weight.
- A history of dieting. Dieting is one of the most powerful risk factors for eating disorders in both men and women.
- Being excessively concerned with fitness, which in turn can lead to over exercising. Men in particular, can become obsessed with moulding their bodies into a particular physique.
- Participation in a sport or other activity that demands thinness. Runners, jockeys, boxers, rowers and dancers, for example, are at higher risk than football players.
- A job or profession that demands thinness. Male models, actors and entertainers seem to be at higher risk than the general population.
- Conflict and anxiety over gender identity or over sexual orientation may precipitate the development of an eating disorder in some males.
Some men experience severe distress due to body image disturbance. This condition is known as Body Dysmorphia.
Reverse Anorexia is a name given to a disorder where there is a drive to increase bulk accompanied by obsessive behaviours (related to both exercise and nutrition) and significant body image distortion. This is also known as Muscle Dysmorphia.
Many men feel shy and awkward about getting help for an eating disorder, see General Information on eating disorders. It is important to remember that seeking help and treatment early will often mean that recovery will be less difficult and treatment less intensive. Eating disorders have a number of medical and psychological consequences and treatment should always include looking at both the psychological issues underlying the disorder and the physical aspects.
Eating disorders are serious, potentially life threatening issues. However, with appropriate treatment and support, most people make a full recovery though this can take time.
Suggested websites with helpful sections for men:
Making Weigh: Men's Conflicts with Food, Weight, Shape and Appearance, Andersen, Cohen and Holbrook, Gurze Books, 2000, www.gurze.net
Fit to Die - Men and Eating Disorders, Anna Patterson, Lucky Duck Publishing, 2004, www.luckyduck.co.uk
Anorexia Nervosa: a Survival Guide for Families, Friends and Sufferers, Janet Treasure, Psychology Press, 1997
Getting Better Bit(e) by Bit(e): a Survival Kit for Sufferers of Bulimia and Binge Eating Disorder, Ulrike Schmidt and Janet Treasure, Laurence Erlbaum Associates, 1993
Binge eating - Breaking the Cycle: a self help guide towards recovery, available from Bodywhys, 2006.
Males with Eating Disorders, Arnold Andersen, Brunner Mazel, Eating Disorders Monograph Series 4, 1990.
Other Eating Disorders & Related Conditions
Throughout life, we all experience periods of both positive and negative stress. During these times of stress it is quite common for people to experience eating problems and / or sleeping problems. When these problems persist they can cause major distress. They can interfere with daily life and impair an individual's personal, social and professional life. When this is the case, it is important to seek the help and support that you need to try to identify the underlying causes and to develop appropriate coping skills. Seeing a GP to clarify any medical concerns and talking to someone with whom you can address any psychological and emotional issues underlying your difficulty will be of benefit.
Exercise bulimia is the name given to a form of compulsive or obsessive exercise, where the exercise is used as a means of purging calories to compensate for bingeing (or even just for regular eating). In other words, exercise is being used compulsively to control weight.
It often goes undetected as, to the on-looker, the individuals affected seem to be merely very focused on health and fitness. Weight may not necessarily be very low because when you exercise compulsively your body compensates by slowing down metabolically.
One of the signs that exercise is becoming compulsive is that the person affected will have begun to schedule their lives more and more around exercise, missing social engagements and even missing work and appointments in order to work out.
Other warning signs might include:
- Working out for hours at a time each day or not taking any rest or recovery days.
- Working out even if you are injured or feeling unwell or exhausted.
- Becoming depressed, irritable, behaving irrationally if you can't get a work out in.
- Experiencing strong feelings of guilt and anxiety when unable to exercise.
- Never feeling satisfied with your level of fitness or achievement.
- Valuing yourself in terms of physical fitness and appearance, of achievement and performance rather than in terms of inner qualities.
- Giving priority to your exercise schedule before attending to relationships.
Some physical consequences of compulsive exercise:
- Increased risk of injury (such as stress fractures, tendonitis, joint and ligament injuries).
- Heart problems.
- Hormonal disturbances (loss of libido, irregular or no menstruation) and reproductive problems.
- Poorer physical and mental performance overall.
- Low self esteem.
- Perfectionist, black and white thinking.
- Depression, anxiety.
- Withdrawal from relationships.
- Social isolation.
- Inability to derive joy from eating or from exercise
To overcome exercise bulimia, help can be obtained from a number of sources:
To assess and monitor the physical impact of excessive exercise (and of any other harmful behaviours).
To look at the emotional issues that underlie the compulsion to exercise. To explore the motivation behind your behaviours. To explore attitudes and beliefs around exercise, your body and your health and how these influence your feelings and your behaviour. To help you to reduce your emotional and physiological dependence on exercise.
To advise on how the cycle of eating/ purging through exercise is affecting the metabolism and to advise on how to rehabilitate and rebalance the metabolism; to help you to redress the balance between nutrition and exercise in your life.
The use of a diary to record both food intake and exercising behaviours can be a very helpful recovery tool.
If you are a regular attender at a gym/fitness club, it would be helpful for you to talk to your trainer/ instructor and seek their support in overcoming your problem.
Muscle Dysmorphia / Reverse Anorexia / Bigorexia
Muscle dysmorphia, also known as reverse anorexia or bigorexia is a condition in which a person becomes obsessively focussed on being too small and not muscular enough. People with muscle dysmorphia resort to a variety of measures to try to increase muscle mass. These measures may include excessive exercise including weight lifting and other body building exercises, excessive attention to diet, misuse of high protein diet, misuse of steroids and other muscle-building drugs.
Muscle dysmorphia can affect both men and women although it is more common in men and in most cases the person affected in not in reality small or lacking in musculature. In fact, many body-builders are affected.
The obsession with becoming more muscular takes over the person's life to the extent that it may cause a person to forego or to avoid important social, work related or recreational activities. The preoccupation causes major distress and can have a severe impact on relationships as the person’s life becomes restricted to the pursuit of an unattainable ideal body.
A person with muscle dysmorphia will continue to work out and / or diet despite knowing that it is dangerous to their health and general wellbeing. Because of the distortion in self perception it can be very difficult for the person to recognise that they need help.
Muscle failure, osteoporosis, heart and kidney failure are among some of the risks associated with muscle dysmorphia. Depression is often co-existent with the condition.
Treatment should involve medical evaluation and monitoring as well as psychological therapy. A cognitive behavioural approach is often used.
Orthorexia or orthorexia nervosa is the name given to a condition which involves a compulsive preoccupation or obsession with dietary purity.
Attention to a "pure" diet becomes problematic when it is an obsession that has a significant negative impact on a person's life. Whereas anorexia nervosa and bulimia nervosa are marked by a chronic concern for the quantity of food being consumed, orthorexia is characterised by an over-concern with the quality of the food consumed.
Thinking about food and about how it is prepared becomes a means of coping with the stresses of life and avoiding the experience of negative emotions.
For the person with orthorexia, wavering from their "perfect" diet can lead to periods of even stricter rules around food and eating or to periods of fasting.
Psychological therapy can help a person to gain an understanding of the thoughts, beliefs and value that underlie the emotions that are driving their obsession with the 'right' diet and help them to restore balance to their relationship with food and to their lives in general.
Body Dysmorphic Disorder (BDD)
BDD is a preoccupation with an imagined physical defect in appearance or an over-exaggerated concern about a minimal defect. The preoccupation causes severe emotional distress and significant impairment in the individual's life. The obsessive concern can relate to facial features, other parts of the body, hair or even odor.
The person may fear ridicule in social situations and their distress may be so severe that it will lead them to contemplate undergoing procedures to try to change the perceived defect. Procedures rarely bring relief and often lead to a worsening of symptoms.
BDD can lead to social isolation and constant anxiety and obsessing about appearance may make it difficult to concentrate on work / schoolwork. Depression is often present and BDD is also often associated with obsessive compulsive disorder and with delusional disorders.
The distress levels associated with BDD can be so severe that they can lead to suicidal thoughts and to the completion of suicide. It is important not to dismiss the individual's distress. Even if their distress over a perceived defect seems out of perspective to you, it will be extremely real to them.
Treatment usually involves cognitive behavioral psychotherapy. The therapist helps the individual to understand how some of his or her thoughts and perceptions are distorted and helps them replace these perceptions with more realistic ones. The therapist will also help the person to resist any compulsive behaviours associated with the BDD (such as repeatedly looking in mirrors or excessive grooming). If the individual avoids certain situations because of fear of ridicule, the therapist can work with them at finding ways to manage feared situations. In the case of adolescents, some family therapy is seen to be useful. Medication may also be useful in some cases
Tips for Students
Whether in a school, college or work environment, examinations can be a difficult time for most people.
Exams can be particularly stressful for some people, depending on previous experience of exams and the level of support you may have around you.
Your own and other people’s expectations may be a source of pressure you may be feeling at this time.
You may find that your appetite has lessened, or that you are forgetting meals because of an intensive study schedule. You may also find yourself deliberately skipping meals.
Study snacks may become a source of comfort for you if you are particularly anxious about the exams. It may be that your snacking gets out of control or you may become reliant upon it.
You may find yourself exercising very regularly as a means of coping with the stress of the exam period. Again if this becomes something you are relying on to feel okay, there may be a bigger issue there.
All of the above are natural reactions to the stress that may arise around exam time. The important thing is to recognise if a healthy balance starts to slip out of your routine.
During the exams:
- Do your best to regulate meals and sleep: keeping your energy up is an important part of getting through the exams process.
- Plan your time and remember to take regular breaks
- Find ways to relax that let you take your mind off exams. Try to plan activities every week that let you unwind completely even for a few hours.
- If you feel that you are not coping with the pressure of upcoming exams, the sooner you speak to someone the better. Try reaching out to a friend, a parent or a teacher.
- Don’t allow yourself to become isolated by the eating disorder. Your friends and family members can help you to get through this difficult period.
- Do talk to someone. If you have previously received treatment for an eating disorder, it may be useful to let people around you know that the issues are arising again. Alternatively you can contact Bodywhys for confidential support.
- Don’t put pressure on yourself to confront the eating disorder immediately. Acknowledge that the issue is there, and plan to deal with it when you have the time and space to do so after the exams.
After the exams:
- Do give yourself credit for getting through the exams – no matter what the results, working towards the exams is an achievement in itself and it is important to recognise that.
- Exams are often the end of an era and the start of a new challenge. It is natural to feel apprehensive about this sense of change, but it is important that you think about how you might cope with that change.
- It’s a good idea to make plans for what to do in the days after your exams end. Try to give yourself something new to focus on – this may be a trip you are planning, or a new project to work on over the summer months.
- For those who are experiencing an eating disorder, it is very important to create a balance between relaxing and recuperating post-exams, but also keeping to some kind of routine in order to minimise the extent to which you feel out of control.
- If the exam period has brought the eating disorder to the fore, when the exams are over it may be the time to begin to think about getting appropriate help and support.
In case of relapse:
- Do reassure yourself: relapse is very common amongst people who have experienced an eating disorder at some point in their lives.
- Do try to take charge of the situation as soon as possible. Stop and think about what is happening and focus on why it might be happening.
- Don’t think this means you have ‘failed’ in your recovery. Relapse is part of the recovery process. Remember, it is important to take one step at a time and to recognise that using the relapse as something to learn from is an opportunity for a positive outcome. Going back a little isn’t the end of the world - the important point is to try to understand the ‘whys’ of the relapse so that you can begin to move forward again.
- Do seek support and reassurance from others. You may feel overwhelmed and may need help to deal with those feelings.
- Do acknowledge what has happened and try to take some positives from the experience.
Tips for Parents
Exams cause a very natural level of stress for the majority of people in schools and colleges around the country every year.
For those affected by eating disorders, exams and the pressures associated with exams can pose a particular problem.
Sometimes people who have an eating disorder find that the post-exam period is actually more difficult and stressful to deal with than the exam period itself.
The sudden lack of focus, lack of a goal to strive for, and the change in routine, can be very difficult to manage. This can often intensify feelings of being out of control and disordered eating behaviours.
In fact, often this is the time that people with an eating disorder need more support.
- If you have not done so already, get as much information as you can about eating disorders so that you are better placed to support your child
- Remember that an eating disorder is a coping mechanism, and that dealing with the underlying issues will be vital to reaching and sustaining a recovery.
- Speak to your child, and let them know that they can speak to you. It is vital to reassure them that they have a support network available to them.
- Help your child to manage their time, including study plans and mealtimes, to remove as many stressors as possible from the situation.
- If your child has previously received counselling/other assistance for a diagnosed eating disorder, it may be useful to revisit this option.
- Support your child in making plans for the weeks and months after the exams. Having new goals and a new focus will help your child to move forward.
- If your child is moving on to a new school, college or employment opportunity, it is important to work with them in finding support to ease that transition.
- Do seek support for yourself too - if you feel fully supported you will be better placed to support your child.
The term ‘eating disorder’ refers to a complex, potentially life-threatening condition, characterised by severe disturbances in eating behaviours .
If you are thinking of approaching a person about an eating disorder, the most important step you can take to support that person is to accept them as they are now.
It is important to show your willingness to be there for them and to listen without judgement.
Try to show the person that you are not trying to ‘fix’ them or make them stop what they are doing right now.
Show them you understand that whatever they are doing helps them feel safe, and that they may be frightened to acknowledge that there is a problem.
It can seem very difficult to start that first conversation about such a sensitive issue.
You should remember that by asking someone how they are feeling, you are showing them that they have a support network around them – your concern will not make anything bad happen.
The first step towards recovery is being able to acknowledge that there’s a problem, so by approaching someone you are giving them the opportunity to take that first step.
Before you approach someone
- Do inform yourself about eating disorders, with a view to increasing your capacity for empathy
- Do have some information about resources and support services available to the person
- Do seek support for yourself before approaching someone if you are feeling very apprehensive about it. Approaching someone from a position of fear or anxiety is unlikely to be constructive and will only add to their distress.
Starting a conversation
- Do try to approach the person at a time and place that is free from pressure (e.g. time constraints, or possible interruptions).
- Do gently let the person know you are concerned about them
- Do let the person know that you care for them and value them for who they are
- Do tell the person why you are concerned and describe specifically what you have observed that has caused that concern.
Language you use
- Don’t talk abstractly or in generalities; this is more likely to lead to a denial of behaviours. It is more difficult to deny specifics.
- Don’t focus on specifics any longer than you need – move the focus from specifics to ask how the person is feeling or whether there is something going on for them they would like to talk about.
- Do avoid judging, blaming or criticising.
- Do be open and honest about your feelings.
Essential points to remember
- Do communicate an understanding that food, weight and body image issues are only part of the picture – show that you understand that there is something else troubling the person.
- Do focus more on how the person is feeling rather than what they are doing.
- Do try to separate the person you know from the eating disorder that is telling them what to do.
- Do communicate an appreciation of the energy it takes to struggle with an eating disorder. Understand that they may be battling with themselves.
- Do communicate a belief that recovery is possible, and a belief in their ability to recover.
- Do remain mindful that the experience of living with and recovering from an eating disorder is different for every individual.
How to hear what they are saying
- Do encourage them to speak as openly as possible without interrupting
- Do ask the person what it feels like to be in their shoes.
- Do accept all their feelings as real and valid
- Do ask them what they would like to happen.
- Don’t be discouraged if your approach is met by resistance and/or rejection. It may take some time before the person feels ready to be more open to your approach.
- Don’t take it personally if they dismiss your concern or dismiss the idea that you value them as they are.
- Don’t be surprised if they deny there is a problem.
- Do try to negotiate a way forward together
- Do ask the person what they need from you to help reduce the stresses they are experiencing. If they find it hard to identify their needs, suggest to them what you feel might be helpful, but be sure to check with them whether they feel what you are suggesting will make things easier or harder for them.
- Do be honest with them about your own limits
- Don’t put pressure on the person to make immediate changes to their behaviour. The idea of sudden change can be very difficult. It is important for you to understand the eating disorder as a coping mechanism, and allow time for gradual change.
- Do let the person know that you are there for them to discuss the issue(s) further if they want to do that. Hopefully this will not be a once-off conversation.
To support someone else, you need to support yourself too, so remember:
- Don’t put the needs of the person you are trying to support above your own needs. Looking after your own needs first not only models healthy behaviour but will put you in a stronger position to be able to support them.
- Respect confidentiality, but do not put yourself in the position of colluding to deny or cover up behaviours by allowing yourself to be drawn into making promises to keep secrets. Where appropriate, encourage the person to talk to others who may be in a position to help them and signpost them to appropriate services.