Recently it was reported by the BBC and others, that experts were seeing a sharp rise in eating disorders. The Royal College of Paediatrics are seeing a 3 to 4 fold increase in the number of cases in young people since the pandemic began, and The Guardian reported a 20% increase in inpatient referrals for adults.
And it is not just the UK experiencing a surge in diagnosis. A study in Australia in June 2020 recorded increases too.
Pre-Covid the NHS reported that 19% of women and 8% of men over the age of 16 screened positive for an eating disorder.
No doubt about it eating disorders are a significant problem, and a growing problem, and need extra attention and awareness.
Many people do not realise how serious, or how common, eating disorders are. They have the highest mortality rate of any mental health problem, can cause many serious physical and mental health problems, and can take years to recover from.
Why is Covid increasing eating disorders?
- Covid has increased mental health problems issues like anxiety. As eating disorders are a way of coping then it makes sense they would be on the rise too.
- Many of us are at home a lot more. Things that previously went unnoticed in a loved one may now be obvious. Or perhaps you fear your own eating patterns being observed by others.
- Usual routines around food and exercise may have been disrupted – feeling trapped outside of usual routines, perhaps cannot buy ‘safe’ foods, or unable to binge in private, cannot exercise enough.
- For people of a larger size there has been pressure to lose weight because of the statistics around body size and Covid severity. Size stigma increases problems around eating, rather than having the desired benefit of motivating someone to lose weight.
What is an Eating Disorder?
These are the main types that are clinically recognised –
- Anorexia Nervosa – where someone restricts their eating, and may exercise obsessively, to such an extent that they can slowly starve themselves. Many sufferers develop strict rules about what they will eat, how much, and when. They experience body dysmorphia, unable to see their real size or believe other people that they are not fat. It has the highest mortality rates, 1 in 5 sufferers can die in the long run. Although anorexia is a mental health condition, it can cause many physical problems, such as a loss of bone density. It will only officially be diagnosed when BMI decreases to 17.5 or under, meaning there are many sufferers with the anorexic mindset that cannot officially receive diagnosis as their weight is too ‘high’.
- Bulimia Nervosa – a vicious circle of consuming a lot of food very quickly (bingeing) is followed by purging (getting rid of the food). During binging sufferers feel out of control, yet also can be euphoric or peaceful as it is their way of coping with life. After a binge, feelings of intense shame and disgust follow, and sufferers ‘cleanse’ themselves by purging. Purging can take the form of vomiting, laxative abuse, using diuretics, fasting or exercising obsessively. Victims may not be underweight. Again, there are serious physical and mental health implications; e.g., tooth enamel erosion from vomiting, digestion and bowel problems from laxative misuse, malnutrition from chaotic eating.
- Binge Eating Disorder (BED) – like Bulimia, but without the purging. It follows that often sufferers are or a larger body size as a result, in fact up to 50% of people with BED are obese. Sufferers eat what is considered to be a large amount of food in a short space of time, without regard to hunger, with no control or being able to stop, often until they feel ill. Binges are usually followed by extreme guilt, self-criticism, and retribution, as sufferers are often seeking weight loss. For an official diagnosis binges must happen at least once a week for at least 3 months.
- Other Specified Feeding and Eating Disorders (OSFED) – this diagnosis is for disorders which may not fit into the 3 categories above. OSFED is just as serious, yet is less well known, and harder to be diagnosed. This could be an anorexic in a larger body, a binge eater who does not binge often enough, or someone who intermittently lurches from set of behaviours to another.
Lastly, there are many other forms of eating problems that have not yet been medically classified, and therefore cannot be officially diagnosed as an eating disorder. This does not mean that they are not distressing, in fact the level of distress in the mind can be just as severe as in the officially categorised disorders. These include Compulsive Eating, Orthorexia, ARFID, PICA and Rumination.
Who suffers from eating disorders?
Anyone can have an eating disorder, at almost any age, they have been reported in children as young as 6 and in adults in their 70s. Statistically women are more likely to suffer than men, most frequently in the age group 16-24. The older a woman is the less likely she is to suffer, though even 5% over 75’s screened positively for an eating disorder in 2019, according to the NHS.
BEAT, the UK’s largest Eating Disorder Charity, stated in 2015 that 15% of calls to its helpline were from people aged 40 +. 15% of sufferers are underweight.
There are many more undiagnosed cases than diagnosed. And it is something that can disappear for a while and return decades later, for example women who suffered as a teenager and did not receive treatment find that their problems return in the menopause years.
What causes an eating disorder?
There is no single cause, it is a complicated, multi-layered problem. However, there are some common characteristics:
Eating disorders are a way of our minds trying to cope with a stressful situation. It is a kind of self-preservation tactic from the brain, not knowing how else to deal with a problem, a self-soothing technique to deal with unwelcome emotions.
There is likely to be something that happened just before the eating disorder began that triggered it, such as an illness or being teased about size.
In addition, there will be reasons why, once started, the eating disorder continues. For example, initial praise from others at weight loss, not having other ways to manage stress, habit, becoming hooked on a sense of release the behaviour brings (whether eating, or not eating).
There are certain historic factors from family and childhood which may make someone more susceptible to developing a disorder – genetics, childhood trauma, family relationships, maturation.
Often there are frequently found personality traits such as anxiety, sensitivity, kindness, low self-worth. Each eating disorder tends to have common characteristics amongst sufferers.
One thing unites pretty much all eating disorder sufferers – dieting. Diets are often the start; it is rare to find an eating disorder sufferer who has not dieted. This could perhaps be a successful dieter loving the compliments from friends as the weight initially comes off. Or it could be the misery of a failed diet, the ‘sod it’ mentality, leading to bingeing. Dieting can predispose to eating disorders. In one large prospective cohort study in the US, pupils aged 14 to 15 years were followed for 3 years, dieting was found to be the most important predictor of a developing eating disorder. Pupils who severely restricted their energy intake and skipped meals were 18 times more likely to develop an eating disorder than those who did not diet.
What to look out for as a symptom of an eating disorder, particularly during Lockdown.
According to the National Centre for Eating Disorders, these are some signs to look out for: –
- Increasing and extreme fear / panic of putting on weight. Obsessing about ‘being fat’ can manifest itself through repetitive talk of it, reading, researching, scanning social media. Perhaps more weighing on the scales more than before lockdown.
- New excuses not to eat. Or new elaborate food rituals around how food is prepared and eaten, a meticulous attitude to food and lots of careful planning.
- Or perhaps a new chaos around food, a new inability to eat regular meals.
- Increasing guilt and shame around eating, particularly over ‘naughty’ foods. Rumination on what ‘shouldn’t’ have eaten. Perhaps ‘punishment’ for eating.
- Being unable to see true size for what it really is, despite comments from others.
- Frequent bathroom trips to purge, particularly after eating. Others in the house may notice lots of mints and toothpaste being used, or a lot more toilet roll.
- A new and increasing list of foods that will not be eaten, believing them to be not safe, or triggers for binges, or fattening. Forbidden foods. However, ……
- Avoiding these foods often leads to cravings for them, and binges. Bingers often steal foods from kitchen cupboards hoping it will go unnoticed and try to hide food wrappers. Or they may stockpile binge foods in their room.
- Lockdowns may have increased fears that certain ‘safe’ foods will not be available.
- Exercising more – feeling a ‘need’ to exercise rather than wanting to. Exercising when tired, ill, injured, or not convenient. Feeling guilty for missing a session, or a missed session could be a trigger for a binge.
- Eating disorders usually exist alongside another mental health problem, like depression or stress. They also can ‘rob’ the person of their personality – they become vacant, distracted, not really themselves. Look out for diminished personality, feeling low all the time, negativity and anxiety.
How to get help
Sadly, many people do not seek treatment, and can suffer for decades. Which is a great shame as the sooner treatment is sought, the higher the likelihood of recovery, as habits are less likely to be entrenched. The average recovery time for anorexia is 7 years.
Eating disorders are unlikely to go away on their own, untreated they can cause a lifetime of misery, distress, and health risks.
Whatever the eating problem, it is important to start with the GP to discuss what treatments might be available, and for a health check on any associated physical symptoms.
Private treatment is the only option for many, and can take many different forms – counselling, psychotherapy, yoga therapy, coaching, hypnotherapy, or energy therapies.
Seeking help for eating problems is not something to be put off until after the Pandemic. Please don’t tell yourself it isn’t serious enough, or it can wait. Taking action now is crucial, whether it is for yourself or a loved one.
There is plenty of further advice available from these links: –
https://www.bbc.co.uk/newsround/17098920 For young people or parents – What in an Eating Disorder?
https://www.beateatingdisorders.org.uk/ The UK’s largest Eating Disorder charity
https://freedfromed.co.uk/freed-for-all – for 16 – 25-year-olds
Cathy Houghton is a Health Coach specialising in Disordered Eating. She lives in Newton Abbot and can be contacted on firstname.lastname@example.org or through her website www.blossomhealthcoaching.co.uk
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