Eating disorders are a group of mental illnesses that relate to the way you eat and how you feel about your body. This info sheet will focus on three illnesses: anorexia nervosa, bulimia nervosa, and binge-eating disorder.
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What are eating disorders?
While anorexia nervosa, bulimia nervosa, and binge-eating disorder are all called eating disorders, it's important to remember that these disorders are about much more than food—they're also about how you feel about yourself, how you cope with your feelings and other factors.
Anorexia nervosa (anorexia) includes:
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Eating fewer calories than you need to maintain health and well-being. People with anorexia eat very little, refuse to eat at all, or exercise excessively to "burn off" the calories they ate. To reduce calories in a different way, other people may purge (try to eliminate food you just ate, such as making yourself vomit or misuse medications like laxatives).
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Having a lot of fear or anxiety around gaining weight. These fears often come up no matter how much weight someone has lost.
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Having a distorted view of your body shape, like seeing yourself as much bigger or heavier than you really are. Some people see their entire body as too big or overweight while other people may focus on a specific body part. They may base their self-esteem on their looks, such as feeling good about themselves if they’ve lost weight or feeling like a failure if they've gained weight.
While weight loss is generally part of anorexia, it can depend on age. Younger people may try to avoid gaining weight from normal growth and development rather than try to lose weight.
Anorexia is associated with low body weight, but everyone's body is different and anorexia doesn't look the same in all people. In addition, warning signs of an eating disorder can start long before you notice significant weight loss, and health problems related to eating disorder behaviours like restricting food, bingeing, or purging can affect people at any weight. If you're concerned about your own health or a loved one's health, it’s best to seek help.
Bulimia nervosa (bulimia) is similar to anorexia, with the addition of purging. Bulimia includes:
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Bingeing/binge-eating, or eating a large quantity of food over a short period of time based on the situation. For example, eating a lot at a special holiday meal wouldn't usually be considered a binge. People who binge often say that they feel like they can't control how much they eat and feel like once they've started, they can't stop despite feeling physical discomfort.
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Purging, or eliminating food, to try to prevent weight gain from a binge. Purging includes making yourself vomit, using medications like laxatives in unsafe ways, fasting (avoiding all food for a period of time) or exercising a lot.
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As with anorexia, people living with bulimia may base their self-esteem on their weight or the way they look, have an untrue or distorted picture of their body, and feel a lot of fear or anxiety around gaining weight.
People living with bulimia may not physically appear to be sick and may secretly binge and purge—many people living with bulimia say they feel embarrassed or ashamed of these actions. Even though bulimia isn't always as visible as anorexia, it can still cause serious long-term health problems.
Binge-eating disorder is an eating disorder that is categorized by consuming a large amount of food in a short time (bingeing) on a regular basis. You can't control what you eat or how much you eat, but you feel distressed, disgusted, guilty or depressed after eating. Binge eating may be a response to low mood or depression, anxiety, stress or feeling "numb." The difference between binge-eating disorder and bulimia is that people living with binge-eating disorder don't try to purge after a binge.
People who experience some but not all symptoms of anorexia, bulimia, or binge-eating disorder often receive the diagnosis of "other specified feeding or eating disorder or unspecified feeding or eating disorder." Eating disorders don't look the same in everyone, and people can still have a lot of distress and problems around eating even when their experiences don't perfectly fit into a particular list of symptoms.
Related to eating disorders
Body dysmorphic disorder or BDD is not an eating disorder, but it does impact the way people see and understand their bodies. People with body dysmorphic disorder believe that some (or many) parts of their bodies are flawed in some way—for example, they may believe that their body shape is "just not right" or intensely focus on normal changes in their skin. In response to those beliefs, people with BDD spend a lot of time comparing themselves to others, attempting to cover up the perceived flaw, or repeatedly checking themselves in a mirror. Some people pursue unhealthy diets, cosmetic procedures, or surgeries in an attempt to correct their bodies. Many people with BDD avoid social situations and may leave school, work, or other important activities in order to avoid others.
Who do they affect?
Globally, anorexia affects 0.4 % to 4% of all people and bulimia affects about 1% of all people. Binge-eating disorder affects up to about 2% of all people. These illnesses are more likely to affect the following groups of people:
Women—Up to 90% of people diagnosed with anorexia and bulimia are women. However, more boys and men are being diagnosed with eating disorders, and it's likely that experiences of boys and men aren't caught in current statistics. Binge-eating disorder is diagnosed in men and women more equally.
Young people—Anorexia, bulimia, and binge-eating disorder often start in the teenage and young adult years, though they can also start earlier or later in life, too.
Family members—Eating disorders tend to run in families, so you have a higher risk of developing an eating disorder if a close family member also has an eating disorder.
People with other mental illnesses—People who experience an eating disorder are more likely to be diagnosed with mood disorders like depression and bipolar disorder, an anxiety disorder, a substance use disorder, or a personality disorder.
People with certain ways of coping or thinking about themselves—Eating disorders are not necessarily about the food itself. They may have a greater effect on people who feel poorly about the way they look, people who want everything to be perfect all the time, and people who have a hard time coping with stress or expressing their feelings. Anorexia and bulimia may also give people a sense of control, and may be a way to cope when they feel like they have little control in their life.
People who diet—Teens and young adults who try to control their body shape through food restriction and exercise are more likely to develop symptoms of an eating disorder as a result, especially when their approach is very strict or severe. However, not all people who diet go on to develop an eating disorder, so it isn't clear exactly how the relationship between eating disorders and dieting works.
People from certain cultures or careers—Anorexia and bulimia are more common among people who have jobs that depend on the way their body looks. This may include some dancers, models and athletes. Eating disorders may also be more common in cultures with strong gender stereotypes—for example, ones that idealize thin women and lean, muscular men.
Could I have an eating disorder?
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I'm always thinking about food, dieting and my weight
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I feel guilty and ashamed after I eat
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I often feel out of control when I eat
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I feel better when I don't eat
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I will never be happy unless I reach my ideal weight
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I often try to "get rid" of food by purging
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I experience physical signs that my body isn’t getting enough nutrients, such as hair loss, dry skin, dizziness or lack of energy
If you answered yes to any of these questions, it's best to talk to your doctor.
What can I do about it?
It's very important to get help for an eating disorder because bingeing, purging and/or severely limiting how much food you eat can cause a lot of serious health problems such as bone loss, kidney problems, or heart problems, which can be life threatening. But eating disorders are treatable and many people recover with treatment. Treatment for an eating disorder often includes support from a few different professionals. Regular medical check-ups are also important to treat physical health problems. The earlier someone seeks help for their eating disorder, the better the outcomes.
The following are common treatments for eating disorders:
Psychotherapy—Psychotherapy is a very important part of treatment. Psychotherapies for eating disorders include:
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Cognitive-behavioural therapy or CBT. CBT helps you understand the thoughts, feelings and behaviours behind the disorder.
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Dialectical behaviour therapy or DBT. DBT is a form of CBT that can help you manage difficult feelings or emotions and build mindfulness skills.
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Interpersonal therapy or IPT. IPT can help you build healthier relationships with others.
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Family-based therapy or FBT. Families are a very important part of recovery, especially when a young person experiences an eating disorder, so family members may also participate in some treatments. FBT is an family approach specifically for young people who experience an eating disorder. Other therapies may also benefit from family involvement.
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MANTRA or Maudsley Anorexia Nervosa Treatment for Adults. MANTRA is a new approach that combines different psychotherapies in order to build a treatment that addresses each person’s individual needs and goals.
Nutritional help—A registered dietitian can help you learn about food and help you create healthy meal plans.
Support groups—Support groups for yourself or your loved ones can help you see that you aren't alone. You can learn new ways of coping and find support from others.
Hospitalization—If you start to develop serious health problems, you may need to be treated in the hospital.
Medication—Some antidepressants may help treat bulimia and binge-eating disorder. Other medications may be prescribed to help treat eating disorders or other mental illnesses that go along with an eating disorder.
Self-help—There are many things you can do at home to help yourself cope. Some ideas include getting enough sleep, learning stress management and problem-solving strategies, keeping in touch with family and friends, practicing relaxation techniques, and taking time to do things you enjoy. Your mental health professional can suggest other useful things to try at home.
Where do I go from here?
In addition to talking to your family doctor, check out the resources below for more information about eating disorders:
Jessie's Legacy Program, a program of Family Services of the North Shore
Visit www.jessieslegacy.com or call 604-988-5281 ext. 349 or email jessieslegacy@familyservices.bc.ca to contact Jessie's Legacy. Jessie's Legacy provides eating disorders prevention education, resources and support for BC youth, families, educators and professionals.
Kelty Eating Disorders
Contact Kelty Eating Disorders at keltyeatingdisorders.ca or 1-800-665-1822 (toll-free in BC) or 604-875-2084 (in Greater Vancouver) for information, support, and a BC-based program locater for children, youth and their families. Kelty Eating Disorders is a program of Kelty Mental Health Resource Centre.
BC Partners for Mental Health and Substance Use Information
Visit www.heretohelp.bc.ca for the Managing Mental Illnesses series of info sheets, a screening self-test for body image, activities, workbooks, and personal stories about eating disorders and other mental health problems.
HealthLink BC
Call 811 or visit www.healthlinkbc.ca to access free, non-emergency health information for anyone in your family, including mental health information. Through 811, you can also speak to a registered nurse about symptoms you're worried about, talk with a pharmacist about medication questions, or talk to a registered dietician about healthy eating, food or nutrition.
Crisis lines aren't only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal.
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.
