Information
on Eating Disorders
What is an “Eating Disorder?”
If you are here, your loved one has recently been given a diagnosis of an eating disorder.
This is not your fault.
Eating disorders are complex and do not have a single cause. They affect people of any gender, race and social group. They are treatable but they are serious and parents & carers are critically important to support a young person to become well again. Recovery can happen.
If you are here you are likely waiting for or just beginning treatment for your child’s eating disorder.
There are two potential ways in which your loved one will have been diagnosed with an eating disorder. However, getting stuck in the criteria is not always helpful – recovery is the main aim and the most important thing. The following information is just in case you’d like to know!
ICD-10 stands for International Classification of Diseases, 10th edition which was developed and is updated by the World Health Organisation (WHO). It is mainly used in Europe but is used in other areas of the world such as China.
The DSM stands for Diagnostic Statistical Manual of Mental Disorders, 5th Edition. This is an American diagnostic manual published by the American Psychiatric Association. It is mainly used in America however, can be used in the UK and is frequently referred to in eating disorder research.
The DSM and ICD help mental health professionals to identity the symptoms of mental health disorders. Both the DSM and ICD have similar criteria and both can potentially be used in the diagnosis of your loved one in the UK.
Anorexia Nervosa (AN)
To be diagnosed with anorexia nervosa a person must be seen by a psychiatrist, an experienced mental health clinician or sometimes a GP. To be diagnosed with anorexia a person must:
- Have restricted energy intake which has lead to weight loss.
- Have an intense fear of being fat, gaining weight despite even being underweight or ongoing behaviour that interferes with weight gain.
- Have a disturbance in the way they see their own body shape or weight, over evaluation of weight and shape and/or a denial of how serious the weight loss has been/how low current weight is.
People with anorexia will restrict their intake of food and sometimes liquids. They may restrict particular food groups such as fats or carbohydrates.
They may exercise excessively or may be “always on the go”, unable to sit down or very fidgety.
They may also induce vomiting or use laxatives after eating.
These behaviours are caused by the eating disorder.
Hiding symptoms or even denying them is common.
Anorexia Symptoms
You may already be aware of some these symptoms. A number of the physical symptoms are corrected once a young person is having adequate nutrition or is weight restored (their weight is healthy for their age, gender and height).
Physical
- Dizziness
- Constipation and bloating
- Stomach aches
- Cold feet & hands
- Fine hair on arms and face (lanugo)
- Dry dull hair and sometimes hair loss
- Low blood pressure, body temperature and heart rate
- Unable to concentrate
- Bad breath
Emotional
- Anxiety
- Low mood
- Irritable
- Self Harm
- Anger
Behavioural
- Excessive movement, unable to sit down, exercising a lot or be very fidgeting
- Preoccupied with food: making food, planning food, watching food based TV programmes, reading recipes, reading ingredients
- Distorted understanding of the relationship between nutritional intake and potential weight gain. i.e “one bite of chocolate will make me gain 2kgs”
- Mood swings
- Social withdrawal
- Preoccupied with images of food or taking/looking at photographs of food on social media
- Preoccupied with weight and/or shape; looking in the mirror a lot, measuring body, comparing self to others touching/feeling for bones (this is also known as body checking)
- Wearing baggy clothes
- Wearing inappropriate clothing for weather (too much or too little)
- Struggles to tell the truth about weight, behaviours and food
- Throwing food away or hiding it
- Not eating or refusing to eat food previously liked, stating that they no longer like particular foods
- Dramatic food changes; turning vegetarian, gluten free or vegan etc
- Cutting food into very small amounts/mashing food up
- Rigidity around cutlery, plate or portion size, meal times and plans
- Secretive
- Going to the toilet a lot
- Argumentative around food, meal times, schedules etc
- Increased need for work to be perfect
Bulimia Nervosa (BN)
To be diagnosed with Bulimia Nervosa a person must be seen by a psychiatrist, experienced mental health clinician or sometimes a GP. To be diagnosed with Bulimia a person must:
- Eat large volumes of food in one sitting (binge)
- Feel a loss of control over their eating
- Partake in “compensatory behaviours” (also known as purging) to prevent weight gain such as; being sick, misusing laxatives, diuretics or other medication or exercise excessively.
- Self esteem is linked with body shape and/or weight.
Anorexia and Bulimia have some similarities. Generally speaking someone with both bulimia and anorexia symptoms will be diagnosed primarily with anorexia. Also, someone who is recovering for anorexia may develop bulimia as part of the recovery process. It is rare for a person with bulimia to develop anorexia but it can happen. Generally people with bulimia are within the normal weight range and their eating disorder behaviours are usually very secretive, meaning others can be unaware of the difficulties.
Bulimia Symptoms
You might already be aware of some of these symptoms. Most of the physical symptoms are linked to the damage vomiting causes to the body.
Physical
- Marks or cuts on back of hands, often around knuckles from teeth hitting the hand during vomiting
- Constipation
- Bloating
- Gastric problems (reflux, heart burn, oesophageal bleeds)
- Poor oral health
- Bad breath
- Chest pains
- Electrolyte (salt & ions) imbalances/shifts – these are used in hydration, nerve and muscle functioning and pH levels. Imbalances can be a serious issue to cardiovascular health.
- Dehydration
- Swollen face (due to enlarged saliva glands)
Emotional
- Irritable
- Displaying low mood or appearing anxious
- Isolating self
- Self Harm
Behavioural
- Spending lots of money on food
- Hiding food packaging
- Storing or hiding food
- Struggling to be truthful about eating
- Using toilet after eating
- Eating in organised manner – in colours etc
- Organise foods or eating around purging
- Preoccupied with shape and weight
OSFED or EDNOS
OSFED means Other Specified Feeding and Eating Disorder which used to be known as EDNOS – Eating Disorder Not Otherwise Specified.
This means that a person may not quite meet all the criteria for a specific eating disorder diagnosis. This does not mean the eating disorder is any less serious. Usually, a person will be offered treatments most aligned with the eating disorder their presentation is most similar to.
Sometimes people’s eating disorders do not meet full criteria as they have been caught early by parents and carers or services.
Binge Eating Disorder (BED)
To be diagnosed with binge eating disorder a person must be seen by a psychiatrist, experienced mental health clinician or sometimes a GP. To be diagnosed with binge eating disorder a person must experience:
- Persistent episodes of eating large volumes of food in one sitting (binge). These episodes are associated with three (or more) of the following:
- Eating faster than normal
- Eating till feeling uncomfortably full
- Hiding eating and eating alone as feel embarrassed by how much they are eating
- Feeling guilty, depressed or disgusted after overeating
- Distressed around binge eating
- No compensatory behaviours (being sick, exercise, laxatives)
Binge eating disorder has only recently (2016) been added to the DSM V. It is rarer in children and adolescents, however this may be down to a lack of research around it.
ARFID
ARFID means Avoidant/Restrictive Food Intake Disorder.
ARFID was a new diagnosis that was introduced in the new DSM-V (2016). ARFID is a feeding disorder used for those people who may struggle with food and can have a very low weight. However, these people do not have shape and weight concerns like eating disorders such as anorexia and bulimia. It is common for these disorders to begin in infancy and childhood.
To be diagnosed as having ARFID a a person would have to see a specialised health clinician. The criteria for diagnosis would be:
- An eating or feeding disturbance such as: avoidance of food due to sensory issues (like a dislike of the texture or colour) around the food(s), concern about consequence of eating (choking etc), a lack of or disinterest in eating. The result of the would be a persistent failure to meet nutritional or energy needs as associated with one of the following:
- Significant weight loss or failure to achieve expected weight gain or growth in children
- Significant nutritional deficiency
- Dependence on enteral feeding or oral supplements
- Interfere with psychosocial functioning- for example, young person cannot attend school or be involved in age appropriate activities
- The disturbance is not explained by lack of food available or associated with culturally sanctioned practice (i.e Ramadan)
- The eating issue does not occur exclusively if/when a young person has another eating disorder and there is no disturbance in the way the person sees their body.
- The eating disturbance is not due to any other medical, physical or mental condition. Or if there is another medical, physical or mental condition, the eating issue exceeds that routinely associated with the condition.
This website is not directly aimed at parents and carers whose loved one is experiencing ARFID, but some of the content may be useful for you.
