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Disordered Eating

While the portrayal of the “ideal body” in media has long influenced fashion and trends, today’s pervasive social media landscape, fuelled by tailored algorithms, poses unprecedented risks, especially for young people. An online search for health and wellness tips can quickly lead to exposure to harmful content, from extreme dieting advice to body shaming posts, exacerbating unhealthy behaviors and favouring certain body types over others.

It’s no wonder that disordered eating and prevalent eating disorders like anorexia and bulimia often stem from issues of body image and self-worth, where food becomes a battleground for control. Ultimately, eating disorders – affecting millions of people worldwide at any given time[i] – are about more than just food: they reflect deeper psychological struggles and societal pressures and can affect our health, our emotions and our ability to function in life.

What is disordered eating?

Disordered eating is like walking a fine line between normal eating habits and clinically diagnosed eating disorders. While it encompasses a range of symptoms and behaviours associated with eating disorders, it manifests less frequently or with reduced intensity. Common forms of disordered eating include skipping meals, cutting out entire food groups, or sticking to rigid or irregular eating schedules, with dieting being particularly prevalent. Additionally, disordered eating involves patterns like fasting, binge eating, and even using laxatives, steroids, or diet pills in ways they weren’t meant to be used.

Why is disordered eating a problem?

Let’s get one thing straight: eating disorders are not a lifestyle choice—they are severe health challenges that demand attention and care. When we start cutting back on food, our bodies react in ways we might not expect. For example, eating less can slow down our metabolism. This is our body’s attempt to conserve energy, but it can backfire, leading us to overeat or binge eat down the line. Moreover, the road of dieting is often accompanied by unwelcome co-occurring disorders like depression and anxiety.

The ripple effects of disordered eating can touch every aspect of life, making stress harder to manage and stirring up feelings of guilt, shame, and a sense of failure. These feelings can spike particularly after overeating or when a diet doesn’t go as planned. This fear of judgment can push people into isolation, avoiding social gatherings, especially those involving food, which only fuels loneliness, lowers self-esteem, and encourages social withdrawal.

Now I know about disordered eating – but what are eating disorders?

Eating disorders are serious, complex mental and physical health conditions associated with extreme changes to your relationship with food and eating behaviour. These alterations may include eating significantly less than normal, compulsively overeating, resorting to harmful compensatory behaviors, or fixating intensely on body shape or weight.[i] Among the most prevalent eating disorders, which profoundly impact physical, psychological, and social well-being, are:

Anorexia nervosa

This severe condition is characterised by self-starvation leading to significant weight loss, typically indicated by a body mass index below 18.5 for adults. The deliberate and extreme restriction of food intake is driven by an intense fear of weight gain or a strong desire to lose weight. With mortality rates rivalling opioid use disorder, this condition manifests in two main subtypes: the restrictive type, where individuals primarily lose weight through dieting, fasting, or excessive exercise, and the binge eating/purging type, where individuals also engage in intermittent binge eating and/or purging behaviors.

Bulimia nervosa

This eating disorder is marked by recurring episodes of consuming excessive amounts of food (bingeing), where the individual experiences a loss of control over eating. Subsequently, various methods like vomiting or laxatives (purging) are employed to avoid weight gain. The binge eating episodes can occur multiple times daily over extended periods, usually in secrecy. They are followed by feelings of self-disgust which causes purging to prevent weight gain. Purging methods may include inducing vomiting, excessive exercise, or using laxatives, enemas, or diuretics (water pills). Despite often perceiving themselves as overweight, individuals with bulimia often maintain a normal weight, making their condition less noticeable to others.

Binge eating

Binge eating entails consuming a large amount of food within a short period of time, accompanied by a feeling of losing control over what and how much is consumed. This behavior is often clandestine and linked with emotions of shame or embarrassment. The rapid consumption of food often surpasses the point of fullness to the extent of discomfort or nausea. Binges occur at least weekly and are typically followed by “compensatory behaviors” aimed at avoiding weight gain. Such behaviors may involve fasting, vomiting, misusing laxatives, or engaging in compulsive exercise.

Avoidant restrictive food intake disorder (ARFID)onditions

ARFID, characterized by extreme picky eating and resulting persistent failure to meet nutritional needs, can affect individuals of any age but is more prevalent among children. This avoidance of food or preference for a limited diet can stem from a) low appetite and disinterest in food, b) an aversion to sensory aspects of food such as texture, appearance, colour, or smell, or c) concerns about potential consequences like choking, nausea, or allergic reactions. Unlike anorexia nervosa or bulimia nervosa, ARFID is not driven by body weight or shape concerns. However, it can significantly impact families, leading to heightened stress during meals and other social eating occasions.

Pica

Pica triggers intense cravings for non-food items like hair, paper, soap, cloth, chalk, clay, or coal. This behaviour persists for at least one month and warrants clinical attention due to its severity. Individuals with Pica typically do not have a generalised aversion to food, and their behaviour is incongruous with their developmental stage and cultural norms. While Pica can begin in childhood, adolescence, or adulthood, it most commonly manifests during childhood.

Rumination syndrome

Rumination syndrome involves the repetitive regurgitation of undigested or partially digested food from the stomach, followed by repeated re-chewing, then either re-swallowing or spitting it out. Notably, those with rumination syndrome do not intentionally initiate the regurgitation; rather, it happens without conscious effort. As the food has not been yet digested, it purportedly retains its original taste and lacks the acidity associated with vomit. Rumination episodes typically occur shortly after each meal.

Signs and symptoms of eating disorders

As there are different types of eating disorders, their signs and symptoms vary. While many associate eating disorders with extreme weight loss, this isn’t always the case, and it’s not always apparent from someone’s appearance that they are struggling. Additionally, eating disorders can be mistaken for “just dieting”. However, even if someone may exhibit few physical symptoms, they often display noticeable emotional and behavioural signs.

General signs

mood swings
checking one’s appearance frequently for perceived physical flaws
talking a lot about the nutritional content of food
saying that one feels or looks fat
fatigue, dizziness or fainting
thinning hair or hair loss
refusing to eat certain foods or whole food groups, such as carbohydrates
unexplained weight changes or significant weight loss
unusual sweating or hot flashes
preferring to eat alone or avoiding meals with others
withdrawing from social activities or friends
hiding food or throwing it away
fixation on food, calories, exercise or weight loss.
food rituals such as chewing food longer than necessary
cycling between eating a lot of food and eating very little

Specific signs for …

... anorexia nervosa

menstrual periods cease
feeling dizzy or faint due to dehydration
Sensitivity to cold temperatures
muscle weakness and deterioration
heartburn and reflux (for those who vomit)
persistent constipation, bloating, and fullness after meals
stress fractures due to excessive exercise and bone density loss (leading to osteopenia or osteoporosis)
depression, irritability, anxiety, poor concentrating
possible life-threatening medical complications such as irregular heartbeats, kidney problems, or seizures (particularly in those who induce vomiting or misuse laxatives)

... bulimia nervosa

frequent trips to the bathroom right after meals
large amounts of food disappearing or unexplained empty wrappers and food containers
chronic sore throat
swelling of the salivary glands
dental decay resulting from erosion of tooth enamel by stomach acid
heartburn and gastroesophageal reflux
laxative, diet pill, or diuretics (water pills) misuse
recurrent unexplained diarrhea
feeling dizzy or fainting from excessive purging behaviors resulting in dehydration
rare but potentially fatal complications include oesophageal tears, gastric rupture, and dangerous cardiac arrhythmias

... ARFID

significant weight loss (or failure to achieve expected weight gain in children)
significant nutritional deficiency
interference with social functioning (such as inability or dislike to eat with others

... Pica

persistent cravings for and compulsive consumption of non-food items
knowledge of inedibility
coping mechanism to alleviate emotional distress
gastrointestinal complications due to prolonged consumption of non-food items, including blockages, ulcers, constipation, or even perforations in the digestive tract
nutritional deficiencies due to consumation of non-nutritive substances instead of proper nutrition
dental damage, including tooth erosion, chipping, or cracking, due to abrasive or hard substances ingested
toxicity, allergic reactions, or poisoning
consuming items like dirt or faeces may lead to physical symptoms related to infection, such as gastrointestinal distress, diarrhea, or parasitic infestations

... rumination syndrome

effortless regurgitation, often occurring shortly after meals
relief from belly pain or pressure through regurgitation
sensation of fullness
nausea
unintentional weight loss

Concealed struggles: what’s denial got to do with it?

In disordered eating and eating disorders, number of problems tend to prevent people from seeking effective early intervention. A recent survey found self-denial among the main barriers as well as the belief that their problems are not bad enough to seek help.[i] Ambivalence towards treatment, a fear of disclosure to others and of being labeled as having a disorder, or anxiety about changing eating patterns are adding to the reluctance of those suffering from eating disorders to fully acknowledge their severe health condition.[ii]

Denial doesn’t always equal non-compliance, which is a conscious choice to not follow therapeutic advice. Seeking or accepting treatment also depends on weighing potential benefits and drawbacks. When asked to characterise their anorexia as a “friend” or “enemy,” patients assess the pros and cons. For example, benefits may include feeling cared for, gaining control, feeling attractive, avoiding unwanted emotions, and feeling unique, while commonly expressed cons are being controlled by constant thoughts about food, and strained relationships.[iii] In other words, denial may serve a purpose: it may act as the glue that holds a shattered self-esteem together. Consequently, ample support is essential for patients who start acknowledging their illness.[iv]

What causes disordered eating and eating disorders? What are the risk factors?

Eating disorders can affect individuals of any age, ethnicity, gender, neurodiversity, sexual orientation, or body type. While often emerging during adolescence or young adulthood, they can also manifest in childhood or later in life. Their development involves a complex interplay of genetics, brain biology, personality, cultural and social influences, and mental health factors.

What are the health risks of eating disorders?

Without effective treatment, eating disorders can lead to long-term medical complications and, in certain instances, cause death. Eating disorders, anorexia nervosa in particular[v], rank as the second most lethal psychiatric disorder, surpassed only by opioid use disorder.[vi]

Severe calorie restriction, purging, or excessive exercise can significantly impact overall health, resulting in numerous health complications, including:

Arrhythmia, heart failure and other heart problems
Acid reflux
Gastrointestinal problems
Low blood pressure
Organ failure & brain damage
Osteoporosis & tooth damage
Severe dehydration & constipation
Stopped menstrual cycles & infertility.
Stroke

When should I call the doctor?

We strongly advise you to seek professional support if you, or someone you care for, have an eating disorder and experience any of the following:

Your relationship with food is causing you distress and is interfering with your everyday activities and social life.
You have chest pain, shortness of breath, or heart palpitations.
You feel dizzy or experience fainting episodes.
You have a sore throat or acid reflux.
Your speech is slurred or your vision is blurred.

Please note that if someone is severely underweight, dehydrated, or malnourished, they may need emergency help.

NEOVIVA’s approach to treating eating disorders

Eating disorders are a serious problem that can affect your mental and physical health. However, with proper medical care and mental health counseling, you can return to healthier eating habits and learn healthier ways to think about food and your body, while an untreated eating disorder can harm your physical health and may lead to life-threatening problems.

While the most important initial step is allowing yourself to accept that you have a problem, compliance with medical and therapeutical treatment is the subsequent significant challenge, demanding careful attention to each phase of the process.

Partnering closely with renowned hospitals

While at NEOVIVA, we specialise in addressing the mental health aspects of eating disorders, we acknowledge the importance of acute medical attention. In cases of severe health threats, we collaborate with specialised clinics where you will receive medical care before before coming to our treatment to additionally addressing the underlying issues of your condition. Your treatment programme will be complemented by expert guidance on essential aspects like food management, weight monitoring, and nutrition.

This integrated approach enables us to effectively focus on the root causes of eating disorders.

At NEOVIVA, we define four general stages in eating disorder treatment:

1 Assessment

Conducting a thorough clinical assessment is a vital aspect of the rehabilitation process. Individuals struggling with addictions often exhibit a high degree of secrecy, often fueled by fears of legal consequences and societal judgment. Additionally, it is imperative to identify and address any co-occurring mental health disorders simultaneously with the eating disorder.

2 Supervised Medical Care

Hospitalisation at one of our partner clinics may be necessary if your physical health needs immediate attention or if you have anorexia and are unable to eat or gain weight. Severe or life-threatening physical health problems that occur with anorexia can be a medical emergency. In many cases, the most important goal of hospitalisation is to stabilise acute medical symptoms through beginning the process of normalizing eating and weight. The majority of eating and weight restoration takes place in this outpatient setting.

3 Treatment

Treatment

During your treatment at NEOVIVA, we will support you in various ways, including help you normalise your eating patterns, replace unhealthy habits with healthy ones, learn mood monitoring techniques, and explore constructive ways to handle stress. Your treatment will encompass a range of therapies, including group and individual sessions, family-based therapy (especially for underage clients), nutrition counselling, psychoeducation, and creative expression. Moreover, our holistic approach incorporates mindfulness training through addiction and recovery educational groups, alongside body-focused techniques for regulating the nervous system. Backed by a thorough medical and physical assessment, your treatment may be augmented by state-of-the-art methods, such as rTMS, designed to alleviate compulsive behaviour and enhance mood.

4 Continuing Care

As we strongly believe in the significance of ongoing support, we encourage further progress upon returning home by providing a comprehensive Continuing Care programme after you complete your treatment at NEOVIVA.

Reach out to our Client Relations team at 41 58 100 08 08 or contact us online.

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