Facts on Eating Disorders
The Continuum of Disordered Eating
What Factors Contribute to Eating Disorders?
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Signs of Relapse

Facts on Eating Disorders
The incidence of eating disorders has risen significantly over the past 30 years. While

90 to 95% of those affected are female, there is a growing prevalence of eating

disorders in males. Eating disorders also have a serious, negative impact on the family,

social relationships, and the stress levels of those endeavouring to help the sufferer.

This includes parents, siblings, partners, peers, teachers, counsellors, and coaches.

The following facts and statistics help to illustrate the seriousness of these disorders:

• The incidence of eating disorders in London youth is higher than the Canadian

           average (Fisman et al., 2000)

• Onset of eating disorders can range from age 4 to over 75 years of age
• In women ages 15-29 the prevalence of eating disorders is from 3%-10%
• A Toronto study looking into the eating habits of Ontario school girls aged

          12 to 18 found the following:

• 27% have "disordered eating attitudes and behaviours" that are

          precursors to anorexia nervosa and bulimia nervosa

• 23% were on diets
• 15% reported binge eating

8.2% admitted to self-induced vomiting

• 81% of 10 year olds are afraid of being fat
• 98% of females are dissatisfied with their bodies
• Eating Disorders have the highest mortality rate of all mental illnesses.
  Lifetime mortality rates reported for anorexia nervosa have been up to 20%
• Waiting lists for treatment can be anywhere from 2 months to 2 years in Ontario

The Continuum of Disordered Eating
At Hope’s Garden, our view is that disordered eating exists on a continuum and that it

is important to acknowledge that every individual is unique in terms of his or her

personal history, symptoms and needs in terms of the things that will be most effective

on the road to recovery.

At one end of the continuum are attitudes and behaviours which may not seem like

problems now but which could eventually lead to the development of an eating

disorder. Examples are yo-yo dieting, occasional binge-eating, use of diet pills to

control appetite, negative thoughts about your body, excessive exercising, denial of

hunger, exaggeration of body size, emotional eating, etc... In a society that is

obsessed with thinness, perfection and self-control, it is not surprising that these

behaviours and attitudes exist. Certainly they don’t improve a person’s health or

increase self-esteem.

At the other end of the continuum are more serious and debilitating eating disorders

which rob the individual of his or her physical health, emotional well-being and

happiness in relationships. These include Anorexia Nervosa, Bulimia Nervosa and

Binge-Eating Disorder. It is important to know that no one sign or symptom defines

an eating disorder. It is a combination of physical symptoms, behaviours, attitudes

and emotions that leads to their identification.

Below are definitions of each eating disorder and a list of common signs and symptoms.

While there are important differences among the disorders, you will notice that there

are also many similarities.

What Factors Contribute to Eating Disorders?
Eating disorders are very complex problems. Most girls who develop eating disorders

do so between the ages of 11 and 14 (although it can start as early as age 7), and

there are many reasons why. The most common age to develop Anorexia Nervosa is

13, while the most prevalent age of onset for Bulimia Nervosa is 17. Some people

develop eating disorders because of family factors, others because of pressures from

society and the media, while others may develop an eating disorder because of a

traumatic event that they may have experienced as a child or a teenager.

There are many theories about what factors lead to the development of an eating

disorder. What is important to remember is that there is no one single cause for

the development of an eating disorder. Instead we find that there are many factors

that in combination can contribute to the development and maintenance of eating

disorders. In addition, it is important to pay attention to individual differences of

experience with regards to the factors described below.

Social factors

• The teenage years pose an especially difficult and vulnerable time for most

           teens. Puberty hits, and many girls are subjected to teasing by their peers.

• The feelings of inadequacy, the poor-self image, the anxiety, and loneliness

           experienced by many teenage girls (and boys) may contribute to or

           aggravate an eating disorder.

• Sometimes appearance-obsessed friends or romantic partners create

           pressure that encourages eating disorders.

• Cultural norms that value people on the basis of physical appearance and

           not inner qualities and strengths.

• Cultured pressures that glorify "thinness" and place value on obtaining the

           "perfect body” by means of diet, starvation, and over-exercising.

• Some people who develop eating disorders may seem to be living exciting

           lives filled with friends and social activities, but later they will confess that

           they did not feel they really fit in, that no one seemed to really understand

           them, and that they had no true friends or confidants with whom they could

           share thoughts, feelings, doubts, insecurities, fears, hopes, and ambitions.

Media factors

• As a teenager, feelings of inadequacy are easily influenced by the media, which

           sets unrealistic standards and unachievable goals in terms of looks.

• The media promotes a body image which is extremely thin, perfectly shaped

           and flawless. While this body type is presented as glamorous and achievable,

           for the most part, it is fake.

• How we feel about our body image is at its most fragile in adolescence due to

           physical changes of puberty. The tendency to compare ourselves on almost

           every dimension with those around us is also at its peak at this time. Girls can

           find themselves in a subculture of dieting, reflecting messages not only from

           the media but also from parents, peers, members of the opposite sex as well

           as the media.

• Images in the media are air-brushed and optically distorted using lighting and

           computers. In addition, teens are 'promised' that if they achieve these low

           weights and perfect shapes, they will be healthier and happier. The truth is

           that some girls who are affected by these cultural images practice extreme

           dieting and excessive exercise with the hopes of looking like their role models -

           the movie star, the model or the rock star. This is especially dangerous

           because diets can easily snowball into anorexia or bulimia. Dieting can

           become surprisingly addictive.

• Sometimes girls involved in certain sports, like ballet, gymnastics, and ice

           skating, might feel they need to be thin to compete. Girls who model also

           might be more likely to develop an eating disorder. All of these girls know

           their bodies are being watched closely, and they may develop an eating

           disorder in an attempt to make their bodies more "perfect."

What can I do??

Become a critical viewer of the media messages we are

bombarded with each day. Media messages about body shape and size will

affect the way we feel about our bodies and ourselves only if we let them.

When we effectively recognize and analyze the media messages that influence

us, we remember that the media's definitions of beauty and success do not

have to define our self-image or potential.

Familiar Factors

• Another factor which may contribute to the development of an eating disorder

           is family influences. Sometimes eating disorders seem to run in families,

           where a mother, sister, or aunt has also suffered from either anorexia nervosa

           or bulimia.

• Parents can increase a child's risk of developing an eating disorder if they are

           overly concerned about their child's looks or if they aren't comfortable with

           their own bodies and or engage in unhealthy eating habits and behaviours.

• Some other family factors include families that are over-protective, rigid, and characterized as having poor conflict resolution skills.

Psychological Factors

• There are many emotional and psychological factors that may contribute to

           the development of an eating disorder such as low self-esteem, depression,

           anxiety, a personality disorder, anger or loneliness.

• High expectations placed on ourselves by parents, media, friends and family,

           coaches and society in general, can often lead to feelings of inadequacy or a

           lack of control in one’s life.

Interpersonal Factors

• Some individuals who develop an eating disorder have a history of physical

           and sexual abuse or a history of being teased or ridiculed based on body size

           and weight.

• Troubled family and personal relationships, or a traumatic life event, such as

           a parent’s divorce, separation, or death have also been identified as contributor

           to the development of an eating disorder

• Sometimes, the difficulty in expressing emotions and feelings can also contribute

           to an eating disorder.

Anorexia Nervosa
Anorexia Nervosa is characterized by drastic weight loss from excessive dieting, and

intense fears of weight gain even when extremely thin. Up to 15% of people with anorexia nervosa die as a consequence of self-imposed starvation.

Physical Signs and Symptoms

• extreme weight loss
• loss of menstrual cycle
• dizziness or fainting
• sleep disturbances
• thin, brittle hair and nails
• lowered body temperature leading to complaints of always feeling cold
• periods of hyperactivity
• fatigue
• dry skin
• Lanugo – increased growth of fine, downy body hair
• pale, anaemic appearance

Behavioural and Emotional Signs & Symptoms

• preoccupation with food and weight
• unusual eating habits, i.e. eating only certain foods, rituals
• denial of any problems
• distorted body image
  (may view self as fat when others perceive individual as very thin)
• intense fear of weight gain
• perfectionism
• compulsive exercise
• wearing baggy or layered clothing to conceal thinness
• withdrawal form others
• hoarding of food
• frequent weighing and/or measuring of body
• inflexible in behaviour
• tendency to think in extremes (e.g,“Either I’m fat or I’m thin”; “Either I’m

           completely in control or I’m completely out of control”)

• low self esteem—thinness may become the major or only source of self esteem
• difficulty adapting to change

Bulimia Nervosa
Bulimia Nervosa is identified by recurrent episodes of binge-eating followed by some

form of purging such as self-induce vomiting, laxative abuse, fasting or excessive

exercise to avoid weight gain. Individuals feel a lack of control over eating and

experience strong feelings of guilt and shame. Because weight is often in the normal

range, bulimia nervosa may go unrecognized despite the many medical complications

that can result from the condition.

Physical Signs and Symptoms

• frequent weight fluctuations
• irregularities in menstrual cycle
• fatigue
• sleep disturbance
• bloodshot eyes, dark circles under eyes
• swollen glands, puffy face
• frequent sore throats
• frequent bloating and abdominal pain
• dizziness or fainting
• pasty complexion,
• sores on the inside of the mouth
• rashes around the mouth
• increase in dental problems due to erosion of tooth enamel

Behavioural and Emotional Signs and Symptoms

• tends to alternate between periods of dieting and binge-eating
• eats excessive amounts of food but with little or no weight gain
• fear of fat
• low self esteem – shame and self-disgust over bingeing & purging
• highly critical of body size and-or shape
• disappears after meals, evidence of vomiting or laxative abuse
• secretive eating
• mood swings
• poor concentration
• difficulty adapting to change
• frequent weighing and/or measuring of the body
• tendency to think in extremes (e.g., .”Either I’m a success or I’m a failure”)

Binge Eating Disorder
Binge-eating disorder is characterized by frequent binge-eating and a sense of lack of

control over eating. Those who binge-eat also suffer great emotional distress and eat for emotional reasons (anger, anxiety, sadness, loneliness etc.) rather than physical cues

of hunger. They are usually above the average weight.

Physical Signs and Symptoms

• fatigue
• weight gain
• sleep disturbances
• physical deterioration

Behavioural and Emotional Symptoms

• unable to satisfy hunger
• frequent snacking
• secretive eating
• mood swings
• memory lapses
• rapid, out of control eating
• emotional eating (eats in response to anger, sadness, fatigue, anxiety, loneliness

           etc… rather than physical cues of hunger)

• self-hatred
• preoccupied with thought of diets
• loss of interest in activities
• hoarding of food
  

WARNING SIGNS OF RELAPSE

• An increase in obsessive thinking about food, weight or shape
• Recognizing increased self-defeating thought patterns e.g. all-or-nothing thinking
• Experiencing urges to diet – skipping meals forgetting to eat, counting calories or fat grams, cutting back on portions
• Experiencing urges to binge-eat
• Experiencing urges to vomit or abuse laxatives
• Believing that one can purge ‘just once’
• Beginning to think/feel obsessively about exercise in order to compensate for

           food intake

• Ignoring pain and/or exhaustion when exercising
• Becoming dependent on weight or size to determine success or happiness
• Believing on is fat even when others view on as thin
• Increased social isolation
• Fantasizing about perfection as a way to feel better, e.g., imagining the perfect

          body, the perfect mark at school, the perfect relationship, etc…

• Constantly scrutinizing one’s body in the mirror or dread of seeing one’s body
• Drinking excessive amounts of water, coffee, or diet pop to trick oneself into

           believing one has maintained weight or is not hungry

• Using food consumption or dieting to ‘solve’ problems with stress, anxiety, anger,

           conflict

• Providing self or others with inaccurate reports (exaggerated or minimized) about symptoms – eating behaviour, troublesome thoughts or feelings
• Feeling anxious about decisions around food: eating same foods all the time:
• choosing only low calorie/low fat foods: chaotic eating patterns; rapid,
• unconscious eating
• Feeling out of control
• Hiding emotions (anxiety, depression, anger, guilt) from others including therapist
• Inability to tolerate the feeling of food in one’s stomach; feeling ‘gross’ or ‘fat’

           instead of ‘full’ or ‘satisfied’.

• Wearing only loose-fitting clothes – due to negative body image, hiding weight

           loss, extreme discomfort due to feeling ‘fat’

• Feeling guilty for eating, believing that one doesn’t deserve to eat
• Ritualistic eating patterns.
  From Berg et al (2002). Eating Disorders: A Patient-Centered Approach p. 140.