What is an eating disorder?

An eating disorder is a serious mental illness characterised by disturbances to thoughts, behaviours and attitudes to food and eating. For some, this extends to pre-occupation with body weight/shape. 

Eating disorders are not a lifestyle choice, a diet gone wrong or a cry for attention. They are mental illnesses recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and can take many different forms. Importantly, you cannot tell if someone has an eating disorder by the way they look.  

Eating disorders are more common than you may think.

It’s estimated that 1.1 million Australians are experiencing an eating disorder right now, and this number is increasing. 

Classifying eating disorders - DSM 5

Eating disorders are usually clinically defined and diagnosed according to the criteria in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). 

About the DSM-5 

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication of the American Psychiatric Association. It is currently in its 5th edition. The DSM contains sets of diagnostic criteria (symptoms being experienced) grouped into categories (disorders) to assist clinicians with the effective diagnoses and care of people with mental health disorders. It includes the following criteria.

  • Anorexia nervosa 
  • Bulimia nervosa  
  • Binge eating disorder 
  • Avoidant/restrictive food intake disorder (ARFID)
  • Pica  
  • Rumination disorder
  • Unspecified feeding and eating disorders (UFED)
  • Other specified feeding and eating disorders (OSFED): 
    • Purging disorder  
    • Night eating syndrome  
    • Atypical anorexia nervosa 
    • Subthreshold bulimia nervosa and binge eating disorder 
    • Orthorexia 

Who uses the DSM-5?

GPs, psychiatrists and mental health professionals will usually use the criteria from the DSM to compare against an individual’s symptoms. This process will help them to decide whether the individual meets the diagnostic criteria for a particular mental health disorder. A diagnosis can help select the treatments with the best evidence for good outcomes associated with the disorder symptoms. 

It is important to note that the DSM is just one tool to help diagnose and treat eating disorders and may not represent the broad spectrum of eating disorder experiences. Dialogue and research are ongoing to help refine diagnostic criteria, improve clinical practice, and ensure that individuals receive appropriate support and treatment for their experiences with eating disorders. 

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What causes eating disorders?

Eating disorders do not have a single, identifiable cause. There are biological, psychological and social risk factors that may increase the likelihood of an eating disorder developing.

For many people, there will be an overlapping of risk factors that contribute to them developing an eating disorder. We also know that engaging in eating disorder behaviours is often a way to cope with internal or external difficulties, stressors or changes. Addressing these challenges, and developing more healthy coping mechanisms, is often part of the recovery process.

Biological factors

Emerging evidence shows that the development of an eating disorder may have a biological link relating to a person’s genetics. Studies show that eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder have moderate-high heritability. Ongoing research into this field is analyzing hundreds of genes that may influence the chance of developing an eating disorder with the hope of improving treatment and even preventing illness. 

Psychological factors

  • Feelings of inadequacy 
  • Perfectionism 
  • Difficulty expressing emotions and feelings, particularly negative emotions such as anger, sadness, anxiety or fear 
  • Fear or avoidance of conflict 
  • Low self-esteem 
  • Competitiveness 
  • Impulsive or obsessive behaviours 
  • High concern with the opinions of others, often with a need to please 
  • Prone to extremes, such as ‘black and white’ thinking 
  • Difficulty coping with stress 
  • Depression or anxiety 

It is important to note that psychological symptoms can also be present as the result of an eating disorder and the impact of starvation syndrome. Psychological symptoms may resolve with adequate re-nourishing and subsequent recovery. 

Social factors

  • Cultural value placed on ‘thinness’ or small bodies as a moral and health imperative 
  • Normalisation of intentional dieting and weight loss in pursuit of the ‘thin ideal’ 
  • Valuing of people according to outward appearance 
  • Media and popular culture’s portrayal of ‘ideal’ shapes and bodies 
  • Professions with an emphasis on body shape and size (eg. dancers, models, athletes) 

Other factors

  • Significant life stages, such as puberty, pregnancy and post-partum and menopause 
  • Life events, particularly those involving major changes (e.g. loss of a family member or friend, the divorce or separation of parents, moving schools or jobs) 
  • Autism, particularly in women 
  • Engaging in dieting
  • Poor body image 
  • Peer pressure 
  • Difficulties with personal or family relationships 
  • Sexual or physical abuse 
  • Food insecurity 
  • Unmet needs (emotional, psychological, social, professional, spiritual, physical or pleasure) 
  • History of teasing or bullying, particularly when based on weight or shape 

RECOVERY FROM EATING DISORDERS

Eating Full recovery from an eating disorder is possible for everyone, even those who have experienced symptoms for many years. 

The first step towards recovery is to talk about what you are experiencing. This may start with a health professional, a helpline, a trusted family member or friend, a teacher, a coach, or a spiritual leader. If you find that the person you speak to doesn’t validate your feelings, or have much knowledge about eating disorders, it’s important not to ignore your symptoms.