Eating Disorder

What are Eating Disorders?

Eating disorders are serious mental illnesses which can affect you physically, psychologically and socially. They include Anorexia, Bulimia, Binge Eating Disorder and Other Specified Food and Eating Disorders (OSFED), formally referred to as Eating Disorder Not Otherwise Specified (EDNOS).

Around 725,000 people in the UK are thought to be affected by eating disorders (BEAT, 2015). Although eating disorders are serious, recovery is possible with the right help and support. Anyone can be affected by an eating disorder regardless of age; gender or cultural background. Previously, eating disorders were seen as disorders which only affected young teenage girls, but there is growing awareness that eating disorders can affect all gender and age groups. Eating disorders have the highest mortality rate of the mental health disorders, this is often as a result of physical complications or suicide.

The causes of an eating disorder are complex and include biological, psychological and social factors.

Treatment usually involves exploring the various factors that have contributed to the development of the eating disorder.  An example of some of the factors that may be involved include ; issues around control, developmental issues, depression; low self-esteem; sexual abuse; having a first degree relative with an eating disorder; feeding and eating difficulties when younger; puberty; relationship changes; illness; bullying; parental divorce and dieting behaviour

What is Anorexia?
  • Intense fear of being and/or becoming fat
  • Restricting food intake leading to a significantly low body weight for a person’s age, height, gender, developmental trajectory and physical health
  • Distorted perception in how their body is viewed (e.g., thinking that they are fat when they are in fact very thin)
  • Subtypes: Restricting & Binge/Purge.
What is Bulimia?
  • Recurrent episodes of binge eating whereby a large amount of food is eaten over a discrete amount of time in what feels like an out of control manner
  • Behaviours to compensate for the binge such as self induced vomiting; misuse of laxatives and diuretics; over-exercise and fasting or restricting
  • This happens at least once a week for 3 months
  • The person’s view of themselves is unduly influenced by your body shape and weight.
What is Binge Eating Disorder?
  • Recurrent episodes of binge eating whereby a large amount of food is eaten over a discrete amount of time in what feels like an out of control manner
  • The episodes of binge eating are not accompanied by compensatory behaviours such as self-induced vomiting or over-exercising
  • The episodes are associated with three or more of the following:
    • Eating much more quickly than normal
    • Eating until they feel uncomfortably full
    • Eating a large amount of food even when they don’t feel physically hungry
    • Isolating themselves whilst eating due to embarrassment about how much they are eating.
    • Feeling depressed, guilty and disgusted with themselves after the binge.
  • This happens at least once a week for 3 months.
Other Specified Feeding or Eating Disorder (OSFED)

OSFED is diagnosed when there are feeding or eating behaviours that cause significant distress and impairment to daily life but that do not meet the full criteria for any other feeding or eating disorder.

OSFED includes ;

  • Atypical Anorexia Nervosa –all the criteria for anorexia are met but despite significant weight loss, weight remains within or above the normal limit
  • Binge Eating Disorder (of low frequency and/or limited duration) –all the criteria for BED are met but the episodes of bingeing occur less than once a week and/or have been occurring for less than 3 months.
  • Bulimia Nervosa (of low frequency and/or limited duration) – all the criteria for bulimia are met but occur less than once a week and/or have been occurring for less than 3 months
  • Purging Disorder – Occurs in the absence of binge eating and is characterised by recurrent purging behaviour to influence weight or shape
  • Night Eating Syndrome – Recurrent episodes of night eating either by excessive food consumption throughout the evening after the main meal or awakening from sleep to eat during the night. This is diagnosed when the behaviour is not better explained by another mental health disorder (for example, BED).
Unspecified Feeding or Eating Disorder (UFED)
  • This diagnosis applies when the behaviours cause significant distress and impairment to day-to-day functioning but do not meet the full criteria of any of the feeding or eating disorders.
  • This diagnosis may be given if the clinician does not have enough evidence that the behaviours meet criteria for another feeding or eating disorder.
Signs and Symptoms of Eating Disorders
  • Anxiety around food, eating and/or meal times
  • Avoiding mealtimes or eating situations
  • Counting calories/weighing food
  • Sudden avoidance of previously enjoyed foods
  • Labelling of foods as “good and bad”
  • Significant loss of weight
  • Rigid patterns around eating (e.g., eating food in a certain order or cutting food up in a certain way)
  • Social isolation and avoidance of social situations involving food
  • Signs of binge eating (e.g., food missing from the cupboard or fridge; food wrappers hidden or disposed of secretively)
  • Frequent trips to the bathroom after eating (which may be a sign of self-induced vomiting or laxative misuse)
  • Feeling faint or actually fainting
  • Tiredness and difficulty concentrating
  • Swollen cheeks and/or puffy eyes may be a sign of self-induced vomiting
  • Periods may become irregular or stop
  • Evidence of compulsive exercise (e.g., exercising in bad weather or exercising despite having an injury) ]
  • Feeling and being cold
  • Lanugo hair (a fine hair that grows all over the body)
  • Wearing loose clothing to hide weight loss
  • Frequent fluctuations in weight
  • Distorted perception of one’s shape and size
  • Intense fear of gaining weight
  • Preoccupation with weight, shape and food
  • Displays distress at mealtimes
  • Low self-esteem; feelings of worthlessness
  • High expectations of oneself/attempting to attain ‘perfection’ in life
What helps

Accessing appropriate and timely treatment through your GP is an important step towards recovery from your eating disorder. This may involve psychological work to understand where the disorder might have developed from; nutritional education and physical monitoring. Treatment is more effective if the individual themselves is committed to recovery. Having supportive family and friends to lean on during recovery is also invaluable. There are also 3rd sector organisations such as the UK’s leading eating disorder charity, B-eat, who offer telephone support and message boards to those affected by eating disorders. Further details can be found under the Find Out More section.

Referral Pathway

If you are concerned that you or someone that you care for may have an eating disorder, the first point of contact for seeking help would be your GP. The GP can then make a referral to your local Community Mental Health Team (CMHT) as appropriate. For most people, eating disorders can be managed within the CMHT. A CMHT is comprised of psychiatrists; psychologists; community psychiatric nurses (CPNs) and occupational therapists. If your eating disorder is more severe, your CMHT psychiatrist or key worker may choose to make a referral to the Adult Eating Disorder Service (AEDS).

The Greater Glasgow and Clyde Adult Eating Disorder Service (AEDS) is a specialist service offering intensive input for individuals with moderate to severe eating disorders. It also offers support for all professionals working with eating disorders across this area.  AEDS offers a holistic and recovery orientated psychological approach to the treatment and management of eating disorders, supporting individuals and their carers through this difficult journey. The multi-disciplinary team consists of practitioners from various disciplines including psychology, psychiatry, nursing, dietetics and occupational therapy. These practitioners are trained in a variety of therapeutic interventions.

The AEDS complements the intervention offered by the CMHT, it is able to offer more intensive multidisciplinary input as required across out-patient, day programme and in-patient.

The AEDS offers training, education and consultation to other staff and services working alongside people with eating disorders.

Living with...Eating Disorders

Living with an eating disorder is an exhausting and draining experience whereby your daily life is consumed by thoughts of food and weight. You may find yourself thinking about food constantly; for example, you may like baking for others but would never eat what you baked yourself; you may find yourself obsessed by cooking shows; diets in magazines and the weight of celebrities. You will most likely be preoccupied by what you’ve eaten recently and when you will next be eating. Eating is followed by intense feelings of shame, guilt and disgust. The preoccupation with food and weight may become so severe that it stops you being able to function in other areas of your life. This may lead to you needing to take time out from studying and/or work. You may withdraw from your friends socially because you lack the energy to engage with them or because you are fearful that the interaction may involve food. You may become very aware of what others around you are eating and you may feel distressed and/or irritable if you perceive them to be eating less then you. In addition, you may find yourself critically comparing your weight, shape and size with strangers leading to feelings of worthlessness and disgust. It is likely that you will prefer to eat on your own when there is no-one around to watch you.

Often people who have an eating disorder feel as though they don’t deserve nice things unless they weigh X amount or follow a rigid eating pattern without deviating from it. This creates immense amounts of pressure. These expectations are often unrealistic and so when they are not met, they result in the individual feeling like a failure leading to further unrealistic expectations being made.

If you are underweight, you may feel cold, faint and tired lots of the time. You may find it difficult to concentrate on things like reading a book or watching a television show. If you are female, your periods may become irregular or even stop leading to longer term complications like osteoporosis and fertility issues. Combined, these factors can often lead to depression and/or suicidal ideation because life becomes restricted only by the perceived success of manipulating your weight, shape, size and diet. If you binge eat, this may result in feelings of disgust, shame and worthlessness. You may also find that your day is preoccupied by when you are next going to binge and planning what you are going to binge on.

Find out more

B-EAT Beating Eating Disorders

Eating Disorders - NHS Choices

NICE Guidelines on Eating Disorders  

Centre for Clinical Interventions including Eating Disorders

Link to online version of the EDE-Q

Looking after someone with an Eating Disorder

It can be very difficult to watch someone that you love and care for struggle with an eating disorder. You may feel confused, frightened or angry with them. It can be very easy to focus on weight and food and believe that if they would ‘just eat’, everything would be OK. It is important to realise that the behaviours you see are your loved ones way of controlling, avoiding and managing emotional distress. It may help to gently express your concern without becoming overly emotional; listen to your loved one if they want to talk about things and offer them support to seek help from their GP if they choose to do so. Only the person suffering from the eating disorder can make the changes necessary to recover but having supportive family and friends can go a long way in making the journey towards recovery more manageable.

Unhelpful things to say to someone with an eating disorder

  • ‘Why don’t you just eat this?’
  • ‘Why are you putting me through this?’
  • ‘Look at what you’re doing to everyone around you’
  • ‘You look like you’ve put on weight’
  • ‘You don’t look that thin’
  • ‘I’m trying this new diet because I feel so fat’
  • ‘It’s not that hard to eat’.

Helpful things to say to someone with an eating disorder

  • ‘You’re doing really well, I know how hard this is for you’
  • ‘I believe in you’
  • ‘I’m here for you’
  • ‘If you need someone to talk to, you can always speak to me’
  • ‘You’re not alone’
  • ‘I can see this is tough for you but I’m proud of you’
  • ‘You’re showing lots of strength and determination’.

Caring for someone with an eating disorder can be very draining so it is also very important to look after yourself throughout this process. Make sure to schedule in activities that you enjoy and supportive people you can talk to when things feel overwhelming.

Further information for carers is available on our Looking After Someone page and from the NHS Greater Glasgow and Clyde carers site

Real life stories
BSL - Eating Disorders

NHSGG&C BSL A-Z: Mental Health - Anorexia Nervosa

A type of eating disorder where the person will restrict the amount of food they take in with a view to losing weight or maintaining a low body weight that is unhealthy. It is frequently associated with an increased pre-occupation with their weight and possibly perceiving themselves as being fat or over-weight even when this might not be the case.

NHSGG&C BSL A-Z: Mental Health - Bulimia Nervosa

A type of eating disorder where a person goes through periods where they eat a lot of food in a very short amount of time (binge eating) and then are deliberately sick, use laxatives (medication to help them poo) or do excessive exercise, or a combination of these, to try to stop themselves gaining weight.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde, and is not a description of the text on this website.