Eating disorders can be very scary, confusing and anxiety provoking illnesses for everyone involved. This includes friends and relatives. It is unusual for a week to go by without us being asked for advice on how to help, support or confront a friend or relative who has or might have an eating disorder For that reason we thought we’d make that the topic of our latest blog: how to help a friend.
The first essential thing to remember when talking to or supporting a friend with an eating disorder is that it is pretty much impossible to always say the right thing. Expect to get it wrong sometimes and don’t let this put you off trying to help. At some point your friend will probably need to see a professional who is trained in supporting people to over come an eating disorder. You should never try to take responsibility for helping your friend alone.
Below we have tried to offer some guidance about what to do and what not to do to best support a friend.
Remember, you don’t have to know all the answers. Just being there is what’s important. This is especially true when it feels like your friend or relative is rejecting your friendship, help and support.
There are a multitude of physical, emotional and psychological consequences of eating disorders. One of the issues that we commonly get asked about is what impact eating disorders have on fertility – both short term and long term.
Concern about fertility is one of the most common reasons that women cite for seeking treatment for an eating disorder. Whilst we still don’t feel that there is enough research in this area to be able to give a definite statement about the long term impact of either anorexia or bulimia on fertility, we do know that women with current eating disorders are more likely to experience fertility problems.
It is fairly well known that in restrictive eating disorders, where periods stop due to low weight, fertility issues are very likely. However studies have also identified fertility difficulties in women with eating disorders who are at a healthy weight.
A research study done in 2013 (Int J Eat Disord 2013; 46:826–833) is the most recent study that we are aware of that investigated the impact of a current eating disorder on fertility. The researchers compared 2,257 women with a current diagnosis of an eating disorder with 9,028 women without an eating disorder. An advantage of this study is that it explored fertility issues in women across all eating disorder diagnoses: anorexia nervosa, bulimia nervosa, atypical eating disorder and binge eating disorder.
The researchers found that across all eating disorders, women were more likely to be childless. Whilst this doesn’t necessarily point to fertility problems in itself, it does support previous research in highlighting the presence of increased fertility difficulties in women with eating disorders. This research also found that women with bulimia nervosa or binge eating disorder were at increased risk of miscarriage.
Previous research has also found that in restrictive eating disorders with resulting low weight, up to 1/4 of patient may never regain normal menstruation cycles, suggesting that fertility may be affected even following successful treatment. In women that do become pregnant there is a known increased risk of complications like miscarriage, birth defects and low birth weight babies, Cesarean section, and postpartum depression.
We would reinforce that we don’t feel there is enough research at present to know what the long term fertility implications for people in recovery from an eating disorder are. There is some evidence though that fertility may not always return to normal once a person has fully recovered from an eating disorder. We would suggest that this is more likely if the eating disorder has been severe and long term.
I you are concerned about the impact of an eating disorder on your fertility, we would encourage you both to seek professional help and to be open about your eating disorder history with your GP or any other professional involved in your fertility care.
In the past it was believed that people with bulimia nervosa had a binge-eating disorder and that they dieted in order to counteract the effects of a binge. Although it is true that people sometimes restrict their eating after binging, we now know that dieting in fact precedes, and is the major cause of binge-eating.
Dieting causes binge-eating primarily because it results in a state of deprivation in the body. The body can only tolerate being deprived of essential nutrients for so long and then it rebels and overeats to compensate for what it hasn’t been getting. In the same way that people who become extremely thirsty tend to drink more than usual, people who’s bodies are extremely hungry, will tend to binge. How long it takes to develop binge-eating varies. Some people manage to maintain extreme restriction for a long time without bingeing, however for the vast majority of people, and for 50% of people with anorexia, restriction will at some point result in binge-eating. This is often taken as a sign of failure or weakness, however it is actually near impossible to override a physiological urge to binge
The body makes significant adaptations in response to both restriction and bingeing, meaning that the effect of bingeing on the body can change over time. Firstly, if the body learns that it has to exist on a small amount of energy (as it does in those who chronically diet), it slows its metabolic rate down in order to use food more efficiently. Dieting actually reduces the metabolic rate by around 15-30% and reduces the amount of energy expended during activity. This compensation is found irrespective of the body size of the individual. The longer a person diets for the more the metabolic rate is slowed, and the longer it takes for the metabolic rate to recover.
This has important implications for understanding the effects of binge-eating cycles. It is likely that weight loss becomes increasingly difficult each time a person tries to restrict their food intake, and that the calories taken in during binges are less likely to be burned as fuel and are stored more readily by the body as fat. This is one of the reasons why people with bulimia nervosa tend to gain weight over time, even if their eating doesn’t seem to have changed. This weight gain (or increased difficulty in losing weight) makes it more likely that people will try and diet. However this only serves to increase the frequency and intensity of being eating. Thus a vicious cycle begins.
Vomiting and using laxatives often begin as ways of regaining control after “over-eating.” These practices soon result in even greater breakdown in control since they “legitimize” binging (“It’s all right to binge, because I can get rid of it all afterwards”). They may also contribute to a physical relief after the fullness of binging or eating, and the person may eventually feel she must vomit or use laxatives after every meal or at the end of every day to try to get back the sense of relief. Although the individual may initially lose weight through purging, this is most often temporary as the effectiveness of vomiting becomes limited over time (see blog post: the ineffectiveness of purging). Although vomiting “solves” the short-term problem of getting rid of unwanted food that may lead to weight gain, in fact it only gets rise of around 30% of calories consumed during a binge, and actually makes it more likely that a person will binge as it increases hunger and urges to binge. Thus over time, people who purge after bingeing are also more likely to see an increase in bingeing and resulting weight gain.
Taking laxatives can also be part of this cycle. Regular laxative use can result in a physiological reliance on the laxatives. This may be because the bowel’s normal muscle contracting ability is impaired by repeated laxative use due to damage to intestinal nerves. Severe constipation or water retention can result when laxatives are not used, so that it seems that continuing to take the laxatives is the only way to continue “regular” bowel movements. Besides being extremely dangerous, laxatives are a completely ineffective method of trying to prevent the absorption of calories. In fact all laxatives get rid of is water, thus removing essential hydration from the body.
Occasionally bingeing eating occurs solely because of these physiological effects, however in bulimia nervosa there can often be emotional triggers to bingeing as well. In these circumstances bingeing tends to be triggered by intense emotions or as a desire to escape from strong emotions. This means that when bingeing stops, strong emotions may start to reveal themselves. For these people, it can be very important to seek support from a professional to help them to identify, understand and cope with these strong emotions.
The exact cause of binge eating disorder is still unknown, but researchers are beginning to understand factors that lead to its development. Like other eating disorders, binge eating disorder seems to result from a combination of psychological, biological, and environmental factors.
Binge eating disorder has been linked to other mental health disorders. Nearly half of all people with binge eating disorder have a history of depression, although the exact nature of the link is unclear. Many people report that anger, sadness, boredom, anxiety, or other negative emotions can trigger an episode of binge eating. Impulsive behavior and other psychological problems also seem to be more common in people with binge eating disorder.
Eating disorders, including binge eating disorder, can sometimes run in families, suggesting that a susceptibility to eating disorders might be inherited. Researchers also are looking into possible abnormal functioning of chemical messages to the brain involving hormones that regulate appetite (such as leptin and ghrelin) and proteins that regulate blood sugar and body metabolism (such as adiponectin).
People with binge eating disorder often come from families that overeat or put an unnatural emphasis on food; for example, they may use food as a reward or as a way to soothe or comfort, leading to binge eating as a learned behavioral response to stress.
Binge eating also sometimes can be an undesirable side effect of certain psychiatric or other medications that stimulate appetite and may interfere with people being able to sense when they are full after eating a meal.
Can Binge Eating Disorder Be Prevented?
Although it might not be possible to prevent all cases of binge eating disorder, it is helpful to begin treatment in people as soon as they begin to have symptoms. In addition, teaching and encouraging healthy eating habits and realistic attitudes about food and body image also might be helpful in preventing the development or worsening of eating disorders.
We praise the recognition among schools that encouraging pupils to strive for perfection in all areas can increase the risk of mental health conditions including depression and eating disorders.
Unrelenting standards and a core sense of failure or not being good enough are common difficulties among people who present to us for treatment. Targeting these issues at a younger age and encouraging people to resist the urge to need to be perfect at all times is crucial to good mental health. We hope to see more schools following this example.
1. You feel almost constantly preoccupied or concerned with your body weight and shape.
2. You regularly diet or make attempts to burn or lose calories after you have eaten something that you think you shouldn’t have.
3. You experience guilt or shame following over-eating or deviation from an eating plan.
4. You fear that eating even a small amount of food will trigger an episode of excessive eating
5. You make excessive attempts to control your weight or you engaging in unwanted behaviours to counteract the effects of eating.
6. You have experienced eating until you feel uncomfortably full
7. You have eaten with the intention of getting rid of the calories you have consumed at a later point
8. You experience constant dissatisfaction with weight, or anxiety about weight gain
9. You believe that weight is central to how others view you and to your self worth. If you gain weight, you fear that others will judge or view you differently
10. You make significant efforts to keep many of your eaten patterns a secret from others, and feel ashamed or worried about others knowing what you do.