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What are eating disorders (EDs)?
Eating disorders are mental illnesses that often have serious physical effects. People with EDs often have other mental illnesses such as anxiety and depression.
People with EDs usually have the wrong idea of what they look like, for example, that they are bigger than they really are. They have different types of unhealthy eating, depending on the disorder. They often don’t enjoy food for the flavour or for the social aspect of meals and snacks. Instead, they eat too little or binge (eat significantly more than they are hungry for over a shorter period of time). Typically, they feel ashamed or guilty about their eating and will often eat alone.
EDs happen most often in girls and young women, but more and more boys and men have EDs too. Other behaviours can also come along with disordered eating, like exercising too much, obsessing about food, throwing up or taking laxatives to get rid of food eaten. The most common eating disorders are:
| Anorexia Nervosa (also called Anorexia) |
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People living with anorexia are extremely worried about eating and gaining weight and become obsessed with these worries. They usually restrict food intake to lose weight. They may also over exercise or vomit after meals in an effort to control their weight, when in fact their weight is controlling them. They may hide their restrictive behaviour by saying they aren't hungry or that they had a big lunch or snack to avoid eating dinner. Anxiety and depression are common with anorexia. People with anorexia:
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| Bulimia Nervosa (also called Bulimia) |
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Like anorexia, people with bulimia also have a poor body image and worry too much about eating and weight. Someone with bulimia would typically eat large amounts of food very quickly and getting rid of it by:
Bulimia is sometimes harder to notice in others, as people living with bulimia may hide their behaviours and not fit the ED stereotype by appearing underweight. Secrecy, feelings of shame, anxiety and depression are often part of bulimia. It is also a dangerous eating disorder, with additional harmful effects if the person is purging or abusing laxatives. |
| Binge Eating Disorder (BED) |
| Binge eating means eating a large amount of food, but without the purging behaviours (vomiting, laxatives, exercise) seen in bulimia. This is not the same as having a bad day and eating more ice cream than you usually would. People with a BED often describe feeling out of control during a binge, that they are often not aware of the food, the amounts they are eating or how quickly they are eating. They often eat alone or in secret. Binge eating is often triggered by an upsetting situation or difficult emotions. People with BED often feel overwhelmed by negative emotions, and eating gives them a temporary feeling of comfort. But this feeling of comfort is followed by feelings of guilt and shame. People with BED are sometimes larger than an 'average sized' person, but not always. They usually suffer from low self-esteem and depression. |
| Other or 'Unspecified' Eating Disorders |
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Many serious EDs don't fit perfectly into one of the above definitions. For example, someone may either:
These illnesses are still very serious, as our health depends on being able to eat (and keep down) regular meals with the right 'dose' of nutrition to fuel our bodies and minds. |
How do I know if I have an ED?
- intense fear of gaining weight
- obsession with dieting or weight
- being overly picky with the food being eaten
- hiding or getting rid of food
- not telling the truth about what else they have eaten that day
- losing an unhealthy amount of weight
- skipping meals
- refusing to eat with friends or family or eating in secret
- missing 2 menstrual periods
- bingeing (eating large amounts of food and feeling out of control while doing so)
- using diet pills or laxatives
- throwing up after eating
- refusing to eat foods that "aren't healthy" according to incorrect stereotypes (see socio-cultural influences below)
- refusing to let others prepare their food, or insisting that they watch when someone else prepares the meal incase they are trying to "make them fat"
- cutting food in very small pieces
- weighing and measuring food amounts
- obsessing over calorie and carb content of foods
- not getting taller when they should be growing
- feeling you have to exercise even if they don’t need or want to
- slower healing times
- light headedness when standing
- poor physical performance in activities they used to be good at (e.g. can't swim as far or as fast as they used to)
- sore muscles
- lowered heart rate
- dehydration
- loss of periods in those who menstruate
- difficulty sleeping or fatigue
- being cold more often
- hair loss
- growth of a fine, new hair called lanugo
- lower sex drive
- breakdown of tooth enamel
- thinning of the bones
- stunted growth
- organ failure
- death
What causes EDs?
Eating disorders often begin with worries about food or weight. Dieting can cause an eating disorder to develop. While many teenagers will try to diet, only a few go on to develop a disorder. Things that might contribute to eating disorders are feeling stressed or anxious, low self-esteem, feeling depressed or feeling badly about yourself or your appearance.
| Socio-cultural influences |
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Unreal standards of beauty Media messages constantly tell us that being thin is essential for love, success and happiness. It might be hard to imagine, but there were times in history when round hips, bellies and thighs were celebrated! The 'ideal' model is now impossibly thin, surgically changed, airbrushed and photo-shopped, giving us even more unrealistic images to compare ourselves to. These images want us to accept their (warped) view of what is acceptable or beautiful. It can be hard to ignore these messages because they are everywhere, and really do get 'under our skin'. Perhaps these messages are intended to make us all feel 'not good enough' so that we will spend more money on trying to improve our appearance! We need to work on creating our own ideas of beauty that celebrate a wide variety of size, shape, colour and ability. Instead of seeing our bodies as 'ornaments', we need to think of them more as 'instruments' for doing the stuff we need and want to do! Food stereotypes In schools and families, in the media and among friends, there is lots of misinformation about what “healthy” food is. For example, contrary to what some people believe, fats ARE good for you; they help your brain work properly, keep your joints moving smoothly and help you have healthy hair. Broccoli, celery and cucumber can be part of a healthy diet but they are not any healthier than bananas, potatoes, steak or ice cream. In fact, eating these vegetables instead of protein, more fibre, dairy and other carbohydrates is definitely not healthy. The body needs a variety of nutrition from all different food groups to take in and use all the nutrients those items provide. Without it, your body won’t be able to function at its best. |
| Personality traits |
| People dealing with EDs often struggle with low self-esteem and can be extremely concerned about how others see them. Some are considered "super feelers". This means they feel emotions very intensely, both their own, and those of others. This makes them highly sensitive to how other people perceive them. This can be a wonderful quality as it can make a person very kind and compassionate, but it can also cause a person to want to please everyone and to be perfect as much as possible. This perfectionism tends to put pressure on them to always do better but they are rarely satisfied with the results of their efforts. For many people, the main feeling underneath an ED is feeling 'not good enough' in some way. |
| Genetics |
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Like other physical and mental health concerns, your genes can influence your risk of developing an ED. People with a family history of EDs, obsessive-compulsive disorder, depression or anxiety have a greater risk of developing an ED. Your genes also play a big role in the size and shape of your body. It's hard to fight against your genes. And fighting your natural body type through starvation or disordered eating is dangerous. It's healthier if we learn to love and accept our bodies. We need to practice giving our bodies what they need, taking good care of them so they can take care of us. |
| Gender and sexuality |
| Members of the 2SLGBTQ+ community are more likely to have an ED than cisgender, heterosexual people. Transgender and non-binary individuals may have an ED or disordered eating behaviours as a way to hlep their body conform to their gender identity and minimize unwanted body changes such as breast development or increased muscle. |
How are eating disorders treated?
First, talk to someone you trust. There is no shame in having an ED. It is not your fault in any way. It's important for you to build a support team that understands you so that you do not have to feel alone.
Arrange a visit to your family doctor or nurse practitioner. Either one can help you explore options that make sense to you.
| Family-Based Treatment (FBT) |
| Family-based treatment is the first-line treatment for young people suffering from anorexia nervosa and bulimia nervosa. This treatment supports parents or caregivers to take a central role in supporting their loved one to manage their eating and their symptoms. Once they are able to do so, the young person can then return to a more normalized eating pattern. |
| Cognitive-Behavioural Therapy for Eating Disorders (CBT-E) |
| If FBT is not an option or not effective, cognitive-behavioural therapy for eating disorders (CBT-E) is an individual treatment for young people suffering from anorexia nervosa, bulimia nervosa, and binge eating disorder. This treatment involves creating an individualized treatment plan based on the reason for the eating problem. Treatment strategies include psychoeducation, self-monitoring, normalized eating, exposure and family support. |
| Medications |
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Medications can be a useful option to consider when you are feeling very stuck and having great difficulty reaching your goals, even with all the other support options. Medications can also:
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| Intensive Treatment |
| Going into the hospital may be necessary if you are medically unwell and need further care and monitoring. It may also be an option for people who aren't getting better at home, even with the support of family and professionals. |
Helping yourself get better
While it's important to have professional and family support to recover from an eating disorder, there are some things that you can do on your own too.
Remember!
When you have an ED, you usually can't tell how you really look. For example, many people with eating disorders think they are really overweight, when they're not. This kind of warped image of your body can get worse when you're not getting enough energy and nutrients.
The role of food in recovery
The only way out of an eating disorder is by getting back to eating normal meals at regular times throughout the day. For those with anorexia, the only way out of the illness is to get back to your body's healthy weight. For those with bulimia, the only way to leave the illness behind is by pushing yourself to eat regular meals and snacks all day. This is the only way to end the cycle of hunger, bingeing and purging.
| Scheduled eating |
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Scheduled eating is the way to re-nourish your body and train it to get back into healthy habits. This is the most important step in recovering from an ED and its effects. It sounds simple, but experts know that when your ED is trying to control you, it will make you worry a lot about eating "too much" or "gaining too much weight," and it can be incredibly difficult. Scheduled eating means eating at regular times, even when you don't want to. So, you schedule, eat, and keep down 3 regular size meals a day, with snacks in between. Snacks are important, because they keep your metabolism at a healthy rate (when you don't eat enough, your metabolism slows down). At first, your brain might not 'feel' hungry or want to eat. As you retrain and re-feed, you and your body will learn how to read natural hunger cues again. Giving your body the nutrients, it needs will also help to clarify your thoughts and feelings, because your brain won't be suffering from inadequate nutrition. |
| Automatic eating |
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Some people find that when they start trying to eat more normally, the ED thoughts can be very strong during a meal or snack. In this situation, it can be helpful to break every action into many smaller steps such as:
At first, it can be helpful to have someone else there to tell you each of the steps. This person can also help keep your mind on other things when it feels hard (talk to you about things you are interested in, listen to music with you, play cards, watch a favorite movie or show). Over time, you can take over the prompts and learn to say them to yourself rather than have to hear them out loud. |
When you have an ED, eating normally is not easy. It will take a lot of strength, determination and commitment to make it work. Here are some tips that will help:
Stand up to your eating disorder
Your ED is not you. Don't let it define you. It can help if you give it an identity of its own — like a bully who is trying to control and harass you.
- Name the bully inside your head. Some people call it 'Ed' or 'Ana', but feel free to get creative. By giving your ED a name, you help to separate yourself from it. Your ED bully will try to manipulate you into believing that it (and no one else) has the answer to making you feel better about yourself. It will always make you feel that you are eating too much and gaining too much weight. It will always try to make you feel guilty and bad about yourself so it can control you and push you around even more.
- Don't let the bully talk trash about you. Fight back with thoughts and arguments that show you're just fine the way you are. Recovery means learning to stand up to the bully and not listen to it.
- Your caregivers want to help you. They will learn how to help you at meal times and at snacks and can remind you of all the things they love about you.
Don't just focus on your appearance. You're so much more than that. Think about things you can do, things you like to do, things you're good at, things you're proud of or that bring you peace and joy. If it helps, write down the things it's saying about you. Then push back by writing down the reasons your bully is completely wrong about you.
Be your own best friend. We often have great advice for our friends, but maybe we should sometimes take our own advice. If a friend was being treated badly by someone, what kinds of things would you tell them?
Plan meals. Set a fixed time when you will eat your breakfast, lunch and dinner. Work towards planning ahead what you will be eating to help stay focused on the goal. For extra support, think of where you will eat and with whom. Take part in grocery shopping and pick foods you used to enjoy eating before the eating disorder.
Don't avoid any foods or food groups — 'everything in moderation' is the key!
Look ahead
Take some time to think about what is most important to you. Ask yourself, what do I value the most in my life? Where do I want to be in 5 or 10 years? What kind of person do I want to be? What goals do I have? You might find there are many things that are meaningful to you. Think about the steps you need to take to be who you want to be. Worry less about the things that aren't as important to you. Think about who and what can help you to reach your long-term goals. Invest your time and energy in taking care of yourself, focusing on positive relationships and reaching your goals, instead of trying to be perfect in everything. Also, ask yourself, what makes a good friend? Who are the most important people in my life? Is it their weight that matters most to you? Would they want you to be obsessing about your weight?
Exercise your gratitude muscle
Noticing and paying attention to good things in your life is important. It's a habit, and we need to practice it. Take some time every day to think about things you're grateful for. They don't have to be big things.
You might be grateful for...
- a warm smile
- your affectionate dog
- a purring cat
- a warm breeze
- a good friend
- awesome shoes
You'll be surprised at how nurturing an 'attitude of gratitude' will help you see more of the positive things in your world.
Accept yourself
Science proves that there is a weight that your body wants to be, called your natural set point. This is where your body is at its healthiest and is probably not model-thin - remember the information under the socio-cultural elements about how so-called "ideal bodies" are created by technology and surgery.
There is also a healthy 'dose' of nutrition that is right for our bodies. Eating disorders develop when we try to change either of these things and can spell disaster for our physical and mental wellbeing. Recovery means learning to accept ourselves at the weight that our body wants us to be. If the vet told you that your puppy needed 1 cup of dog food 3 times a day, would you give your puppy only half that amount, and let your puppy go hungry? Of course, you wouldn't. We need to be able to do the same for ourselves. We need to take in the amount of nutrition our bodies need to be healthy.
Battling an ED can be very tiring. This might feel like a tug of war, with your ED on one side and you on the other. Instead of trying to overpower the ED, take another tactic and simply let go of the rope. Accept that the urge to binge, purge or avoid eating exists. Notice that these feelings are there, but don't act on them. You are coping without acting upon these urges. This will eventually allow you to let go of this power struggle altogether.
Relax when feeling overwhelmed
Find ways to calm yourself when you're feeling overwhelmed and having urges to engage in eating disorder symptoms. Try to focus only on the present moment and practice one of your favourite relaxation skills, like:
- breathing exercises
- going out for a walk
- reading a book
- taking a warm bath or shower
- talking with friends
- making positive affirmations
It’s common to be self-critical, and we are often way too hard on ourselves. Positive affirmations are things you say to yourself to help change your thinking when you are hard on yourself. For example, when you are thinking “I’m such a loser, what's wrong with me?”, try saying instead “I’m being too hard on myself; I have a friend who likes me and that's good enough”. At first, you might find it difficult not believing all the self-critical thoughts, but with practice you’ll notice the negative thoughts will be less frequent and intense. You can also find other ideas for positive affirmations on the internet simply by searching for them. Go a step further by writing your positive affirmations on a sheet of paper or journal and go over them every day. The secret here is focusing on what you do like about yourself.
If this is too hard right now, ask yourself what other people think of you – your friends, neighbours, family, kids you babysit, your teachers or coaches – and write that down. Even if you don’t believe it.
Where to find more support
Make a Referral to the CHEO Eating Disorder Program
Learn more about CHEO’s Eating Disorders Program. To start a referral, make an appointment through 1Call1Click.ca online or by calling 613-737-7600 extension 2496.
Looking for community treatment, resources and support?
Visit our Eating disorders resource and support page to find community treatment, recommended websites and more to support you or a loved one who is struggling with an eating disorder.