Eating disorders

What are eating disorders?

There are many different kinds of eating disorders that affect young people. Essentially eating disorders are understood to be present when an individual has a distorted body image and constantly disturbed or irregular eating patterns. Many students with eating disorders may be unaware that their eating and exercise patterns are unhealthy or causing illness, or may not want help. The most prevalent types of eating disorders are outlined below.

Anorexia Nervosa

Anorexia nervosa is an eating disorder that often presents with very specific characteristics and physical signs. Anorexia nervosa develops when an individual severely reduces food intake and/or exercises excessively over a considerable period of time which results in substantial weight loss. For someone to be diagnosed with anorexia they must have a significantly low weight for their age, sex, developmental stage and health. Despite this low weight, people affected by anorexia nervosa continue to feel dissatisfaction with their body and often continue to feel overweight. Given this, people with anorexia nervosa are often unwilling to alter their food intake and exercise patterns for fear of gaining weight. This can result in many people with anorexia nervosa not understanding themselves as having a problem, or being unwilling to change even if they are aware of it. More than half of people with anorexia nervosa also have another mental health condition, with depression and anxiety both being very common.

Signs and symptoms associated with anorexia nervosa:

• intense fear of gaining weight
• social isolation, often stemming from not wanting to eat around others and needing to carefully monitor what foods are eaten
• purging behaviours (self-induced vomiting, laxative use or excessive exercise to make-up for food intake)
• constant monitoring of food (calorie counting)
• excessive exercise
• feeling cold easily or often.

Physical signs of malnutrition:

• loss of menstruation or irregular periods (amenorrhea)
• infertility
• soft hair that covers the body, a biological mechanism to increase body warmth in the absence of body fat (lanugo)
• brittle nails
• yellowed skin
• difficulty concentration and irritability
• irregular heartbeat and possible heart failure.

Bulimia Nervosa

Bulimia nervosa involves episodes of binge eating, that is consuming a lot of calories in a short period of time, often followed by some form of purging behaviour such as induced vomiting, laxative use or excessive exercise. People with bulimia nervosa tend to feel out of control when binging and often suffer from poor body image and self-esteem. Binging episodes can often be triggered by, or follow attempts to restrict calorie intake and many people with bulimia nervosa may feel intense guilt over their food intake.

Signs and symptoms associated with bulimia nervosa:

• depression
• hiding food, binging in private
• fatigue
• tooth decay
• digestive problems (indigestion or reflux, stomach ulcers).

Binge eating disorder

Binge eating disorders occur when an individual experiences frequent episodes of binge eating (consuming a large amount of food, beyond the point of comfort or feeling full). People with a binge eating disorder often report feeling out of control when they are binging. Diagnosis of binge eating disorder requires that these binges occur at least once a week over a period of 3 months or more. Individuals with binge eating disorder tend to vary in weight with some people maintaining a normal weight, with others being overweight or obese. The main difference between binge eating disorder and bulimia nervosa is that people with binge eating disorder do not regularly engage in purging behaviours.

Episodes of binging may occur in response to stress or anger but can also be triggered by boredom or general distress. In this way, binge eating may act as a way in which people manage and cope with challenging emotions.

Signs and symptoms of binge eating disorder:

• feeling out of control when eating
• eating a large amount in one sitting or over a short period of time
• regularly eating beyond the point of feeling full
• hiding food and eating in secret
• feeling embarrassed or guilty about how much food is eaten
• experiencing guilt and disgust after an episode of binge eating.

What can you do to support students with eating disorders?

It is important students receive professional help as soon as possible if you are worried about them having an eating disorder.

Often, it will be parents, friends or other staff who notice the signs that something may be wrong. If you are concerned about a student, it is best to speak with their parent or carer in the first instance and suggest referral services and places they can go for reliable information. Often, they will have noticed something as well and be wondering what they should do.

Butterfly Foundation is a great information source and GPs will be able to refer young people to appropriate specialised care, such as a nutritionist or psychologist. It is also important to think about the needs of students with eating disorders on a case by case basis. Each student will have their own recovery plan with some common considerations such as restrictions to their activities or time at school and supervised mealtimes. In these instances, the school and family must work together to build a program and support system which best helps the young person in their recovery.

ReachOut.com resources on eating disorders

• What is bulimia nervosa?
• What is binge eating disorder?
• What is anorexia nervosa?
• About body image
• Making healthy food choices
• Being overweight doesn't mean being unhealthy

Recommended professional resources

The Butterfly Foundation specialises in support and resources for those experiencing eating disorders and those supporting them – including a national support line, web counselling, and education programs for professionals, parents, young people and schools.

The National Eating Disorders Collaboration provides more information on eating disorders, plus information on treatment, recovery and information on how to help – including the Eating Disorders in Schools booklet, which provides schools and school staff with the key information and resources they need to effectively prevent, identify, and respond to eating disorders in their community.