Eating disorders affect all kinds of people people all year round. In the northern hemisphere, as summer approaches, companies take it upon themselves to remind people that they need to get in shape, to get ‘beach-body-ready’, to shed the pounds to be desirable. This is an unhealthy message for anyone, and particularly for anyone dealing with eating disorders. This is why we made eating disorders our focus for June 2022.
It’s such a sensitive topic and so misunderstood in the mainstream, so we partnered with Dr Nadia Craddock PhD, who is a body image researcher at the Centre for Appearance Research, UWE Bristol, to bring academic excellence to this important subject
Alongside her research, Nadia is a member of the Dove Self-Esteem Project academic partnership team and her work focuses on body image interventions at the individual and societal level, eating disorder prevention, and colourism. She’s currently on the Academy for Eating Disorders’ DEI advisory committee to the board of directors and is a reviewer for the scientific journal Body Image – an International Journal of Research.
For any keen podcast listeners, Nadia also co-hosts two podcasts: ‘The Body Protest’ with Honey Ross and ‘Appearance Matters: The Podcast!’ – the official podcast for the Centre for Appearance Research.
This partnership has enabled us to share lesser-known information about eating disorders, and interrogate common misconceptions and stereotypes.
EATING DISORDER
Eating disorders are serious and complex, but treatable and preventable, mental illnesses. People of all ages, genders, ethnicities, social backgrounds, and body sizes can be affected by eating disorders. Approximately 1.25 million (1 in 50) people in the UK have an eating disorder. (Source: BEAT)
However, common misconceptions about who gets eating disorders, perpetuated by mainstream media stereotypes, impact who receives a diagnosis and who is afforded care and treatment.
People from ethnic minority backgrounds, people who are higher weight, those from socioeconomically disadvantaged backgrounds and men are just some of the groups who are underdiagnosed and undertreated because of healthcare biases. It is important to consider how different identities intersect in how people are believed and treated when presenting with eating distress. (Source: Sonneville & Lipson 2018)
There are also misconceptions concerning why people get eating disorders. Eating disorders are not a choice and they are not a vanity pursuit.
While the precise constellation of factors leading to an eating disorder will vary from individual to individual, eating disorder risk factors include: dieting, appearance-based teasing and bullying, negative body image, low self-esteem, perfectionism, depression, experiences of trauma, and food insecurity.
In addition to these social and psychological factors, evidence indicates that a person’s genes can contribute to the risk of developing an eating disorder.
It’s important to remember that eating disorders are treatable and preventable. People can and do recover. Small actions like avoiding diet talk such as “I’ve lost 5lb on the xxx diet so far”, or body talk like “I want to get shredding for summer” can be helpful for those with or vulnerable to eating disorders.
BINGE EATING DISORDER
Binge eating disorder (BED) is the most common distinct eating disorder. It is a serious mental illness characterised by regularly eating large amounts of food while feeling ‘out of control’ and experiencing psychological distress. Many people with BED also experience other mental health conditions such as anxiety and depression.
The diagnostic criteria for BED specified by the Fifth Edition of the Diagnostic and Statistic Manual of Mental Disorders (DSM-5) includes frequent and recurring binge eating episodes that are not accompanied by inappropriate compensatory behaviours such as purging (which is indicative of Bulimia Nervosa). The DSM-5 states that, on average, someone with BED experiences binge eating at least once a week for 3 months.
Binge eating refers to consuming an unusually large quantity of food within a discrete period of time (< two hours), while feeling out of control (like you can’t stop and can’t control how or what you are eating). Binge eating can feel physically very uncomfortable and is often emotionally very distressing - people often feel embarrassed, ashamed, and guilty during and following a binge. Binge eating is not the same as ‘overindulging’ and it is common for people to engage in binge eating in secret. (Source: BEAT)
Binge eating can be premeditated (i.e., planned) where certain foods are intentionally brought or prepared. In other cases, binge eating can be spontaneous, triggered by certain foods like high calorie, high carbohydrate, dense or sweet foods that a person may have been restricting or labelled as ‘forbidden’.
Such restriction can lead to binge eating due to feelings of deprivation and hunger. In turn, the shame and guilt associated with binge eating can prompt a renewed drive for restrictive eating. This can lead to a vicious, punishing cycle of bingeing and restrictive eating, which can be hard to break.
BED can affect anyone of any age, gender, body size, ethnicity or background. Although many people with BED unfortunately do not seek or receive medical attention, BED can be treated and recovery is possible. Practising self-compassion and unsubscribing from diet culture messaging are two useful techniques to try.
ARFID
ARFID is an acronym that stands for Avoidant/Restrictive Food Intake Disorder, which is an eating disorder where people avoid certain types of food, restrict intake of foods overall, or both.
Such restriction can negatively affect physical health (due to nutritional deficiencies and/or general low intake), psychological wellbeing, and general quality of life. As with all eating disorders, ARFID can affect people of all ages, genders, ethnicities and body shapes, sizes and weights.
ARFID is described as an umbrella term because the way it manifests from person to person can be very different. Here are four examples from BEAT:
1️⃣ Someone might be very sensitive to the taste, texture, smell, or appearance of certain types of food, or only able to eat foods at a certain temperature. This can lead to sensory-based avoidance or restriction of intake.
2️⃣ Someone may have had a distressing experience with food, such as choking or vomiting, or experiencing significant abdominal pain. This can cause the person to develop feelings of fear and anxiety around food or eating, and lead them to avoid certain foods or food textures.
3️⃣ Some may experience more general worries about the consequences of eating that they find hard to put into words, and restrict their intake to what they regard as ‘safe’ foods.
4️⃣ In some cases, the person may not recognise that they’re hungry in the way that others would, or they may generally have a poor appetite. Eating might seem a chore and not something that is enjoyed, resulting in them struggling to eat enough.
Less is known about ARFID compared to more established eating disorders such as anorexia nervosa and bulimia nervosa. Research into specific clinical characteristics of ARFID, its epidemiology, and course is still in its early stages.
But it’s important to say that as with all eating disorders, ARFID is treatable.
OSFED
OSFED is an acronym that stands for ‘Other Specified Feeding or Eating Disorder’ and is used to describe eating disorders that do not fit the defined behavioural, psychological, and physical symptoms of the more commonly known anorexia nervosa, bulimia nervosa, and binge eating disorder.
Eating disorders currently categorised under ‘OSFED’ are commonly diagnosed and include ‘atypical’ anorexia, ‘subthreshold’ versions of bulimia nervosa and binge eating disorder, as well as eating disorders with different symptom profiles to other established eating disorders.
Atypical anorexia is where someone has all the symptoms of anorexia nervosa, except they are not low weight. This can be viewed as an example of weight stigma within eating disorder diagnoses. ‘Atypical’ anorexia is still associated with medical harm and psychological distress.
Bulimia nervosa (of low frequency and/or limited duration) is where someone has all of the symptoms of bulimia, except the binge/purge cycles don’t happen as often or over as long a period of time.
Binge eating disorder (of low frequency and/or limited duration) is where someone has all of the symptoms of binge eating disorder, except the binges don’t happen as often or over as long a period of time.
Purging disorder is where someone purges (e.g., vomits or uses laxatives) to affect their weight or shape, but this isn’t as part of binge/purge cycles.
Night eating syndrome is where someone repeatedly eats at night, either after waking up from sleep, or by eating a lot of food after their evening meal.
As with all eating disorders, OSFEDs are serious mental health illnesses that affect people of all ages, genders, ethnicities and body shapes, sizes and weights. They shouldn’t be ignored or downplayed just because they’re lesser known. And as with all eating disorders, recovery is possible with treatment and support.
Our mission at The Other Box is to make space for difference. Diversity Dictionary is where we explore meanings and histories of the language of diversity, beyond a dictionary definition, so we can all build a deeper awareness and critical understanding of perspectives that may be different to our own.
On all our social channels, we share weekly words and their definitions, with a different theme each month. These terms are a taster and have been taken from our Diversity Dictionary™ course in our TOB for Teams™ programme. If you'd like to learn more, check out our courses page and fill in the contact form.
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Words by Roshni Goyate
Header image by Amer Mughawish on Unsplash