Understanding eating disorders

Photography by Ian McCausland

Imagine limiting your food intake to the point where you count the calories in your toothpaste. Imagine forcing yourself to vomit after a piece of food passes your lips. Imagine being unable to stop eating even though your belly is full, almost as though you’re in a trance.

For those suffering from an eating disorder, those scenarios can be very much a reality. Characterized by an abnormal perception of one’s body image, eating disorders involve unhealthy eating behaviours and an obsession with food and weight. For many people, these behaviours develop into compulsions and become so extreme that they can lead to serious long-term mental and physical problems and even death.

Unfortunately, eating disorders—the most common of which are anorexia nervosa, bulimia nervosa and binge eating disorder—are far more prevalent than most people think. In fact, according to a study by the Public Health Agency of Canada, three per cent of women will be affected by an eating disorder during their lifetime and anorexia has the highest morality rate of any psychiatric illness.

“It’s a very, very deadly, dangerous and debilitating illness and we need to create more awareness about it,” says Elaine Stevenson, who lost her daughter Alyssa to an eating disorder in 2002 and has since established the Alyssa Stevenson Eating Disorder Memorial Trust.

One of the most common misconceptions is that eating disorders only plague younger women. Though it’s true many sufferers are teens or young adults, anyone—regardless of age or gender—can develop one. “I’ve had clients all the way to almost 60 years old, who have been struggling for anywhere from 20 to 30 years,” says Erin Dowling, program coordinator for the Canadian Mental Health Association’s Eating Disorder Self-Help Program.

Another common misconception is that eating disorders are all about food, which both women stress is not the case. “I can’t tell you how many times people have said, ‘Why don’t they just eat?’ but it’s about deeply-rooted emotional pain or emotional issues,” says Stevenson. “An eating disorder didn’t happen overnight.”

With no sole cause, eating disorders can manifest themselves for a wide variety of reasons. Research suggests genetic factors can play a role in the development of anorexia, and eating disorders are also often strongly associated with other mental illnesses like mood, personality and anxiety disorders.

“There is definitely a co-relation with anxiety— 70 per cent of people with an eating disorder also have an anxiety issue, while 25 per cent have Obsessive-Compulsive Disorder,” says Lisa Naylor, a counsellor at the Women’s Health Clinic’s Provincial Eating Disorder Prevention and Recovery Program.

And with our society often equating body size to happiness, there is also pressure to pursue an unrealistic body type. “The way that our society perceives the female body has changed dramatically, even over the past 50 years,” says Dowling.

“It’s not our weight or bodies that need changing; it’s our attitudes,” agrees Stevenson. “Thin does not mean healthy.” She also stresses the importance of handling obesity the right way and stop blaming people for being overweight. “If we continue on this path, the pendulum will swing the other way and more and more people will begin to suffer from eating disorders. We need to work together at looking at both ends of the disordered eating spectrum.”

Indeed, biological, psychological, personal and social factors—as well as our society’s perception of body image—can all play a role in the development of an eating disorder, but each person’s journey through the illness is ultimately unique. “The ways in which people retreat into the depths of an eating disorder are really personal—and so are their recoveries,” says Dowling. “There’s no one thing that’s going to work for everybody.”

Despite the unique nature of the illness, there are a number of characteristics usually present in individuals who have eating disorders, including low self-esteem, a high rate of selfcriticism and sensitivity to others’ opinions, high expectations of themselves, and the tendency to be a perfectionist. “The women I meet are highly sensitive, highly intuitive individuals—

quite intelligent, with a really good heart and really wanting to please people,” says Dowling. “Taking care of other people and neglecting themselves in order to make everyone else happy are traits that are quite common.”

Dowling can vouch for that firsthand—she suffered from anorexia and bulimia for many years, starting when she was in elementary school. “It was a long time before I realized that eating disorders are not about food or weight. It’s about an inner emotional turmoil and this is your coping mechanism that has really kept your head above water when things feel unbearable at a certain time in your life,” she says. “It becomes more of an addictive, numbing behaviour—a mind/body split.”

The Eating Disorder Self-Help Program offers women with eating disorders—and their loved ones—a place to turn to for help. In addition to an information and referral line, it runs two support groups, one for women in various stages of recovery and the other for family and friends. “I came into the program in 2008 and it was exactly what I needed—I had hit my last rockbottom and I think that’s when real change can happen,” says Dowling. “I was able to understand my eating disorder and accept it. It took away that self-blame and criticism and I was really able to look at the issues underneath. You can’t just fix the food or the weight and then be done with it.”

Similarly, the Women’s Health Clinic looks at all of the factors surrounding a woman’s disorder, and offers mental health and medical assessments, treatment groups, nutrition counselling and workshops. “Our goal is to help them achieve the best health they can and develop healthy relationships with food and with their body,” says Naylor. “People think this isn’t a serious illness or that people could stop if they wanted to”—and that’s just not the case, she adds.

An advocate for over 20 years, Stevenson has lobbied government to better track mental health issues in order to provide even more treatment options for women—as well as men and children— suffering from eating disorders. “We don’t properly track various mental health issues and we’re working with governments that assign funding based on the number of people who have the illness,” she says.

An estimated 11,000 Manitoban women will suffer from an eating disorder in their lifetime, but Stevenson thinks the number is actually much higher, as that figure that does not include males and children, as well as people with Eating Disorders Not Otherwise Specified (EDNOS). People with EDNOS do not meet all of the Diagnostic Services Manual’s eating disorder criteria but exhibit many signs of disordered eating.

She would also like to increase accessibility to eating disorder programming, especially for people living in remote northern communities and rural areas, as most eating disorder treatment programs have a lengthy waiting list.

“We’re not meeting the need and we need to be looking at ways we can get to people earlier in the process, when they have a better chance of recovery,” says Stevenson, whose daughter developed her eating disorder when she was 12 years old. “We’re making a dent but we have a long way to go.”

All three women continue to work tirelessly to educate others and bring awareness to eating disorders. With reports of girls as young as five years old developing signs of disordered eating, she also hopes there is someday a shift in attitude as to what constitutes beauty, removing one possible factor in the development of these illnesses.

“We unfortunately live in a society that is very focused on what you look like as opposed to who you are and that saddens me greatly,” says Stevenson. “Who determines who’s beautiful? We’re all different and to me, that’s beautiful.”

Warning signs: what to look for

You may suspect someone you know has an eating disorder or suffers from disordered eating. But how can you be sure?

“With anorexia, it’s a little easier to tell because of the severe weight loss, which usually happens quite quickly,” says Dowling. “With bulimia or binge eating disorder, these individuals are often of a normal weight.”

The physical warning signs can vary depending on the eating disorder the person has, but there are behaviours to watch for in all cases. Things to look for would be a retreat from regular activities, less energy, mood swings and even a change in personality. “There is also a preoccupation with food, dieting, weight and shape,” says Naylor. “Avoiding food even when hungry, feeling guilty and ashamed of eating, or being secretive about it are all important signs of someone struggling with disordered eating.”

Stevenson agrees, adding people with eating disorders often exhibit “strange rituals and behaviours around food, like pushing food around on a plate to give off the appearance of eating or making up excuses as to why they’re not eating.” Isolation from friends and family can also be a warning sign.

If you suspect someone you know has an eating disorder or is engaging in disordered eating, inform yourself as to what supports are available and have a conversation with the person in a kind, loving—rather than attacking—way. “Catching it early is important and gives your loved one a far better chance at recovery,” says Dowling. “But you have to be careful because you don’t want to accuse someone of having an eating disorder when they don’t, because that can be counter-productive.”

“Encourage the person to get a medical assessment and be supportive by doing things like driving them to appointments,” adds Naylor.

For more information about eating disorders, visit the Manitoba Health website at www.gov. mb.ca/health/mh/eatingdisorders/index.html.