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Eating disorders

Eating disorders

Eating disorders are complex and serious mental health conditions—but the right mix of services and supports can reduce their severity, duration and impact. This eating disorders pathway shows the ‘system of care’ for someone experiencing an eating disorder, and the carers or key supports involved in their care.

Eating disorders are complex and serious neuropsychiatric disorders, with medical and physiological components. Eating disorders often relate to negative body image, weight and shape concerns, challenges eating and compensatory behaviours.

Often the outward sign of deeper psychological issues, eating disorders can be a coping mechanism for other things going on in a person’s life. Eating disorders are not just about weight, appearance or calories. They are often very private and hidden, can exist for a long time before they are recognised, and can coexist with a wide range of other mental health concerns. Eating disorders can be misunderstood, stigmatised and accompanied by a sense of shame.

Eating disorders do not discriminate and affect people of all genders, age, race, ethnicity, body shape and weight, sexual orientation and socio-economic status. Up to 9% of the Australian population will be affected by an eating disorder in their lifetime, with an increase to 15% for women. The fatality rate for eating disorders is the highest of any psychological disorder, and only 25% of Australians with eating disorders are known to the health system.

Eating disorder treatment is essential to reducing the severity, duration and impact of illness. This treatment should be person-centred, targeted and provided early. Evidence shows that with the appropriate support, full recovery from eating disorders is possible.

Question: What is the difference between an eating disorder and disordered eating?

Disordered eating sits on a spectrum between normal eating and an eating disorder. Disordered eating may include symptoms and behaviours of eating disorders but at a lesser frequency or lower level of severity. Disordered eating may include restrictive eating, compulsive eating, or irregular or inflexible eating patterns. Dieting is one of the most common forms of disordered eating. Although both disordered eating and eating disorders are abnormal, eating disorders have very specific diagnostic criteria outlining frequent and severe behaviours.[1]

Myth: Eating disorders are about vanity.

False! Eating disorders are serious and potentially life-threatening mental illnesses—they are not a lifestyle choice or a diet gone ‘too far’. A person with an eating disorder experiences severe disturbances in their behaviour around eating, exercising and related self-harm because of distortions in their thoughts and emotions.

Myth: Eating disorders aren’t that serious.

Yes they are! Eating disorders are complex mental illnesses that require comprehensive and effective treatment from specialists.

Eating disorders can also be fatal. Eating disorders carry an increased risk of premature death due to long-term medical complications and increased rate of suicide. The mortality rate for eating disorders is between 1.5 and 12 times higher than the general population.

Myth: Only young, middle-class white women get eating disorders.

False! However, it is true that the peak period for the onset of eating disorders is between the ages of 12 and 25 years, with a median age of around 18 years.

One key group with a high risk of eating disorders is women, particularly those going through key transition periods (e.g., from school to adult life, pregnancy and menopause). This high risk has led to a misconception that eating disorders only happen in this population.

The reality is that eating disorders could afflict anybody. They occur:

  • across all cultural and socio-economic backgrounds
  • among people of all ages, from children to the elderly
  • in all genders.

In addition to women and adolescents, there are other groups in the community who are also at a higher risk of developing an eating disorder:

  • people who engage in particular sports (e.g. gymnastics, athletics, rowing) or occupations (e.g. dancing, modelling)
  • people experiencing high levels of stress
  • people with other mental illnesses, such as anxiety or depression
  • people with other physical illnesses, such as diabetes and polycystic ovary syndrome.

Eating disorders are not limited to any single group of people and the prevalence of eating disorders in specific high-risk groups should not distract the community from the importance of recognising eating disorders in other populations.

There is limited research on the prevalence of eating disorders among Aboriginal and Torres Strait Islander peoples. However, emerging research suggests that Aboriginal and Torres Strait Islander peoples experience eating disorders and body image issues at a similar or higher rate than non-Indigenous people.

Myth: Eating disorders are a cry for attention, or a person going through a ‘phase’

A prevailing misconception about eating disorders is that the individual can simply just ‘get over it’. The reality is that individuals with eating disorders are likely to go to great lengths to conceal their behaviours or the impact the eating disorder is having on their life. An eating disorder is a serious mental illness. It is not a phase, and it will not be resolved without treatment and support.

Regardless of age of onset, there is often a considerable time difference between onset and treatment, up to an average of approximately four years.[2] A person will often need to see multiple different healthcare providers before they can receive a correct diagnosis.

Question: Aren’t diets a normal part of life? What is the difference between the two?

Dieting may be the single biggest predictor for the development of an eating disorder.[3] Most people recognise that eating disorders are potentially harmful—however, they also accept body obsession and dieting as normal parts of life.

Eating disorders almost always occur in people who have engaged in dieting and disordered eating. Persistent and unhealthy dieting can lead to significant mental and physical consequences. This is particularly true if the dieting behaviours start in childhood or adolescence.

Myth: Social media is the reason so many people have eating disorders.

One of the common misunderstandings about eating disorders is that social influences are to blame.[4] While environmental factors certainly play a part, they can’t be solely responsible for the development of an eating disorder. However, for individuals who are biologically susceptible to these psychiatric illnesses, social influences can trigger and perpetuate the progression of an eating disorder.

It’s important to understand that an adolescent is still in a phase of brain development and emotional regulation. Frequent exposure to particular environmental or social factors can therefore have a disproportionate impact on this age group, particularly those who are susceptible to developing an eating disorder. For most people, the development of an eating disorder is due to a combination of factors, not just one.

Myth: Families, particularly parents, are the reason people have eating disorders.

There is no evidence that eating disorders can be caused by particular parenting styles.[5] There is strong evidence to suggest that eating disorders may be strongly linked to genetic factors and that people who have family members with a history of eating disorders may be at higher risk of developing eating disorders themselves. However, although a person’s genetics may predispose them to developing an eating disorder, this is certainly not the fault of their family. Genetics play a role in many illnesses—both mental (e.g. schizophrenia) and physical (e.g. breast cancer and heart disease).

Family and friends can play a crucial role in the care, support and recovery for people with eating disorders. This can be especially true for adolescents, where family-based treatment is currently the treatment with the strongest evidence base.

The effects of an eating disorder are often felt not only by the person experiencing it, but also by their family and support network. Carers, including parents, partners, friends, grandparents, children, siblings, grandchildren, neighbours or any other person caring for someone with an eating disorder, often feel:

  • distressed about what is happening to themselves, the person they care for and their family
  • burnt out from the demands of caring for someone with an eating disorder on top of family life and work commitments
  • confused about the best way to help, both daily and in the long-term goal of recovery
  • anxious about the physical and psychological changes in the person they care for
  • fearful of daily routines such as meal times
  • frustrated by being unable to fix or resolve the eating disorder
  • unable to continue doing things they used to enjoy
  • hopeless about their ability to provide support.

All of these feelings are valid and normal. Caring for someone with an eating disorder is a huge responsibility and comes with considerable personal strain.

Myth: You can tell if someone has an eating disorder by looking at them.

Eating disorders come in all shapes and sizes. You can be considered a ‘normal size’ or be in a larger body and still have an eating disorder.[6] Individuals who may appear physically well may still be susceptible to eating disorders. Appearance alone does not indicate whether a person may have an eating disorder.[7]

High body weight can be a predictor of the presence of eating disorder symptoms, and individuals with high BMIs are at higher risk of developing an eating disorder. Individuals who do not fit a stereotypical image of a person with an eating disorder, particularly those living in larger bodies, often take longer for their eating disorder to be diagnosed and thus receive different treatment and have a poorer prognosis.[8]

Myth: Recovery is impossible.

Recovery is possible. Eating disorders can be treated and they can be treated at every age, stage and point in a person’s life. It’s different for everyone, but recovery from an eating disorder involves overcoming physical, mental and emotional barriers in order to restore normal eating habits, thoughts and behaviours.[9]

Evidence has shown that the sooner somebody starts treatment for an eating disorder, the shorter the recovery process will be.

Recovery is a deeply personal journey that looks different for everyone. It can be an ongoing process where some people may consider themselves to be ‘in recovery’ while living a full and satisfying life. There are also those who never fully recover. Only you know what full recovery will look and feel like for you, but you don’t need to face your eating disorder alone.

[1] https://www.verywellmind.com/difference-between-disordered-eating-and-eating-disorders-5184548#eating-disorders-vs-disordered-eating

[2] https://nedc.com.au/eating-disorders/eating-disorders-explained/myth/

[3] https://nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting/

[4] https://www.eatingdisorderhope.com/blog/the-influence-of-social-media-on-adolescent-eating-disorders

[5] https://butterfly.org.au/eating-disorders/myths-about-eating-disorders/

[6] https://nedc.com.au/eating-disorders/eating-disorders-explained/people-living-in-larger-bodies-and-eating-disorders/

[7] https://www.eatingdisorderhope.com/blog/male-body-builders-and-disordered-eating

[8] https://www.sciencedirect.com/science/article/abs/pii/S1054139X14002511

[9] https://nedc.com.au/eating-disorders/treatment-and-recovery/recovery/

The purpose of the Eating Disorders System of Care Pathway is to provide a guide to the local system of care for people with eating disorders living in North Brisbane and Moreton Bay.

The pathway offers information regarding the types of services and supports that are available and accessible to a person experiencing an eating disorder. Where specialist services and supports are not available locally, options outside the region (that may require travel) have been provided. Online and digital services and supports are also included.

The pathway can be helpful for:

  • people seeking information about eating disorders
  • people seeking help with an eating disorder or working towards their recovery goals
  • carers, key supports and health professionals supporting someone with an eating disorder.

The pathway describes the types of services and supports that may benefit someone with an eating disorder at various stages along their journey. It also describes what people can expect from each type of service or support, and how they can access relevant and credible services and resources.

The pathway is not intended to be linear—it recognises that people will obtain support along the pathway at different points in time, and not all people will follow the same path or access every component.

This system of care pathway was developed by Eating Disorders Queensland (EDQ) in collaboration with an expert advisory group comprising multidisciplinary health professionals (e.g. general practitioners, psychiatrists), eating disorders experts, people with lived experience of an eating disorder who have navigated the treatment system, and carer representatives. Valuable input was also provided by statewide hospital and specialist services, including the Queensland Eating Disorders Service (QuEDS), regional eating disorder hubs across the Sunshine Coast, Gold Coast and North Queensland, and the Child and Youth Mental Health Service (CYMHS).

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