Disordered Eating or An Eating Disorder?

Disordered Eating Sits In A Place Between Normal Eating And A Diagnosed Eating Disorder. In a world of Google misinformation it is difficult to understand what foods are nutritious and how we should eat them

Leone explores and explains the differences, the symptomatic behaviours of several eating disorders, and disordered eating. Reflecting on her own journey of overcoming Anorexia and Bulimia Nervosa she explains how she then developed disordered eating and exercising patterns of behaviour. 

Leone then highlights some infamous urban myths surrounding food.

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Transcript

Disordered eating sits in a place between normal eating and a diagnosed eating disorder. 

When I was younger, I experienced Anorexia, then Bulimia and as I recovered from these, disordered eating. There is however a distinct difference between all three. I say ‘as I recovered’ because both Anorexia and Bulimia Nervosa are eating conditions and classified as mental health disorders due to the reason they occur. It is not simply about dieting and wanting to look nice. Rather, Anorexia and Bulimia evolve when a person feels they have little to no control over their existence and these provide a safe place where there is autonomy or personal control.

This was me, as a young girl growing up in an environment of sexual abuse with no recourse, being bullied daily with no respite and a grandmother who had her own mental health issues as a primary caregiver, not to mention an alcoholic mother and absent father. A perfect storm for the manifestation of an eating disorder. Those of you who have listened to previous episodes would know that I was a patient of Chelmsford where I was literally in fear for my life. This is a very important factor in the development of PTSD, which I believe informed the direction of my life as a young woman. Hence, the bulimia I believe. As a summary, I was anorexic and institutionalised from 12 and a half until I was 13 and a half. From that time, I learnt that I could avoid hospitalisation by switching the witch for the bitch – switching to bulimic behaviour over anorexic behaviour. We are wiley and clever those of us with active eating disorders! We always find a way.

Of course, these eating disorders are a tough gig and I am just so grateful to have fallen pregnant with my first child. At this point it was no longer ‘all about me’ and my sense of responsibility kicked in. I evolved from an eating disorder to disordered eating. There is a huge difference between the two and I am not sure the average person is aware of this. Too often the term eating disorder is bandied around without understanding the difference. Why did I evolve? I believe that falling pregnant allowed me to feel worthy, loved and gave me a positive expectation for the future – this all fell into my control. As you might know from previous episodes, my boy died of SIDS, but that is another story, although pertinent to my emotional growth and me stepping beyond unhealthy relationships.

Most women I have met exhibit some type of disordered eating and I wonder if this comes more from a society perspective whereby women have been ‘fed’ the idea that they must ‘watch what they eat’ to remain attractive?  For me, having come off the back of both Anorexia and Bulimia, I would say I actually didn’t know how to eat or how much to eat. I was overfed by my matriarchal grandmother and told by my mother I was too fat and to limit my food. My eating disorder was due to trauma, but my disordered eating was a result of confusion. 

And this was before the world of Google! Now it must be even more confusing. However I don’t advocate relying on Cleo or Cosmopolitan for healthy advice on bodies or food, especially in the 70s and 80s. Remember Twiggy? I can’t say society benefitted from this body image idealisation, not that she wasn’t beautiful in her own right. And now look at what is regarded as the epitome of beautiful. Such a funny race we are, but such an influential one and this is likely the biggest problem of all. Imagine when food is a punishment when it should be a pleasure. How often I hear people say to me “If I could just have a pill rather than food I would be happy”. So sad because this speaks to the difficulty one has navigating healthful respect of food, our fuel source.

One of my pet hates around disordered eating is the promotion of ‘superfoods’ or ‘clean eating’. This then makes one question the dangers of other foods. Not just processed foods, but often so so many foods and then that person excludes many types of foods and this will impact their health detrimentally. I get it – I like living too. And yes I want to live a long time. But I also know that if we are missing out on vital nutrients we simply won’t live a long time. My mother died at 56. She had a health problem and she ended up in ICU, but had she eaten well and nutritious food her body would have had the ability to help her ‘pull through’. On her death certificate was the words ‘died of lifestyle choices’. Yes she smoked, and drank alcohol BUT the biggest issue here was the fact she was always dieting and restricting food. How many people do you know who smoke or drink but eat well and live well? Plenty. A lack of nutrition is why she died. Her body had no resources to use to recover.

She was so afraid of losing her looks, and of dying that she restricted foods that were healthful and she lost her looks and she died prematurely. I don’t want that for you, or any of my clients…..

So let’s take a look at this problem a little more intently -

Disordered eating may include restrictive eating, compulsive eating, or irregular or inflexible eating patterns. At points in time, those people experiencing disordered eating may show some symptoms of eating disorders however disordered eating is quite different to a true eating disorder. I would suggest that most people have some form of disordered eating and that many perceive foods as having some sort of ‘super power’. We have lost intuitive eating practices. 

Some symptoms of disordered eating are –

• Fasting
 • Binge eating
 • Skipping meals
 • Avoiding a type of food or food group
 • Self-induced vomiting
 • Laxative, diuretic, enema misuse
 • Steroid and creatine or protein supplementation
 • Using diet pills or products

Disordered eating can have a negative impact on a person’s life and has been linked to a reduced ability to cope with stressful situations. Feelings of guilt, shame and failure are common in people who engage in disordered eating. These feelings can arise as a result of binge eating or ‘breaking’ a diet. A person with disordered eating behaviours may isolate themselves for fear of socialising in situations where people will be eating. This can contribute to low self-esteem and social withdrawal.

Disordered eating behaviours and in particular dieting are among the most common risk factors for the development of an eating disorder

Eating disorders however have little to do with appearance and weight. What sits behind an eating disorder is someone who feels they lack control in some aspect, or many aspects of their life. A true eating disorder often co-occurs with other psychiatric disorders most commonly, mood and anxiety disorders, obsessive-compulsive disorder, and alcohol and substance use disorders. Frequently you will find eating disorders occur in children of substance abuse adults or in situations of childhood trauma where the young person develops a sense of control using food as the tool.

Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder and affect approximately 5% of the population. 

Anorexia Nervosa

Anorexia nervosa is characterized by self-starvation and weight loss resulting in low weight for height and age. Anorexia has the highest mortality of any psychiatric diagnosis other than opioid use disorder. There are two types of Anorexic –

·       Restricting type, whereby people lose weight primarily by dieting, fasting or excessively exercising.

·       Binge-eating/purging type in which persons also engage in intermittent binge eating and/or vomiting or laxative abuse. 

Leading to osteoporosis and brittle bones, gastrointestinal issues, anaemia and cold intolerance, poor focus and mental health which only exacerbates the problem as one doesn’t have the physical or mental ability to overcome it. Hence why many are hospitalised to simply be fed to gain weight and whilst they are gaining weight, psychological interventions are used.

For me as you now know, the first of these admissions resulted in PTSD and thank goodness dangerous interventions like those used at Chelmsford are now against the law. In my experience with clients I understand that the goal of hospitalisation is primarily to keep one alive so weight gain by any means is desirable. But what then? I remember being on weekend excursions during my commitment in North Ryde Psych Centre and I was so weak that when I fell out of a canoe in water as deep as my shins, I literally could not lift my head. I was panicking – hang on I actually don’t want to die – this shit is getting real! Dion, my buddy who was 9, pulled me out of the water. To everybody’s shock, once I was warm and dry again – I had a sausage in bread from the barbie. And so it began, but I knew no ‘off’ switch and I was usually very unwell after eating. Let’s face it I had barely eaten for 10 months and my stomach was like – What the f is this. And up it would come. This was likely my segway into Bulimia.

Bulimia Nervosa – People experiencing bulimia nervosa typically alternate dieting, or eating only low calorie “safe foods” with binge eating on “forbidden” high calorie foods. Binge eating is defined as eating a copious amount of food in a short period and associated with feeling a loss of control over what is eaten and how much they eat. This behaviour is usually secretive and the person often feels ashamed or embarrassed. Binges may be very large and food is often consumed rapidly, beyond fullness to the point of nausea and discomfort.

Binges will happen quite regularly with compensatory behaviours in between times. Think calorie deficit, fasting, overexercising, laxatives or vomiting.

Notably, sufferers of either of these eating disorders are constantly pre-occupied with food, shape or weight and this impacts their mental health negatively. If your life revolves around food and restriction then that is not living.

I remember counting calories (which I now see the flaw in, but that is another story) and restricting foods to the point that I would binge on 3-4 times the amount a normal person would eat. I remember reading about Karen Carpenter’s death from exactly this condition, but still finding myself lying on the floor stretching my abdomen simply so I could still breathe. I was at a point again, where I was fearful of death. For those of you who cannot remember, Karen Carpenter died aged 32 from cardiotoxicity because she was taking Ipecac daily. Ipecac makes you vomit your food and is used for food poisoning. This affected her heart, and bingeing on large amounts of food pushes your diaphragm, affecting your breathing and your heart. To bring this case back to control, it was only once the Carpenters rose to fame that Karen’s anorexia began. It’s a lot for a twenty year old to digest, quite literally. Nice choice of words, If I do say so. But twenty and your life is no longer your own. Twelve years later, she is dead. Twelve years of an eating disorder.

Bulimia leads to other rare but potentially fatal complications including esophageal tears, gastric rupture, and dangerous cardiac arrhythmias. Teeth erosion through stomach acid if one regularly vomits

Binge Eating Disorder

People with binge eating disorder have periods of binge eating in which they consume large quantities of food in a brief period. For a diagnosis the bingeing would be at least once a week over a three month period. Individuals experience feelings of losing control over their eating and are upset by their binging behavior. However, they don’t exert any compensatory measures like laxatives, purging or excessive exercise.

Symptoms of binge eating disorder are-

• Eating more rapidly than normal.
• Eating until uncomfortably full.
• Eating large amounts of food when not feeling hungry.
• Eating alone because of feeling embarrassed by how much one is eating.
• Feeling disgusted with oneself, depressed or very guilty after a binge.

This clearly then has systemic metabolic effects due to increased weight and inflammation.

Specified Feeding & Eating Disorder

This diagnostic category includes eating disorders or disturbances of eating behavior that cause distress and impair family, social or work functioning.

Avoidant Restrictive Food Intake Disorder

A disturbance in eating resulting in persistent failure to meet nutritional needs and extreme picky eating. 

Symptoms are –

• Low appetite and lack of interest in eating or food.
• Extreme food avoidance based on sensory characteristics of foods (e.g. texture, appearance, colour, smell).
• Anxiety or concern about consequences of eating, such as fear of choking, nausea, vomiting, constipation, an allergic reaction, etc. The disorder may develop in response to a significant negative event such as an episode of choking or food poisoning followed by the avoidance of an increasing variety of foods.

FOOD IS LITERALLY MEDICINE

When we understand food as nutrition and simply as fuel for our cells, perhaps we can view it less emotionally and develop healthier eating patterns. However, there is so much misinformation out there in the world of  Google, it doesn’t surprise me that so many people are confused. 

Some of the most believed urban food myths I come across are –

Baby spinach is a source of iron – actually no it contains oxalates that bind the minerals so that they are not absorbed. Oxalates are a plant’s natural way of deterring pests and occurs in many vegetables

That meat is a bad food – no let’s think how ancestral man ate. Perhaps it is better to source grass fed meats as having a lot of grain can be inflammatory

That vegetable oil is good for you – it is one of the worst oils. Just like sunflower and canola oils. Let’s choose olive oil, lard, tallow, grass fed ghee and butter – real food. And on that note margarine is a man made food that is grey until they add yellow colouring..  Nah not for me.

Soy milk is better than cow milk – not necessarily so. And definitely not if you have a sluggish thyroid

The list goes on an on. My advice would be to consider what food is the closest to the way nature intended. If it is highly processed – skip it. Eat as your ancestors did for the best health benefits.