INFORMATION PACK FOR THE MEDICAL
WHAT IS EATING DISTRESS?
Eating Disorders such as Anorexia Nervosa, Bulimia Nervosa,
Binge-Eating Disorder and Eating Disorders Not Otherwise Specified,
as described in the psychiatric manual DSM IV, are just labels which
concentrate mostly on the description of a person’s behaviour. The
different types very often overlap and even the top experts agree
that it is difficult to make a clear diagnosis. But all of these are
only the symptoms of the condition known as Eating Distress (ED).
ED is a condition where the mind culminates all of the negative
assumptions the person has about him or herself. The negative mind
becomes more powerful than the positive mind and has much more
influence on the person’s thinking, feelings and behaviour. This
state of mind develops subconsciously and the person is not always
aware that they are victims of this self-destructive condition.
Often we read that sufferers have a low self-esteem. However, in
reality, he or she has no sense of self at all. Therefore, this
condition is extremely abusive and manifests itself with highly
destructive symptoms in which an Eating Disorder is one.
All types of eating disorders, Self-mutilation, Substance Abuse,
Self-harm and Activity Disorder are different manifestations of the
one basic condition. Food becomes the most important relationship,
but is never a happy one or an easy one. Slowly and surely
everything is eventually excluded and thoughts constantly centre on
food or body. It is a way of communicating with inner unhappiness.
To help, we need to develop more understanding about this matter and
especially more understanding of what ED is really about.
Controlling the body is a way of controlling life. Control is the
centre of a sufferer’s life.
ED is very preoccupying. That is its function. ED occupies the mind
fully and excludes all other issues. ED is a cushion against painful
reality. ED is symptom of how the person relates to the world; food
is only a lonely substitute.
Eating Disorders are usually very private disorders and not often
brought voluntarily to the attention of health professionals. The
symptomatology of slimming may be so normal in our society that
recognition of its adverse consequences is easily ignored.
ED is a self-abuse; the person wants to be so perfect that they
stop being aware of reality.
EMOTIONAL SUFFERING is common in all forms of ED however the
physical symptoms differ.
Anyone can suffer from an ED at any age.
WHAT IS NEEDED WHEN TREATING A
We need to get inside the person’s world. Learn to value the eating
behaviour as a necessary way for them to express their feelings,
rather than a nuisance. Learn to understand their behaviour, and how
they use it.
The ED sufferer relies more than most on other peoples’ opinions and
reflections of her/him to determine how she/he feels about
herself/himself. Eating Disorder sufferers are terrified of
criticism, it is usually translated in the sufferer’s mind, as
others do not approve of something they do or say, and it is taken
as a personal judgement.
ED person is not just a need for approval, but a hunger for care and
affection as well. Despite the feeling of dependency, people with ED
don’t want to rely on or need other people. Feeling dependent or
needy leaves them feeling weak or like a failure, and it is avoided
at all costs. For some people there is an intense fear that others
will be overwhelmed by their needs and leave them, or stop loving
them. To avoid this they try to be perfect inside and out. The
strain is enormous. They feel, to be loved, they need to be perfect.
Eating Distress has a long and complex build up and there is not one
single cause. Just as the disease is a combination of factors, many
outside our control, so is the cure.
All Eating Disorders develop subconsciously; victims are as confused
as those around them when the symptoms emerge.
Eating Disorder Not Otherwise Specified (EDNOS)
Binge Eating Disorder
Different types very often overlap and
even the top experts agree that it is impossible to make a clear
diagnosis. All of these forms of Eating Distress are simply
different manifestations of one basic condition.
ANOREXIA IS CHARACTERISED
Fear of gaining weight
Denial of physical and emotional needs
Distorted body image
Develops ritualistic eating habits
Becomes more critical and less tolerant of others
Missing a monthly menstruation
Withdrawing from all social contacts
Perfectionist in their own world
Dizziness and fainting spells
Dressing in layers to hide body
Fear situations where food may be present
Rigid exercise program
Insecurities about their capabilities
Does not reveal feelings
Has highly self-controlled behaviour
Sufferers tend to isolate themselves,
they feel very unhappy, lonely and confused. Panic attacks are
common. People with Anorexia become addicted to the sensations
caused by starvation. Long-term data indicates that mortality in
anorexia sufferers is 10% to 15%. Organs in both the digestive and
nervous system are, in most cases, affected. Most medical
complications are the result of starvation and can be reversed with
a well-planned re-feeding program. This re-feeding, however, is only
effective when in combination with intensive psychological work.
THIS DISEASE IS VERY WIDESPREAD, AFFECTING ALL SECTORS OF SOCIETY.
There is at present, no organic cause for this illness has been
BULIMIA IS CHARACTERISED
Repeated episodes of compulsive binge eating
with or without self-induced vomiting
Laxative and diuretics abuse
Abuse of diet pills or other energy enhancers
Complaints of fatigue and muscle pain
Puffiness in the cheeks broken blood vessels under the eyes
Weight fluctuations, often within 10 to 20 lb ranges
Preoccupation with and constant talk about food or weight
Bathroom visits after meals
Extreme mood shifts from very excited to severe depression, sadness,
guilt and self-
Self-worth determined by weight
About 4% of the western population
show full blow symptoms. 9% show sub-clinical syndrome symptoms.
Both bulimia types are more common than anorexia and less easily
detected. There is still a lot of confusion about this condition.
Not all specialists are alert to the distress and the physical
danger to their patients with bulimia symptoms. People of normal
weight may have disrupted their body chemistry so severely that they
are at risk of sudden, fatal heart attack, epileptic fits, kidney
failure and hypoglycaemic attacks.
Anorexia attracts all the attention and sympathy, but bulimia
involves the greater risk to the health, both physical and
People can appear cheerful, relaxed, and confident. But, in reality,
they have a very strong sense of shame, self-hate and need for
security. More and more people with bulimia are coming for help.
But, because of the shame factor, they came for help under the
pretence of physical complaints. However, About 40% of people with
anorexia have bulimia symptoms. Experts agree that the real number
will be much higher.
EMOTIONAL OVER-EATING / DIETING SYNDROME
This condition has only recently started to be recognised. Emotional
overeating is a psychological disorder in which food is used,
unknowingly, to cope with stress, emotional conflicts and daily
problems. Dieting is mistakenly seen as the solution and is
undertaken with strenuous effort. Feelings of deprivation set in
because the dieting is approached in a rigid manner. Whether
emotional overeating or dieting, the person is still engaged in a
struggle with food. About 80% of women and more and more men are on
diets or feeling out of control around food. Mental turmoil and
self-hate is intense and destructive. They feel socially unaccepted.
Emotional overeating is often confused with obesity. However, one
does not necessarily follow the other. Obesity is a term used when
someone weighs more than 25% above the expected normal body weight.
A person who overeats, may or may not be obese.
Obesity is a definition based on weight with no reference to
psychological factors. It can result from any number of conditions
that are unrelated to psychological issues. As with the other forms
of ED, the person who is vulnerable is the one for whom the food
meets psychological needs. When someone does not have other tools or
resources to deal with stressful situations, then food may be used
as a way of coping.
There is a high proportion of males who overeat. Men and women alike
seek treatment. It is a common clinical observation that emotional
overeating runs in families with a low tolerance for stress.
Emotional Eating and Dieting
Either constantly eating through the day or occasional binges
Eating in secret, often eating at night
Feels out of control and hopeless around food
Makes excuses to skip meals and does not eat with others
Develops a tendency to be perfect in almost everything
Conversation is mostly focuses on food or around body shape
Often hears other people’s problems, but ignores his or her own
Pattern of strict dieting, possible abuse or use of laxatives, diuretics
and slimming tablets
Hypertension or fatigue
Inability to maintain consistent weight
Guilt and shame about amount eaten
Looking constantly for approval from other people
Weight is the focus of life
Fantasising about being a better person when thin
People are driven to emotional eating
through suppressed anger, loneliness, stress in work. They turn to
food to compensate for the areas they cannot fulfil in their life.
They can also suffer from malnutrition in the western sense of the
word; they may be starved of nutrients because of their insufficient
There is also a tendency to pretend that the problem does not exist.
If someone in the family develops an ED, it is time to listen, not
to blame. Families need to learn about the condition and then can be
If we only concentrate on controlling the eating behaviour, the ED
ED deserves to be taken seriously, but, panicking does not help. The
sufferer is in a vicious circle and the easiest thing to do in a
vicious circle is to stay within it.
At least 5% to 20% of ED sufferers will eventually die from an
If a person suffers for up to 5 years, the chance of a fatality is
If a person suffers for over 20 years, the chance of a fatality is
(Professor Maher, University of Colorado)
Bulimia has a much higher mortality rate.
Bulimia has higher suicidal tendencies and long term medical
Dr. Andersen, University of Iowa 1992, has linked ED with the rings
of a tree; each episode leaves a permanent impression. We must
become aware of the impact an Eating Disorder can have on each organ
and the body as a whole.
ASSESSING THE SITUATION
behaviour and attitudes
2- Depression and negativity
3- Cognition - thought patterns
4- Hopelessness and suicide
6- Interpersonal skills
7- Body image, shape and weight concerns
8- Sexual or other trauma
10- Family history and family symptoms
11- Relationship patterns
12- Other behaviour: drugs, alcohol...
Eating distress is a psychosomatic
disorder; the sufferer’s health needs to be monitored regularly.
Disturbed psyche contributes to a disturbed soma/body.
· Laboratory and other diagnostic tests
· Nutritional evaluation
· Physical exam
Consequences of starving
Dry skin covered with downy fuzz
Brittle splitting nails
Weak and wasted muscles or tremors
Constipation, bloating and abdominal discomfort
Kidney and bladder infections
Urinary track stones
Cavities and gum disease
Frantic activity and depression
Absence of menstrual cycle for females
Consequences of bingeing and vomiting
irregularities in females and low testosterone in men
Swollen glands in neck beneath jaw
Sore throat or sinus infections
Cavities and loss of tooth enamel
Puffy, moon-shaped face
Raw fingers caused by acid from vomiting – Russell’s stings
Bags under eyes
Rapid or irregular heartbeat
Stomach and abdominal discomfort as well as bloating
Ulcers or colitis
Blood sugar irregularities
Kidney and bladder infections
Eating disorders are the most life threatening of all psychiatric
illnesses; people need regular medical attention.
Two people with the same behaviour may develop completely different
symptoms. It is necessary to have a well-trained and experienced
physician as part of the treatment for an Eating Disorder.
For more information, contact
THE MARINO THERAPY CENTRE
Dr. Tarek Zourob
01 84801747, 087 2100251