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Home , Anorexia nervosa, Bulimia nervosa, Eating disorder, Mental health, Overeating

Eating disorders, and

Having an disorder is emotional issues such as negative disorder neither a lifestyle choice, a ‘ feelings and low self-esteem. • Eating excessive amounts of gone wrong’, nor an attempt to Eating disorders are common and food, often when not hungry, as get . A person with an increasingly prevalent. In Australia, a distraction from other problems. has a mental one in four people knows someone • No purging, but feelings of intense condition. Eating disorders who has experienced an eating guilt, shame and self-hatred are serious, potentially fatal disorder. About two to three in every after binges. 100 Australian females has conditions, and most people with • May involve sporadic fasts and or , and around four repetitive diets. eating disorders need psychological in 100 Australians have symptoms treatment and/or physical health of .1 It is not Other Specified Feeding and Eating treatment (e.g. nutritional advice) to uncommon for a person to progress Disorders (OSFED) from one eating disorder to another. promote recovery. OSFED is a term used when a person Anxiety and depression are common Eating disorders can shows signs of but in people with eating disorders. The people from any age group, gender does not meet all the criteria for a good news is that there are effective or socioeconomic and cultural specific eating disorder. For example, treatments both for eating disorders background. a person may show all of the and for anxiety and depression. psychological signs of anorexia but Features of eating disorders not yet be considered for This fact sheet looks at the links their height. This does not mean that between eating disorders and other the person has a less serious eating conditions, such as • Distorted and obsessive disorder; all disorders in this category anxiety and depression. It also looks fear of gaining weight. are serious mental health conditions at where to get help, treatment options • Extremely limited food intake and/ that cause significant distress. and what family and friends can do to or increased levels of exercise. support people with eating disorders. While the goal of diagnosis is to • Can lead to a dangerously low body accurately describe symptoms and weight, and . seek the right treatment for them, What are eating disorders? a large number of people have Bulimia nervosa other significant eating concerns Eating disorders involve an unhealthy • Often starts with to and distorted body image which are preoccupation with eating, exercise lose weight. not covered by these categories. and body weight/shape. Distorted thoughts and about body • Binge eating followed by , , overexercising, or using Warning signs of an eating image and self-worth can lead disorder to marked changes in eating and / as a means exercise behaviours – these may of purging. If you are aware of someone displaying some of the following warning signs, include excessive dieting, fasting, • The binge/purge/exercise cycle can seek professional help. overexercising, using become increasingly compulsive (e.g. slimming pills, diuretics, and uncontrollable over time. laxatives), vomiting or binge eating. An unhealthy relationship with food is often an attempt to deal with

www.beyondblue.org.au 1300 22 4636 1 Behavioural signs • dieting or excessively • eating very quickly or very slowly • eating only certain types and amounts of food • avoiding social situations that involve food • ‘playing’ with food rather than eating it • going to the bathroom straight after meals • wearing loose-fitting clothes to hide • preparing and cooking meals for others, but not actually eating • engaging in repetitive or obsessive behaviours relating to and weight (e.g. weighing) • exercising excessively, feeling compelled to perform a certain number of repetitions of exercises Eating disorders can result in a wide Signs of anxiety or experiencing distress if unable range of physical health problems, The symptoms of anxiety can often to exercise. including severe malnutrition, or develop gradually over time. Given , heart or problems, which Physical signs that we all experience some anxious may lead to loss of consciousness feelings, it can be hard to know how • weight loss or weight fluctuations or death. People with untreated much is too much. In order to be eating disorders can die as a result • sensitivity to the cold or feeling diagnosed with an anxiety condition, of these illnesses. cold most of the time, even in it must have a disabling impact on warm temperatures the person’s life. There are many types of anxiety, and there are a range of • changes in or loss of menstrual What is anxiety? symptoms for each. patterns Anxiety is more than just feeling • fainting stressed or worried. Anxious feelings Anxiety can be expressed in different are a normal reaction to a situation ways such as uncontrollable worry, • swelling around the cheeks or jaw, where a person feels under pressure intense fear ( or panic attacks), on knuckles, or and usually go away once the stressful upsetting dreams or flashbacks of a to teeth due to vomiting. situation has passed, or the ‘stressor’ traumatic event. Emotional or psychological symptoms is removed. Some common symptoms of anxiety • thinking and talking a lot about However, for some people these include: body image, body weight and food anxious feelings happen for no • hot and cold flushes • expressing extreme dissatisfaction apparent or continue after • racing heart with body or having a distorted the stressful event has passed. body image For a person experiencing anxiety, • tightening of the chest anxious feelings cannot be brought • snowballing worries • becoming irritable or withdrawing under control easily. Anxiety can be from family and friends a serious condition that makes it hard • obsessive thinking and • being sensitive to comments about for a person to cope with daily life. compulsive behaviour. food, exercise, weight or body shape There are many types of anxiety and There are effective treatments many people with anxiety experience • feeling anxious or depressed available for anxiety. For more symptoms of more than one type. information on anxiety and treatments • having difficulty concentrating Living with an eating disorder is one of see the beyondblue Understanding • having problems with relationships many things – such as a family history anxiety fact sheet or visit • having suicidal thoughts of mental health conditions, stressful www.beyondblue.org.au/anxiety or behaviour. life events and personality factors – that may trigger anxiety. Anxiety is common and the sooner a person gets help, the sooner they can recover.

2 What is depression? • trouble getting to sleep, staying However, it is unclear whether asleep and being tired during depression is a for an While we all feel sad, moody or low the day eating disorder, or occurs as a result from time to time, some people of an eating disorder. Depression experience these feelings intensely, • feeling worthless, helpless and guilty can make people more likely to feel for long periods of time (weeks, negatively about their bodies and months or even years) and sometimes • increased irritability, frustration themselves – this may put them at without any apparent reason. and moodiness risk of developing an eating disorder. Depression is more than just a low • feeling unhappy, sad or miserable Eating disorders may also make mood – it’s a serious condition that most of the time people more at risk of developing has an impact on both physical and depression, particularly if they • thoughts such as, “I’m a failure”, mental health. experience rapid weight loss or “Life’s not worth living”, “People starvation. Depression affects how a person would be better off without me”. feels about themselves. A person Research has demonstrated that As with anxiety, there are effective may lose interest in work, hobbies people with anorexia nervosa tend treatments available for depression. and doing things he or she normally to have childhood and personality For more information on depression enjoys. Some people may lack energy, characteristics such as obsessions and treatments see beyondblue’s have difficulty sleeping or sleep more and perfectionism, suggesting that Anxiety and depression: An information than usual, while some people feel they have an underlying anxious trait booklet or visit www.beyondblue.org. anxious or irritable and find it hard that precedes the eating disorder. to concentrate. au/depression The conditions also share many risk The good news is that just like a factors: physical condition, depression is What are the links between treatable and effective treatments eating disorders, anxiety • biological factors are available. and depression? • genetic factors e.g. a family history of mental health problems Signs of depression Research indicates there is a link between anxiety, depression and • social factors e.g. media emphasis A person may be depressed if he or on a ‘’ of she has felt sad, down or miserable eating disorders. Eating disorders are most of the time for more than two thought to affect about 9 per cent of • psychological factors e.g. low 2 weeks and/or has lost interest or the population , and almost 3 million self-esteem, ineffective pleasure in usual activities, and has Australians are living with depression strategies and poor relationships. or anxiety.3 One in five women and also experienced some of the signs Managing anxiety and depression can one in eight men will experience and symptoms on the list below. greatly improve people’s wellbeing and depression at some time in their as well as their eating It’s important to note that everyone life. On average, one in four people disorder and their attitude towards it. experiences some of these symptoms will experience anxiety.3 People with People with anxiety and/or depression from time to time and it may not eating disorders are twice as likely can find it difficult to take the first necessarily mean a person is to experience anxiety and depression step in seeking help. They may need depressed. Equally, not every person when compared to people in the wider the support of family, friends and/or a who is experiencing depression will community. One study found that . have all of these symptoms. The close to 50 per cent of adolescents symptoms will not provide a diagnosis with eating disorders had high levels – for that you need to see a health of anxiety and depression, especially professional – but they can be used those with bulimia.4 as a guide. Some common symptoms of depression include: • not going out anymore, loss of interest in enjoyable activities • withdrawing from close family and friends • being unable to concentrate and not getting things done at work or school • feeling overwhelmed, indecisive and lacking in confidence • increased alcohol and drug use • loss or change of and significant weight loss or gain

3 • Interpersonal (IPT) is also effective for treating depression and some types of anxiety. It helps people find new ways to get along with others and to resolve losses, changes and conflict in relationships. Psychological may not only help with recovery, but can also help prevent a recurrence of anxiety or depression. These therapies help build skills in coping with stressful life circumstances and can be provided by a , or other trained health professional.

Medication , alongside psychological therapies, can also play a in the treatment of moderate to severe depression and some anxiety conditions. Making a decision about which What are the treatments for Physical health management antidepressant is best for a person eating disorders, anxiety Physical health management aims can be complex. The decision will and depression? to monitor, restore and maintain a be made in consultation with a person’s nutritional balance (avoiding doctor, after careful assessment There is no one proven way that starving or overeating) and also treat and consideration. The doctor people recover from an eating the longer-term physical problems should discuss differences in disorder, anxiety or depression and it’s that result from unhealthy eating effects and possible side-effects of different for everybody. However, there patterns. The treatment usually medications. Stopping medication is a range of effective treatments and involves seeing a doctor and/or a should only be done gradually, with health professionals who can help dietitian, developing a plan for healthy a doctor’s recommendation and people on the road to recovery. There eating and having regular check-ups. under supervision. are also many things that people with Some people need more intense and anxiety, depression and an eating A doctor or treating health structured care in . Being disorder can do to help themselves to professional will take into account admitted to hospital for treatment recover and stay well. The important several factors when suggesting of weight loss occurs only if the thing is finding the right treatment the most suitable treatment. Regular individual is very malnourished. and the right health professional that contact with and ongoing assessment works for you. by a doctor to check that treatments Psychological treatments are working effectively is an important Different types of anxiety or Psychological treatment for eating part of becoming and staying well. depression require different types disorders begins to address eating Most people taking medication will of treatment. This may include patterns and related thoughts, also benefit from psychological physical exercise for preventing and feelings and behaviours by helping therapies, which will reduce the treating mild anxiety and depression, people find new ways of thinking likelihood of after the person through to psychological and about and handling issues such as has stopped taking the medication. medical treatment for more severe self-esteem, control, perfectionism episodes. The treatment for anxiety and family problems. This can include Who can assist? and depression in someone with an individual and and eating disorder involves a coordinated psycho- (information on A General Practitioner (GP) is a good approach that monitors and treats the psychological issues). Psychological first step to discuss your concerns. symptoms of anxiety, depression and therapies are also used to treat A good GP can: the eating disorder. anxiety and depression. • make a diagnosis Professional treatment for eating • Cognitive (CBT) • check for any physical health disorders involves managing physical is an effective treatment for people problem or medication that may health (including nutritional advice) with anxiety and depression. It be contributing to the condition and promoting mental health. In teaches people to evaluate their addition, medication, support groups thinking about common difficulties, • discuss available treatments and some alternative therapies may helping them to change their be helpful. thought patterns and the way they react to certain situations.

4 • if appropriate, work with the person to draw up a Mental Health Treatment Plan so he or she can get a Medicare rebate for psychological treatment • provide brief counselling or, in some cases, psychological therapies • prescribe medication • refer a person to a mental health specialist such as a psychologist, social worker or psychiatrist. Make sure that the doctor managing your eating disorder knows if you have anxiety or depression. It is recommended that people consult their regular GP or another GP in the same , as medical information is shared within a practice. are health professionals who provide psychological therapies such as cognitive behaviour therapy (CBT) and interpersonal therapy (IPT). Psychologists are not doctors and cannot prescribe medication Occupational therapists in mental To find a mental health practitioner in Australia. health help people who, because of a in your area, visit www.beyondblue. are doctors who mental health condition, have difficulty org.au/find-a-professional or call specialise in mental health. They participating in normal, everyday the beyondblue Support Service on can make medical and psychiatric activities. Mental health occupational 1300 22 4636. assessments, conduct medical therapists also provide focused tests, provide therapy and prescribe psychological self-help strategies. Helpful strategies and tips medication. Psychiatrists often use Aboriginal and Torres Strait Islander psychological treatments such as • Learn about anxiety, depression mental health workers understand CBT, IPT and/or medication. If the and eating disorders and how these the mental health issues of Indigenous condition requires hospital admission, conditions interact. people and what is needed to provide a psychiatrist will be in charge of the culturally safe and accessible services. • Develop a mental health plan with person’s treatment. Some may have undertaken training your doctor. Mental health nurses are specially in mental health and psychological • Visit your doctor regularly to review trained to care for people with mental therapies. Support provided by your eating disorder and mental health conditions. They work with Aboriginal and Torres Strait Islander health management. psychiatrists and GPs to review a mental health workers might person’s mental health, monitor include, but is not limited to, case • Talk to your doctor about possible medication and provide information management, screening, assessment, barriers to treatment, such as cost, about mental health conditions and referrals, transport to and attendance organisation or planning, as well as treatment. Some have training in at specialist appointments, education, what to do if your condition worsens. psychological therapies. improving access to mainstream • Get help, support and services, advocacy, counselling, encouragement from family and Social workers in mental health are support for family and acute friends and have them help you specially trained to work with people distress response. to follow your mental health plan. who are experiencing difficulties in life. Social workers can help people The cost of treatment from a mental • Learn techniques. find ways to manage more effectively health professional varies. However, • Get involved in social activities. some of the situations that trigger in the same way that people can get these conditions such as family a Medicare rebate when they see a • Stay active and exercise under issues, financial problems, work doctor, they can also get part or all of the supervision of a doctor. and living arrangements. the consultation fee subsidised when • Eat healthily and include a wide Mental health social workers can also they see a mental health professional variety of nutritious foods. provide focused psychological self- for treatment of anxiety or depression. • Limit your use of alcohol, tobacco help strategies. See beyondblue’s Getting help – and caffeine. How much does it cost? fact sheet at www.beyondblue.org.au/resources

5 How family and friends can help • When a person has an eating disorder and anxiety or depression, Where to find more information it can affect family and friends. It’s important for family and friends to beyondblue look after their own health as well www.beyondblue.org.au as looking after the person who has Learn more about anxiety and depression, or talk it through with an eating disorder. our support service. • Learn about eating disorders, 1300 22 4636 anxiety and depression and their Email or chat to us online at www.beyondblue.org.au/getsupport symptoms to help you recognise mindhealthconnect warning signs. www.mindhealthconnect.org.au • Encourage the person to go to Access to trusted, relevant mental services, online the doctor if their eating disorder, programs and resources. anxiety or depression gets worse. Make sure you seek help if you The Butterfly Foundation think you need it, too. www.thebutterflyfoundation.org.au 1800 33 4673 • Support the person by helping Education, support and services for people with eating disorders and them to follow their mental health their families. plans. Gently remind the person to take their anxiety and depression National Eating Disorder Collaboration medication regularly and to attend www.nedc.com.au all their medical appointments. Evidence-based information on eating disorders; their prevention, • Encourage the person to do things identification and treatment. that they would normally enjoy. Eating Disorders Foundation of Victoria • Look after your own health by www.eatingdisorders.org.au eating well, exercising regularly, 1300 550 236 getting enough sleep and doing Support and information for people with eating disorders and their families things that you enjoy, too. in Victoria. Eating Disorders Foundation of ACT (EDFACT) References (02) 6166 1679 1 Victorian Centre of Excellence in Eating [email protected] Disorders & Eating Disorders Foundation of Information and referral for people with eating disorders and their families Victoria (2004). An Eating Disorders Resource for in the ACT. Schools. A Manual to Promote Early Intervention and Prevention of Eating Disorders in Schools. Eating Disorders Association Inc (QLD) Melbourne: beyondblue. www.eda.org.au 2 Weltzin T E, Weisensel N, Franczyk D, Burnett (07) 3394 3661 K, Klitz C, and Bean P. (2005). Eating disorders Support and referral for people with eating disorders and their families in QLD. in men: Update. Journal of Men’s Health & Gender, 2(2), 186-193. Anxiety, Compulsive and Eating Disorders Association (ACEDA) SA 3 Australian Bureau of Statistics (2008). National www.aceda.org.au Survey of Mental Health and Wellbeing: Summary (08) 8237 4011 of Results 2007 (4326.0). Canberra: ABS. Information and support for people with eating disorders, their friends 4 Patton GC, Coffey C & Sawyer SM (2003). and families in SA. The outcome of adolescent eating disorders: findings from the Victorian Bridges Association Inc (WA) Cohort Study. European & Adolescent www.bridges.net.au 12: I/25-9. Information and support for all people affected by eating disorders in WA. The Centre for Eating and Dieting Disorders (NSW) www.cedd.org.au Information for people with eating disorders, their family and friends in NSW. beyondblue would like to acknowledge facebook.com/beyondblue twitter.com/beyondblue the assistance of the National Donate online www.beyondblue.org.au/donations Eating Disorder Collaboration in the production of this fact sheet.

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