Understanding EDs 

 

Q. What are eating disorders and who can have an eating disorder?

 

Ans. Eating disorders are mental health conditions that cause disruption or disturbance in eating patterns and related thoughts that cause distress or discomfort to one's mental, physical, and social health. To know more about eating disorders, you can watch this video. 

 

Eating disorders can impact anyone regardless of gender, age, race, religion, sexual orientation, ethnicity, body shape, and weight.

 

Q What causes an eating disorder?

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Ans. While the causes of eating disorders are not fully clear, the larger consensus is that there can be a range of psychological, biological, and sociocultural contributing factors. These factors include genetics, gender, media portrayal of thinness, past trauma, stress, and body shaming.

 

Q How do I know if I have an eating disorder?

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Ans. Though a screening tool isn’t a formal diagnostic tool, it can help you understand if you need to seek help or are at risk for an eating disorder. The screening tool can be accessed on the NEDA website. (we will have a simpler one on our website by the end of this month) 

 

Q. What are some common signs of eating disorders?

 

Ans. Emotional/Behavioural Signs

• Attitudes and behaviours pointing towards dieting, weight loss and control of food are becoming increasingly important. 

• Frequent dieting, including refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, no sugar etc.)

• Extreme mood swings

• Focusing on weight, food, calories, carbohydrates, fat grams, and dieting

• Appears uncomfortable eating around others

• Food rituals (e.g. eats only a particular type of food or food group [e.g. condiments], excessive chewing, doesn’t allow the foods to touch each other)

• Not having full meals or having small portions of food at regular meals

• Withdrawal from usual friends and activities

• Extreme concern with body size and shape 

• Frequently checking the mirror to see the flaws in appearance

• Disruption or change in Eating Patterns

• Fixation on Nutritional Content of foods

 

Physical Signs 

• Noticeable weight fluctuations - significant weight loss or gain

• Fainting or dizziness

• Difficulty concentrating, sleeping

• Issues with dental, skin, hair, and nail health

• Stomach cramps, other general gastrointestinal problems (acid reflux, constipation, etc.)

• Loss, delay or disturbance of menstruation in people who menstruate 

• Abnormal laboratory findings (low thyroid and hormone levels, anemia, low potassium, low  red and white blood cell counts)

• Dental problems, such as cavities, enamel erosion and tooth sensitivity

• Dry skin and hair, and brittle nails

• Muscle weakness 

• Impaired immune functioning

• Musculoskeletal injuries and soreness or pain from overexercising

• Having low energy levels

• Feeling cold even when there is warm weather

 

Q. How many types of eating disorders are there?

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Ans. The DSM 5 (Diagnostic and Statistical Manual of Psychiatric disorders) categorizes eating disorders into Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Other Specified Feeding and Eating Disorder-(OSFED), Avoidant/Restrictive Food Intake Disorder, Pica and Rumination disorder. 

 

Types  of Eating Disorders – we definitely should do types of EDs as a brochure or as part of a brochure

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Q. What is Anorexia Nervosa? 

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Ans. Anorexia nervosa involves restricted food intake, leading to a lower-than-expected body weight, fear of weight gain, and disturbance in body image. In severe cases, it can cause significant mental distress, malnutrition, anaemia, irregular periods and other physical illnesses. 

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Q. What is Binge Eating Disorder? 

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Ans. Binge eating involves repeated episodes of binge eating at least once a week, with symptoms having lasted for at least the last 3 months. Bingeing is consuming a large amount of food in a short period of time, accompanied by a feeling of loss of control. People who binge often do so in private and can have feelings of guilt or disgust after the binge is complete. There is no recurrent use of compensatory behaviour such as excessive exercise, vomiting or use of laxatives. 

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Q. What is Bulimia Nervosa?

 

Ans. Bulimia nervosa involves recurrent episodes of binge eating where one eats a large amount of food in a short period of time and a sense of lack of control while the binge occurs. This is followed by compensatory behaviours—behaviours designed to make up for the calories consumed. These behaviours may include vomiting, fasting, excessive exercise, and laxative or diuretics use.

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Q. What is Other Specified Feeding and Eating Disorder (OSFED)?

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Ans. Other specified feeding and eating disorders encompass a broad range of eating problems that cause significant distress and impairment in occupational, social, or other important areas of daily functioning but do not fall under the formal diagnosis for anorexia nervosa, bulimia nervosa, or binge eating disorder. People who are diagnosed with OSFED might often feel their feelings were invalidated or that they don’t deserve help, which is not true. OSFED can be as serious as other eating disorders and also include subclinical eating disorders.

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Q. What is Avoidant/Restrictive Food Intake Disorder (ARFID)?

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Ans. Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disturbance that keeps people from meeting their nutritional needs. People who are dealing with ARFID may experience noticeable weight loss, dependence on nutritional supplements, impact on their psychosocial functioning, or nutritional deficiencies. 

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Q. What is Pica?

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Ans. Pica involves eating materials that have negligible nutritional value over a time period of at least 1 month. Someone struggling with pica might eat items like ice, clay, soil or paper.

 

Q. What is Rumination Disorder?

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Ans. Rumination Disorder consists of repeated regurgitation of food for a period of least one month. This includes re-chewing, re-swallowing or spitting out food.

 

Body Image Related Concerns

 

Q. What is meant by body image?

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Ans. Body image is the way one sees themselves in the mirror, or in their thoughts - a person’s perception of their physical self, as well as the thoughts and feelings the person has as associated with their physical self-perception. These feelings and thoughts can be stressful at times and are influenced by environmental and individual factors. 

 

It’s important to recognise that body image is heavily influenced by social media & traditional media, our culture, celebrity culture, and a lack of representation of different body types in the media. No one person can be blamed for negative feelings or thoughts regarding body image and it can often be a long process to change or challenge these thoughts that have been in a person’s environment from a very young age. 

 

Q. What are body image concerns?

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Ans. When a person has difficult thoughts and feelings about their own body and is preoccupied with the way they look, it can be very distressing. This could happen when they feel upset, overwhelmed, or distressed about their physical appearance and evaluate themselves largely based on their physical features. They may spend more time thinking about their body as compared to other aspects of their life i.e., school, work, family, hobbies etc.  Anyone, irrespective of their body shape and size can have body image concerns.

 

When someone has body image concerns, they may resort to frequent body checking i.e., examining specific parts of their body that they’re conscious about, which could also mean spending a lot of time in front of the mirror or even frequently checking weight and measurements. Slight fluctuations in weight and or other body measurements can cause a marked distress in some and then lead to either restrictive eating or excessive exercising or emotional eating etc. Comparing and scrutinising others’ bodies with respect to their own is also a common sign. On the other hand, some people with body image concerns may show complete avoidance towards their body. They may be avoidant or in denial of how they feel about their body, may be terrified of checking their weight, avoid mirrors, wear baggy clothes and not want to buy new clothes when their size changes etc. 

 

While body image concerns can manifest in several ways ranging from preoccupation to avoidance, they can cause a lot of distress to a person by affecting other areas of their wellbeing such as a low self-image, low confidence, social skills, interpersonal relationships and also cause anxiety about eating or exercising around other people. Some people may stop going out with friends or find it difficult to perform academically or at work because of these concerns. 

 

Q. Where do body image concerns arise from?

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Ans. Body image concerns are known to have arisen from environmental factors and the ideal body that society’s norms prescribe a person should have. A person’s social circle including family, friends, acquaintances, teachers and the media all have an impact on how that person sees and feels about themselves and their appearance. When someone is shamed for having a particular body or in general, there is a large emphasis on how one should look, it can cause body image concerns. Each person has a different degree of distress depending on how their environment is and how they process information and their feelings. 

 

Q. What is body shaming? 

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Ans. Body shaming is when someone judges or passes hurtful comments about someone based on their physical appearance. With undue importance on one’s appearance, people are often body shamed when their bodies do not fit society’s prescribed beauty standards. This could happen in many ways; comparing one’s own appearance to another person’s, sometimes criticising some else’s appearance in front of them or conversely, without their knowledge. Regardless of how body shaming happens, it leads to shame and guilt. 

In India, body shaming is very common among friends and family. Often, people believe that body shaming may may motivate others to eat less, exercise more, and lose weight, but scientific evidence has proven that shaming someone for their weight or weight-based discrimination can actually be counterproductive. 

 

Q. Why is body shaming counterproductive and unhelpful?

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Ans. Body shaming and passing judgement on someone’s physical appearance can negatively impact their self-esteem and can play a significant role in exacerbating mental health issues. When body shaming occurs, the hope is often that shaming one into feeling bad about their body will consequently lead to gaining, or more often, losing weight to fit into society’s beauty standards. Research has shown that weight discrimination causes stress and leads overweight people to gain more weight. A 2019 study found that the more children and teenagers were teased about their weight, the more weight gain they experienced. 

Body shaming is not only unhelpful, but also detrimental to one's overall health and wellbeing, specifically their mental health. It can cause social anxiety, a lot of consciousness, loss of confidence in oneself, depression and can sometimes contribute to the progression of eating disorders. 

 

Getting Help

 

Q. How do I confide in someone that I have an eating disorder?

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Ans. It may be overwhelming to talk to someone about how you are feeling with regard to your eating disorder. Because of the stigma surrounding eating disorders and mental health, especially in India, it takes a lot of courage to talk to someone about it. 

Remember, early intervention is the cornerstone of all eating disorder recovery and sharing how you feel takes you one step closer towards dealing with your disorder. If you feel a loved one may be able to comfort you or give you the courage to reach out for professional support, please do so. 

In case you want your loved ones to have better knowledge about eating disorders, you can share reading material like this FAQ or other video resources that can better equip them with information before you share how you feel with them. You can use different forms of communication if that suits you like writing to them or sending them an audio message. Feel free to do this in a way you feel comfortable. 

To reach out to professionals who have an understanding of eating disorders, you can check out Freed’s directory of mental health professionals in India, on our website. 

This article by Shachi Dalal shines light on the unique factors that have allowed, and continue to allow, eating disorders to flourish in India

 

Q. In what different ways can I receive support while trying to improve my relationship with food? 

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1. Seek professional help - Several professionals help people who have an eating disorder, including psychologists, psychiatrists, general physicians, nutritionists, social workers, nurses, and others. 

Healthcare providers can assist and provide the support required for each individual. They can assess the physical and psychological needs of the individual and prescribe the appropriate course of action. A combination of psychotherapy, medication and medical attention could help a person struggling with an eating disorder. Psychotherapy may be able to provide individual therapy options, giving you a space to process your emotions, identify your own behaviour patterns and learn and apply tools that can help you with your eating disorder. You can access our directory of professionals here.

1. Join a support group - Support groups are places where people can meet other people experiencing eating disorders and struggling with similar mental health conditions. A support group’s aim is to create a community, a safe space, for anyone with disordered eating concerns, or their loved ones to share their problems and connect with others who share similar concerns. We’re working on curating support groups, so please write to us here.

2. Self Help resources - Books and other self-help resources may be able to aid in your journey towards recovery and wellbeing. These resources are available on our website. Additionally, persons with mild to moderate presentations of bulimia or binge eating disorder can be treated with a method of Cognitive Behavioural Therapy - Guided self help - a method of manualised self-help done with or without the support of a therapist. Details of these resources are available here. 

 

Q. What happens in therapy? 

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Ans. Individual therapy provides you a safe space to process your emotions, identify your own behaviour patterns and learn and apply tools that can help you with your eating disorder. It can help you uncover and deal with different aspects of yourself, your thoughts and feelings. 

Finding the right therapist for you requires time and you may need to talk to a few therapists before finding the right fit for you. Therapy is a long process and may require a series of sessions for you to see tangible changes in your life. The types of therapies shown to be effective for eating disorders are Cognitive Behavioural Therapy, Interpersonal psychotherapy and Dialectical Behaviour Therapy. 

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Q. What if I can't pay for mental health support from a clinical psychologist or psychiatrist?

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Ans. Freed’s directory of mental health professionals includes a range of options for you. A lot of our partners offer sliding scale options so don’t hesitate in asking for financial support if you require it. 

 

Q. I don't think I have an eating disorder, but I have some body image concerns or recent changes in eating patterns. Do I still need to get support? 

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Ans. Diagnoses help you understand the nature of distress and provide effective evidence-based treatment. Sometimes however, mental health diagnoses are evolving and may not encompass or accurately include each and every person’s feelings. If your relationship with food or body image feels stressful to you irrespective of fitting into any diagnostic criteria or not, you deserve to get support and help. 

Research shows that many people with subclinical eating disorders (not having symptoms to be formally diagnosed but having distress around eating behaviours and thoughts) will be likely to develop full eating disorders, so early intervention can be helpful. Studies show that early intervention and treatment fastens recovery, reduces symptoms and improves the likelihood of staying free of the eating disorder.

 

Gentle Actions Around EDs

 

Q. How do I know if a loved one is showing signs of an eating disorder? 

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Ans. If you have concerns for a loved one who may have an eating disorder, look out for common emotional and physical signs. 

 

Q. How do I talk to a loved one if I think they might have an eating disorder? 

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Ans. Check out this page by BEAT, a UK based charity, to see how you can talk to a loved one who you think may have an eating disorder. 

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Q. Is it common to indulge in self-harm for someone with an eating disorder?

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Ans. When most people think about self-harm, they typically think of someone engaging in cutting or other self-injurious behaviour that would cause an individual external physical harm and/or pain. What many people do not realize, is that engaging in eating disorder behaviours can be characterized as extreme forms of self-harm as well. 

Self-harm occurs when an individual deliberately inflicts physical harm on themselves in order to manage uncomfortable emotions and/or punish themselves for perceived “bad behaviour”. While indulging in other forms of self-harm is not a given for PwED, it is also not uncommon. 

If you notice any signs of self-harm in a loved one, consult with a psychologist who understands EDs urgently! 

 

Q. How do I take care of myself while caring for a loved one with an eating disorder?

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Ans. Take time for yourself. Keep in mind that what you do is a much more powerful message than what you say. Being a good role model for your child or family member during the healing process means taking care of your own physical, emotional, and spiritual needs. Seek support from family, friends, and/or professionals whom you find to be helpful. Allow yourself to be cared for!

 

Q. How does the Freed Helpline help?

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The helpline’s purpose is to provide a safe, stigma-free space for expressing feelings and distress surrounding eating disorders and body image concerns. The helpline can be used to inquire about anything and everything about Eating-disorders, to help them find resources and professional help all at one place.  We hope to be able to be:

• Empathetic listeners where you can have a space to talk to be heard

• Providing information about eating disorders 

• Providing information about different support options available to you - individual therapy support groups, self-help resources, website. 

 

This is not a crisis intervention helpline; if you are feeling suicidal, have thoughts of self-harm, or have any other mental health-related emergency or crisis situation please call a crisis helpline. The list of such helplines is provided below. 

 

24 x 7 Helplines in India

Vandrevala Foundation: +91 9999 666 555 | WhatsApp: +1(256)6662142 

Fortis: +91-8376804102

Aasra: +91-9820466726

KIRAN: 1800-599-0019

 

Q. What about persons who may have other mental health illnesses or issues?

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Responding to those with other mental illnesses may be done with empathetic listening and open ears. If it is a crisis situation you can redirect them to a crisis helpline (list of helplines  provided below) after you have listened to what they had to say.  It may be helpful to know that those with eating disorders have comorbidities such as depression and anxiety at least in 50 % of cases. 

 

24 x 7 Helplines in India

Vandrevala Foundation: +91 9999 666 555 | WhatsApp: +1(256)6662142

Fortis: +91-8376804102

Aasra: +91-9820466726

KIRAN: 1800-599-0019

 

 

Q. What else is Freed doing in the area of eating disorders?

I’d like to mention at least a little bit about research, initiating conversations here.

 

Miscellaneous

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Q. We would like to collaborate with Freed for something? How can we get in touch? 

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Ans. For specific requests, you can email us as info@imfreed.org. We will respond within 2-3 working days.