Eating Disorders

Disclaimer:

This publication is based on a Mind UK publication and the original version may be found here: https://www.mind.org.uk/information-support/a-z-mental-health/

Thank you to Mind UK for sharing their valuable content with us. Content included in Mental Health A-Z is made available free of charge and does not form part of any commercial activity. The adaptation has been done independently by Mind HK and is intended for general information purposes only.

What type of eating disorders are there?

This section describes the most common kinds of eating disorders:

  • Bulimia nervosa
  • Anorexia nervosa
  • Binge eating disorder
  • Eating disorder not otherwise specified (EDNOS)

While you may not have the signs and symptoms to warrant a medical diagnosis for any of these disorders, it may still be helpful to look at the following sections to identify some of the harmful behaviours you may have and think about ways that you can address them.

Bulimia nervosa

If you experience bulimia nervosa, you may find that you eat large amounts of food all in one go, often because you are feeling upset or worried. This is called bingeing. You may then feel guilty or ashamed after bingeing, so you try to get rid of the food you have eaten by using compensatory behaviours such as self-induced vomiting or excessive exercise. This is called purging.

These are some of the feelings and behaviours you might experience, and some of the physical effects you might notice in your body.

Below are some of the feelings, behaviours, and physical symptoms associated with bulimia nervosa:

How you might feel:

  • Ashamed or guilty
  • That you hate your body or that you are fat
  • Scared of having your bingeing or purging behaviours be found out by family and friends
  • Depressed or anxious
  • Lonely, especially if no one knows about your eating problems
  • Very low and upset
  • As if your mood changes quickly or suddenly
  • Out of control, especially when bingeing
  • Numb, as if feelings are blocked out by binging or purging

What you might do:

  • Eat lots of food in one go (binge), especially foods that you think are bad for you, in a discrete period of time
  • Go through cycles of eating, feeling guilty, purging, feeling hungry and eating again throughout the day
  • Starve yourself in between binges
  • Eat in secret
  • Crave certain types of food
  • Try to get rid of food you’ve eating (purge) by making yourself vomit, using laxatives, or exercising excessively

What might happen to your body:

  • You may stay roughly the same weight, or you may go from being overweight to underweight quite often
  • You may become dehydrated, which can cause skin to bruise easily, dry easily, or appear yellowish in colour
  • If you menstruate, your periods might become irregular or stop altogether (amenorrhea)
  • If you make yourself vomit repeatedly, your stomach acid can harm your teeth and you can get a sore throat
  • If you use laxatives, you could develop irritable bowel syndrome (IBS), stretched colon, constipation or heart disease

With bulimia nervosa, you may stay roughly the same weight. Unfortunately, this may make it difficult to get a bulimia nervosa diagnosis, because getting a bulimia nervosa diagnosis and accessing treatment can sometimes be related to how much you weigh. Also, people may be less likely to notice the eating disorder or to offer help without you asking, making it harder to get support even when you feel ready to try to get better.

“When I was at the worst phases of bulimia, and realised that it was so damaging to me, I tried to reach out, but no one responded to me in the way that I needed. I tried and tried to tell people that this was not okay, but all they saw was a diet gone wrong and that I’d sort it out by myself.”

Anorexia nervosa

If you experience anorexia nervosa, you may find that you don’t allow yourself to eat enough food relative to the energy requirements of your age, sex, and developmental trajectory, leading to a significantly low body weight. You may also experience intense fear of gaining weight or becoming fat, and this obsession over weight gain and weight loss may result in very low self-esteem, negative self-image, and feelings of intense distress.

Below are some of the feelings, behaviours, and physical symptoms associated with anorexia nervosa:

How you might feel:

  • Like you can’t think about anything other than food
  • Like you want to disappear
  • That you have to be perfect
  • Like you are never good enough
  • Lonely, especially if no one knows about your eating problems
  • That by eating you lose the control you feel you need
  • That you are hiding things from your family and friends
  • That you are fat and your weight loss isn’t enough
  • Frightened of putting on weight
  • Angry if someone challenges you
  • Tired and disinterested in things
  • Depressed or suicidal
  • Anxious
  • A high or sense of achievement from denying yourself food or over-exercising
  • Panicky around meal times

What you might do:

  • Reduce your food intake or stop eating altogether
  • Count calories obsessively
  • Hide food or secretly throw it away
  • Avoid foods that you feel are dangerous, like food with high amounts of calories or fat
  • Cook elaborate meals for people but not eat them yourself
  • Use drugs that reduce your appetite or speed up your digestion
  • Think about losing weight more often than not
  • Make yourself vomit
  • Use laxatives
  • Exercise excessively
  • Wear baggy clothes to cover up weight loss
  • Compete to eat less than other people
  • Make rules about food, such as listing ‘good’ and ‘bad’ foods or only eating things that are a certain colour
  • Check and weigh your body compulsively

What might happen to your body:

  • You may weigh less than you should or lose weight very fast (at least 15% below a healthy weight for your age and height)
  • You may become physically underdeveloped, especially if anorexia nervosa starts before puberty
  • You may feel weak and move slowly
  • You may feel very cold all the time
  • If you menstruate, your periods might become irregular or stop altogether (amenorrhea)
  • Your hair may thin or fall out
  • You may develop fine, fuzzy hair on your arms and face (called ‘lanugo’)
  • You may lose interest in sex or not be able to have or enjoy it
  • You may find it very hard to concentrate
  • Your bones may become fragile and you might develop problems like osteoporosis

“Mine started when I started starving myself as a means of control. Everything else had been taken out of my control, but no one could force me to eat. I’d enjoy and crave the feeling of my stomach being so empty I had cramps, felt sick and became so weak I couldn’t sit up”

Binge eating disorder

If you have binge eating disorder it means you recurrently engaging in binge eating behaviours, during which you feel like you can’t stop yourself from eating. It is sometimes described as having a food addiction or compulsive eating. Also, if you have binge eating disorder, you may have come to rely on food for emotional support, or be using food to mask difficult feelings.

Below are some of the feelings, behaviours, and physical symptoms associated with binge eating disorder:

How you might feel:

  • Out of control
  • Embarrassed or ashamed
  • Lonely and empty
  • Very low, even worthless
  • Unhappy about your body, especially if you are gaining weight
  • Stressed
  • Anxious

What you might do:

  • Pick at food all day, or eat large amounts at once (bingeing)
  • Eat without really thinking about it, especially when you are doing other things e.g. watching television
  • Regularly eat unhealthy food i.e. foods high in sugar, fat, or salt
  • Hide how much you’re eating
  • Eat until you feel uncomfortably full or sick
  • Try to diet, but find it hard
  • Eat for comfort when you feel stressed or upset

What might happen to your body:

  • You may put on weight
  • You may develop health problems associated with being overweight, such as diabetes, high blood pressure or joint and muscle pain
  • You may experience breathlessness
  • You may frequently feel sick
  • You may experience sugar highs and crashes (having bursts of energy followed by feeling very tired)
  • You may develop health problems such as acid reflux and irritable bowel syndrome (IBSE)

“I was badly depressed and found myself becoming a chocaholic. I just couldn’t go a day without it […] I have now cut down my addiction, but it’s the worst thing ever not being in control.”

Eating disorder not otherwise specified (EDNOS)

EDNOS is a diagnosis that is becoming more common. If your doctor diagnoses you with EDNOS, it means you meet some but not all of the criteria for the eating disorders mentioned (bulimia nervosa, anorexia nervosa, and binge eating disorder). For example, you may be starving yourself but be close to what is considered a healthy weight for your age and height, therefore eliminating a diagnosis for anorexia nervosa. Or, you may binge and purge every month, but not regularly enough for a diagnosis of bulimia nervosa.

EDNOS can be a confusing diagnosis. It can seem like you are being told your problems are not as serious as other eating disorders, but this is not true. Any eating problem can be difficult to deal with, and the impact it has on your life can feel really overwhelming.

“I was assessed by my local [eating disorder] service, was given a diagnosis of EDNOS. I then managed to get my eating back on track, and have done since then. I continue to work on the feelings with the help of my therapist, and am very much in recovery”.

What is iACT Service?

Improving Access to Community Therapies (iACT®) is one of the services from Mind HK. Trained Wellbeing Practitioners will offer initial assessment and early intervention for people dealing with mild to moderate symptoms of depression, anxiety, or other emotional difficulties.

 

The service includes 6-8 sessions of low-intensity psychological support, the flexibility of the service allows individuals to receive free and timely support when needed.

If you’re aged between 18 – 65 and are facing some emotional challenges, we would like to invite you to take an online assessment for us to gain a better understanding of your current emotional struggle.

 

If you’re eligible, we’ll get you connected with a Wellbeing Practitioner within two weeks to sort out the next steps.

The service runs for about 3 months and includes 6-8 support sessions, tailored to your needs.

 

We encourage you to attend all sessions and actively practice the tips and exercises provided by your Wellbeing Practitioner.

We take your privacy seriously. Your chats with the Wellbeing Practitioner are confidential.

 

We won’t share any of your info unless you’ve provided consent or if there are risks detected.

This programme isn’t suitable for people facing emergencies, major setbacks, or those diagnosed with serious or complex mental health conditions.

 

If you’re having thoughts of suicide or self-harm, this programme might not meet your needs, so please seek help right away. You can check out Mind HK’s “Find Help Now” page for immediate information and services.

Most of our Wellbeing Practitioners have backgrounds in psychology or counselling and are passionate about mental health. They’ve gone through about 140 hours of intensive training and completed at least 120 hours of supervised clinical practice over 9 months to ensure the quality of service.

 

They’re trained by accredited local experts in the mental health field, including clinical psychologists, counselling psychologists, counsellors, and psychiatrists. Plus, we regularly check how effective our services are. All service outputs and performances are subject to consistent monitoring.

Who is suitable for participating in this programme?

This programme welcomes anyone between the ages of 18 and 65 who may be feeling lost or facing emotional difficulties. Please note that this programme is not suitable for individuals diagnosed with severe or complex mental health conditions.

This programme is not suitable for individuals diagnosed with severe or complex mental health conditions, but suitable for those who experience mild to severe moderate anxiety, mild to moderate depression, or other emotional challenges. If you are currently experiencing a major setback or even having thoughts of suicide or self-harm, please visit the “Find Help Now” page on our Mind HK’s website for immediate information and services.

After signing up, our Wellbeing Practitioner will contact you within two weeks to schedule a convenient time for a 45-minute conversation, either via video or phone call, according to your preference. During the conversation, the Wellbeing Practitioner will understand your current situation and help you gain a better understanding of your emotional state based on the questionnaire you filled out during application. Additionally, they will provide recommendations for appropriate community resources based on your needs, helping you take an important first step in taking care of your mental health.

Although the intervention procedure is mostly standardised, Wellbeing Practitioners will work flexibly with clients to address individual presenting problems and unique characteristics.

Our Wellbeing Practitioners are trained to support people who experience mild to moderate mental health difficulties primarily. This programme is not suitable for the situations mentioned above. If you are currently experiencing a major setback or even having thoughts of suicide or self-harm, please visit the “Find Help Now” page on our Mind HK’s website for immediate information and services.

Your conversations with the Wellbeing Practitioner are absolutely confidential. Any information about you will not be shared with anyone without your consent unless you or others are at immediate risk or the Wellbeing Practitioner has reason to believe that you may be in imminent danger.
Supervisors will monitor trainees’ development throughout the placement to ensure that they are meeting the required level of competency to pass the training course at the end of the placement.

Yes, it is necessary to book an appointment in advance by filling out the form. Additionally, you can select one of the five stores yourself. We will allocate clients to different Wellbeing Practitioners based on their chosen location.

Before having the conversation, we will ask you to fill out a basic questionnaire for preliminary screening assessment. This screening process aims to ensure that the training received by the Wellbeing Practitioners is sufficient to meet the needs of the individuals receiving the service. If it is determined after the screening assessment that the service is not suitable for you, Mind HK will provide alternative recommendations to ensure your safety and support.

For adults who are suitable for this service, all Wellbeing Practitioners have received training on how to identify and respond to safety and risk issues. If you have any concerns about the support process, the Wellbeing Practitioners have appropriate measures in place and will develop response plans based on the urgency of the situation. They can also access support from clinical practitioners from Mind HK or participating organisations.

What private training does Mind HK provide?

Mind HK provides 4 themes of mental health training, including: Supporting Self, Supporting Others, Family Wellbeing and DEI (Diversity, Equity and Inclusion).

 

Check out the brochure here for more information.

Mind HK provides a wide range of standardised mental health training, which can be tailored to different circumstances. Chat with our team to explore more

Our trainers come from a diverse, accredited pool of clinically experienced professionals. Check out our trainers’ biographies here.

Yes, the Mental Health First Aid class of Mind HK is internationally accredited by the MHFA International. The content and certification is delivered by trainers certified from the Mental Health Association of Hong Kong. You can find out our trainers accreditation here.

We are here to support your mental health education journey! Reach out to us and chat with our team.

Types of Eating Disorders

What type of eating disorders are there?

This section describes the most common kinds of eating disorders:

  • Bulimia nervosa
  • Anorexia nervosa
  • Binge eating disorder
  • Eating disorder not otherwise specified (EDNOS)

While you may not have the signs and symptoms to warrant a medical diagnosis for any of these disorders, it may still be helpful to look at the following sections to identify some of the harmful behaviours you may have and think about ways that you can address them.

Bulimia nervosa

If you experience bulimia nervosa, you may find that you eat large amounts of food all in one go, often because you are feeling upset or worried. This is called bingeing. You may then feel guilty or ashamed after bingeing, so you try to get rid of the food you have eaten by using compensatory behaviours such as self-induced vomiting or excessive exercise. This is called purging.

These are some of the feelings and behaviours you might experience, and some of the physical effects you might notice in your body.

Below are some of the feelings, behaviours, and physical symptoms associated with bulimia nervosa:

How you might feel:

  • Ashamed or guilty
  • That you hate your body or that you are fat
  • Scared of having your bingeing or purging behaviours be found out by family and friends
  • Depressed or anxious
  • Lonely, especially if no one knows about your eating problems
  • Very low and upset
  • As if your mood changes quickly or suddenly
  • Out of control, especially when bingeing
  • Numb, as if feelings are blocked out by binging or purging

What you might do:

  • Eat lots of food in one go (binge), especially foods that you think are bad for you, in a discrete period of time
  • Go through cycles of eating, feeling guilty, purging, feeling hungry and eating again throughout the day
  • Starve yourself in between binges
  • Eat in secret
  • Crave certain types of food
  • Try to get rid of food you’ve eating (purge) by making yourself vomit, using laxatives, or exercising excessively

What might happen to your body:

  • You may stay roughly the same weight, or you may go from being overweight to underweight quite often
  • You may become dehydrated, which can cause skin to bruise easily, dry easily, or appear yellowish in colour
  • If you menstruate, your periods might become irregular or stop altogether (amenorrhea)
  • If you make yourself vomit repeatedly, your stomach acid can harm your teeth and you can get a sore throat
  • If you use laxatives, you could develop irritable bowel syndrome (IBS), stretched colon, constipation or heart disease

With bulimia nervosa, you may stay roughly the same weight. Unfortunately, this may make it difficult to get a bulimia nervosa diagnosis, because getting a bulimia nervosa diagnosis and accessing treatment can sometimes be related to how much you weigh. Also, people may be less likely to notice the eating disorder or to offer help without you asking, making it harder to get support even when you feel ready to try to get better.

“When I was at the worst phases of bulimia, and realised that it was so damaging to me, I tried to reach out, but no one responded to me in the way that I needed. I tried and tried to tell people that this was not okay, but all they saw was a diet gone wrong and that I’d sort it out by myself.”

Anorexia nervosa

If you experience anorexia nervosa, you may find that you don’t allow yourself to eat enough food relative to the energy requirements of your age, sex, and developmental trajectory, leading to a significantly low body weight. You may also experience intense fear of gaining weight or becoming fat, and this obsession over weight gain and weight loss may result in very low self-esteem, negative self-image, and feelings of intense distress.

Below are some of the feelings, behaviours, and physical symptoms associated with anorexia nervosa:

How you might feel:

  • Like you can’t think about anything other than food
  • Like you want to disappear
  • That you have to be perfect
  • Like you are never good enough
  • Lonely, especially if no one knows about your eating problems
  • That by eating you lose the control you feel you need
  • That you are hiding things from your family and friends
  • That you are fat and your weight loss isn’t enough
  • Frightened of putting on weight
  • Angry if someone challenges you
  • Tired and disinterested in things
  • Depressed or suicidal
  • Anxious
  • A high or sense of achievement from denying yourself food or over-exercising
  • Panicky around meal times

What you might do:

  • Reduce your food intake or stop eating altogether
  • Count calories obsessively
  • Hide food or secretly throw it away
  • Avoid foods that you feel are dangerous, like food with high amounts of calories or fat
  • Cook elaborate meals for people but not eat them yourself
  • Use drugs that reduce your appetite or speed up your digestion
  • Think about losing weight more often than not
  • Make yourself vomit
  • Use laxatives
  • Exercise excessively
  • Wear baggy clothes to cover up weight loss
  • Compete to eat less than other people
  • Make rules about food, such as listing ‘good’ and ‘bad’ foods or only eating things that are a certain colour
  • Check and weigh your body compulsively

What might happen to your body:

  • You may weigh less than you should or lose weight very fast (at least 15% below a healthy weight for your age and height)
  • You may become physically underdeveloped, especially if anorexia nervosa starts before puberty
  • You may feel weak and move slowly
  • You may feel very cold all the time
  • If you menstruate, your periods might become irregular or stop altogether (amenorrhea)
  • Your hair may thin or fall out
  • You may develop fine, fuzzy hair on your arms and face (called ‘lanugo’)
  • You may lose interest in sex or not be able to have or enjoy it
  • You may find it very hard to concentrate
  • Your bones may become fragile and you might develop problems like osteoporosis

“Mine started when I started starving myself as a means of control. Everything else had been taken out of my control, but no one could force me to eat. I’d enjoy and crave the feeling of my stomach being so empty I had cramps, felt sick and became so weak I couldn’t sit up”

Binge eating disorder

If you have binge eating disorder it means you recurrently engaging in binge eating behaviours, during which you feel like you can’t stop yourself from eating. It is sometimes described as having a food addiction or compulsive eating. Also, if you have binge eating disorder, you may have come to rely on food for emotional support, or be using food to mask difficult feelings.

Below are some of the feelings, behaviours, and physical symptoms associated with binge eating disorder:

How you might feel:

  • Out of control
  • Embarrassed or ashamed
  • Lonely and empty
  • Very low, even worthless
  • Unhappy about your body, especially if you are gaining weight
  • Stressed
  • Anxious

What you might do:

  • Pick at food all day, or eat large amounts at once (bingeing)
  • Eat without really thinking about it, especially when you are doing other things e.g. watching television
  • Regularly eat unhealthy food i.e. foods high in sugar, fat, or salt
  • Hide how much you’re eating
  • Eat until you feel uncomfortably full or sick
  • Try to diet, but find it hard
  • Eat for comfort when you feel stressed or upset

What might happen to your body:

  • You may put on weight
  • You may develop health problems associated with being overweight, such as diabetes, high blood pressure or joint and muscle pain
  • You may experience breathlessness
  • You may frequently feel sick
  • You may experience sugar highs and crashes (having bursts of energy followed by feeling very tired)
  • You may develop health problems such as acid reflux and irritable bowel syndrome (IBSE)

“I was badly depressed and found myself becoming a chocaholic. I just couldn’t go a day without it […] I have now cut down my addiction, but it’s the worst thing ever not being in control.”

Eating disorder not otherwise specified (EDNOS)

EDNOS is a diagnosis that is becoming more common. If your doctor diagnoses you with EDNOS, it means you meet some but not all of the criteria for the eating disorders mentioned (bulimia nervosa, anorexia nervosa, and binge eating disorder). For example, you may be starving yourself but be close to what is considered a healthy weight for your age and height, therefore eliminating a diagnosis for anorexia nervosa. Or, you may binge and purge every month, but not regularly enough for a diagnosis of bulimia nervosa.

EDNOS can be a confusing diagnosis. It can seem like you are being told your problems are not as serious as other eating disorders, but this is not true. Any eating problem can be difficult to deal with, and the impact it has on your life can feel really overwhelming.

“I was assessed by my local [eating disorder] service, was given a diagnosis of EDNOS. I then managed to get my eating back on track, and have done since then. I continue to work on the feelings with the help of my therapist, and am very much in recovery”.