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”.