ARE YOU AT RISK?

The purpose of Module 1 was to try and help you determine what you feel about YOURSELF and how eating and exercise plays a part in the way you manage the feelings about yourself that you have. The aim was also to identify any emotions that dominate the way you feel in
certain situations and if you can see a pattern in the way you feel and what you do in order to deal with any negative emotions.

The manner in which we can use food, eating and exercise may be a means of coping with these. There may also be other ways that you cope in conjunction with diet and exercise. Throughout this course you will learn how to, not only identify emotions, but also better ways to cope other than with using unhealthy diet and exercise behaviours.

In this module, we will outline common characteristics of the major types of eating disorders and other unhealthy behaviours. Here you will also find links to other resources for further reading.

It is important to point out that if you feel you have an eating disorder, you need to speak with a health professional. A general practitioner would be a good place to start.

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2.1 Eating Disorders and Disordered Eating

Eating disorders and disordered eating are becoming an increasing problems in today’s society. They are serious mental illnesses and not merely body image issues. Dieting may be used as a means of controlling or coping with an underlying issue, or another mental illness.

Eating disorders are often co-morbid with other mental illnesses including anxiety, depression, obsessive compulsive disorder, post traumatic stress disorder and or substance abuse disorder.

Eating disorders are not indicated by body shape or size.

People with eating disorders are NOT a problem.
People with eating disorders DO NOT wake up one day and CHOSE to have an eating disorder.
Eating disorders are no respecter of age, gender, ethnicity, socio-economic status, religion or culture.

The estimated number of people in Australia who suffer from an eating disorder is approximately 4% of the population. Of these, 47% have Binge Eating Disorder (BED), 12% Bulimia Nervosa (BN), 3% Anorexia Nervosa (AN) and 38% other eating disorders (Butterfly Foundation, 2012). Although the majority of the sufferers are women (64%), the prevalence of eating disorders is increasing amongst boys and men (Butterfly Foundation, 2012; NEDC, 2012a).

While there are many risk factors that can contribute to the development of an eating disorder, the biggest single risk factor of developing an eating disorder is dieting.

Disordered Dieting and Compensatory behaviours are also prevalent. Prevalence studies for Australians show:

• 38% of 12–13 years olds are dieting
• Over 50% of the total population are dieting
• 47% experiment with crash dieting, fasting and vomiting
• 3% vomit at least once per week
• 26-28% fast occasionally
• 6% fast at least once per week
• 7% of boys aged 11 -1 5 had tried fasting, vomiting and/or laxative abuse
• Body Image for both male and females is in the top 3 concerns for young Australians as revealed in The Mission Australia National Youth Survey (2009 – 2015)
• 90% females and 68% males aged 12 – 17 had dieted

Above stats from CEDD and http://www.eatingdisorders.org.au/key-research-a-statistics.

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2.1.1 What is the difference between Disordered Eating and Eating Disorders?

While these terms are quite similar, both involve the attachment of emotion to eating causing anxiety. The main difference is the the diagnostic criteria. Disordered eating is often a precursor for an eating disorder.

2.1.1.1 Disordered Eating

Disordered eating may involve an intense fear of certain foods, sticking to fad diets, and using food and eating to control negative emotions. Dieting can be like ‘pain relief’ to those who use these methods to control negative feelings, much like those who may use drugs and alcohol for these reasons. It is risky behaviour and dieting is the single biggest predictor for the onset of an eating disorder, particularly for females aged 12 – 20 years.

Many kinds of fad diets can be used as an excuse to ‘cover up’ disordered eating. Unless there is a diagnosed medical reason for eliminating a particular food from your normal eating, I would be seriously thinking about WHY you are doing so. The REAL reason why.

Cutting out meat and dairy products due to fear of eating them can be disguised as becoming vegetarian. The craze of ‘clean eating’ raises many concerns. Sugar free diets can lead into cutting out of further foods like fruit and some vegetables as the fear of sugar increases. These are just two examples of how disordered eating can become a bigger problem. The key is to determine the real motivation as to why someone is choosing certain eating behaviours.

(http://www.nedc.com.au/disordered-eating)

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2.1.1.2 Eating Disorders

As mentioned above, the main difference between disordered eating and an eating disorder is the diagnostic criteria and at the moment there are four eating disorders that are recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM). These include:

1. Anorexia Nervosa (AN)
2. Bulimia Nervosa (BN)
3. Binge Eating Disorder (BED)
4. Other Specified Feeding and Eating Disorders (OSFED)
5. Muscle dysmorphia

(http://cedd.org.au/begin-recovery/about-eatingdisorders/types-of-eating-disorders/)

1. Anorexia Nervosa

AN is a severe psychiatric illness with the highest mortality rate of all psychiatric illnesses. It is the third most chronic disease in 15 – 24 year olds, and is characterised by an intense fear of gaining weight, highly restrictive eating and/or excessive exercise with high level of body
image distortion. The effects of starvation in AN creates many physical and metabolic complications. The most concerning are the biochemical and cardiac concerns which may be life threatening, irreversible such as osteoporosis and infertility.

As well as the physical changes that occur with starvation, the social, cognitive and behaviour changes include:

• Increased anxiety and mood fluctuations
• Changes in personality
• Eating and food behaviour changes
• Social and sexual changes
• Poor sleep quality
• Low self-esteem
• Hypersensitivity to noise and light
• Obsessive and compulsive thinking
• Perfectionism

(http://www.nedc.com.au/anorexia-nervosa)

2. Bulimia Nervosa

BN is a serious psychiatric illness characterised by episodes of binge-purging cycles with a great sense of loss of control. The over consumption of large quantities of food in a short space of time creates feelings of guilt and shame, leading to behaviours such as vomiting, laxative abuse, excessive exercise, fasting and/or enemas as compensatory behaviours. Many people with bulimia nervosa can experience weight fluctuations and may appear to have a normal weight range. 15-18 year olds are at highest risk for age of onset and 3-5% have a risk for lifetime suffering from bulimia nervosa.

(http://www.nedc.com.au/bulimia-nervosa)

3. Binge Eating Disorder

BED is similar to bulimia nervosa in that the sufferer consumes large quantities of food in a short space of time, but does not employ compensatory behaviours.

(http://www.nedc.com.au/binge-eating-disorder)

4. Other Specified Feeding or Eating Disorders (OSFED)

OSFED are eating disorders are characterised by eating and feeding behaviours that cause clinical distress and impaired functioning, yet do not fit all the criteria of the other eating disorders.

(http://www.eatingdisorders.org.au/eating-disorders/other-eating-disorders)

5. Muscle Dysmorphia

Muscle Dysmorphia (MD), also known colloquially as ‘bigorexia’ or ‘reverse anorexia nervosa’, is a mental and behavioural condition characterised by pathological preoccupation with a perceived lack of muscularity, typically despite bigger muscularity and leanness than
average people. The behaviours involved in this illness include rigid dietary control, compulsive excessive and repetitive exercise, the use of steroids and over-the-counter dietary supplements as well as body checking, avoidance, comparison and camouflaging.

(https://inshapenewsflash.com/2017/02/17/what-is-muscledysmorphia-md/)

The New Zealand bodybuilder in this clip displays all the signs mentioned above. He has since died.

https://www.youtube.com/watch?v=j4HEmmXvxdw&list=PLQ-9cD2HouNUKpOC_ai2kCiCW9rmnvp8y

If you feel you or anyone you know is suffering from any eating disorder, medical attention is needed. Please contact your general practitioner in the first instance for medical advice.

The five eating disorders outlined above are recognised by the DSM. However, along with disordered eating behaviours there are also disordered exercise behaviours that will be outlined in detail in Module 3.

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2.1.2 Predisposing Risk Factors for Development of an Eating Disorder

Eating disorders are extremely complex and there is no single cause. There are many risk factors that may combine to contribute to the development of an eating disorder. However, studies have shown that teenagers who diet at a moderate level are 5 times more likely to develop an eating disorder.

Risk factor categories for developing an eating disorder:

Personal Characteristics

• Low self esteem
• Perfectionist personality
• Heightened feelings of guilt and shame
• Heightened tendency to self-blame
• Inability to name emotions
• Passive in communication
• Poor resilience
• The ability to control is important
• Emotions are inhibited
• Needs order and certainty
• Has very high standards
• Rigid thinking
• Feels a sense of being ineffective
• Feels dissatisfied with self
• Feels dissatisfied with life
• Believes that self is faulty
• Believes that they are inferior
• Have high concerns about what others think of them
• Difficult interpersonal relationships
• Need to be doing something all the time
• Introverted

Cultural and Societal Issues

• Acceptance of ‘thin ideal’
• Peer group pressure to diet
• Fear of body fat
• Societal Views of Obesity
• Media Influences
• Photoshopped images that distort reality
• Belief that muscularity equates with success/happiness
• Belief that thinness equates with success/happiness/beauty
• Acceptance that a person’s worth is based on appearance rather than who they are
• Gender based role expectations e.g. housekeeper, sex object, provider, hunter and gatherer masculinity.
• People’s worth based on what they look like rather than inner qualities
• Pressure to succeed

Interests

• Dedication to a career, hobby or sport where distorted thinking may develop
• The notion that being thin means that you are physically fit
• Activities where low weight is a prerequisite e.g modelling, horse jockey
• Any sports where there are weight classes e.g. boxing
• Sports that have an aesthetic judging component e.g bodybuilding, gymnastics, dance

Genetic and Family Issues

• Family history of eating disorders
• Family history of any mental illness
• Family dieting
• Adverse comments from family members about eating, appearance or weight
• Childhood obesity
• Parental obesity
• Early menstruation
• Exposure to affective disorders (anxiety, depression etc)
• Exposure to substance abuse
• Exposure to obsessive / compulsive disorder
• Strained relationships within a family

External Factors

• Life events involving a major change e.g loss of a family member, friend, separation/divorce of parents, moving schools or job
• Dieting
• Peer Pressure
• Poor coping skills to deal with stress
• Sexual abuse
• Emotional abuse

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2.2 Eating behaviours

In today’s society we are bombarded with mixed messages about what healthy eating actually is. Just look at all the different fad diets out there. They are all promoting different eating habits and behaviours so no wonder there is so much nutritional confusion. In addition, there is also so many messages about exercise and training.

For any eating regime we need to consider:

• Is it scientifically proven after much research
• Do you have a diagnosed medical reason to follow this diet?
• Is this diet adding to the anxiety you have about certain foods?
• Is the diet based on strict rule keeping to follow it?
• Is following this diet going to isolate you socially?
• Is this diet going to create anxiety if you cannot follow it at any particular time?
• Are whole food groups eliminated? If so, then essential nutrients are eliminated.

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2.2.1 Fad Diets

There are a lot of different fad diets promoted in media and these can be divided into food type diets such as the ketogenic diet, calorie controlled diets such as Isagenix or other diets such as intermittent fasting.

Fad diets, although different, often share some common characteristics such as:

• Overemphasizing the health benefits of certain food groups or specific foods
• Recommends against the inclusion of certain food groups or specific foods without scientific support
• Provides a list of foods that should be included and others that should be eliminated/avoided
• Use anecdotal evidence to support their claims, rather than scientific evidence
• Promote the diet will deliver quick results
• Promote an unhealthy rate of weight loss
• Using emotional descriptors of certain foods or food groups eg. clean eating, superfoods, dirty foods, healthy eating
• Use a celebrity for endorsement
• Overemphasis on the use of supplements, pills or potions, often to replace whole meals
• Requires the following of rigid rules with little to no flexibility
• Strongly suggests that the diet can alter the body’s chemistry such as changing PH balance of the body

https://www.betterhealth.vic.gov.au/health/healthyliving/weight-loss-and-fad-diets

Some fad diets include High Protein Diets, Liquid only diets, grapefruit diet, juice or broth only diets, diets that combine certain foods for claimed ‘greater weight loss’.

 

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2.2.1.1 Using emotional descriptors

As mentioned above, a lot of fad diets use emotional descriptors such as ‘clean’ vs. ‘dirty’, ‘healthy’ vs. ‘unhealthy’, ‘good’ vs. ‘bad’. For someone that is struggling with their selfworth, which is a common characteristic of eating disorders, it implies that if they do not eat
‘clean’, then they are dirty, impure and contaminated. This can accelerate and add heighten already risky eating/exercise regimes.

Our society is so used to labelling foods as ‘gross’ that we associate the people that eat them as ‘gross’. This is a judgment call that adds to the self judgment that is already experienced by someone that is using unhealthy eating and exercise habits to improve their sense of worth. If they eat outside this regime they can feel ‘disgusting’.

ACTIVITY: Fad diets you have tried

In this exercise, we’d like for you to reflect on your previous dieting history and how you felt following these diets. We’d also like for you to reflect on your relationship with certain foods and food groups and how these foods make you feel.

List any fad diets you have followed	List words to describe how you felt following these diets
List foods that you consider ‘healthy’, ‘good’, ‘clean’, ‘allowed’	List words to describe how these foods make you feel

 

 

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2.2.2 Healthy and Unhealthy Eating behaviours

Everyday we engage in eating behaviours, making choices about when, what and how much to eat. However, it is important that we learn how to differentiate between healthy and unhealthy eating behaviours.

2.2.2.1 Healthy eating behaviours

So what does healthy eating actually look like?

1) Cooking

• Cooking without anxiety
• Cooking for self and others

2) Eating out

• Being able to eat out and at social events without anxiety and stress
• Being able to eat what others are eating
• Being able to enjoy the occasion
• Being able to eat food that other people have prepared without anxiety and stress

3) Enjoyment

• Being able to enjoy all foods because it tastes good
• Being able to enjoy and eat food in social situations

4) Balanced thinking

• Not having a lot of rules around food choices, meal times or cooking
• Being able to eat food even if not knowing what’s in the meal or how it’s been cooked
• Being able to identify signals of fullness and hunger
• Being able to cope with various emotional states without attachment to excessive dieting and exercise
• Not overvaluing one food group over another
• Not obsessing over calories

5) Balanced nutrition

• Eating adequate amounts to maintain all physiological, psychological and hormonal functions at an optimal level
• Meeting nutritional requirements for macro- and micronutrients
• Eating a variety of foods across all food groups: fruit, vegetables, dairy/dairy alternatives, meat/meat alternatives, grains and legumes
• Not excluding foods or food groups unless there’s a medical reason for it
• Not skipping meals

6) Behaviours

• Not using compensatory strategies after meals
• Be relaxed about eating
• To eat mindfully
• To be flexible about eating and food choices
• To eat culturally appropriate foods for particular occasions
• To have fluctuating appetite
• Not labelling food as ‘good/bad’, ‘clean/dirty’

7) Body weight

• Allow fluctuations in body weight

http://daa.asn.au/wp-content/uploads/2017/01/Slides.pdf

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2.2.2.2 Unhealthy eating behaviours

1) Cooking

• Feeling the need to prepare foods themselves all the time, without exception
• Feeling the need to prepare foods in specific ways all the time, without exception

2) Eating out

• Unable to eat out and at social events without anxiety and stress
• Unable to eat what others are eating
• Unable to enjoy the occasion
• Unable to eat food that other people have prepared without anxiety and stress

3) No Enjoyment of all foods and eating

• Unable to enjoy all types of foods
• Unable to enjoy and eat food in social situations

4) Unbalanced thinking

• Having a lot of rules around food choices, meal times or cooking
• Unable to eat food if not knowing what’s in the meal or how it’s been cooked
• Unable to identify signals of fullness and hunger
• Unable to cope with various emotional states without attachment to excessive dieting and exercise
• Overvaluing one food group over another
• Obsessing over calories

5) Unbalanced nutrition

• Not eating adequate amounts to maintain all physiological, psychological and hormonal functions at an optimal level
• Not meeting nutritional requirements for macro- and micronutrients
• Not eating a variety of foods across all food groups: fruit, vegetables, dairy/dairy alternatives, meat/meat alternatives, grains and legumes
• Excluding foods or food groups without a medical reason for it
• Skipping meals

6) Unhealthy Behaviours

• Using compensatory strategies after meals
• Unable to feel relaxed about eating
• Not able to eat mindfully
• Not able to be flexible about eating and food choices
• Not able to eat culturally appropriate foods for particular occasions
• Suppressing or ignoring signs of hunger
• Labelling food as “good”/”bad, “clean”/”dirty”

7) Unhealthy Body weight Attitude

• Obsessed about body weight
• Does not allow normal weight fluctuations
• Feel the need to be a certain body weight or size in order to be happy

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The World Health Organisation’s definition of Health is a state of complete physical, mental,
and social well-being and not merely the absence of disease or infirmity. When our eating
behaviours have negative consequences on these components of health, then we have
imbalance. What are often labelled to be healthy behaviours may not be that ‘healthy’.