August 4, 2014

Eating Disorders

Eatingdisorder-counselling-vancouverEating Disorders are a complex and challenging group of issues based on food related behaviours. Little is known of the exact cause of each, and it is theorized that they arise from an array of factors including individual temperament, individual metabolism and physiological make-up, family dynamics, tendency toward anxiety, tendency toward obsessive-compulsiveness.

Eating Disorders can occur in both boys and girls, but occur more frequently in girls. It typically begins in adolescence, and can occur in children in the “tween” years and earlier. It usually takes years for an eating disorder to manifest fully, and it can take years to treat successfully.

Formally diagnosed eating disorders include Anorexia Nervosa (restriction of caloric intake), Bulemia Nervosa (bingeing and purging food),  Anorexia Athletica (excessive exercise), Binge Eating Disorder, and Eating Disorder Not Otherwise Specified (mix of symptoms of the previous disorders). All of them are defined by abnormal eating habits that may involve insufficient or excessive food intake to the detriment of an individual’s physical health.


Often a child’s disordered relationship with food starts with a combination of low self-esteem and anxiety, paired with some kind of family tension. The child reacts to what feels like a chaotic life by choosing to control the most fundamental relationship in their lives – their relationship with food. Food is something we are intimate and personal with on a daily basis. We know what we like, what food tastes and textures appeal to us and which don’t. We also know how certain foods make us feel in our bodies. All of this intimate experience can become skewed when it becomes the over-focus of a child’s life. Bodily sensations are intensified as are textures and tastes. Thoughts and feelings about food take on huge proportions and become altered from normal. Children learn behaviours around how to interact with food the way they feel they need to, while appearing to eat normally. They learn to sneak, hide and go underground with their behaviours. They learn to view their bodies in a distorted fashion, dwelling on the tiniest aspects and seeing only their perceived imperfections. The internet becomes a source of reinforcement for their altered life. Already tense families are challenged beyond their resources as their watch their child descend into worse and worse health. Youngsters with disordered eating are often blamed for their own problems and for the problems of their family.

The trap of controlling food as a coping mechanism is it has no end. Eating disordered people often tell themselves, “I’ll stop when I reach that weight” or “I only want to get to that goal then I’ll be happy”. Then the goal is reached but they are still miserable and they still feel ugly. They can’t stop. Most often they want to stop the disordered behaviour. They ache for someone to be able to help them stop the madness they’ve started. But the disorder becomes the controlling voice in their head. The voice that tells them “you’re not good enough”, “you’re ugly”, “you’re disgusting” spurs them on to new distorted goals. They are at the mercy of something bigger than them… again. Self-esteem plummets even lower, stress increases, and the behaviours get more intense. Until something “gives”, usually their own bodies.

Signs and Symptoms

These are the signs of eating disordered children:

Anorexia signs and symptoms may include:
• Refusal to eat and denial of hunger
• An intense fear of gaining weight
• A negative or distorted self-image
• Excessive exercise
• Flat mood or lack of emotion
• Irritability
• Fear of eating in public
• Preoccupation with food
• Social withdrawal
• Thin appearance
• Trouble sleeping
• Soft, downy hair present on the body (lanugo)
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Constipation
• Abdominal pain
• Dry skin
• Frequently being cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration

Bulimia signs and symptoms may include:
• Eating until the point of discomfort or pain, often with high-fat or sweet foods
• Self-induced vomiting
• Laxative use
• Excessive exercise
• An unhealthy focus on body shape and weight
• A distorted, excessively negative body image
• Low self-esteem
• Going to the bathroom after eating or during meals
• A feeling that you can’t control your eating behaviour
• Abnormal bowel functioning
• Damaged teeth and gums
• Swollen salivary glands in the cheeks
• Sores in the throat and mouth
• Dehydration
• Irregular heartbeat
• Sores, scars or calluses on the knuckles or hands
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Constant dieting or fasting
• Possibly, drug or alcohol abuse

Symptoms of binge-eating disorder may include:
• Eating to the point of discomfort or pain
• Eating much more food during a binge episode than during a normal meal or snack
• Eating faster during binge episodes
• Feeling that your eating behaviour is out of control
• Frequently eating alone
• Feeling depressed, disgusted or upset over the amount eaten

When to see a doctor

Because of its intensity, an eating disorder can be difficult to manage or overcome alone. Eating disorders can virtually take over your life. You may think about food all the time, spend hours agonizing over what to eat and exercise to exhaustion. You may feel ashamed, sad, hopeless, drained, irritable and anxious. You may also have a host of physical problems because of your eating disorder, such as irregular heartbeats, fatigue, and bowel or menstrual troubles. If you’re experiencing any of these problems, or if you think you may have an eating disorder, seek medical help.


The treatment for eating disorders always includes a psychotherapeutic component as well as behavioural and medical components. Often the young person will be brought to counselling after being taken to their physician or hospital for medical problems cause by their disordered eating. They may then be given a diagnosis and they and their families are referred for help.

Besides learning to approach food positively again, the young person will need to address the stresses and anxieties that brought on the need to control food in the first place. For best results, their families become involved in therapy, in order to change negative patterns, or cultures of anxiety or disordered thinking that inadvertently reinforce their child’s issue.

This work must be done sensitively, carefully and slowly. Because  the young person’s life has changed negatively in such a pervasive way, their thoughts, feelings, behaviours, relationships with others and with themselves and their own bodies, it takes time for everything to recalibrate to something healthful again. Therapy can provide a safe, neutral place away from the “craziness” of their lives, where the young person can start to get in touch with the part of them that wants to live and be healthy.

The therapist will need to use several different approaches to be effective: CBT for dealing with problematic thoughts and behaviours, relaxation to provide self-calming strategies, trauma work if the disorder arose from a previously experienced trauma, family counselling to provide strategies and to create appropriate supports for family members. Together with nutritional support and medical support, it is possible for young people struggling with eating disorder to heal and regain their lives.

For more information:

Stillwater Studio Counselling: 604-734-2779