Understanding Eating Disorders: Why Early Support Matters
If you or someone you now is struggling with food, weight or body image, it can be hard to know when to seek help, or whether what you are experiencing is serious enough to warrant it.
Eating disorders are often misunderstood and that misunderstanding can make it harder for people to recognise when they need support. They are serious mental health conditions that can affect the way a person thinks, feels and behaves around food, weight, body image and self-worth.
They can also have significant effects on physical health, including the heart, bones, hormones, digestive system, fertility, dental health and overall medical stability. In severe cases, they can be life threatening.
Eating disorders also have some of the highest mortality rates of all psychiatric disorders. Despite this, up to 75% of people with eating disorders may not try to access treatment, meaning many people only present for support once the illness is already well established.
At Eastern Suburbs Psychiatry in Darlinghurst, Sydney, we see many adults navigating these challenges. Dr Stephen Freiberg, Consultant Psychiatrist and Psychotherapist notes that eating disorder recovery is not only about changing eating behaviour, it also involves understanding the emotional distress, sense of self and relationship with the body that may be contributing to the illness.
What are the main types of eating disorders?
Eating disorders can present in different ways. The most recognised forms include Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder.
- Anorexia Nervosa is commonly associated with significant food restriction, intense desire to be thin and a distorted relationship with body image. Some people may also exercise excessively or use other behaviour to control weight.
- Bulimia Nervosa involves episodes of binge eating followed by behaviour that attempt to ‘undo’ the eating, such as self-induced vomiting, fasting, laxative use or excessive exercise. It involves an intense desire not to gain weight.
- Binge Eating Disorder involves eating a large amount of food in a short period of time while feeling a loss of control. Unlike Bulimia Nervosa, it does not usually involve regular purging behaviour.
Symptoms can change over time. Many people move between patterns of restriction, bingeing or compensatory behaviour throughout the course of the illness.
Signs and impact
Common signs of an eating disorder
Eating disorders are not always easy to recognise. Some people may appear to be coping, while privately experiencing significant distress around food, weight or body image.
Signs that someone may need support can include:
- Increasing preoccupation with food, weight, shape or exercise
- Avoiding meals or eating in secret
- Rigid food rules or feeling out of control around food
- Vomiting, laxative use, fasting or excessive exercise
- Withdrawals from family, friends or usual activities
- Mood changes, shame guilt or distress after eating
- Physical signs such as fatigue, dizziness, digestive symptoms or changes in weight
How eating disorders affect the mind and body
Eating disorders involve three connected areas: emotional, behavioural and physical.
- Emotional distress may include fear of weight gain, body dissatisfaction, low self-worth, perfectionism, shame, anxiety or obsessive thoughts about food and body image.
- Eating-related behaviour may include restriction, binge eating, purging, excessive exercise, hiding food, avoiding meals or following rigid food rules.
- Physical health effects can involve the heart, bones, hormones, digestion, dental health, fertility and overall medical stability.
As the underlying emotional distress is often central, treatment needs to address more than eating behaviour alone.
Eating disorders and other mental health conditions.
Many people with eating disorders also experience co-occurring conditions such as depression, anxiety, trauma-related symptoms, substance use concerns or suicidal thoughts. A comprehensive psychiatric assessment is therefore important to understand the full picture.
Why early support is important
Why people delay seeking help
Many people with eating disorders delay seeking help due to shame, fear, secrecy, denial, or feeling they are “not sick enough”. However, eating disorders can become more complex over time.
What early support can do
Early assessments and treatment can help reduce risk, support medical stability and significantly improve the chance of recovery. Early support is important because eating disorders can become more difficult to treat over time. Some studies suggest that across eating disorders, less than 50% of people experience complete remission, while 30% experience residual symptoms and 20% develop chronic illness.
What does treatment involve?
Treatment works best with a coordinated team approach. Depending on individual needs, this may include a GP, psychiatrist, dietitian and other specialists to address any additional physical complications.
Treatment may involve:
- Medical assessment and stabilisation
- Psychotherapy with the treating psychiatrist
- Support for nutrition with a dietician
- Management of any co-occurring mental health conditions
- Family or relationship support, where appropriate
- Ongoing monitoring of physical and psychiatric risk
The goal is to improve eating patterns, support emotional wellbeing, reduce medical risks and address the underlying factors that maintain the disorder.
Recovery is possible
Recovery from an eating disorder can take time. Some people recover fully, while others may experience ongoing symptoms or periods of relapse, particularly during times of stress.
With early support, careful assessment and a coordinated treatment approach, recovery is possible. If you or someone you know is struggling with food, weight, body image or eating behaviour, it may be helpful to speak with a GP for a referral to a psychiatrist as a helpful first step.
Eastern Suburbs Psychiatry offers specialist assessment and treatment for adults experiencing eating disorders and related psychiatric concerns in Darlinghurst, Sydney.
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