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As parents, we're responsible for feeding and nurturing our children and it can be hard to understand why they might ever use food to harm themselves. Food is often the focus of family celebrations, and regular shared meal times are a well-known way to keep the family connected - so when a child has an eating disorder, it can be difficult for the whole family.
"Food can become the new four letter word when your family is affected by an eating disorder," says Mary George of beat (the Eating Disorders Association). "To your child, food is the enemy." Contrary to popular belief, eating disorders like anorexia and bulimia have nothing to do with wanting to be thinner or a size zero, says beat.
"An eating disorder is a serious mental illness - not a fad or a diet gone wrong," says the charity's Mary George. "With all eating disorders, food is used in some way to control or block out difficult thoughts and feelings." There is rarely one specific cause or trigger. Each case is unique and could be the result of a number of different pressures such as bullying and teasing, abuse, pressure to succeed academically, body image issues, friendship worries, and relationship difficulties..
Research suggests that more than one million people in the UK are affected by an eating disorder, but only a small percentage will have been diagnosed to receive appropriate treatment. Eating disorders are most likely to affect girls aged between 14 and 25 (however, there are cases of girls as young as eight developing anorexia). Around one tenth are estimated to be male.
We've called on the expert knowledge of beat, to give you details of different types of eating disorders, and the signs and symptoms to look out for if you’re concerned. And we have a step by step guide to finding the help you need to set your child on the road to recovery.
This word literally means 'loss of appetite for nervous reasons', but experts agree that the condition has more to do with denying hunger than losing appetite. People with anorexia usually restrict what they eat or drink - either by skipping meals and/or drastically reducing food types and portions.
As the disorder progresses they become seriously underweight and are likely to suffer from malnutrition. Subsequent chemical changes that occur in the body affect the brain and distort thinking, making it almost impossible to think rationally about food.
Studies show that anorexia has a higher death rate than any other mental health illness - either through suicide or the effects of prolonged starvation (in particular, heart failure). However, experts stress that once treatment has started the risk of premature death reduces significantly.
Severe weight loss; circulatory problems and feeling cold, tiredness but difficulty sleeping; dizziness; stomach pains; constipation; growth of soft, downy body hair; periods stopping or not starting; poor skin; hair loss.
Excessive exercising, ritual or obsessive behaviours about food; lying about eating ('I've already had lunch'), cooking or preparing food for everyone else - but not consuming any themselves; wearing baggy clothes; mood swings; perfectionist standards; distorted body image (i.e. a conviction that they are fat when, in fact, they are severely underweight); irritability and mood swings; shutting themselves off from the world; difficulty concentrating.
People with anorexia may try to hide their lack of eating by cutting food up and pushing it around the plate. They may hide food in pockets, drop it under the table for pets, or slide it onto siblings' plates.
"There is usually an intense interest in what others are eating but an absolute denial that there is a problem," says Mary. "The longer the eating disorder persists, the smarter the sufferer gets at pretending to eat. If eating is unavoidable, compensatory action such as purging or exercising will be taken as soon as possible to prevent weight gain."
Bulimia is a more common illness but, as the associated weight change is less noticeable, it tends to remain more hidden. Bulimia involves in a cycle of bingeing and purging - eating large amounts of food and then inducing vomiting or taking laxatives or diuretics. After an episode, which usually takes place in secret, people with bulimia may limit food intake, triggering extreme hunger before the cycle repeats.
Both Bulimia and Binge Eating Disorder (see below) have a significantly lower death risk than anorexia. "However, sufferers still need help and support as both the side effects and consequences can be very serious," explains Mary George.
Prolonged purging can lead to dehydration, while internal organs may become damaged by dangerously low levels of essential minerals. Bulimia can also cause malnourishment, damage to the oesophagus, rupture of the stomach, choking, erosion of tooth enamel and Polycystic Ovary Syndrome, a condition which affects fertility.
Sore throat, bad breath, tooth decay and mouth infections; stomach pains; irregular periods; dry or poor skin; difficulty sleeping; constipation; puffy cheeks or face due to swollen salivary glands; dehydration, fainting; kidney and bowel problems.
Secret bingeing; buying and hiding large quantities of food; disappearing to the toilet straight after meals; frequent vomiting or use of laxatives; periods of fasting; excessive exercising.
BED involves eating large amounts of food in a short period of time as a way of coping with difficult feelings and emotions. Unlike bulimia, there is no 'purging' phase so, if the disorder continues, it can lead to weight gain and obesity. Obesity carries further health problems like high blood pressure and heart disease. Bingeing episodes are often followed by feelings of shame, depression and guilt.
Gaining weight; eating much more rapidly than usual; eating until uncomfortably full or eating large amounts of food when not hungry; stomach pains, irregular periods, poor or spotty skin; difficulty sleeping, constipation, secrecy and lying about food; feelings of depression.
Mood swings; obsession with weight; avoidance of social events; eating very little in front of others.
Compulsive overeating and its effects are similar to BED but overeating is constant rather than in binges.
Eating far more than the body needs at mealtimes; eating when not hungry.
This can involve having some, but not all, of the symptoms of anorexia, bulimia or BED. Symptoms may overlap between two or more different disorders. These are the most common types of eating disorders and are taken seriously by health professionals. In these cases, people are usually treated for the disorder that most resembles their symptoms.
This describes a disorder when the sufferer spits out food rather than swallowing, or eats items like paper tissues to fill up without consuming calories. These behaviours are more common than many people believe and sometimes exist alongside other symptoms, say beat experts.
For expert advice on what to do if someone in your family has an eating disorder, see our page Eating disorders - getting help.