Eating disorders

The leading eating disorder charity B-eat has estimated that at least one million people in the UK are affected. The numbers involved have increased alarmingly over recent years. It can develop in boys, girls, men and women, regardless of background. As many as one woman in 20 will have some form of eating distress, the overwhelming majority of them aged 14 to 25 years old.

Types of eating disorder

An eating disorder is recognised by an unhealthy relationship to food; this can take a number of different forms.

Anorexia Nervosa

Someone who has anorexia may be torn between not being able to bear putting on weight, and yet not wanting to die of starvation. To them, putting on weight means losing control. What they eat, and if and when they eat it, may feel like the only part of life that they have under control. The act of eating can come to represent everything bad, including the feelings that aren't allowed to come to the surface. Not eating, and losing weight, can therefore become that person's only way of feeling safe.

Bulimia Nervosa

Bulimia means eating large amounts of food, and then trying to undo the effects by starving or by vomiting or, less usually, by using laxatives (both known as purging). In extreme cases someone can make themselves sick as often as 30 to 40 times a day.

Bulimia is more common than anorexia, but because people keep their weight roughly the same, it's not so visible. People are often at great pains to keep the bulimia outwardly hidden. Inwardly, they will be thinking constantly about eating, and having irresistible cravings for particular foods. They dread being fat and believe they should be much thinner than a normal weight.

Compulsive / over eating

Someone who eats compulsively has come to rely on food for emotional support. They may pick at food all day and feel they can't stop themselves. As a result, they are likely to be heavily overweight, and in danger of developing health problems because of it.

Compulsive eating is a way of masking problems, often connected with close relationships. Underneath it people may feel very worthless, lonely and empty, and have a deep sense of loss. Compulsive eaters often deal with problems in life by denying there's anything wrong.

What triggers an eating disorder?

It is likely that a combination of factors, events, feelings or pressures lead to feeling unable to cope and this feeling of being out of control results in a coping strategy that involves food.  These may include:

• ­ Low self-esteem, lack of confidence
• ­ Being self critical or perfectionist
• ­ Problems with friends, for example, being bullied
• ­ Difficult family relationships or upheavals, for example, divorce
• ­ The death of someone special
• ­ Problems at work, college or at university
• ­ Sexual or emotional abuse
• ­ Feeling ‘too fat’ or ‘not good enough’
• ­ Family attitudes towards food
• ­ High academic expectations, competitiveness
• ­ Peer pressure to conform to an ideal weight or body shape
• ­ Traumatic events
• ­ Long term illness or disability

Often people with eating disorders say that their eating behaviour patterns are the only way they feel they can stay in control of their life, but as time goes on it isn’t really them who is in control – it’s the eating disorder.

Eating disorders and ministry

Because of the high prevalence of eating disorders in the UK, clergy are highly likely to meet people affected by eating disorders either within their own families or in their congregations or work settings. The triggers mentioned above are ones that can be found inside any vicarage. Often there are high expectations and pressures on both adults and children in this environment. Clergy may also find themselves with an unhealthy relationship to food as a means of coping with ministry pressures and/or depression. 

Secrecy and shame around eating habits is a common feature of all eating disorders so symptoms amongst clergy and parishioners may not be obvious or may be disguised with excuses that seem plausible. It may also be difficult to be open about an eating disorder within the church / work community which adds to the sense of isolation and lack of support.

Overcoming an eating disorder

Those with an eating disorder need the help and support of friends, family and professionals in order to understand the reasons for their eating disorder and to begin to change their behaviour. Receiving help sooner rather than later from experienced professionals in the field of treating eating distress may be crucial in resourcing a sufferer so they can be free from their problematic relationship with food.

The first step is usually to contact the GP who will need to check that symptoms, such as weight loss, are not due to an underlying illness. GPs may not have the necessary time or skills to help, but should be able to offer advice and referrals. There are professionals, clinics and organisations specialising in helping people with eating distress.  The problem needs tackling on both the physical front, through changing the eating pattern, and the emotional front, in terms of the feelings behind it.

Talking to a counsellor or psychotherapist can help people to face and release painful feelings, in a way that's constructive rather than destructive. These professionals are trained to listen and to help people find their own solutions to problems.

If the situation is serious, it may be necessary to go into hospital or to a clinic. Treatment usually involves a combination of re-feeding and talking treatments. At its best, this will be tailored to the individual and to their circumstances.  Good treatment will reduce the chances of relapse, although someone with severe eating distress may relapse more than once. Before treatment can be really effective, the person has to want to get better. It may take them time.

Two other means of getting support include self-help groups and alternative therapies:

• Self-help groups - If you experience eating distress you may feel extremely ashamed. You may feel no-one really understands what you're going through. You may also be very used to hiding your behaviour and this can be very isolating. There are great benefits from talking to others with the same problem.
• Alternative therapies - Alternative therapies can help people who find it hard to express themselves in words to do so through dance, movement, art or music. People with eating distress often have a difficult relationship with their bodies. Dance and movement therapies can help someone feel more connected to and happier with their body. Other therapies, such as massage, reflexology and aromatherapy, may also be very beneficial.

Supporting someone with an eating disorder

If you are supporting someone with an eating disorder, the advice below may assist you:

• ­Don’t look for simple explanations or make assumptions, for example, that they have been abused or are avoiding adulthood. If you interpret or misunderstand someone's eating distress in a particular way without really listening to the person themselves, it could add to their feeling of being out of control. It could make them even less able to share their emotions.
• Don’t persuade your friend or relative to change their eating behaviour, either to put on weight or to lose it. This may make things worse. You may find it very hard to accept that what your friend or relative does is their own decision and that you can't  magically make them better.
• Try to understand that for your friend or relative their eating distress is a solution and not a problem. It's a way of expressing terribly painful feelings which may include anger, rage, guilt and loss. They may not want to recognise that they have an eating problem. They may be secretive and even obstructive. This is one of the obstacles to treatment that needs to be overcome.
• Without trying to persuade the person to change, you may want to talk about how their eating behaviour makes you feel. It's important to be honest and to get support for yourself.
• Help them by giving them the opportunity to talk about their feelings. If they don't want to, make it clear that you still care for them and will be there if they want to talk to you another time. You could also encourage them to seek professional help. If they are worried about doing this you could offer to go along with them.