Disordered relationships with food take many forms: whether eating too much or too little, food becomes a powerful preoccupation. Although much of the attention around disordered eating focuses on body standards, for many people disordered eating offers a means of control—albeit a very dangerous one.
Anorexia nervosa is characterised by a strict sense of control over what a person eats, and often comes with a strong desire to exercise or ‘burn off’ the energy from a person’s diet. Many people with anorexia relate their restrictions to weight loss or body image.
People with chronic bingeing eat beyond the point of discomfort, often to cope with uncomfortable thoughts or feelings.
Bulimia is a form of restricted eating in which a person purges what they eat by being sick or taking laxatives. Purges do not have to follow any particular rhythm or pattern. Like anorexia, people with bulimia often relate their restrictive behaviour to how much they weigh or how they appear.
When a person applies very strict rules to what they eat, often to follow a supposedly ‘pure’, ‘healthy’ or ‘clean’ diet, they might get what is a relatively new ED diagnosis of orthorexia. Like with other eating disorders, people might find that orthorexia forces them to obsess about their restrictions, makes them physically ill, and affects their relationships with loved ones.
People who have an ARFID diagnosis obsessively restrict what they eat out of fear or anxiety – not about weight or body image but to avoid choking, being sick or getting stomach pain. They might also restrict their diet because they don’t recognise hunger well, or feel extremely sensitive to the taste, texture or smell of food.
When a person uses various types of disordered eating to cope with how they feel, a doctor might use an OSFED diagnosis to help them get treatment that recognises this. OSFED may previously have been diagnosed as Eating Disorder Not Otherwise Specified (EDNOS).
If you are worried that your relationship with food is not normal, or seems to change depending on your mood or stress levels, it might be worth seeking help from a GP or therapist.
It can be difficult to get specialist treatment for eating disorders on the NHS, so some people choose to look for a private therapist to speed up treatment.
If thoughts of eating and restriction are taking over your life, you should seek support to find out how to manage anxiety around eating.
People who are accused of being ‘picky’ might not have an eating disorder, but having a difficult relationship with food – particularly one that gets worse when anxiety is higher – is stressful. It might be worth discussing why food is such a thorny topic with a therapist.
If you notice ED symptoms in your child, or secrecy around eating or restricting, talk to them about it. You might want to seek outside help, such as a specialist therapist or GP.
Many people find that once their relationship with food has been damaged by stress or anxiety, even when they feel ‘normal’ again they take special care of what they eat, and tightly manage their behaviours around food. There is no “cure” for eating disorders, but with treatment, care and support people with ED can recover.
The charity Beat estimates that about 1.25m people in the UK have an eating disorder.
Eating disorders can come out of the blue, or after a stressful experience. They can come at any time in life but during adolescence is common. Eating disorders tend to be a symptom of or method for dealing with anxiety, depression or stress.
People with existing mental health problems such as depression, anxiety, bipolar and BDD are at greater risk of developing an ED, as are people with low self-esteem.
Unlike other EDs, ARFID is more common in people with developmental disorders or neurodivergence such as autism or ADHD, because these people might find eating more difficult.
Talking therapy really helps patients with disordered eating, if they want to get better. Behavioural therapies such as CBT and its variants (e.g. Acceptance and Commitment Therapy) can help people question parts of their relationship with food, self-image and anxiety.
Antidepressants can tackle underlying mental health concerns and support someone who is struggling with disordered eating.
For eating disorders crises, for example if someone’s health is at risk from their restrictive eating, there are in-patient facilities that can help people get back to a weight that can support normal functioning.
The UK’s leading charity for people with eating disorders and their families.