Types of eating disorders and symptoms

1. Anorexia nervosa (severe restriction of food intake)

Anorexia nervosa is an eating disorder characterised by an intense fear of becoming fat. People with anorexia severely restrict food and fluids mainly because of a distorted body image and low self-esteem. They normally weigh less than what is developmentally expected for their age and height. There is an intense preoccupation with food and body size.

Most individuals suffering from this eating disorder do not realise how underweight and undernourished they are in spite of comments from other people. They see themselves as overweight, and they constantly deny that they have a ​problem or that they are too thin. 

Even after reducing to dangerously low weights, these individuals will still convince themselves that they need to lose more weight, as they have not gotten rid of the perception of being fat.

They develop unusual eating habits such as avoiding food and meals, picking out a few foods and eating them in small quantities, or carefully weighing and portioning food. Anorexics repeatedly check their body weight. 

Many engage in other techniques to control their weight such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas and diuretics.

Symptoms to look out for:

• Intense fear of gaining weight

• Distorted body image 

• Eating restrictively or starving self intentionally

• May use additional techniques to control weight (i.e. excessive exercise or abuse of laxatives, enemas, or diuretics)

• Tend to engage in behaviours that seem abnormal or compulsive to others (e.g. weighing self every day, calorie counting, avoiding meals or multiple types of food, checking the mirror frequently, weighing and portioning foods carefully, etc.)

• Tend to have significantly low body weight in relation to height or developmental stage

2. Bulimia nervosa (cycle of bingeing and purging)

Bulimia is a cycle of uncontrolled binge eating followed by purging through self-induced vomiting or misuse of laxatives or other medication; fasting; or excessive exercise. Individuals with bulimia usually weigh within the normal range for their age and height since the purging or other compensatory behaviour follows the binge-eating episodes.

Like individuals with anorexia, they fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviours in secrecy, feeling disgusted and ashamed when they binge, yet relieved once purged.

Symptoms to look out for:

• Intense fear of gaining weight

• Distorted body image

• Engage in repeated episodes of binge-eating (i.e. eating large amounts of food in limited time until uncomfortably full) and compensating via purging (i.e. vomiting), excessive exercising, or abusing laxatives, enemas, or diuretics 

• Tend to be within normal weight range in relation to height or developmental stage

3. Binge eating disorder (frequent episodes of out-of-control eating)

Binge eating disorder, commonly known as compulsive overeating, is charterised by frequent episodes of out-of-control eating. Therefore, many with the disorder are overweight for their age and height. 

Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.

Symptoms to look out for:

• Tend to experience out-of-control eating but not engage in compensatory behaviours 

• Tend to be overweight as a result of eating habits 

• May develop metabolic complications such as diabetes, hyperlipidaemia, obesity, and hypertension over time

A person with an eating disorder may resist or delay treatment for his or her condition as dieting, bingeing, and purging can bring about different perceived benefits, such as a greater sense of control, feelings of comfort and relief from emotional distress, and increased self-esteem.

However, in avoiding treatment, individuals with eating disorders expose themselves to serious risks that can damage their physical and emotional health, self- esteem, and sense of competence and control.

When to seek professional help

"While dieting and paying additional attention to body image can be a phase for many individuals, it can become a serious problem if it gets out of control. Identifying signs of an eating disorder early on and resolving them quickly is crucial for recovery," explained the team from the Eating Disorders Programme at SGH. 

Warning signs of an eating disorder include: 

• Frequent weighing, 

• Denial of hunger, 

• Avoidance of eating in public or situations where there is food, 

• Frequent trips to the bathroom (especially right after meals), 

• Mood shifts, 

• Fear of becoming fat, 

• An excessive or rigid exercise regime, and 

• Binge or secretive eating