Eating disorders

Most eating disorders develop in adolescence, and can affect anyone regardless of age, gender, ethnicity or cultural background.

Disordered eating can present in different ways:

severely limiting the amount of food eaten
eating very large quantities of food at once
getting rid of food eaten by making yourself sick and/or by misusing laxatives
fasting
undertaking excessive exercise
or a combination of these behaviours.

For many young people, body weight and shape are significant factors affecting their sense of self-worth. The possible peer pressure around body shape, dieting and weight loss, potentially nurtured by the media and social media, may contribute to the increasing prevalence of eating disorders.

Disordered eating may make young people feel that, at least temporarily, they are more in control, and can cope with difficult situations and feelings. People with eating disorders think about food and calories all the time, and they develop strict rules as to what, when and where they will eat.

Types of eating disorder

There are three main types of eating disorder:

Anorexia nervosa (known as anorexia)
Bulimia nervosa (known as bulimia)
Binge eating disorder

Anorexia is the most common form of adolescent eating disorder. It is a serious illness – it has the highest mortality rate of any psychiatric illness. Young women are particularly susceptible, with U.K. estimates showing 37 new diagnoses of anorexia nervosa per 100,000 girls aged 10–19 years, compared with 3 per 100,000 of boys of the same age.

Bulimia is more likely to start in late adolescence. Young people with bulimia are caught in a cycle of eating large quantities of food (bingeing) and then trying to get rid of it (purging) by vomiting, taking laxatives or diuretics, fasting, or exercising excessively to compensate for the overeating. Bingeing and vomiting often becomes a way of coping with difficult emotions, for example when feeling stressed, upset or angry.

Binge eating disorder is also a serious mental illness, though less common in young people than the other two forms of eating disorder. Large quantities of food are eaten over a short period of time but, unlike people with bulimia, this is not followed by getting rid of the food.

How do eating disorders affect mental health?

Anorexia is a severe mental illness, with psychological symptoms being evident often before physical signs become obvious. There is an excessive focus on body weight, with distorted perceptions of body shape and weight, and a denial of the severity of the problem.

There is usually significant anxiety, particularly about eating in front of other people. Other forms of mental illnesses, such as depression or obsessive-compulsive disorder, may also be present.

With bulimia, the associated binge/purge cycles can dominate daily life and lead to difficulties in relationships and social situations. Sufferers are often a ‘normal’ weight and hide their illness from others, and it can be very difficult to spot from the outside.

Young people with anorexia or bulimia often feel a strong sense of shame and will hide their symptoms and struggle with the illness in secret.

Identifying the signs

Early signs of an emerging eating disorder may be that a young person:

often skips meals, or says they have eaten earlier or eaten later when asked
avoids eating around other people
eats very slowly
regularly goes to the bathroom soon after eating
becomes socially withdrawn and isolated
won’t participate in P.E. or other physical activities

There may also be some physical signs that school staff may notice, including:

thinning hair
dry skin
wearing baggy clothing
often complaining of being cold

A young person with an eating disorder may also have a persistent low mood, irritability and unpredictable mood swings.

What schools and further education settings can do

Eating disorders are serious mental illnesses. If identified early, schools can help young people get the help they need.

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Concerned about a child or young person?

If you are worried that a child or young person is at risk involve your designated safeguarding lead as a matter of priority, who will contact the parents/carers and other services as necessary. If the child or young person is at immediate risk, ensure that they are taken to their GP or A&E as a matter of urgency, depending on the severity of the concern.

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