Eating disorders in adults

Eating disorders are health conditions that affect your mental health due to problems in how you think about food, the shape of your body and your weight.

Controlling what you eat and controlling your weight are elements of most eating disorders and can be a way to deal with negative emotions.

If you have an eating disorder requiring treatment, your physical and mental health will be affected. Your level of functioning will be impaired compared to what it used to be, and the condition is likely to lead to work/school issues and affect your social life.

Types of eating disorders

There are a number of different eating disorders. At the Psychiatric Clinic for Eating Disorders, we offer to treat moderate to severe degrees of:

• Anorexia
• Bulimia
• Binge-eating Disorder (BED).

You can read more about the symptoms of the various eating disorders under ‘Symptoms’.

There is no single reason why some people develop an eating disorder. Below you can read about different risk factors.

Vulnerability

You may be vulnerable to developing an eating disorder. Risk factors can be biological, social or psychological and may include:

• Experiences of personal trauma, such as divorce, bullying, death, abuse or assault.
• Suffering from low self-esteem and finding it difficult to enter into trusting and close relationships.
• Not finding it easy to express your emotional state.

Triggering factors

Triggering factors are events in your life that cause your eating disorder to manifest and develop and may include:

• Weight loss.
• Stress and strains.
• Breakups or loss of important relationships (family, friends, boyfriend/girlfriend etc.).
• Pregnancy.
• Other diseases.
• Traumatic events.

Maintaining factors

Once you have developed an eating disorder, there are several factors that can make it difficult for you to let go of it. Possible factors include:

• Positive response from other people

If you are trying to lose weight and you get a lot of positive comments from people around you.

• Rituals and rules

You may have very ingrained rituals around food, and having to change your eating habits can feel unsettling. Examples of such rules can be: “I need to eat less today than I did yesterday!”, “I must not eat more than a certain number of calories”, or “I must walk x number of steps today”. Such rules can make you stay underweight. Or they can make you overeat.

• Changes in self-perception

If you suffer from anorexia or bulimia, you are likely to feel and see yourself as fat. You are therefore likely to want to lose weight. If you suffer from BED, overeating will usually lead to you becoming overweight. You will therefore have a great desire to lose weight.

• Resistance to treatment

You may be reluctant to accept the fact that you are ill and in need of treatment. You may find it difficult to give up the control of food.

• Bodily changes

If you eat very little, your stomach may shrink, causing you to very quickly feel full and therefore eat less. Conversely, prolonged overeating will expand your stomach, and you will therefore need to eat more to not feel hungry.

Societal and cultural factors

In our culture, there is a strong focus on the body, on the ‘ideal’ look and on how you appear to others. The social media are full of exercise and fitness programmes and rules about what to eat if you want the perfect body and the perfect life. It leaves us with an unbalanced focus and a simplistic idea of what constitutes a good life, and it can help trigger behaviours associated with eating disorders.

Depending on your current life situation, background, your physical and psychological makeup and networks, you may be at greater or lesser risk of developing an eating disorder.

Girls and young women aged 12 to 24 are at particular risk of developing eating disorders Boys/men and older women can also develop eating disorders, but it is less common.

Symptoms of anorexia

• Your eating behaviour is disturbed. Your body weight is low.
• Your BMI (Body Mass Index) is below 17.5.
• You have lost a lot of weight and reduced your body weight by many kilogrammes.
• You have gained no weight during pregnancy.
• You have lost weight during pregnancy – to the extent that you are underweight.
• You exercise excessively and find it difficult not to.
• You use weight loss products, laxatives or other medications to regulate your weight.
• You vomit.
• You feel that you are too fat.
• You are very preoccupied with your weight and/or body shape.
• You suffer from hormonal disturbances. Hormonal disturbances may mean that you lose the desire and the ability to have sex, or that your menstrual periods stop (if you are a woman).

Symptoms of bulimia

• Recurring episodes of overeating. Overeating is when:
  • You eat large amounts of food within a short time. Bigger portions than what others would ‘normally’ eat.
  • You have a feeling of being unable to control your eating. You cannot stop eating, or you cannot prevent yourself from eating.
• You are very preoccupied with your weight and/or body shape.
• You try to avoid putting on weight by:
  • Restricting how much you eat.
  • Fasting.
  • Vomiting.
  • Exercising a lot.
  • Taking weight loss products, laxatives or the like.

If you are developing bulimia, you will often feel great shame. Even though you want to get better, telling others about your symptoms might feel so embarrassing that it is easier not to seek help.

Symptoms of Binge-eating Disorder (BED)

• Recurring episodes of overeating. Overeating is when:
  • You eat large amounts of food within a short time. Bigger portions than what others would ‘normally’ eat.
  • You have a feeling of losing control of what you eat.
  • You cannot stop eating, or you cannot prevent yourself from eating.
• You have negative thoughts.
• You feel ashamed of yourself after a binge.

Physical consequences of being underweight

The physical consequences of being underweight may include:

• Absence of menstruation in women.
• Low body temperature, slow pulse and constipation. General weakening of muscles
• Fluid accumulations and swellings
• Hair loss and lacklustre skin.
• Increased body and facial hair growth.
• Hormonal disorders that may lead to a lack of desire and ability to have sex.

Being very underweight for a long time can cause permanent damage to your health in the form of osteoporosis, heart problems, cerebral atrophy and an increased risk of dying. Most of these physical consequences will subside or disappear altogether if you start gaining weight.

Physical effects of compensatory behaviours

Compensatory behaviours are actions performed to lose weight. Such behaviours include provoked vomiting or excessive exercising. They may lead to:

• Dental damage and ulcers in the corners of the mouth due to corrosions from gastric juices as a result of vomiting.
• Substantial weight fluctuations of 5 to 20 kg within short periods of time.
• Poor intestinal function with sluggish and bloated stomach as a result of long-term use of laxatives or slimming agents.
• Damage to muscles, bones (stress fractures), joints and tendons.
• Burns in the oesophagus.
• Enlarged salivary glands.
• Disturbed salt balance, leading to muscle cramps, cardiac arrhythmia and heart failure.

If the behaviour stops, many of these problems may be diminished or completely disappear again.

If you or members of your family think you are showing signs of an eating disorder, you need to consult your doctor. Your doctor will assess whether your symptoms may be signs of an eating disorder and whether your symptoms are mild or more severe. If your symptoms indicate a moderate to severe eating disorder, your doctor should refer you to the psychiatric services for an assessment of whether you would be eligible for psychiatric treatment.

Signs of bulimia

If you have symptoms of bulimia, you will initially be offered help by your own doctor, a private psychologist, a dietician or your municipality. Only then can you be referred for psychiatric treatment.

An appointment will be sent to you via Digital Post, inviting you to a consultation with a therapist from the psychiatric services.

The purpose of the consultation is to find out whether you suffer from an eating disorder that makes you eligible for psychiatric treatment. You should know that as part of the consultation, you will be weighed.

If you are found to be suffering from an eating disorder that needs to be treated by the psychiatric services, you will be given an appointment for a preliminary examination. During the preliminary examination, you will talk to a doctor and a psychologist.

The preliminary examination takes place at the Psychiatric Clinic for Eating Disorders in Gødstrup (Herning) or Skejby (Aarhus).

• Psychiatric Clinic for Eating Disorders

During the preliminary examination by the psychologist, you will be asked about:

• Onset and development of the eating disorder.
• Restrictions and rules in relation to your diet and eating habits. Overeating.
• Psychological symptoms in the form of:
  • Weight anxiety.
  • Feeling obese.
  • Difficulties concentrating due to thinking about food and eating.

As part of the preliminary examination, a doctor will perform a physical examination. Blood samples will be taken, and you must have an electrocardiogram (ECG). The electrocardiogram shows whether your organs are affected by the eating disorder.

The results of both preliminary examinations will show what eating disorder you suffer from, and what treatment you may be offered.

After the preliminary examinations, you will be given an appointment to discuss the test results. Your diagnosis will be described to you, and you will be informed about the treatment that you are being offered.

If you accept the treatment offer, you will be given a treatment plan describing your diagnosis as well as the treatment you will undergo.

It is a good idea to have a close relative accompany you to this appointment.

Doubts about the treatment being offered?

Once you have been diagnosed and offered treatment, you may feel in doubt about whether you want to go ahead with the treatment offered.

There may be many reasons why you are feeling doubtful:

• You feel that the treatment will take up a lot of time and interfere with your daily life.
• You may need to go on full-time/part-time sick leave from your study programme or work.
• You will have to involve your family in your problem, as a number of treatment options involve families.
• You must change your eating behaviour.
• You must cut down on your excessive exercising.
• You have to give up on being underweight or on your desire to lose weight.

The treatment is organised so that it is possible for you to overcome your doubts. You will also have a chance to share your doubts with others in a similar situation.

If you are in the early stages of developing anorexia, you will often find it difficult to admit that you have a disorder. Therefore, you will often insist that your life is under control and oppose the idea of needing treatment.

If you are developing bulimia or BED, you will often feel great shame. Even though you want to get better, telling others about your symptoms may feel so shameful that it may seem easier not to seek help.

It is important that your family knows that somebody who is suffering from an eating disorder may be ill for many years without seeking help. It is therefore extremely important that your family should help you to start treatment.

Involve your closest family in your diagnosis and treatment. This is important because:

• It increases your chance of getting better.
• Your family can support you – both in starting to eat normally and in difficult eating situations.
• Your family can help you to start treatment.
• By being involved in your treatment, your relatives can learn about your eating disorder and so be better able to help you get better.
• Your relatives can help you talk about symptoms. They can provide important details, which will give the treatment team a more realistic impression of your eating disorder and how it affects your daily life.

The purpose of treatment is for you to gradually develop a healthy relationship with food, your body shape and your weight. At the same time, it is important that you learn to cope with the feelings and challenges that may have triggered the condition.

On this page, you can read about the treatment offered by the Psychiatric Clinic for Eating Disorders. The treatment takes place in Skejby (Aarhus) and Gødstrup (Herning).

  Psychiatric Clinic for Eating Disorders, Adults.

You will be offered treatment based on your symptoms and your situation in general. Your offer of treatment may therefore be different from what is described on this page.

The standard treatment of anorexia consists of several elements, including a mastery group and individual therapy.

Mastery group

You must participate in a mastery group every other week. Read more about mastery groups

Individual sessions

You talk to the same psychologist every 14 days. You will be weighed every time. The sessions will provide you with:

• The support you need to talk about difficult feelings.
• Insights into your relational patterns of behaviour.

It is important that you learn to talk about your feelings and your relationships with others because your eating disorder has been a way for you to handle one or more emotionally or relationally difficult issues.

Initially, the focus will be on how you can overcome your disordered thoughts about eating and eating behaviours. When your eating disorder symptoms start to fade, the focus will shift to the possible reasons why you developed an eating disorder in the first place.

Other forms of treatment of anorexia:

Sessions with a dietician

The focus of the sessions is on stopping your weight loss. The dietician can do a diet plan for you that will help you regain weight. Your individual energy needs will be calculated, and the dietician will do a thorough review of your dietary habits (dietary history).

Sessions with a social worker

By talking to a social worker, you will get help to assess whether you need to go on sick leave or whether you may need socio-pedagogical support from your municipality.

Intensive treatment

You may be offered intensive treatment if it is assessed that the standard treatment is not enough to successfully treat your anorexia. The intensive treatment can consist of meal appointments, a focused meal group and an outpatient treatment programme.

It may also be that you need to be admitted to a ward.

Treatment options for those with long-term anorexia

If you have been ill with anorexia for several years and have undergone several courses of treatment, the treatment offer will be specially tailored to your needs.

The treatment consists of a 12-week body therapy and psychoeducational treatment programme. Read more about treating bulimia in adults.

The BED treatment is currently project-based. This means that there is a limited number of places on the programme. The treatment of BED consists of a course of group therapy. Read more about group therapy for BED.

What can be done to prevent eating disorders?

Eating disorders cannot be prevented completely. But a lot can be done to strengthen the mental robustness of individuals and create social environments in which people’s diversities are recognised.

In order not to develop an eating disorder, it is important to have:

• Healthy self-esteem.
• Good social relations.
• Normal and flexible dietary habits.
• A positive and accepting body relationship.

A focus on and comments on the body and what you eat can amplify the initial symptoms. Therefore, avoid over-exercising and having a persistent focus on slimming and weight loss. It may, in fact, lead to unhealthy notions of ‘the ideal body’ and a misconception of what it means to eat a healthy and varied diet.

What can you do yourself if you suffer from an eating disorder?

• Work on your relationship with food
• Follow your diet plan if a plan has been drawn up for you
• Make sure to eat 5-6 regular meals a day, eat a varied diet, and eat appropriate quantities.
• Accept that you have to prioritise following a diet plan for a period of time – even if you don’t like the idea of doing so.

Set small and realistic goals

Try to define small and realistic goals for yourself. The goals must steer you in the direction of eating normally and restricting your eating disorder behaviours.

Talk to your family, friends and other relatives

• Tell them what is difficult for you.
• Tell them what support you need.
• Reach out to others even if they may not know much about or understand what it means to have an eating disorder.
• Be open about your condition, when appropriate. Being open does not mean you have to disclose everything.

Accept that getting better will take time

• Accept that getting better may be challenging – but that it is possible.
• Accept that, for a period of time, you may not have enough energy for as many activities as you used to.
• Accept that your illness may have been triggered by strains and stresses that have previously been difficult for you to handle.
• Recognise that changes may feel unsettling and give rise to anxiety.
• Trust that you can get better.

“For 27 years, bulimia was my safe space. Eating and vomiting was an essential part of who I was and of my life. In 2015, I was ‘caught out’, which left me feeling ashamed and embarrassed. However, it also meant that I could look at bulimia as something I wanted to get away from. The solution for me was to go for long walks.

While after dinner I used to head straight for the bathroom, I started to take myself off for a walk. Whatever the weather, I walked. Walking made me feel at peace. Walking meant that I was able to think positive thoughts and get my feelings and emotions under control.

Today, I’m grateful that somebody realised what was happening, and I’m proud that I didn’t just think that I wanted to get away from a life with bulimia. I actually did something about it – I went walking. Today, bulimia is a thing of the past.”

- Henrik

Family members and other relatives are often the first to notice an eating disorder. Here, psychologist Stine Lystrup talks about the symptoms to look out for.

The text is from the Central Denmark Region’s newsletter Din guide til sundhed, March 2024

Low weight. If, as a relative or in your social circle, you notice that someone has lost a lot of weight, I would probably always be concerned.

Rapid weight loss. Weight loss does not have to end with the person being underweight, it could also be a very significant weight loss from overweight to normal weight. Unfortunately, we see that some people who lose a lot of weight cannot stop their weight loss and end up with an eating disorder.

Often on a diet. Being on a diet is fairly common. But I would be concerned if somebody is no longer able to deviate from their diet, or if they start avoiding social events because they are on a diet.

Doesn’t eat with others. And I would also be concerned if someone never eats with other people and always comes up with an excuse for not eating. Some people feel ashamed of other people seeing them eat.

Rigid rules about exercise and food. You should be concerned if someone in your social circle is becoming compulsive about exercising and is starting to adhere to extremely rigid rules about what they eat.

Social isolation and low mood. It may be a cause for concern if a family member starts to withdraw from social events, or starts behaving differently. You may, for example, notice mood changes, or that they seem more depressed.

Going to the bathroom after meals. Some choose to go to the bathroom to vomit after meals. This is also something that you, as a relative, can register.

There are a number of things that you can do as a relative. Read more below.

Express your concern if suspicious

If you suspect that somebody is developing an eating disorder, it is important to ask how they are feeling and what sort of situation they are finding themselves in.

For example, you can ask whether:

• They are not feeling well.
• They are struggling with anything in particular at the moment.

It may also be relevant to voice your concerns and thoughts about the person’s relationship with food, their body shape and their weight. If in doubt, you could, for example, contact your own doctor or a professional helpline.

As a relative, it is important that you learn as much as possible about eating disorders. This will help you deal with the many and difficult challenges that might arise.

At the same time, it is also important that you look after yourself and your own needs. Otherwise, it will be difficult for you to find the energy to cope with the various strains and stresses.

Clear arrangements

Without clear arrangements as regards meal times, food quantities, exercise and the like, a person with an eating disorder can be severely affected by feelings of anxiety and insecurity.

Without clear arrangements, they will often eat too little or find it difficult to actually stick to their diet plan. Most people who are undergoing treatment for an eating disorder want their close relatives to lay down clear rules and arrangements regarding their diet, exercise and the like.

You can do this by, for example:

• Playing an active role in the course of treatment.
• Upholding the agreements that can support the recovery of the person with an eating disorder, for example agreements that:
  • You eat meals together.
  • Meals are eaten at set times.
  • Meals must be aligned with the diet plan.
  • A meal should last a maximum of 30 minutes
• Planning an activity after the meal to:
  • Prevent excessive and obsessive exercise.
  • Prevent vomiting.
  • Distract the person’s many thoughts about food, body weight and body shape, which often crop up after a meal.

The person with an eating disorder may react violently to your demands. But it is important to be firm and consistent. Such support is absolutely key to the person’s recovery and chance of re-establishing a normal relationship with food, their body weight and body shape.

Show your feelings and worries

• Don’t be afraid to voice your concerns.
• Talk to the afflicted person about symptoms, feelings, thoughts and about life with and without an eating disorder.
• Acknowledge how difficult it is to suffer from an eating disorder.

Your role as a relative

There is a role for you to take on for a period of time, as, without your support, the person with an eating disorder will find it very difficult to get better on their own.

For example, it is important that you support the afflicted person in:

• Following the dietary guidance that has been issued, typically in the form of a diet plan.
• Eating regularly.
• Avoiding overeating.
• Avoiding compensatory behaviours, such as excessive and obsessive exercise, vomiting and abuse of laxatives.

It is of great value to the person with an eating disorder that you are supportive of their treatment and dare to be clear and consistent about the rules and arrangements.

Text on this page updated in June 2024.

Most recently revised by: Louise Reinert, Senior Specialist Psychologist, Psychiatric Clinic for Eating Disorders, Department of Depression and Anxiety, and Mette Serup, Head Nurse, Psychiatric Clinic for Eating Disorders, Department of Depression and Anxiety.

Direct link: www.en.eat.ps.rm.dk