Eating disorders in children, adolescents and adults

At some point in their lives, many girls/women and some boys/men believe that they are fat. Even if they are not. Many also have periods in which they try to lose weight by following a diet, eating less or exercising.

Some also engage in overeating and have no control over the amount of food they consume. It may be that they eat without being hungry, or until they are uncomfortably full.

It only becomes an eating disorder when the person finds it difficult to focus on anything other than his or her relationship with food and his or her body. In most eating disorders, the person’s weight will also be significantly affected.

There are different types of eating disorders, including:

• Binge eating disorder (BED)
• Anorexia
• Bulimia

There are also other eating disorders:

• Different variations of anorexia and bulimia
• Orthorexia: exaggerated focus on health and a rigid diet
• Megarexia: exaggerated focus on having a muscular body.

You can read more about the characteristics of the individual types under ‘symptoms’.

You may have a susceptibility. It can be caused by either biological, social or psychological factors.

This may, for example, be that:

• other members of your family have had an eating disorder or other mental disorder
• you have experienced some stressful things in your childhood such as divorce or death in your family
• you suffer from low self-esteem.

Triggering factors are events in your life that cause your eating disorder to manifest itself.

This may, for example, be:

• Prolonged stress
• Breakup of important relationships (family, friends, boyfriend/girlfriend, etc.)

Once you have developed an eating disorder, there are several factors that can retain it. This may, for example, be:

• Bodily changes
  

  If you eat little, your stomach may, for example, shrink, so you very quickly feel full and therefore eat less. Conversely, prolonged overeating will expand your stomach, and you will therefore need to eat more to feel satiated.

• Rituals and rules
  

  Food habits may become very ingrained. Perhaps you need to eat certain types of food – and to overeat them to feel comfortable. It may also be that you have the following rule: ‘I have to eat less today than yesterday!’.

• Changes in self-perception
  

  People with anorexia or bulimia typically see themselves as fat. This means that most of them have a continuous desire to lose weight.  If you suffer from BED, overeating may conversely lead to you becoming overweight. This may contribute to the sense of shame that perhaps resulted in binge eating in the first place. You consequently end up in a vicious spiral.

Societal and cultural factors are also of importance to the development of an eating disorder. In our culture, there is extreme focus on the body, on looking the ‘right’ way and on how you appear to others. Media and magazines are packed with fitness programmes and dietary rules aimed at helping us get a little bit thinner.

Over the past 50 years, the bodies presented in the media as those that are ‘right and beautiful’ have become thinner, while our physical bodies have become bigger. This means that, through the media, we get the impression that there is something wrong with us: We are too fat.

Depending on our current life situation, background, our physical and psychological structure and networks, we may be at greater or lesser risk of developing an eating disorder. Especially girls and young women aged 12 to 24 have the greatest risk of developing eating disorders. Boys may also develop eating disorders, but for every 10-12 girls who have an eating disorder, there is only about 1 boy.

Eating disorders are associated with several psychological symptoms. Perhaps you can recognise one or more of them:

• A sense of shame as a result of the changed relationship with food
• Increased need for checking. This can be anything from calorie intake, schoolwork, exercise, to relatives
• Resistance to accepting being ill and needing treatment
• Difficulty concentrating, learning difficulties, irritability and sadness
• Behavioural changes – the thought of food, eating, weight and figure can take up so much space that everything else loses importance
• Social isolation due to difficulties eating together with others
• Low self-esteem and poor self-image.

As mentioned, BED stands for Binge Eating Disorder. Signs of BED may be:

• Recurring episodes of overeating. Overeating is when:

• you eat large amounts of food within a short time. Bigger portions than what others can ‘normally’ eat
• you have a feeling of losing control of what you eat. You cannot stop eating or you cannot prevent your eating
• You have negative thoughts and low self-esteem
• You feel shame after overeating. 

Unlike bulimia, you do not typically vomit after overeating.

Signs of anorexia may be:

• Weight loss leading to underweight. This may be because:
• you eat too little
• you vomit
• You exercise based on a training programme that you follow very rigidly
• You use slimming formulas or laxatives
• You have a feeling of being too fat
• You are very concerned with your weight and/or figure
• Hormonal disturbances that may mean that you lose your sexual desire and ability, or that you do not get your menstrual period, if you are a woman. 

In children, a lack of physical development is seen in the form of a lack of growth or insufficient weight gain.

Signs of bulimia may be:

• Recurring episodes of overeating. Overeating is when:
• you eat large amounts of food within a short time. Bigger portions than what others can ‘normally’ eat
• you have a feeling of losing control in connection with eating. You cannot stop eating or you cannot prevent your eating
• You are very concerned with your weight and/or figure
• You try to avoid putting on weight by:
• limiting how much you eat
• vomiting
• exercising a lot
• using slimming pills, laxatives or similar.

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

There are also other types of eating disorders. You can read about two of them below.

Orthorexia

If you have orthorexia, you are extremely focused on having a healthy diet.  This focus is so great that it negatively impacts your everyday life. You can therefore say that orthorexia is characterised by healthy becoming unhealthy. 

Megarexia

If you have megarexia, you have a desire to have a more muscular and bigger body. You therefore do an extreme amount of physical training and you are highly focused on eating in a way that can make your muscles bigger.

However, this page primarily addresses the eating disorders BED, anorexia and bulimia. 

If you or your relatives have any doubts about whether you have an eating disorder, you need to consult your own doctor. If your doctor finds that your symptoms may be signs of an eating disorder, we will receive a referral at the hospital – that is a message to call you in for an examination.

If your doctor has referred you for examination for an eating disorder, you should:

• await an invitation (notice calling you in for an examination) from one of our departments in your e-Boks
• participate in a clarifying consultation – preferably together with your relatives
• be prepared that you may have to go through several different examinations before it can be finally confirmed whether you have an eating disorder.

You will be called in for an examination at one of these clinics depending on where you live:

• Psychiatric Clinic for Eating Disorders in Herning (Gødstrup)
• Psychiatric Clinic for Eating Disorders in Aarhus (Skejby).

Your doctor or a psychiatrist will usually make the diagnosis. It is made on the basis of one or more consultations and physical examinations.

During these consultations, your therapist will focus on a number of aspects, including:

• Onset and development of the eating disorder
• Restrictions and rules in relation to diet and eating
• Overeating
• Mental symptoms in the form of:
• Weight anxiety
• Feeling of obesity
• Concentration difficulties due to thoughts of food and eating.

Finally, a physical examination is performed, which includes:

• Blood test to assess the degree to which your organs are affected by your eating disorder
• ECG to assess whether your heart is affected.

Feel free to contact the clinic that has examined you while you wait for the results of your examination. This may, for example, be if your symptoms have suddenly worsened or if there is something you have become uncertain about. We will do our best to help you.

The path to getting into treatment may be complicated and difficult both for you who have an eating disorder and your relatives.

Your relatives may be in doubt about:

• what is ‘normal’ and what is morbid
• whether you are eating healthily and adequately or have a much too one-sided and unhealthy diet
• whether they have a responsibility for not having noticed the symptoms earlier
• how they are to convince you that you need to get into treatment.

For children and adolescents aged under 18, relatives are involved in the examination and diagnosis. For adults, participation by relatives is endeavoured.

Your relatives can help you put your symptoms into words

Many people who suffer from an eating disorder find it difficult to describe their symptoms because it is difficult for them to notice their feelings and behaviour and put them into words. For example, many may be inclined to:

• Understate symptoms
  

  Maybe they state that they exercise like others, even if they overexercise, for example by doing 500 sit-ups a day.

• State that they do not skip meals
  

  Therefore, they say that they eat normally, but they forget to mention that they avoid all food containing fat or carbohydrates.

• Be ashamed of not being able to control their eating
  

  Therefore, they do not mention that they regularly overeat and vomit.

Parents or other relatives can often add details to the information so that the doctor or other therapists get a more realistic impression of the person’s eating disorder and how affected the person is in his or her daily life.

If you are developing anorexia, you will often find it difficult to admit that you have a disorder. Therefore, you will often maintain that your life is under control and oppose the idea of having to undergo treatment.

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

It is important that parents or other relatives know that a person suffering from an eating disorder may be ill for many years without personally seeking help. It is therefore of great importance that the relatives help the person get into treatment.

The physical consequences of overweight may include:

• Type 2 diabetes
• Elevated blood pressure
• Osteoarthritis of hip and knee
• Reduced fertility
• Risk of blood clots

In most cases, these effects may be improved or completely disappear if you lose weight.

The physical consequences of underweight may include:

• Delayed puberty and missed menstruation in girls/women
• Low body temperature, slow pulse and constipation
• General weakening of muscles
• Fluid accumulations and swellings
• Hormonal disorders that may lead to lack of sexual appetite and ability
• Increased body and facial hair growth.

If you have been highly underweight for a long time, this may include the following permanent health damage: brittleness of bones, heart problems and cerebral atrophy.  But most of the above effects will diminish or completely disappear if you gain weight.

Compensatory behaviour consists of actions performed to lose weight. This may, for example, be provoked vomiting or excessive exercising. It may have several consequences, including:

• Dental damage and ulcers in the corners of the mouth due to corrosions from gastric juice as a result of vomiting
• Large weight fluctuations of 5 to 20 kg within short periods
• Poor intestinal function with sluggish and bloated stomach as a result of long-term use of laxatives or slimming agents
• Damage to muscles, bones, joints and tendons
• Menstrual disturbances and possible cessation of menstruation in women/girls
• Delayed or lack of gender development
• Disturbed salt balance, which may lead to muscle cramps, cardiac arrhythmia and heart failure.

If the behaviour stops, a large part of the effects may be diminished or completely disappear again.

The purpose of treatment is that you gradually develop a normal relationship with food, body and weight. At the same time, you must develop your ability to cope with the feelings and challenges that may have been of importance to the onset of the disorder.

Under this section, you can read about the treatment available to persons with eating disorders in Central Denmark Region. Some of the treatment applies generally to patients with BED, anorexia and bulimia. While other treatment will be treatment options linked to the specific diagnoses. It will be described if the treatment is only relevant for a single diagnosis.

The purpose of the psychological treatment is to:

• provide support and guidance aimed at combating the symptoms of the eating disorder
• establish more underlying psychological difficulties and maintaining factors
• help you return to being able to do the things you cannot do anymore
• promote new strategies to enable you to handle difficult feelings, strains, stresses and psychological problems.

For adults, the psychological treatment is most often provided in groups, while, for children and adolescents, it is provided by family-based therapy and/or group therapy. 

You will be offered education about your disorder. We call this psychoeducation. Here, the focus is on:

• The needs and way of functioning of the body
• Positive and negative aspects of exercise
• Risks of overweight or underweight and compensatory behaviour.

Psychoeducation is most often conducted in groups. If you have BED, the education is provided as part of the group course.

When you are in treatment, we always have a great focus on involving your relatives because they are of great importance to a successful outcome of your treatment.

If you live with your parents, they will be involved in the course of treatment. If you live on your on or are an adult, other relatives will typically be involved. This may, for example, be friends, boyfriend or girlfriend or spouse.

In the therapy, we work to help both relatives and patients recover the resources that were present before the disorder took control, so that everyone has a well-functioning everyday life.

The primary treatment of adults with BED consists of an extended course of group therapy. The course takes place at our clinic in Herning.

The purpose of treatment is to normalise your relationship with food, body and weight. In addition, you are to develop your abilities to manage and regulate difficult feelings and agitation which may be of importance to the development and maintenance of your compulsive overeating.

Our work in the group includes:

• acquiring knowledge about what the eating disorder is
• trying out different methods for controlling and reducing the symptoms
• participating in a group with other people with BED and exchanging experiences
• becoming aware of body signals
• examining and working with the personal issues which may underlie the eating disorder.

If you have anorexia and are very underweight, the first step is to learn to eat again. We call this re-nutrition. Re-nutrition is about meeting your nutritional needs and increasing your weight. To gain weight, you are given:

• dietary guidance
• specific support for eating – either individually, together with your family or in a group.

In connection with severe bulimia, you may be offered pharmacological treatment. In some cases, the medication may reduce overeating and vomiting.

You may also be offered pharmacological treatment if you have complex physical symptoms. In addition, medication is used if you also need to be treated for another mental disorder concurrently with your bulimia. This could, for example, be a depression.

When your eating disorder becomes less severe, a new phase of your treatment will begin. During this phase, the treatment consists of group therapy and body therapy. The purpose includes the following:

• To prevent recurrence
• To maintain normal eating behaviour and normal exercise
• To make you more familiar with bodily reactions
• To develop healthier and more flexible reaction patterns
• To change an inappropriate sense of perfectionism
• To increase your ability to accommodate and handle difficult feelings
• To strengthen your self-esteem.

You can read more about this on our page ‘Livet med en spiseforstyrrelse’ (Living with an eating disorder), to which you can find a link below.

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

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

• Good self-esteem
• Good social relations
• Normal and flexible dietary habits 
• A healthy relationship with your body in all its diversity.

Focus and comments on the adolescent’s body and what he or she eats can amplify beginning symptoms.

Therefore, avoid over-exercising and having a persistent focus on slimming diets and weight loss. It may, in fact, lead to unhealthy notions of ‘the right body’ and a misconception of what it means to eat a healthy and varied diet. This applies both in families but also in schools and in sports clubs.

Work on your relationship with food

• Follow your dietary plan if you have had one prepared or find one at www.spiseforstyrrelser.net
• Be sure to eat regularly, varied and in appropriate quantities
• Accept that you need to prioritise following a dietary plan – even if you do not feel like.

Set small realistic goals

• Try to set up small realistic goals for yourself. The goals must point towards eating normally and limiting your eating disorder behaviour.

Talk to family, friends and other relatives

• Tell them what you are finding difficult
• Tell them what support you need
• Make use of others even if they may not know about or understand what it means to have an eating disorder.
• Be open about your disorder, when appropriate Being open does not mean you have to disclose everything.

Accept that it takes time to get well

• Accept that it may be very challenging to get well – but that it is possible.
• Accept that you may not have energy for as many activities as in the past for a period.
• Accept that there may be strains and stresses behind your disorder that you have previously had difficulty handling.
• Recognise that changes may give rise to agitation and anxiety.
• Trust that you can get well.

There are several things that you can do as a relative. You can read about this below.

Ask if you have a suspicion

If you suspect that a person is developing an eating disorder, it is important to ask how he or she is doing and what their situation is right now.

For example, you can ask about whether:

• he or she is not thriving
• there is something that feels particularly difficult at the moment.

It may also be relevant to voice your concerns and considerations in relation to the person’s relationship with food, weight or figure. If you have doubts, you can, for example, contact your own doctor or a professional hotline.

It is important that, as a relative, you acquire as much knowledge as possible about eating disorders. This may enable you to deal with the many and difficult challenges that the course of the disorder entails. At the same time, it is also important that you meet your own needs. Otherwise, it will be difficult to maintain your resources for coping with the various strains and stresses.

Ensure a regular framework

A person with an eating disorder can be severely affected by anxiety and insecurity if there is no regular framework for meal times, the quantity of food, the extent of exercise and the like.

If there is no clear framework, he or she will often eat too little or have difficulty daring to eat according to the dietary plan. Most people who have entered into treatment for an eating disorder want their parents or other close relatives to lay down clear rules and arrangements regarding diet, exercise and the like.

You can do this by, for example:

• actively participating in the course of treatment
• maintaining the agreements that can support the afflicted person in getting well. This may, for example, be agreements that:
• you eat meals together
• meals are be eaten at set times
• the meal must be adapted to the dietary plan
• a meal is only to last 30 minutes
• you plan an activity after the meal to:
• avoid forced exercise
• avoid vomiting
• divert the many thoughts about food, weight and figure, which often occur after the meal.

The person with an eating disorder may react violently against your demands. But it is important that you stand firm and are consistent. This support is absolutely central to getting well and re-establishing a normal relationship with food, weight and figure.

Show your feelings and worries

• Do not be afraid to show your concern.
• Talk to the afflicted person about symptoms, feelings, thoughts and about life with and without eating disorder.
• Recognise how difficult it is to suffer from an eating disorder.

Your task as a relative

There are special tasks that you must undertake for a period of time, as, without support, the person with an eating disorder will find it very difficulty to get well on his or her own.

These tasks may, for example, be about supporting the afflicted person in:

• Following dietary guidance typically in the form of a dietary plan
• Eating regularly
• Avoiding overeating
• Avoiding compensatory behaviour, such as compulsory exercise, vomiting and abuse of laxatives.
• It is of great value to the person with an eating disorder that you support the treatment and dare to set the framework and be consistent.

Most relatives need to talk to other relatives, and they need to be in contexts where others understand the difficulties that they are facing on a daily basis.

Perhaps you can get sufficient support and help from family and friends. Perhaps you can benefit from meeting other relatives who understand your situation. It may also be that you need special support in the form of consultations with a psychologist or the like. You may also need to be bought free from your work for a period of time to enable you to support your child. If you are to bought free from your work for a period, you can contact the social services.

If you are a parent of a child aged under 18, your own doctor may refer you to a psychologist for consultations. It is also possible to seek help on websites, contact the telephone advisory hotline or carer associations. You can read more about them below.