Eating disorders

Learn about eating disorders, signs to look for, how your doctor determines if you have an eating disorder and treatment options.
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Found in: Mental Health Conditions
Date: March 2023

About eating disorders

Eating disorders affect the way you eat and the way you feel about food and your body. People with eating disorders may severely restrict how much they eat, eat large amounts in one sitting, exercise excessively or do ‘purging’ behaviours such as vomiting.  

Our culture places great value on outward appearances, and advertising and social media messages can lead to people who don’t fit a narrow definition of ‘attractiveness’ feeling stigmatised. As a result, many of us have complicated, difficult relationships with food and body image.

For some of us, there is a greater risk that these difficulties will turn into an eating disorder, because a combination of genetics and life experiences have made us more vulnerable.

Eating disorders are much more than an extreme focus on diet and exercise. They are serious conditions that can have a devastating effect on your day-to-day life and your long-term health. They are not a ‘phase’ or a ‘choice’, and it is extremely hard to recover from them without professional help.

However, with the right treatment and support, you can make a full recovery. If you think you or a loved one may have an eating disorder, it’s important that you seek help as soon as possible.

Types of eating disorders

The most common eating disorders are anorexia nervosa, bulimia nervosa and binge eating disorder. 

  • If you have anorexia, you significantly limit how much food you eat, leading to weight loss. Your weight is lower than is considered healthy for your age and sex. There may also be times when you binge eat, and you may use exercise or purging behaviour (vomiting or using laxatives, diuretics or enemas) to prevent weight gain. You may feel very negative about your body and fearful of gaining weight.
  • If you have bulimia, you regularly binge eat – eating a large amount of food in one sitting and feeling you have no control over it – and regularly purge to compensate for the food you’ve eaten. The size and shape of your body has a big impact on how you feel about yourself.     
  • If you have binge eating disorder, you regularly binge eat without purging. You feel very distressed by the binge eating and may do it secretly, even when you are not hungry, and past the point of feeling uncomfortably full.

Other formally recognised eating disorders are avoidant/restrictive food intake disorder (ARFID), where you avoid eating certain types of food to the point where it affects your physical health; pica, where you eat or crave non-food items like dirt, ice or paper; and rumination disorder, where you unintentionally bring up food or drink that you recently swallowed.

If your feelings and behaviours around food are causing you a lot of distress but you don’t fit the criteria for one of the above eating disorders, or your clinician doesn’t have enough information to make a specific diagnosis, you may be diagnosed with other specified feeding or eating disorder (OSFED) or unspecified feeding or eating disorder (UFED).

There are several other conditions that are related to eating disorders, even though they are not officially classified as such: for example, orthorexia, an obsession with eating only ‘healthy’ food.

Who gets eating disorders?

Eating disorders most often begin in adolescence or early adulthood (apart from ARFID, which is more common in children). However, they can affect people of all ages, genders, races and social groups. Sadly, the stereotype of eating disorders affecting only young women can sometimes stop other people from getting the help they need.

Eating disorders are often associated with other mental health conditions. If you have an eating disorder, you may also experience symptoms of anxiety, depression, body dysmorphic disorder (BDD), or obsessive-compulsive disorder (OCD). You may do self-harming behaviours. Your clinician can help design a treatment plan for you that takes these factors into account.

What causes eating disorders?

We don’t yet fully understand the cause of eating disorders, but researchers now believe it is a combination of genetics (40–60%) and environment, just like many other illnesses. That is, you might be born with a higher risk, and then something might happen in your life – whether intentional (diet, exercise) or unintentional (illness, trauma) – that triggers this genetic propensity and leads you to develop an eating disorder, where another person in the same circumstances might more easily go back to their normal eating behaviours. 

Eating disorder behaviour tends to become habit-driven. It may begin as something you do to ease feelings of distress in the short term, but it then ‘takes on a life of its own’, with the behaviour becoming more extreme and turning into a vicious cycle. When you get treatment for an eating disorder, your clinician will be interested in the circumstances that led to the start of the eating disorder, but they will also focus on the behaviour itself, working to break the cycle and understand the factors that keep it going.

Having an eating disorder is not your or anybody else’s fault, even though it may feel like that. Nobody chooses to have an eating disorder. Recovery is possible, and your chances of a full recovery are better the sooner you seek treatment.


Signs to look for (symptoms)

If you are experiencing an eating disorder, you – or the people around you – may notice some of the following behaviours, feelings and physical symptoms. It’s important to remember that eating disorders can affect people of any weight and body shape. Even if you look ‘healthy’ to other people, or your medical tests come back normal, you may still be seriously unwell.  

  • The way you eat: Skipping meals, preferring to eat alone or secretly, hiding or secretly throwing away uneaten food, having rituals around eating, following strict rules about what you eat, weighing or measuring your food, developing new ‘intolerances’, eating only ‘diet’ or ‘low-fat’ products, paying close attention to calorie content, being dishonest about what you’ve eaten, finding it hard to stop eating even when you’re full, drinking water or chewing gum instead of eating, feeling anxious or irritable during mealtimes, having a strong interest in cooking/cookbooks/what other people are eating but not eating yourself.
  • Your attitude towards your body: Low self-esteem, feeling dissatisfied with your body, thinking or talking a lot about losing weight or being ‘fat’, wearing baggy or layered clothes to disguise weight loss, asking people for reassurance about your body size, weighing/pinching/looking in the mirror obsessively, strong interest in images and information about weight loss/thin people.
  • The way you exercise: Exercising in secret, exercising intensely with no pleasure, developing rituals around exercise, exercising to compensate for eating.  
  • Signs of purging: Sore throat, tooth decay, bad breath, a rounder face from swollen glands, swollen/red marks on fingers or knuckles, using diet pills/laxatives/diuretics/enemas, going to the bathroom straight after meals, running water in the bathroom to cover vomiting sounds, using mints or gum to cover the smell of vomit.   
  • Physical symptoms: Fluctuations in weight, weight change after illness/travel/increased involvement in sport or exercise, brittle nails, hair thinning/breaking/falling out, dry skin, downy hair on body, abnormal blood count, irregular heart rhythms, low pulse, low blood pressure, constipation, stomach pains, periods stopping/becoming irregular/delayed in starting, dehydration, loss of bone mass, feeling cold (especially hands and feet), fainting/dizziness, skin problems, lethargy/tiredness. 
  • Other behaviours: Struggling to sit still, having rigid (black-and-white) thinking, increased perfectionism, seeing other people as judgmental, becoming more isolated and socially withdrawn, difficulty talking about emotions.

How to access help

The first step is to visit your GP, who will do an initial assessment and examination. Since eating disorders can carry significant medical risk, your GP will weigh you, order blood tests, check your pulse and blood pressure, and ask about any other physical symptoms, such as weight loss, whether your periods have stopped or changed or presence of binge eating or purging behaviour. 

Your GP can then give you a referral for the eating disorder service provided by Te Whatu Ora. You could also look into finding a private therapist who specialises in eating disorder treatment. Private treatment will involve a cost, but it might mean a shorter wait for an appointment and will give you a choice about who you see.

Reaching out for help can feel scary. You might worry about being judged or not taken seriously. You might find it difficult to put your experience into words. Living with an eating disorder often involves secrecy; it can be hard to break this pattern and let someone else know what is really going on for you.

Also, you might have mixed feelings about getting treatment. You might be afraid to let go of behaviours like dieting, exercising, purging or binge eating, because they have helped you feel safe in some ways.

These are all valid feelings. It might be helpful to let your clinician know that you are uncomfortable. They will understand and can help you work through these feelings. You might also find it helpful to bring a support person along to your first appointment or write down your experiences/feelings/questions ahead of time.

If you don’t feel comfortable with a particular clinician, or don’t feel they are understanding you, keep trying. See a different doctor, ask a support person to advocate for you, or send a follow-up email. It is important that you keep looking for the help you need.

Another option is to make contact with the Eating Disorders Association New Zealand (EDANZ), who can provide you with support and information.

How the clinician determines if you have an eating disorder (diagnosis)

Eating disorders are diagnosed based on specific criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Your clinician will ask you questions about the way you eat and exercise, whether you do any purging behaviours, and how you feel about food and your body. They will want to know how often you do certain behaviours and how long this has been going on for, since it can influence what treatment approach to suggest and discuss with you.  

Once your clinician has the information they need, they will work out whether your symptoms match the criteria for a particular eating disorder.

Even if you aren’t given an official diagnosis, this doesn’t mean your experience is any less real or serious. You can – and should – still get support and treatment. 

Treatment options

There are several types of therapy and treatment settings that can be used in treating eating disorders. Largely, treatment consists of specialist evidence-based psychological treatments. This includes individual therapy and family therapy. It can at times also include group therapy, provision of nutritional advice and meal planning with a dietician, and education for you and your family/whānau.

Depending on how severe the eating disorder is, you may attend a clinic for residential or day treatment for a number of weeks to provide a more structured setting for support. You may be admitted to hospital for medical stabilisation as an in-patient if you are at risk and medically compromised.

There is no specific medication to treat eating disorders, but you may be prescribed medication to assist with treatment. Some medications may make your eating disorder thoughts less intense and help with depression or anxiety symptoms.

Talking Therapies

Below are some of the specialist evidence-based psychological therapies used to treat eating disorders. Your clinician can help you decide which one is right for you.

General counselling has not been shown to be effective in treating eating disorders. Make sure your clinician is trained in specialist eating disorder treatment, experienced in treating your type of symptoms, and being supervised for their work.

  • Family Based Treatment (FBT) is the first line of treatment for adolescents and young adults with anorexia and bulimia. Recovery rates of FBT for treatment of adolescents with up to three-year illness duration are about twice as high as individual treatment (AFT). Therapists and parents work together to help the young person’s recovery, restoring weight and addressing the eating disorder behaviour. The treatment lasts for one year, with the parents gradually supporting the adolescent to learn how to take on more responsibility in the management of eating behaviour.
  • Adolescent Focused Therapy (AFT) is also effective for anorexia in young people and is used in circumstances where FBT is not possible or has not been taken up by the family. In individual sessions across about 12–18 months, with some parental involvement, the therapist works with the young person to strengthen their sense of self and help them find new ways to handle the challenges of adolescence other than through their eating disorder.
  • Cognitive Behavioural Therapy (CBT-E) is the first line of treatment for bulimia nervosa and binge eating disorder but has now also been expanded to treat anorexia nervosa. It focuses on patterns of thought and behaviour that are happening in the present day, rather than experiences in your past. You will work together with your therapist with a focus on behavioural change, using daily monitoring forms, introducing regular eating, challenging patterns of thought and behaviour that contribute to disordered eating, and learning techniques to change these.
  • Integrative Cognitive Affective Therapy (ICAT) is a structured short-term treatment for bulimia and binge eating disorder, over 20 sessions. It focuses on development of emotion awareness in the very moment before a binge in order to learn and apply different skills to manage these situations. 
  • Maudsley Anorexia Treatment for Adults (MANTRA) In addition to working on weight recovery and challenging eating disorder behaviour, MANTRA addresses the function of the eating disorder in the person’s life more fully and focuses on strengthening the person’s ability to develop better emotional and interpersonal skills and address unhelpful thinking styles.
  • Specialist Supportive Clinical Management (SSCM) is less structured than CBT or MANTRA. It is a practical approach that combines supportive therapy, information, advice and encouragement.

All types of therapy should be provided to you and your family/whānau in a manner that is respectful of you, and that helps you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices. All psychological therapies are designed to be done without disrupting study or work.

Other strategies to support recovery

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and which may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. However, you should not rely on these therapies alone to treat eating disorder symptoms.

Family/whānau support and involvement

If someone you love is experiencing an eating disorder, you are likely feeling many emotions: fear, sadness, worry, frustration and more. It’s important to remember that eating disorders are strongly influenced by biology: it is not your fault that your loved one has an eating disorder, and it’s not something they can change or recover from without professional help.

As a family/whānau member, you have an important role to play. Learning as much as you can about the eating disorder and its treatment will reassure you and help you support both their recovery and your own wellbeing. Reach out to your own support network for practical help, seek counselling for yourself, and remember to care for your own physical and mental health. The groups listed below, under ‘Resources and links’, offer valuable support to parents and caregivers of people with eating disorders.

Thanks to Dr Roger Mysliwiec, Director New Zealand Eating Disorders Clinic, for reviewing this content.
Date last reviewed: March 2023