Most people have a general understanding of the two major eating disorders. Anorexia is self-starvation and Bulimia is purging (vomiting) after you eat. However, up to 50% of diagnoses of eating disorder, fall into another category, mostly referred to as (ENDOS) Eating disorder not otherwise specified. This means that many eating disorder sufferers are not going to show “signs” that you would typically expect. I am going to review three disorders that I find interesting – Exercise Bulimia, Body Dysmorphic Disorder and Orthorexia. To me, these disorders can go easily undetected since they can fit nicely into modern culture.
Exercise bulimia is the name given to a form of obsessive exercise, where the exercise is used as a way to burn calories to compensate for eating. In other words, exercise is being used compulsively to control weight.
It often goes undetected because the person may appear merely to be very focused on health and fitness. Weight may not necessarily be very low because when you exercise compulsively your body compensates by slowing down metabolically.
One of the signs that exercise is becoming a problem is that the person starts to schedule their lives more and more around exercise, missing social engagements and even missing work and appointments in order to work out.
Other warning signs might include:
Working out for hours at a time each day or not taking any rest or recovery days.
Working out even if you are injured or feeling unwell or exhausted.
Becoming depressed, irritable, behaving irrationally if you can’t get a work out in.
Experiencing strong feelings of guilt and anxiety when unable to exercise.
Never feeling satisfied with your level of fitness or achievement.
Valuing yourself in terms of physical fitness and appearance, of achievement and performance rather than in terms of inner qualities.
Giving priority to your exercise schedule before attending to relationships.
Some physical consequences of compulsive exercise:
Increased risk of injury (such as stress fractures, tendonitis, joint and ligament injuries).
Hormonal disturbances (loss of libido, irregular or no menstruation) and reproductive problems.
Poorer physical and mental performance overall.
Perfectionist, black and white thinking.
Withdrawal from relationships.
A Therapist might be needed — To look at the emotional issues that underlie the compulsion to exercise
A Nutritionist might be needed –To advise on how the cycle of eating/ purging through exercise is affecting the metabolism and to advise on how to rebalance the metabolism; to help you to redress the balance between nutrition and exercise
The use of a diary might be helpful – To record both food intake and exercising behaviours can be a very helpful recovery tool.
Muscle Dysmorphia / Reverse Anorexia / Bigorexia
Muscle dysmorphia, also known as reverse anorexia or bigorexia is a condition in which a person becomes obsessively focussed on being too small and not muscular enough. People with muscle dysmorphia resort to a variety of measures to try to increase muscle mass. These measures may include excessive exercise including weight lifting and other body building exercises, excessive attention to diet, misuse of high protein diet, misuse of steroids and other muscle-building drugs.
Muscle dysmorphia can affect both men and women although it is more common in men and in most cases the person affected in not in reality small or lacking in musculature. In fact, many body-builders are affected.
The obsession with becoming more muscular takes over the person’s life to the extent that it may cause a person to forego or to avoid important social, work related or recreational activities. A person with muscle dysmorphia will continue to work out and / or diet despite knowing that it is dangerous to their health and general wellbeing. Because of the distortion in self perception it can be very difficult for the person to recognize that they need help.
Muscle failure, osteoporosis, heart and kidney failure are among some of the risks associated with muscle dysmorphia. Depression is often co-existent with the condition.
Treatment should involve medical evaluation and monitoring as well as psychological therapy. A cognitive behavioral approach is often used.
Orthorexia is the name given to a condition which involves a compulsive preoccupation or obsession with dietary purity.
Attention to a “pure” diet becomes problematic when it is an obsession that has a significant negative impact on a person’s life. Whereas anorexia and bulimia are marked by a constant concern for the quantity of food being consumed, orthorexia is characterised by an over-concern with the quality of the food consumed.
For the person with orthorexia, wavering from their “perfect” diet can lead to periods of even stricter rules around food and eating or to periods of fasting.
Psychological therapy can help a person to gain an understanding of the thoughts, beliefs and value that underlie the emotions that are driving their obsession with the ‘right’ diet and help them to restore balance to their relationship with food and to their lives in general.
Body Dysmorphic Disorder (BDD)
BDD is a preoccupation with an imagined physical defect in appearance or an over-exaggerated concern about a small defect. The obsession causes severe emotional distress and many aspects of the person’s life. The obsessive concern can relate to facial features, other parts of the body, or hair.
The person may fear ridicule in social situations and their distress may be so severe that it will lead them to contemplate undergoing procedures to try to change the imaginary defect. Procedures rarely bring relief and often lead to a worsening of symptoms. BDD is also often associated with obsessive compulsive disorder and with delusional disorders.
Treatment usually involves cognitive behavioral psychotherapy. The therapist helps the individual to understand how some of his or her thoughts and perceptions are distorted and helps them replace these perceptions with more realistic ones. The therapist will also help the person to resist any compulsive behaviors associated with the BDD (such as repeatedly looking in mirrors or excessive grooming). In the case of adolescents, some family therapy is seen to be useful. Medication may also be useful in some cases.
Want to read more:
This is the site of Gurze Books, specialists in eating disorders publications. Contains an online catalogue of over 200 books and other resources. It also provides extensive general information and links. Very helpful for searching for publications and getting further access to information.
Read my other article on Eating Disorders.