Health Conditions E - M

Eating Disorders

An eating disorder is a severe disturbance in eating behaviour. However, it can be difficult to recognize an eating disorder, given that our culture condones dieting, views fat negatively, and values dieting as a sign of self-control.

Also, the inability to diet, a reluctance to eat, or a tendency to binge eat during times of stress can be misinterpreted as signs of a primary eating disorder rather than as the symptoms of some other serious distress. Dieticians often do not recognize the psychological factors that contribute to the self-abusive behaviours of an eating disorder.

Specific eating disorders are known as anorexia nervosa, bulimia nervosa, and binge eating. The definitions and characteristics of these disorders are as follows:

Anorexia Nervosa Bulimia Nervosa Binge Eating
Sufferers refuse to eat enough to maintain normal body weight for height, claiming to not feel hungry or that it is uncomfortable to eat Usually, bulimics are people of normal weight who have powerful urges to overeat, which they alternate with vomiting or purging to control their weight

The rapid consumption of a large amount of food in a discrete period of time, usually less than 2 hours. Lack of control during the episode. Not associated with compensatory behaviours of fasting/exercise

Characteristics Characteristics Characteristics
  • Refusal to maintain minimum body weight for age/height
  • Intense fear of gaining weight and becoming fat
  • Body weight and shape has undue influence on self-evaluation. Denial of seriousness of low body weight
  • Absence of a minimum of 3 consecutive menstrual cycles
  • Recurrent inappropriate compensatory behaviour to prevent weight gain, e.g., self-induced vomiting, inappropriate use of laxatives, diuretics, fasting, or excessive exercise
  • Binge eating and compensatory behaviours both occur, on average, twice a week for 3 months
  • Self-evaluation is unduly influenced by body shape and weight
  • At least 3 of following symptoms:
  • Eating much more rapidly than normal, until feeling uncomfortably full
  • Eating large amounts of food when not physically hungry
  • Eating alone because embarrassed about amount eaten
  • Feeling disgusted with oneself, depressed or guilty after over-eating
  • Marked distress experienced regarding binge eating
  • Binge eating occurs, on average, 2 days per week for 6 months

Source: Diagnostic and Statistical Manual of Mental Disorders, Revised 4th ed. (DSM-IV). American Psychiatric Association, 2000.



Different causal factors will influence the development of an eating disorder in each person. While many different causes have been put forward for eating disorders, there is clearly no one factor that can be said to be responsible for them.

Causes are usually not merely physical; physical changes are a consequence, rather than a cause of an eating disorder. Psychopathalogic causes play a large part in the drive for thinness, fatness, and extreme concern with body shape and weight. Factors that may play a part include stress-induced or comfort eating, disturbed family relationships (enmeshment, over-involvement, blurring of boundaries, over-protectiveness, rigidity, or inability to resolve conflict), child sexual abuse, and socio-cultural impact.

The IMI Approach

Engaging in treatment for an eating disorder can be very difficult. The client may experience shame, fear, anxiety, and ambivalence about sharing their experience. Therefore, it is important that the counsellor or therapist have an attitude of complete acceptance.

The initial interview will be conducted with both non-direct and directly focused questions to assess and determine the nature of the client's problem. Questions will relate to situational factors, history of the problem, attitudes toward food, eating, weight, body shape and dieting, symptoms, and the effect these symptoms are having on the client's life.

Not all clients are ready to change. When they are ambivalent, the advantages and disadvantages of maintaining the current situation will be weighed, and aspects that will help them change and the obstacles they must overcome will be reviewed.

The agenda for therapy will then be set. Therapy can involve psycho-education, nutritional counselling, cognitive behavioural therapy, psychodynamics, emotional freedom technique (EFT), and guided visualization.